Assuntos
Artéria Radial , Tomografia de Coerência Óptica , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Valor Preditivo dos Testes , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/efeitos adversosRESUMO
BACKGROUND: The characterization of radial artery perforation (RAP) patterns using optical coherence tomography (OCT) has not been well established. This study aimed to identify the characteristic RAP patterns in patients diagnosed through post-procedural OCT examination. METHODS: This retrospective study included 1936 consecutive patients who underwent radial artery (RA) OCT following OCT-guided transradial coronary intervention (TRI) from January 2016 to July 2022. Data regarding RAP characteristics were collected through OCT, including the perforation site as well as dimensions such as the length, width, and arc. Furthermore, RAP types were classified as small or large perforations, with a cut-off arc value of ≤90°. RESULTS: RAP, as identified by RA angiography (RAA) during TRI and on post-procedural OCT, was found in 16 out of 1936 patients (0.83 %). RA OCT imaging showed that the median distance between the RA ostium and the perforation site, the perforation length, width, and arc were 30.6 (14.4-42.2) mm, 1.55 (1.03-1.92) mm, 0.74 (0.60-1.14) mm, and 42.5 (25.0-58.1) °, respectively. Small perforations (arc ≤90°) were observed in 14 out of the 16 (87.5 %) patients with RAP. Post-procedural RAA revealed that 15 out of the 16 (93.7 %) patients with RAP had sealed perforations, with the remaining patient requiring external compression. CONCLUSIONS: Our findings demonstrated that RAP is uncommon during TRI, with clearly defined characteristic patterns on OCT. Most RAPs are small and tend to spontaneous seal through catheter tamponade.
Assuntos
Valor Preditivo dos Testes , Artéria Radial , Tomografia de Coerência Óptica , Lesões do Sistema Vascular , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Punções , Cateterismo Periférico/efeitos adversos , Resultado do Tratamento , Fatores de RiscoRESUMO
The thumb is acknowledged to contribute significantly to hand function, accounting for up to 40% of its overall capability. Consequently, injuries affecting the thumb can have a profound impact on the quality of life experienced by patients. When it comes to the surgical reconstruction of thumb injuries, the primary objective is to promptly provide coverage of the affected area with glabrous skin, thus preserving both the length and functionality of the thumb. Managing injuries specifically involving the thumb pulp can be particularly challenging due to the digit's size and vital role. Acquiring an adequate amount of glabrous soft tissue poses a difficulty in such cases. Various reconstructive approaches, encompassing a range of options on the reconstructive ladder, have been documented for thumb pulp injuries. The most popular options include pedicled flaps and free flaps obtained from both the hands and feet. However, a consensus regarding the optimal method for reconstructing the thumb pulp has yet to be reached. We present a case of total thumb pulp reconstruction for a 40 × 30 mm defect using the free thenar flap in a 65-year-old carpenter who sustained a work-related injury. This flap was designed and raised on the superficial branch of the radial artery with a single subcutaneous vein and a branch of the palmar cutaneous nerve, the flap measured 43 × 32 mm. It was inset transversely with an end-to-end arterial anastomosis to the ulnar digital artery, venous anastomosis to the dorsal digital vein and nerve coaptation to the ulnar digital nerve. The postoperative course was uneventful, and the patient was discharged the following day without any complications. Eight months after surgery, the patient was extremely satisfied with the results of the procedure in terms of both function and appearance. The patient had experienced an improvement in function, sensation, and aesthetics. The patient had a QuickDASH disability/symptom score of 15.91 and a QuickDASH work module score of 18.75; the range of motion in the treated thumb was almost the same as the opposite thumb. The patient successfully resumed work three weeks following the procedure, initially with modified duties, and fully regained their work capacity within six weeks. As the patient's primary concern was their ability to return to work, the utilization of a free thenar flap offered several distinct advantages. These included minimal post-operative complications, facilitated by a single operative site, allowing for reconstruction under regional anesthesia. Moreover, the procedure was conducted in a single stage, enabling the patient to be discharged on the same day without the need for further procedures. Furthermore, similar to several other reconstructive options for the thumb, the utilization of a free thenar flap offered the advantage of providing high-quality, like-for-like glabrous tissue.
Assuntos
Traumatismos dos Dedos , Retalhos de Tecido Biológico , Traumatismos da Mão , Procedimentos de Cirurgia Plástica , Humanos , Idoso , Polegar/cirurgia , Polegar/lesões , Retalhos de Tecido Biológico/cirurgia , Qualidade de Vida , Traumatismos da Mão/cirurgia , Artéria Radial/lesões , Artéria Radial/cirurgia , Traumatismos dos Dedos/cirurgia , Transplante de Pele/métodos , Resultado do TratamentoRESUMO
Idiopathic true aneurysm of the distal radial artery is a rare disease with only few reported cases. Most patients were treated surgically with proximal and distal arterial ligatures, while there are reports of only 7 cases where revascularization procedures were performed. We present a case of a 66-year-old man with a pulsatile mass in the right forearm at the location of the radial artery. Six months preceding the presentation, the patient had first noticed a pulsatile tumefaction which gradually increased in size, with a sudden increase during the last month. The patient worked as a waiter and was a non-smoker with no significant comorbidities. There was no history of trauma, recent infection, hospitalization, recurrent injury, or peripheral venous cannulation. After CDT diagnosis, we performed resection of aneurysm and reconstruction with cephalic autovenous graft. One month afterwards, at the follow-up visit, the patient denied having symptoms of hand ischemia and duplex ultrasound examination showed adequate patency of the radial artery. This paper presents a rare case of a true idiopathic radial artery aneurysm that was treated surgically by complete resection and interposition with a reverse cephalic vein autovenous graft. Detailed anamnesis and clinical examination are necessary for the appropriate surgical treatment of the disease.
Assuntos
Aneurisma , Artéria Radial , Masculino , Humanos , Idoso , Artéria Radial/cirurgia , Artéria Radial/lesões , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , IsquemiaRESUMO
The transradial approach for cardiac catheterization, coronary angiography, and percutaneous intervention is associated with a lower risk of access site-related complications compared to the transfemoral approach. However, with increasing utilization of transradial access for not only coronary procedures but also peripheral vascular procedures, healthcare personnel are more likely to encounter radial access site complications, which can be associated with morbidity and mortality. There is significant heterogeneity in the reporting of incidence, manifestations, and management of radial access site complications, at least partly due to vague presentation and under-diagnosis. Therefore, physicians performing procedures via transradial access should be aware of possible complications and remain vigilant to prevent their occurrence. Intraprocedural complications of transradial access procedures, which include spasm, catheter kinking, and arterial dissection or perforation, may lead to patient discomfort, increased procedure time, and a higher rate of access site cross over. Post-procedural complications such as radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve injury could lead to patient discomfort and limb dysfunction. When radial access site complications occur, comprehensive evaluation and prompt treatment is necessary to reduce long-term consequences. In this report, we review the incidence, clinical factors, and management strategies for radial access site complications associated with cardiac catheterization.
Assuntos
Falso Aneurisma , Arteriopatias Oclusivas , Intervenção Coronária Percutânea , Falso Aneurisma/etiologia , Arteriopatias Oclusivas/complicações , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesõesRESUMO
Resumo O tamanduá-bandeira é um mamífero encontrado na América Central e na América do Sul. Esse animal possui garras que podem chegar a 6,5 cm de comprimento, utilizadas para escavar formigueiros e obter alimento, além de servir para sua defesa. Relatamos o caso de paciente masculino de 52 anos, com histórico de epilepsia, que foi levado desacordado ao pronto-socorro, devido a lesões no seu braço direito causadas por um tamanduá. Frente à suspeita de trauma vascular, o paciente foi submetido a exploração cirúrgica, que evidenciou uma lesão combinada de vasos braquiais, submetida a reparo. Apresentou boa evolução do quadro, recebendo alta hospitalar no segundo dia de pós-operatório e, no seguimento ambulatorial, evoluiu sem sequelas neurológicas ou vasculares.
Abstract The giant anteater is a mammal found in Central and South America. These animals have claws that can reach 6.5 centimeters in length, which they use to dig anthills to obtain food and for defense. We report the case of a 52-year-old male patient with a history of epilepsy who was taken unconscious to the emergency room due to injuries to his right arm caused by an anteater. He underwent surgical exploration to investigate suspected vascular trauma, revealing a combined (arterial and venous) injury of the brachial vessels, which were repaired. He recovered well and was discharged on the second postoperative day. During outpatient follow-up he continued to improve, with no neurological or vascular sequelae.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artéria Braquial/lesões , Artéria Ulnar/lesões , Artéria Radial/lesões , Lesões do Sistema Vascular/cirurgia , Vermilingua , Embolectomia , Lesões do Sistema Vascular/tratamento farmacológico , Lesões Acidentais , Casco e GarrasRESUMO
OBJECTIVE: To evaluate a new haemostasis method using an ultrasound probe to compress the radial artery and haemostasis under direct vision to replace traditional manual compression of the radial artery. METHODS: According to a random number table, 240 patients with gastrointestinal tumours who had undergone arterial puncture were divided into Group A (120 cases) and Group B (120 cases). In Group A, patients were under the guidance of ultrasound to confirm the vascular port, determine the compression position of the ultrasound probe, observe the degree of vascular deformation, and press the radial artery puncture port with pressure to stop bleeding under direct vision. In Group B, traditional manual compression was used. All patients received 5 min of compression for haemostasis, and haemostasis conditions were recorded after compression and 24 hours postoperatively. RESULTS: The incidence of bleeding, haematoma, and skin ecchymosis at the puncture site after 5 minutes of compression in Group A was lower than that in Group B (P < 0.05). No significant difference was found between the two groups at 24 hours after the operation (P > 0.05). CONCLUSION: The method using an ultrasound probe to guide radial artery compression to haemostasis is better than traditional manual compression when applied for compression haemostasis after removing the radial artery catheter.
Assuntos
Hemostasia , Punções/efeitos adversos , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Ultrassonografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
CASE DESCRIPTION: A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery, identified by angiotomography. CLINICAL FINDINGS: A wound in the distal third of the left forearm with present pulses and adequate hand coloration. An angiotomography of the upper left limb showed a median artery originating as a continuation of the anterior interosseous artery and ending in the palm of the hand with an incomplete superficial palmar arch. TREATMENT AND OUTCOMES: Ligation of both radial and ulnar arteries was performed. It was not possible to follow up the patient. CLINICAL RELEVANCE: Forming the superficial and deep palmar arches, the irrigation of hand comes from the ulnar and radial arteries, which can compromise the viability of the limb when injured. The median artery is present in 0.6-21.1% of the population, originates from the anterior interosseous artery (branch of the ulnar), accompanies the median nerve in its path and ends in the palm joining the superficial palmar arch. Diagnostic imaging is a key tool for assessing arterial circulation and characterizing upper limb vascular lesions. Knowledge of the anatomical variations of the arterial supply of the hand, including variability of the superficial palmar arch, is crucial for the safety and success of hand surgeries.
DESCRIPCIÓN DEL CASO: Un paciente joven de sexo masculino con sección completa de las arterias cubital y radial conservó la perfusión de la mano a través de una variante anatómica, la arteria mediana, identificada por angiotomografía. HALLAZGOS CLÍNICOS: Herida en el tercio distal del antebrazo izquierdo con pulsos presentes y coloración adecuada de la mano. Una angiotomografía del miembro superior izquierdo mostró una arteria mediana que se originaba como continuación de la arteria interósea anterior y terminaba en la palma de la mano con un arco palmar superficial incompleto. TRATAMIENTO Y RESULTADOS: Se realizó la ligadura de las arterias radial y cubital. No fue posible realizar un seguimiento del paciente. RELEVANCIA CLÍNICA: La irrigación de la mano proviene de las arterias cubital y radial, que forman los arcos palmar superficial y profundo, comprometiendo la viabilidad de la extremidad cuando se lesionan. La arteria mediana está presente en el 0.6-21.1% de la población, se origina en la arteria interósea anterior (rama del cubital), acompaña al nervio mediano en su recorrido y termina en la palma uniéndose al arco palmar superficial. El diagnóstico por imagen es una herramienta clave para evaluar la circulación arterial y caracterizar las lesiones vasculares del miembro superior. El conocimiento de las variaciones anatómicas de la irrigación arterial de la mano, incluida la variabilidad del arco palmar superficial, es de importancia crucial para la seguridad y el éxito de las cirugías de la mano.
Assuntos
Mãos/irrigação sanguínea , Artéria Radial/lesões , Artéria Ulnar/lesões , Adulto , Artérias/diagnóstico por imagem , Traumatismos do Antebraço/diagnóstico , Humanos , Masculino , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/cirurgiaRESUMO
BACKGROUND: The study aimed to assess the effects of serum YKL-40 level on patency at the repair site in patients who underwent arterial repair at the level of the forearm. METHODS: The study included 58 subjects, including 29 patients (aged 18-50 years) who had ulnar or radial artery injury secondary to cut injury to wrist between June 2015 and November 2019 and no comorbid disease and 29 age- and sex-matched healthy controls. The vascular patency was assessed using Doppler sonography in patients who underwent arterial repair at the level of the forearm. The patients were defined as flow failure if the blood flow was ≤50%, and sufficient flow if the blood flow was >50% of those in the synonymous artery on the intact extremity. The YKL-40 level differences in the patient and control groups were compared to those in the sufficient and insufficient flow groups. RESULTS: The patients were stratified into 2 groups based on the presence of sufficient flow. The mean YKL level was 11.96 ± 8.87 in the sufficient flow groups, whereas it was 32.22 ± 15.43 in the insufficient flow groups (p= 0.038). Besides, it was found that each unit of increase in the YKL-40 level increased the likelihood of having flow failure by 1.128. CONCLUSION: Based on our results, it was observed that over-expression of the YKL-40 level has adverse effects on patency following arterial repair.
Assuntos
Proteína 1 Semelhante à Quitinase-3/sangue , Antebraço/irrigação sanguínea , Artéria Radial/cirurgia , Artéria Ulnar/cirurgia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/lesões , Ultrassonografia Doppler , Regulação para Cima , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/sangue , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Adulto JovemRESUMO
PURPOSE: Simultaneous lesions of both proper digital arteries of the thumb are common in hand trauma surgery. The purpose of this anatomical study was to determine if the dorsal arterial network could be sufficient to ensure the vascularization of the thumb skin sheath. METHODS: We carried out a cadaveric study on 22 hands. The ulnar and radial proper digital arteries of the thumb were ligated at the base of the first phalanx. Red dye was injected into the radial artery and blue dye into the ulnar artery at the wrist level. Visual evaluation of skin staining and systematic photographs was done at 1, 3 and 10 min after injection of dyes. RESULTS: Staining of the thumb sheath was obtained in 100% of the dissections and complete in 91.91% of cases. Staining originated from mixed radial and ulnar artery origins in 81.82% of cases. It was incomplete in 9.09% of cases with a missing on the dorsoradial edge of the proximal phalanx. In one dissection, the whole hand skin was only stained red, and in another dissection only stained blue. CONCLUSION: The dorsal vascular network ensures the substitution of the skin vascularization in more than 90% of cases when ligating the proper digital arteries of the thumb. A clinical impression of good skin vascularization after injury of both proper digital arteries might lead the surgeon not to perform systematic revascularization, but the risk of variable damages of adjacent tissues due to an interruption of one major arterial system requires a palmar arterial anastomosis whenever possible.
Assuntos
Artéria Radial/lesões , Polegar/irrigação sanguínea , Artéria Ulnar/lesões , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Cadáver , Feminino , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/anatomia & histologia , Artéria Radial/cirurgia , Artéria Ulnar/anatomia & histologia , Artéria Ulnar/cirurgiaRESUMO
BACKGROUND: Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population. METHODS: We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic. RESULTS: Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01). CONCLUSION: Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.
Assuntos
Cateterismo Periférico , Artéria Radial , Adolescente , Fatores Etários , Cateterismo Periférico/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Punções , Artéria Radial/lesões , Artéria Radial/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia , VasoconstriçãoRESUMO
AIM OF THE STUDY: The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss. METHODS: This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate. RESULTS: The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma. CONCLUSION: Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor.
Assuntos
Amputação Cirúrgica , Artérias/lesões , Salvamento de Membro/estatística & dados numéricos , Extremidade Superior/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Adulto , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Artéria Braquial/lesões , Artéria Braquial/cirurgia , Feminino , Antebraço/irrigação sanguínea , Traumatismos do Antebraço/etiologia , Traumatismos do Antebraço/cirurgia , Humanos , Masculino , Artéria Radial/lesões , Artéria Radial/cirurgia , Procedimentos de Cirurgia Plástica , Reoperação , Estudos Retrospectivos , Fatores de Risco , Tunísia , Grau de Desobstrução Vascular , Lesões do Sistema Vascular/cirurgiaRESUMO
BACKGROUND: This study aimed to evaluate acute injuries of the radial artery (RA) using optical coherence tomography (OCT) in patients who underwent coronary intervention via the snuffbox approach. METHODS: Forty-six patients, who underwent coronary intervention and assessment of the conventional RA using OCT via the snuffbox approach, were enrolled from two university hospitals between August 2018 and August 2019. RESULTS: The mean age of the patients was 65.1 years. In this study population, 6-French (Fr) sheaths were used. The mean diameter of the conventional RA was 2.89 ± 0.33 mm, and the mean lumen area of the conventional RA was 6.68 ± 1.56 mm2. Acute injuries of the conventional RA, after the snuffbox approach, were observed in 5 (10.9%) patients. Intimal tear was observed in the RA in 1 (2.2%) case. Intraluminal thrombi, without vessel injuries, were detected in the RA in 4 (8.7%) cases. However, medial dissection was not observed in the OCT analysis. CONCLUSIONS: This retrospective OCT-based study showed that the diameter of the conventional RA was 2.89 mm and acute vessel injury of the conventional RA was rare in patients who underwent coronary intervention via the snuffbox approach.
Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Lesões do Sistema Vascular , Idoso , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Artéria Radial/lesões , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaRESUMO
CASE: Two otherwise healthy male patients presented with lacerations to the volar distal forearm. Both patients had capillary refill at the fingertips and intact Doppler signals of the palmar arch. Computed tomography angiography revealed cessation of flow in the major forearm arteries at the level of the lacerations, with distal reconstitution from the anterior interosseous artery in both cases and from a branch off the ulnar artery in 1 case. The patients underwent operative exploration, where complete transections of the radial and ulnar arteries were found and repaired. CONCLUSIONS: In patients without arterial disease, contributions from minor forearm arteries can be sufficient for hand perfusion in the setting of radial and ulnar artery transection.
Assuntos
Mãos/irrigação sanguínea , Artéria Radial/lesões , Artéria Ulnar/lesões , Traumatismos do Punho/cirurgia , Adulto , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/cirurgia , Procedimentos Cirúrgicos Vasculares , Traumatismos do Punho/diagnóstico por imagemAssuntos
Traumatismos do Antebraço/cirurgia , Artéria Radial/cirurgia , Veia Safena/transplante , Técnicas de Sutura , Artéria Ulnar/cirurgia , Enxerto Vascular , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Traumatismos do Antebraço/diagnóstico por imagem , Traumatismos do Antebraço/etiologia , Humanos , Masculino , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Recuperação de Função Fisiológica , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/lesões , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/etiologiaAssuntos
Fístula Arteriovenosa/terapia , Cateterismo Cardíaco , Cateterismo Periférico/efeitos adversos , Angiografia Coronária , Artéria Radial/lesões , Lesões do Sistema Vascular/terapia , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Humanos , Masculino , Punções , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologiaRESUMO
OBJECTIVE: To compare the outer diameter (OD) of conventional and radial sheaths from different manufacturers for sizes typically used in infant catheterization. BACKGROUND: The smallest sheath size is recommended to minimize risk of arterial injury in infants. However, sheath size refers to its internal diameter (ID), but it is the larger OD that determines risk. The OD varies between manufacturers and is frequently not known to the end user. METHODS: Three authors measured the OD of 3, 3.3, 4, 5, and 6 French (Fr) sheaths from different manufacturers using a Mitutoyo digital micrometer. Continuous variables are reported as mean ± SD. The midshaft and proximal-shaft sheath measurements were compared using an independent samples t test. Agreement between author measurements was tested using intra- and inter-rater reliability analysis. Manufacturer sheath OD measurements were obtained. Statistical significance was set at p < .05. RESULTS: There was no difference in the measured sheath diameters at the midpoint and proximally (p < .05). The intra-rater and inter-rater reliability were excellent (Intraclass correlation coefficient 1.0). Among conventional sheaths the OD varied between manufacturers, Terumo sheaths had the smallest and Galt sheaths had the largest OD. Radial sheaths had the smallest OD (1 Fr smaller) when compared to similar sized conventional sheaths. For instance, the OD of 4 Fr radial sheath (1.610 ± 0.006 mm) is essentially the same as the OD of the conventional 3 Fr (1.644 ± 0.016 mm) and 3.3 Fr (1.635 ± 0.005 mm) sheaths. CONCLUSIONS: Our study shows variation in the OD of sheaths used in infant catheterization. The radial sheaths offer the smallest OD across sizes.
Assuntos
Cateterismo Cardíaco/instrumentação , Cateterismo Periférico/instrumentação , Artéria Radial , Dispositivos de Acesso Vascular , Fatores Etários , Tamanho Corporal , Cateterismo Cardíaco/efeitos adversos , Cateteres Cardíacos , Cateterismo Periférico/efeitos adversos , Desenho de Equipamento , Humanos , Lactente , Recém-Nascido , Punções , Artéria Radial/lesões , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controleAssuntos
Falso Aneurisma/diagnóstico por imagem , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Idoso , Falso Aneurisma/cirurgia , Animais , Mordeduras e Picadas , Gatos , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Artéria Radial/cirurgiaRESUMO
The advantages of sheathless guiding catheters over the conventional approach using sheaths in percutaneous coronary intervention (PCI) regarding access-site complications, particularly ultrasound-diagnosed radial artery occlusion (RAO), remain unknown. The present study investigated the incidence of access-site complications of transradial primary PCI using sheathless guiding catheters in acute coronary syndrome (ACS). This prospective study evaluated access-site complications in 500 patients with ACS undergoing sheathless transradial primary PCI. Doppler ultrasound evaluation of the radial arteries was performed 2 and 30 days after the procedure. Sheathless guiding catheters (7.5-Fr) were used in 91.0% of the patients. The procedural success rate was 98.4%. Ultrasound-diagnosed RAO rates were 2.0% and 3.8% at 2- and 30-day follow-ups, respectively. Logistic regression analysis identified that the sheath-to-artery ratio (per 0.1) (odds ratio [OR] 5.71; 95% confidence interval [CI] 1.18-27.71; p = 0.001) was associated with more frequent RAO and that hypertension (OR 0.22; 95% CI 0.06-0.81; p = 0.023) was associated with less frequent RAO. Receiver operating characteristic curve analysis revealed that a sheath-to-artery ratio of 1.47 was the cutoff for 30-day post-procedural RAO (sensitivity 72%, specificity 81%). Sheathless transradial primary PCI for ACS was associated with a low incidence of access-site complications and a higher sheath-to-artery ratio cutoff for RAO than that expected from conventional PCI using sheaths based on historical data, demonstrating the access-site safety of sheathless guiding catheters and their benefit in PCI for ACS (University Hospital Medical Information Network-Clinical Trial Registry Number UMIN000019931).
Assuntos
Síndrome Coronariana Aguda/terapia , Arteriopatias Oclusivas/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial/diagnóstico por imagem , Idoso , Arteriopatias Oclusivas/etiologia , Catéteres/efeitos adversos , Constrição Patológica/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Artéria Radial/lesões , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
BACKGROUND: Remodeling of the radial artery (RA) after transradial percutaneous coronary intervention (TRI) is under studied. OBJECTIVES: To examine the impact of TRI on RA diameter and intimal-medial thickness (IMT) in men and women using 55â¯Mhz ultrahigh frequency duplex ultrasound (UHFDU). METHODS: We performed UHFDU at 24â¯h and 90â¯days after non-emergent TRI in 41 patients (25 men, 16 women). Changes in RA diameter, IMT and RA injury were compared by patient gender. Multivariate linear regression was used to determine the predictors of RA diameter and IMT. RESULTS: Of the 41 patients, mean age was 66⯱â¯9.8. Baseline RA diameter was larger in men vs. women (3.1⯱â¯0.40â¯mm vs. 2.8â¯mm⯱â¯0.36, pâ¯=â¯0.02), however there were similar reductions in 90-day diameter (-0.57⯱â¯0.32â¯mm vs. -0.64⯱â¯0.40â¯mm, respectively; pâ¯=â¯0.48). Baseline IMT was also similar in men and women (0.28⯱â¯0.04 vs. 0.27⯱â¯0.06â¯mm; pâ¯=â¯0.37) and there were 0.073⯱â¯0.11â¯mm (26%) and 0.05⯱â¯0.080â¯mm (19%) increases in IMT noted, respectively (pâ¯<â¯0.0001 vs. baseline, pâ¯=â¯0.48 for men vs. women). Although UHFDU occasionally detected limited access site intimal tears (12%) at 90â¯days, frank dissections (2.4%), pseudoaneurysms (2.4%) and total occlusions (4.9%) were infrequent. Female gender correlated with smaller RA diameter at follow-up and there were no predictors of IMT. CONCLUSIONS: Following TRI, there is a 20% reduction in RA diameter and a 20-25% increase in IMT. Only gender predicted RA diameter. As a simple, noninvasive method to accurately depict the RA healing response following TRI, UHFDU may inform future clinical investigation in this area.