Vascular Closure Devices

In the endovascular procedure setting, vascular closure devices (VCD) have emerged as an alternative to mechanical compression in order to achieve vascular hemostasis after puncture of the femoral artery. VCD are categorized based primarily on the principle mechanism of hemostasis, which includes biodegradable plug, suture, staples, or ultrasound. While VCD offer advantages over mechanical compression (shorter time to hemostasis and patient ambulation, high rate of patient satisfaction, and greater cost-effectiveness) complications related to the site of femoral access are still present. Efficacy and safety of VCD have been evaluated in a number of clinical trials, but to date there is still a lack of randomized clinical trials with sample sizes large enough to reveal superiority or non-inferiority of VCD compared with mechanical compression. Mechanical compression and VCD are effective and well tolerated in the setting of diagnostic procedures and procedures that do not use anticoagulation. For both methods, success rates are lower, and complication rates higher, in the setting of interventional procedures and when anticoagulation medications are used. Regardless of the device type, deployment failure is the major drawback of VCD. However, overall, meta-analysis data demonstrated that complications and success rates are not significantly different between mechanical compression and VCD. Current data suggest that the correct answer on whether or not to use VCD still remains in the operator domain where integration of clinical data and familiarity with a particular closure device plays a key role in achieving successful hemostasis and avoiding access site complication.     

47,XXY female with testicular feminization and positive SRY: a case report

BACKGROUND: Males with a 47,XXY karyotype have the clinical phenotype of Klinefelter syndrome. A few 47,XXY cases with a female phenotype have been reported. These individuals have positive SRY (testis-determining factor). The genetic explanation of this phenomenon is unclear. CASE: A 34-year-old woman presented with testicular feminization and a 47,XXY karyotype. Cytogenetic analysis and fluorescence in situ hybridization suggested that the Y chromosome had a normal structure; the polymerase chain reaction was positive for SRY. CONCLUSION: This is the third reported case of 47,XXY with afemale phenotype in spite of the presence of a Y chromosome and the normal SRY. This suggests that the phenotypic sex in these patients might be due to the involvement of other sex-determining genes.     

Aortic arch aneurysm and patent left internal mammary artery: technique of transposition of supra-aortic vessels and embolization of the subclavian artery

Endovascular treatment of aortic arch aneurysms poses unique problems because of vascularization of the carotid arteries. Transposition of supra-aortic vessels is becoming an established and accepted strategy for expanding the applicability of stent graft repair. left subclavian artery (LSA) is not usually transposed because its overstenting does not produce relevant complications. Nevertheless, some selected cases need high-pressure revascularization of the LSA, such as in the presence of a patent left internal mammary artery. We present a technique of revascularization of supra-aortic vessels and "balloon protected" embolization of the origin of the LSA.     

Comparison of measures of large-fiber nerve function in patients with chronic nerve compression and neuropathy

Measurement of large-fiber peripheral nerve function is critical to the assessment of patients with nerve injury, chronic nerve compression, and neuropathy. We evaluated the Semmes-Weinstein nylon monofilament (SWM), vibrometry, and the Pressure-Specified Sensory Device (PSSD) (Sensory Management Services LLC, Baltimore, Maryland) prospectively on the plantar surface of the hallux, bilaterally, in 35 patients with peripheral nerve problems related to nerve compression and neuropathy. Five patients had carpal tunnel syndrome and, therefore, had normal hallux measurements. Normative data for the SWM were obtained for 59 age-stratified people. A moderately strong Pearson product moment correlation was found for large-fiber nerve function between the PSSD and the SWM and between the PSSD and vibrometry. However, when these functions were compared with normative values for each neurosensory testing technique, sensitivity for detecting the presence of a peripheral nerve problem was 100% for the PSSD, 63% for the SWM, and 30% for vibrometry. False-positive test results were obtained for the hallux in 0% of normal feet when the PSSD was used, in 20% when vibrometry was used, and in 30% when the SWM was used as the test instrument. The PSSD was the most sensitive in identifying the presence of a large-fiber peripheral nerve problem in patients with pain or paresthesia in the foot related to the posterior tibial nerve.