Concept: Radial artery
To demonstrate the feasibility of distal left transradial approach for patients in whom left radial access is preferred over right radial access for coronary angiography and interventions. This procedure is more convenient for the operator. For the right- handed patient, left radial access is more convenient because of the free use of the right hand after the procedure. In addition, this technique reduces the chance for radial artery occlusion at the site of the distal forearm.
Distal transradial access in the anatomical snuffbox has advantages over standard access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve.
Photoplethysmography using a smartphone application for assessment of ulnar artery patency: a randomized clinical trial
- CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
- Published almost 3 years ago
Radial artery access is commonly performed for coronary angiography and invasive hemodynamic monitoring. Despite limitations in diagnostic accuracy, the modified Allen test (manual occlusion of radial and ulnar arteries followed by release of the latter and assessment of palmar blush) is used routinely to evaluate the collateral circulation to the hand and, therefore, to determine patient eligibility for radial artery access. We sought to evaluate whether a smartphone application may provide a superior alternative to the modified Allen test.
Heart rate variability (HRV) is widely used to assess autonomic nervous system (ANS) function. It is traditionally collected from a dedicated laboratory electrocardiograph (ECG). This presents a barrier to collecting the large samples necessary to maintain the statistical power of between-subject psychophysiological comparisons. An alternative to ECG involves an optical pulse sensor or photoplethysmograph run from a smartphone or similar portable device: smartphone pulse rate variability (SPRV). Experiment 1 determined the simultaneous accuracy between ECG and SPRV systems in n=10 participants at rest. Raw SPRV values showed a consistent positive bias, which was successfully attenuated with correction. Experiment 2 tested an additional n=10 participants at rest, during attentional load, and during mild stress (exercise). Accuracy was maintained, but slightly attenuated during exercise. The best correction method maintained an accuracy of +/-2% for low-frequency spectral power, and +/- 5% for high-frequency spectral power over all points. Thus, the SPRV system records a pulse-to-pulse approximation of an ECG-derived heart rate series that is sufficiently accurately to perform time- and frequency-domain analysis of its variability, as well as accurately reflecting change in autonomic output provided by typical psychophysiological stimuli. This represents a novel method by which an accurate approximation of HRV may be collected for large-sample or naturalistic cardiac psychophysiological research.
Objective oTo evaluate whether administration of nitroglycerin through the sheath at the end of a trans-radial procedure might preserve the patency of the radial artery. Background Despite the increasing acceptance of trans-radial approach, radial artery occlusion (RAO) continues to be a vexing problem of trans-radial access and limits utility of the radial artery as an access site in the future. Methods We conducted a multi-center, prospective, randomized, placebo-controlled, operator-blinded trial and enrolled 1706 patients who underwent trans-radial catheterization in three experienced radial centers. Patients were randomized to receive either 500 µg nitroglycerin (n=853) or placebo (n=853), given intra-arterially through the sheath at the end of the radial procedure. The primary outcome was the incidence of RAO as confirmed by absence of antegrade flow at one day after the trans-radial procedure evaluated by duplex ultrasound of the radial artery. Results The use of nitroglycerin, as compared with placebo, reduced the risk of the primary outcome (8.3% vs. 11.7%; odds ratio, 0.62; 95% confidence interval [CI], 0.44 to 0.87; P=0.006). From a multivariable analysis, duration of hemostasis was a predictor of RAO (odds ratio, 3.21; 95% CI, 1.73 to 5.96; P<0.001). There were no significant differences between the groups with respect to the sheath size (P=0.311), number of puncture attempts (P=0.941), duration of hemostasis (P=0.379) and procedural time (P=0.095). Conclusion The administration of nitroglycerin at the end of a trans-radial catheterization, reduced the incidence of RAO, examined one day after the radial procedure by ultrasound. Post procedural/pre-hemostasis pharmacologic regimens may represent a novel target for further investigation to reduce RAO. © 2014 Wiley Periodicals, Inc.
BACKGROUND: Transradial coronary angiography (CA) and percutaneous coronary intervention (PCI) are gaining worldwide popularity due to the low incidence of major vascular complications and early mobilization of patients post procedures. Although post transradial access site complications are generally considered as minor in nature, they are not being routinely recorded in clinical settings. OBJECTIVES: To evaluate the incidence of access site complications and level of puncture site pain experienced by patients undergoing transradial coronary procedures and to examine factors associated with access site complications occurrence and puncture site pain severity. METHODS: A cross-sectional correlational study of 85 Chinese speaking adult patients scheduled for elective transradial CA and or PCI. Ecchymosis, bleeding, hematoma and radial artery occlusion (RAO) were assessed through observation, palpation and plethysmographic signal of pulse oximetry after coronary procedures. Puncture site pain was assessed with a 100mm Visual Analogue Scale. Factors that were related to access site complications and puncture site pain were obtained from medical records. RESULTS: Ecchymosis was the most commonly reported transradial access site complication in this study. Paired t-test showed that the level of puncture site pain at 24h was significantly (p<0.001) lower than that at 3h after the procedure. Stepwise multivariable regression showed that female gender and shorter sheath time were found to be significantly associated with bleeding during gradual deflation of compression device. Only longer sheath time was significantly associated with RAO. Female gender and larger volume of compression air were associated with the presence of ecchymosis and puncture site pain at 3h after procedure, respectively. CONCLUSIONS: The study findings suggest that common access site complications post transradial coronary procedures among Chinese population are relatively minor in nature. Individual puncture site pain assessment during the period of hemostasis is important. Nurses should pay more attention to factors such as female gender, sheath time and volume of compression that are more likely to be associated with transradial access site complications and puncture site pain.
Verapamil is traditionally applied prophylactically in transradial procedures to prevent radial artery spasm. However, verapamil may have side effects and is contraindicated in some clinical settings.
In cerebral revascularization surgery in Japan, the preferred solution for rinsing and intraoperative storage of saphenous vein or radial artery grafts is a heparinized saline solution with albumin. On the other hand, most cardiac surgeons routinely use solutions of heparinized autologous blood during surgery. Here we used the latter type of solution for cerebral revascularization surgery and evaluated its efficacy. Patients and methods:Since December 2011, we have used heparinized autologous blood for saphenous vein grafts during cerebral revascularization surgery. For this, 20mL of the whole blood was obtained from an arterial line;this blood was then mixed with 20mL of a heparinized saline solution containing 500IU of heparin and 40mg of papaverine hydrochloride. The saphenous vein was harvested using standard procedures and immersed in the autologous blood solution just before implantation. Results:Between December 2011 and March 2013, six revascularizations using saphenous vein grafts were performed using this solution. None of the anastomoses presented complications related to revascularization procedures, and all grafts were clearly present postoperatively. Discussion:There is still no evidence that the storage in autologous blood is superior to the use of a saline solution with albumin. However, the national health insurance does not cover the use of albumin products, which carries an additional cost. Furthermore, the autologous blood medium is a red-colored solution that indicates the presence of unfavorable graft leaks when the wall of the graft turns red. Conclusion:We recommend the use of heparinized autologous blood for intraoperative rinsing and storage grafts.
The present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.
Focal fibrocartilaginous dysplasia (FFCD) is a rare benign bone lesion, which mainly occurs in the proximal tibia. In the upper extremity, only 21 cases have been reported so far and 14 of these involved the ulna. We present an additional case of FFCD in the distal ulna that showed progressive bowing of the right forearm and the radial head dislocation. Resection of the abnormal tissue, osteotomy of the radius and ulna, and gradual lengthening of the ulna were performed. On the basis of the previously published data of 14 cases and our data, we have summarized the etiology, clinical features, natural history, and treatment of FFCD in the ulna.