Transauricular arterial access for hepatic artery embolization in rabbit VX2 liver tumor

Purpose: The purpose of this study is to evaluate the feasibility of percutaneous transauricular artery access for hepatic artery catheterization using a peripherally inserted central catheter (PICC) device and hepatic artery catheterization through auricular approach. Methods: Ten New Zealand White rabbits were used to establish a VX2 liver tumor model. Hepatic artery angiography and embolization were performed 3 weeks after inoculation. The rabbits were restrained in supine position under anesthesia. Intra-arterial access was accomplished with percutaneous Seldinger technique through the auricular artery using a PICC device. The hepatic artery catheterization was performed with a microcatheter and guide wire. The rate of technical success and procedure time was investigated. Results: Two rabbits failed initial percutaneous transauricular arterial access, with success in a contralateral attempt. Thus, percutaneous transauricular arterial access was achieved in 10 of 12 auricular arteries, with a technical success rate of 83.3%. The time needed to obtain intra-auricular access was 7.2 ± 3.1 min. Hepatic artery catheterization, angiography, and embolization were accomplished through the auricular approach in all 10 rabbits. Conclusion: Arterial access in rabbits can be achieved through the auricular artery. Hepatic artery catheterization, angiography, and embolization can be performed through auricular arterial access

Implante de cardiodesfibrilador por vía transauricular: descripción de un caso / Placement of an Implantable Cardioverter Defibrillator Thorough a Transatrial Approach: a Case Report

La trombosis de la vena cava superior es infrecuente, pero su aparición dificulta la vía de acceso para el implante de marcapasos y desfibriladores. Existen alternativas cuando no se puede utilizar la vía endovascular y la vía epicárdica es la de elección. Sin embargo, se describieron implantes de catéteres de desfibrilador por vía transauricular por toracotomía mínima con buenos resultados a largo plazo y con el logro de un umbral de desfibrilación adecuado. En esta presentación se describe el caso de un paciente con antecedentes de cardiopatía chagásica e implante de un marcapasos bicameral por enfermedad binodal que necesita un desfibrilador. Debido a que se trata de un paciente joven con accesos dificultosos se decidió utilizar la vía transauricular por toracotomía mínima conservando el catéter auricular para estimulación y sensado.

Thrombosis of the superior vena cava is an infrequent condition; yet, its presence prohibits placement of pacemakers and defibrillator devices. The epicardial approach is indicated when the venous access for lead placement is compromised. However, implantable cardioverter device placement using minithoracotomy has been described with favorable long-term outcomes, achieving an adequate defibrillation threshold. We describe the case of a patient with a history of Chagas cardiomyopathy and dual-chamber pacemaker placement due to coexisting sinus node and atrioventricular node dysfunction. We decided to use the transatrial approach via minithoracotomy leaving the atrial lead for sensing electrical activity and delivering stimulation pulses.