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1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(1): 26-31, 2021 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-33522172

RESUMO

In order to obtain the three-dimensional pulse information and blood pressure waveform needed in the study, a radial artery simulation platform with programmable controlled injection pump as the core was constructed by using the circulation theory of human cardiovascular system and pulse wave formation mechanism. Gaussian function model was selected to synthesize multi-type pulse wave to program and drive the platform. The three-dimensional pulse information and blood pressure waveform of the simulated radial artery were collected by binocular visual pulse detection system and pressure transmitter respectively, and the platform stability and repeatability were tested by Pearson correlation. The experimental results show that the radial artery simulation platform is stable, reliable and repeatable, and can generate multiple types of three-dimensional pulse information and blood pressure waveform at the simulated radial artery. The platform is simple in structure, low in cost, and produces many types of pulsating flow. It provides an experimental research platform for revealing the relationship between the three-dimensional pulse information of radial artery and the change of pressure inside the vessel, as well as the prediction of blood pressure waveform from the three-dimensional pulse information.


Assuntos
Artéria Radial , Sinais Vitais , Pressão Sanguínea , Simulação por Computador , Frequência Cardíaca , Humanos
2.
Zhonghua Zhong Liu Za Zhi ; 43(1): 143-146, 2021 Jan 23.
Artigo em Chinês | MEDLINE | ID: mdl-33472328

RESUMO

Objective: To discuss the safety and feasibility of transradial access (TRA) in performing peripheral arterial intervention. Methods: The clinical data of the patients underwent peripheral vascular intervention via TRA in our hospital from September 2017 to March 2019 were reviewed. The success rate of radial artery puncture and subsequent operation after puncture, and related postoperative complications within 30 days were analyzed. Results: The clinical data of 112 peripheral arterial intervention procedures via TRA performed on 106 patients were reviewed, including transcatheter arterial chemoembolization in 83 cases, bronchial arterial infusion in 4 cases, pelvic tumor embolization in 11 cases and 14 other cases. The success rate of all interventional punctures was 97.3% (109/112), the operative success rate of interventional procedures was 98.2% (107/109). The TRA operation was failed in 5 patients, who were then converted to receive the femoral artery puncture and complete successfully. The severe complication of the operation was aortic dissection (2 cases). Minor complications included 2 cases of radial artery occlusion, radial artery spasm, arm pain and puncture point hematoma for each case. The severe complication and the minor complication rates were 1.8% (2/112) and 4.5% (5/112), respectively. Sixteen emergency operations were performed successfully, and no complication occurred. Conclusion: The TRA is a clinically safe and feasible approach for peripheral arterial interventional procedure.


Assuntos
Carcinoma Hepatocelular , Cateterismo Periférico , Quimioembolização Terapêutica , Neoplasias Hepáticas , Cateterismo Periférico/efeitos adversos , Estudos de Viabilidade , Humanos , Artéria Radial/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
3.
Anesthesiology ; 134(1): 26-34, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33079134

RESUMO

BACKGROUND: Perioperative arterial cannulation in children is routinely performed. Based on clinical observation of several complications related to femoral arterial lines, the authors performed a larger study to further examine complications. The authors aimed to (1) describe the use patterns and incidence of major short-term complications associated with arterial cannulation for perioperative monitoring in children, and (2) describe the rates of major complications by anatomical site and age category of the patient. METHODS: The authors examined a retrospective cohort of pediatric patients (age less than 18 yr) undergoing surgical procedures at a single academic medical center from January 1, 2006 to August 15, 2016. Institutional databases containing anesthetic care, arterial cannulation, and postoperative complications information were queried to identify vascular, neurologic, and infectious short term complications within 30 days of arterial cannulation. RESULTS: There were 5,142 arterial cannulations performed in 4,178 patients. The most common sites for arterial cannulation were the radial (N = 3,395 [66.0%]) and femoral arteries (N = 1,528 [29.7%]). There were 11 major complications: 8 vascular and 3 infections (overall incidence, 0.2%; rate, 2 per 1,000 lines; 95% CI, 1 to 4) and all of these complications were associated with femoral arterial lines in children younger than 5 yr old (0.7%; rate, 7 per 1,000 lines; 95% CI, 4 to 13). The majority of femoral lines were placed for cardiac procedures (91%). Infants and neonates had the greatest complication rates (16 and 11 per 1,000 lines, respectively; 95% CI, 7 to 34 and 3 to 39, respectively). CONCLUSIONS: The overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%). All complications occurred in femoral arterial lines in children younger than 5 yr of age, with the greatest complication rates in infants and neonates. There were no complications in distal arterial cannulation sites, including more than 3,000 radial cannulations.


Assuntos
Cateterismo Periférico/efeitos adversos , Monitorização Intraoperatória/efeitos adversos , Adolescente , Fatores Etários , Anestesia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Periférico/métodos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Artéria Femoral , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/epidemiologia , Artéria Radial , Estudos Retrospectivos
4.
J Vasc Interv Radiol ; 32(2): 226-234, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33339678

RESUMO

PURPOSE: To prospectively validate electromagnetic hand motion tracking in interventional radiology to detect differences in operator experience using simulation. METHODS: Sheath task: Six attending interventional radiologists (experts) and 6 radiology trainees (trainees) placed a wire through a sheath and performed a "pin-pull" maneuver, while an electromagnetic motion detection system recorded the hand motion. Radial task: Eight experts and 12 trainees performed palpatory radial artery access task on a radial access simulator. The trainees repeated the task with the nondominant hand. The experts were classified by their most frequent radial artery access technique as having either palpatory, ultrasound, or overall limited experience. The time, path length, and number of movements were calculated. Mann-Whitney U tests were used to compare the groups, and P < .05 was considered significant. RESULTS: Sheath task: The experts took less time, had shorter path lengths, and used fewer movements than the trainees (11.7 seconds ± 3.3 vs 19.7 seconds ± 6.5, P < .01; 1.1 m ± 0.3 vs 1.4 m ± 0.4, P < .01; and 19.5 movements ± 8.5 vs 31.0 movements ± 8.0, P < .01, respectively). Radial task: The experts took less time, had shorter path lengths, and used fewer movements than the trainees (24.2 seconds ± 10.6 vs 33.1 seconds ± 16.9, P < .01; 2.0 m ± 0.5 vs 3.0 m ± 1.9, P < .001; and 36.5 movements ± 15.0 vs 54.5 movements ± 28.0, P < .001, respectively). The trainees had a shorter path length for their dominant hand than their nondominant hand (3.0 m ± 1.9 vs 3.5 m ± 1.9, P < .05). The expert palpatory group had a shorter path length than the ultrasound and limited experience groups (1.8 m ± 0.4 vs 2.0 m ± 0.4 and 2.3 m ± 1.2, respectively, P < .05). CONCLUSIONS: Electromagnetic hand motion tracking can differentiate between the expert and trainee operators for simulated interventional tasks.


Assuntos
Cateterismo Periférico , Competência Clínica , Fenômenos Eletromagnéticos , Mãos , Destreza Motora , Artéria Radial , Radiografia Intervencionista , Radiologistas , Fenômenos Biomecânicos , Estudos de Viabilidade , Humanos , Projetos Piloto , Estudos Prospectivos , Punções , Fatores de Tempo
6.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(12): 1053-1059, 2020 Dec 24.
Artigo em Chinês | MEDLINE | ID: mdl-33355750

RESUMO

Objective: To investigate the effects of femoral approach versus radial approach on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with coronary heart disease, who received twice contrast agents within a short interval. Methods: A total of 322 patients with coronary heart disease, who admitted to the General Hospital of Northern Theater Command from January 2010 to January 2015, were included in this retrospective analysis. All patients exposed to contrast agents twice within 30 days. The patients were divided into two groups according to the approach of interventional operation: radial artery group (n=235) and femoral artery group (n=87). Serum creatinine (SCr) values were detected at 48 and 72 hours post procedure. Endpoint events were CI-AKI, which was defined as SCr increased>0.5 mg/dl (44.2 µmol/L) or relative ratio ((postoperative SCr-preoperative SCr)/preoperative SCr×100%>25%) within 72 hours after contrast agent use after excluding other causes. Clinical characteristics and the incidence of CI-AKI were compared between the two groups, multivariate logistic regression analysis was used to detect the risk factors of postoperative CI-AKI in these patients. Results: The proportion of smoking, PCI history, STEMI patients and levels of fibrinogen, fasting blood glucose, troponin T was significantly higher in femoral artery group than in radial artery group (all P<0.05). The interval between two procedure sessions was significantly longer in the femoral artery group than in the radial artery group (P=0.001). The incidence of CI-AKI tended to be higher in femoral artery group than in radial artery group after the first operation (18.6% (16/87) vs. 11.9% (28/235), P=0.133). CI-AKI incidence after the second operation was similar between the two groups (P>0.05). Multivariate logistic regression analysis showed that interventional approach was not an independent risk factor for postoperative CI-AKI in patients with coronary heart disease undergoing interventional procedures twice within 30 days (P>0.05);STEMI (OR=2.854, 95%CI 1.100-7.404, P=0.031) and diuretics use (OR=4.002, 95%CI 1.470-10.893, P=0.007) were independent risk factors for CI-AKI after the first operation. Conclusion: There is no correlation between the risk of CI-AKI and interventional approaches in patients with coronary heart disease who undergo interventional surgery twice within 30 days.


Assuntos
Lesão Renal Aguda , Doença das Coronárias , Intervenção Coronária Percutânea , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Artéria Femoral/cirurgia , Humanos , Incidência , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial , Estudos Retrospectivos , Fatores de Risco
7.
Zhonghua Yi Xue Za Zhi ; 100(41): 3246-3249, 2020 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-33167112

RESUMO

Objective: To analyze the mechanism of invasive blood pressure change in radial artery caused by arm elevation by observing pressure, velocity and diameter of radial artery. Methods: Twenty-six hemodynamically stable hepatobiliary surgery patients admitted to the intensive care unit from June to December 2018 after general anesthesia in Tsinghua Changgung Hospital were selected. When the arm was raised, the invasive blood pressure was recorded, and the inner diameter and blood flow velocity of the radial artery were measured by Doppler ultrasound. The data following a normal distribution were compared with paired t test. Results: After arm elevation for 30 s, systolic blood pressure of radial artery decreased and diastolic blood pressure increased significantly((107±16) mmHg vs (120±17) mmHg, (75±6) mmHg vs (71±9) mmHg, t=25.0, -12.6, both P<0.05), but there was no significant difference in mean arterial pressure ((87±10) mmHg vs (87±11) mmHg, t=1.1, P>0.05). The peak velocity, end-diastolic velocity and resistance index of the radial artery increased significantly, and the transverse and longitudinal inner diameters of the radial artery decreased significantly after the arm was elevated for 30 s (t=-63.4, -14.6, -22.5, 31.4, 25.3, all P<0.01). Conclusions: Kinetic pressure compensation and vascular resistance compensation may be the main mechanism of radial artery pressure change when the arm is elevated. Arm elevation can be used as a vascular resistance response test clinically.


Assuntos
Pressão Arterial , Hidrodinâmica , Braço , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Artéria Radial
8.
Medicine (Baltimore) ; 99(46): e23227, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181707

RESUMO

BACKGROUND: When atherosclerosis occurs in the coronary artery, resulting in stenosis, occlusion, or spasm of the coronary artery, the supply of blood and oxygen to the myocardium will be reduced or even unavailable, resulting in myocardial necrosis and heart pain, chest tightness, dyspnea and other symptoms caused by myocardial necrosis are collectively referred to as coronary atherosclerotic heart disease. Coronary angiography can not only understand the degree of coronary artery damage, but also estimate the prognosis of coronary artery stenting, which provides a reliable reference for clinical treatment. Transradial coronary angiography (TCA) has the advantages of high success rate, small trauma, less complications, no bed rest, reduce hospital stay and other superiority, which accepted and used by physicians. Although the success rate of surgery is high, the postoperative complications will still affect the effect of surgery and the prognosis of patients. The main manifestations are radial artery occlusion (RAO), forearm hematoma formation, pseudoaneurysm formation, periosteal compartment syndrome, radial artery perforation, etc. Among the many ways to prevent RAO, anticoagulant therapy with common heparin is one of them, but the dosage of heparin is not clear. Therefore, we decided to use systematic evaluation to evaluate the clinical effectiveness and safety of different dose of heparin in preventing of RAO, and to provide clinical basis for the early prevention and treatment of RAO. METHODS: Two reviewers independently searched PubMed, Embase, the Cochrance Library, Web of Science, Medline, CBM Disc, CNKI, and WANFANG Data to find the eligible research. The retrieval about the randomized controlled trials of different dose of heparin in preventing the occurrence of RAO after TCA in recent years. The retrieval time is set between January 1990 and June 2020. The retrieval language is Chinese/English. Two researchers independently searched, managed and screened the literature through the search terms. When the 2 parties have inconsistent opinions on the inclusion or not of certain literature, the literature will be referred to the third researcher for discussion and decision. The included studies are conducted bias risk assessment through bias risk assessment tool, which based on Cochrane Handbook 5.0. The extracted data uses RevMan5.3 software for statistical processing. RESULTS: The research results of this systematic review will be published in peer-reviewed medical-related academic journals. CONCLUSION: This study adopts the Meta-analysis method and expands the sample size, which will give high-quality evidence-based medicine evidence on the clinical effectiveness and safety of different dose of heparin in preventing the occurrence of RAO. TRIAL REGISTRATION NUMBER: OSF, DOI 10.17605/OSF.IO/CPXJ3.


Assuntos
Arteriopatias Oclusivas/etiologia , Angiografia Coronária/efeitos adversos , Relação Dose-Resposta a Droga , Heparina/administração & dosagem , Artéria Radial/anormalidades , Arteriopatias Oclusivas/fisiopatologia , Protocolos Clínicos , Angiografia Coronária/métodos , Heparina/uso terapêutico , Humanos , Metanálise como Assunto , Artéria Radial/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
9.
No Shinkei Geka ; 48(10): 895-901, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071224

RESUMO

We report the initial experience of the distal radial approach(DRA)via the anatomical snuffbox for various neuroendovascular procedures. DRA was attempted in 16 patients and catheterization of the targeted vessel was successfully performed in 15. In one patient, the puncture was successful, but the wire could not be advanced into the radial artery and a switch to the conventional transradial approach was needed. Among the 15 patients who underwent successful DRA, five patients underwent diagnostic cerebral angiography, five underwent coil embolization of a cerebral aneurysm, three underwent carotid artery stenting, one underwent liquid embolization of an arteriovenous malformation, and one underwent liquid embolization of a chronic subdural hematoma. Operability during the procedures was favorable and good hemostasis was obtained in all cases. There were no complications related to this approach. Our initial experience demonstrates that DRA is technically feasible for various neuroendovascular procedures. It can be a less invasive alternative to the conventional approach.


Assuntos
Malformações Arteriovenosas , Embolização Terapêutica , Humanos , Punções , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Stents
10.
Medicine (Baltimore) ; 99(43): e22866, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120826

RESUMO

BACKGROUND: Acute myocardial infarction is a very common disease in the emergency room. Emergency percutaneous coronary intervention (PCI) is the first choice to open infarct-related artery in time to regain the active blood flow of myocardial tissue. Clinical nursing pathway (CNP), namely clinical project, is an original nursing mode with good quality, outstanding efficiency, and low treatment spending, so it has attracted more and more attention. However, few studies have reported the implementation of a CNP in PCIs. The purpose of the protocol is to assess the impact of CNP on the clinical efficacy of transradial emergency PCI. METHODS: This is a randomized controlled, single center trial which will be implemented from January 2021 to June 2021. Hundred samples diagnosed with acute myocardial infarction will be included in this study. It was authorized via the Ethics Committee of Changshan County People's Hospital (CCPH002348). Patients are assigned to the following groups: control group, given normal routine care; CNP group, treated with CNP plan. The time from door to balloon, hospitalization expenses, length of stay, postoperative complications, patients' satisfaction with treatment are compared and analyzed. All data are collected and analyzed by Social Sciences software version 21.0 (SPSS, Inc., Chicago, IL) program. RESULTS: Differences of clinical outcomes between groups (). CONCLUSION: This original evidence-based nursing model can be used as the foundation for further research. TRIAL REGISTRATION NUMBER: researchregistry6030.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Artéria Radial/cirurgia , Doença Aguda , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/economia , Humanos , Tempo de Internação , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Resultado do Tratamento
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 828-831, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018113

RESUMO

Peripheral vascular flow in response to induced reactive hyperemia of the radial artery is used as a benchmark for non-invasive assessment of the endothelial function. As an alternative to standard modalities, this study investigates the suitability of impedance plethysmography to estimate peripheral vascular flow variations associated with the reactive hyperemia process. Results indicate a consistent variation of bio-impedance during the reactive hyperemia process at higher measurement frequencies and these variations are compatible with a standard tissue impedance model. Further, calculated features of bioimpedance has shown the capability of differentiating healthy and diabetic groups which is useful in estimating the endothelial dysfunction.


Assuntos
Diabetes Mellitus , Hiperemia , Humanos , Hiperemia/diagnóstico , Pletismografia de Impedância , Artéria Radial
12.
Medicine (Baltimore) ; 99(39): e22309, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991437

RESUMO

The safety and feasibility of transradial approach for cerebral angiography has been confirmed previously. However, this approach has been limited used due to the difficulty during the procedure. This study aimed to introduce a pigtail catheter tailing and long-wire swapping technique to improve the success rate without increasing complications.From August 2015 to December 2018, 560 patients who underwent cerebral angiography via transradial approach were recruited. The data including the type of aortic arch, type of Simmon catheter were collected.The loop was successfully constructed in 553 patients using Simmon-2 or Simmon-1 catheter. Of these patients, 72 patients successfully underwent cerebral and renal angiography, while 481 patients underwent cerebral angiography. The time for angiography was 52.87 ±â€Š11.23 minutes and 47.8 ±â€Š11.8 minutes, respectively. There were 369 (66.7%), 135 (24.4%), and 49 (8.9%) patients with type I, type II, and type III aortic arches, respectively, and their success rates of looping using Simmon-2 catheter were 97.8%, 97.0%, and 89.8%, respectively. The success rates of angiography in the right internal carotid artery, right vertebral artery, left internal carotid artery, and left vertebral artery were 100%, 100%, 98.9%, and 98.9%, respectively. No serious complications were observed in all patients.The pigtail catheter tailing and long guidewire swapping is considered as a safe procedure with high success rate for loop construction using a Simmon-2 catheter through the right radial artery, subsequently improving the success rate as well as the efficiency of angiography.


Assuntos
Cateteres Cardíacos/efeitos adversos , Angiografia Cerebral/instrumentação , Utilização de Procedimentos e Técnicas/normas , Artéria Radial/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Cateteres Cardíacos/tendências , Artéria Carótida Interna/diagnóstico por imagem , Cateterismo Periférico/métodos , Angiografia Cerebral/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Artéria Vertebral/diagnóstico por imagem
13.
Am J Cardiol ; 134: 1-7, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32933753

RESUMO

Mortality in patients with STEMI-associated cardiogenic shock (CS) is increasing. Whether a comprehensive ST-elevation myocardial infarction (STEMI) protocol (CSP) can improve their care delivery and mortality is unknown. We evaluated the impact of a CSP on incidence and outcomes in patients with STEMI-associated CS. We implemented a 4-step CSP including: (1) Emergency Department catheterization lab activation; (2) STEMI Safe Handoff Checklist; (3) immediate catheterization lab transfer; (4) and radial-first percutaneous coronary intervention (PCI). We studied 1,272 consecutive STEMI patients who underwent PCI and assessed for CS incidence per National Cardiovascular Data Registry definitions within 24-hours of PCI, care delivery, and mortality before (January 1, 2011, to July 14, 2014; n = 723) and after (July 15, 2014, to December 31, 2016; n = 549) CSP implementation. Following CSP implementation, CS incidence was reduced (13.0% vs 7.8%, p = 0.003). Of 137 CS patients, 43 (31.4%) were in the CSP group. CSP patients had greater IABP-Shock II risk scores (1.9 ± 1.8 vs 2.8 ± 2.2, p = 0.014) with otherwise similar hemodynamic and baseline characteristics, cardiac arrest incidence, and mechanical circulatory support use. Administration of guideline-directed medical therapy was similar (89.4% vs 97.7%, p = 0.172) with significant improvements in trans-radial PCI (9.6% vs 44.2%, p < 0.001) and door-to-balloon time (129.0 [89:160] vs 95.0 [81:116] minutes, p = 0.001) in the CSP group, translating to improvements in infarct size (CK-MB 220.9 ± 156.0 vs 151.5 ± 98.5 ng/ml, p = 0.005), ejection fraction (40.8 ± 14.5% vs 46.7 ± 14.6%, p = 0.037), and in-hospital mortality (30.9% vs 14.0%, p = 0.037). In conclusion, CSP implementation was associated with improvements in CS incidence, infarct size, ejection fraction, and in-hospital mortality in patients with STEMI-associated CS. This strategy offers a potential solution to bridging the historically elusive gap in their care.


Assuntos
Anticoagulantes/uso terapêutico , Protocolos Clínicos , Mortalidade Hospitalar , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/terapia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Aspirina/uso terapêutico , Lista de Checagem , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Artéria Radial , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Volume Sistólico , Resultado do Tratamento
14.
Am Heart J ; 228: 91-97, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871328

RESUMO

BACKGROUND: The optimal role of radial artery grafts in coronary artery bypass grafting (CABG) remains uncertain. The purpose of this study was to examine angiographic and clinical outcomes following CABG among patients who received a radial artery graft. METHODS: Patients in the angiographic cohort of the PREVENT-IV trial were stratified based upon having received a radial artery graft or not during CABG. Baseline characteristics and 1-year angiographic and 5-year clinical outcomes were compared between patients. RESULTS: Of 1,923 patients in the angiographic cohort of PREVENT-IV, 117 received a radial artery graft. These patients had longer surgical procedures (median 253 vs 228 minutes, P < .001) and had a greater number of grafts placed (P < .0001). Radial artery grafts had a graft-level failure rate of 23.0%, which was similar to vein grafts (25.2%) and higher than left internal mammary artery grafts (8.3%). The hazard of the composite clinical outcome of death, myocardial infarction, or repeat revascularization was similar for both cohorts (adjusted hazard ratio 0.896, 95% CI 0.609-1.319, P = .58). Radial graft failure rates were higher when used to bypass moderately stenotic lesions (<75% stenosis, 37% failure) compared with severely stenotic lesions (≥75% stenosis, 15% failure). CONCLUSIONS: Radial artery grafts had early failure rates comparable to saphenous vein and higher than left internal mammary artery grafts. Use of a radial graft was not associated with a different rate of death, myocardial infarction, or postoperative revascularization. Despite the significant potential for residual confounding associated with post hoc observational analyses of clinical trial data, these findings suggest that when clinical circumstances permit, the radial artery is an acceptable alternative to saphenous vein and should be used to bypass severely stenotic target vessels.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana , Oclusão de Enxerto Vascular , Artéria Radial/transplante , Reoperação , Angiografia Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Feminino , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Reoperação/métodos , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
16.
PLoS One ; 15(8): e0237798, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822396

RESUMO

BACKGROUND: Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. MATERIAL & METHODS: Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. RESULTS: The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120-360 minutes). CONCLUSION: Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.


Assuntos
Procedimentos Endovasculares/métodos , Mãos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/cirurgia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
17.
Radiología (Madr., Ed. impr.) ; 62(4): 313-319, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194249

RESUMO

OBJETIVO: El objetivo de este trabajo es presentar nuestros resultados, describiendo la técnica utilizada en el tratamiento endovascular de las hemorroides. MATERIAL Y MÉTODO: La embolización se realizó mediante punción de la arteria femoral derecha o vía arteria radial, y se cateterizó la arteria mesentérica inferior (AMI) accediéndose a la arteria rectal superior con un microcatéter (2,7 F) con el que cateterizábamos cada rama distal, ocluyéndolas distalmente con partículas de PVA (300-500 micras), y proximalmente con coils de 2-3mm. Los pacientes recibieron el alta a las 24 horas, al mes se les evaluó clínicamente y se les realizó una anoscopia. RESULTADOS: El estudio incluye 20 pacientes. (4 mujeres y 16 hombres), edad media de 61,85 años (27-81), con seguimiento medio de 10,6 meses (rango de 28-2 meses). El éxito técnico fue del 90% (18/20) y el éxito clínico de 83,4% (15/18); un paciente requirió nueva embolización de la arteria rectal media y dos pacientes requirieron cirugía. La recuperación fue prácticamente indolora. Al mes todos referían gran satisfacción y la anoscopia demostraba importante mejoría de las hemorroides. No hubo complicaciones secundarias a la embolización. CONCLUSIONES: Los resultados iniciales sugieren que la ESARS es un procedimiento seguro e indoloro, bien tolerado que evita el trauma anorrectal, y recuperación inmediata del paciente


OBJECTIVE: To present our results and describe the technique used for the endovascular treatment of hemorrhoids. MATERIAL AND METHODS: We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy. RESULTS: We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization. CONCLUSIONS: Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/métodos , Hemorroidas/diagnóstico por imagem , Hemorroidas/terapia , Procedimentos Endovasculares , Artéria Femoral/diagnóstico por imagem , Artéria Radial/diagnóstico por imagem , Estudos Retrospectivos , Anemia/etiologia
18.
Int. j. morphol ; 38(4): 853-856, Aug. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1124865

RESUMO

La arteria recurrente radial nace en el extremo proximal de la arteria radial y desde ahí asciende oblicuamente para anastomosarse con la arteria colateral radial, entregando en ese trayecto una serie de ramas para los músculos cercanos. Dicha arteria junto con sus ramas fueron descritas (por su importancia en abordajes quirúrgicos) por Arnold K. Henry como "the radial leash". Actualmente en clínica se utiliza el nombre "leash of Henry" para referirse a una o más ramas musculares de la arteria recurrente radial, sobretodo cuando cuando se encuentran en relación con el ramo profundo del nervio radial, pudiendo llegar a causar compresiones de dicho nervio en algunos casos. Se realizó una descripción de caso de una leash of Henry atípica, encontrada en una muestra cadavérica del laboratorio de anatomía de la Universidad Católica del Maule, de sexo masculino y nacionalidad chilena. La arteria encontrada corresponde a la rama de mayor calibre de la arteria recurrente radial, que se dirige directamente al músculo extensor de los dedos, dibujando un trayecto horizontal y cruzando por anterior al ramo profundo del nervio radial. Esta hallazgo difere a lo descrito por Henry y otros autores más recientes, y por lo tanto aporta información potencialmente útil a la hora de realizar procedimientos quirúrgicos que requieran un abordaje posterior o lateral de la cabeza del radio, como también descompresiones del nervio radial en esta zona.


The radial recurrent artery originates at the proximal end of the radial artery and from there ascends obliquely to anastomosing with the radial collateral artery. It gives off several branches for nearby muscles on its path. This artery along with its branches were described (due to its importance in surgical approaches) by Arnold K. Henry as "the radial leash". Currently, in clinical terms, the name "Leash of Henry" is used to refer to one or more muscular branches of the radial recurrent artery, especially when they are in relation to the deep branch of the radial nerve, and may cause compression of the nerve in some cases. A case description of an atypical Leash of Henry was found, found in a Chilean, male cadaveric sample of the anatomy laboratory, Universidad Católica del Maule. The artery corresponds to the branch of greater caliber of the recurrent radial artery, which goes directly to the extensor digitorum muscle. It draws a horizontal path and crosses the deep branch of the radial nerve anteriorly. This finding differs from what was described by Henry and other more recent authors. Therefore, this is potentially useful information when performing surgical procedures that require a posterior or lateral approach to the radius head, as well as radial nerve decompressions in this area.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Nervo Radial/anatomia & histologia , Artéria Radial/anatomia & histologia , Cotovelo/anatomia & histologia , Cadáver , Cotovelo/inervação , Cotovelo/irrigação sanguínea , Variação Anatômica
19.
Am J Cardiol ; 131: 74-81, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32718554

RESUMO

Up to a quarter of vascular complications during transcatheter aortic valve implantation (TAVI) result from secondary access via the femoral artery (FA). The radial artery (RA) is increasingly used as an alternative to the FA for secondary access in TAVI. Limited data exist on the outcomes of RA secondary access versus FA secondary access. We therefore conducted a systematic review and meta-analysis comparing secondary access sites. PubMed, EMBASE, Scopus, Cochrane library and CINAHL were searched systematically for studies comparing RA and FA as secondary access sites for TAVI. Primary outcomes of interest were vascular complications and major bleeding. Secondary outcomes included all-cause mortality, stroke and myocardial infarction (MI). Risk ratio (RR), standardized mean difference and corresponding 95% confidence intervals (CI) were calculated using a random effects model. Six observational studies comprising 6,373 patients (RA: 1,514, FA: 4,859) met inclusion criteria. Secondary access was utilized for aortography during valve deployment and to manage primary access site complications. Procedural characteristics were similar in both groups. RA was associated with a lower risk of major bleeding (RR: 0.51, 95% CI: 0.40 to 0.64, p <0.00001). No statistically significant difference was observed in the incidence of overall vascular complications, however, the risk of major vascular complications was lower with RA (RR: 0.45, 95% CI: 0.32 to 0.63, p <0.00001). The incidence of stroke and all-cause mortality was lower in RA, whereas no difference was observed in the risk of MI. In conclusion, our meta-analysis suggests that RA secondary access is associated with better outcomes for TAVI than FA.


Assuntos
Estenose da Valva Aórtica/cirurgia , Artéria Femoral , Artéria Radial , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/mortalidade , Humanos , Complicações Pós-Operatórias/mortalidade , Fatores de Risco
20.
Vasc Endovascular Surg ; 54(8): 665-669, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32720585

RESUMO

PURPOSE: To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. MATERIALS AND METHODS: A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. RESULTS: Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site-related complications. CONCLUSION: Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.


Assuntos
Cateterismo Periférico , Embolização Terapêutica , Procedimentos Endovasculares , Hemorragia/terapia , Artéria Radial , Lesões do Sistema Vascular/terapia , Adulto , Idoso , Cateterismo Periférico/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Hemodinâmica , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Punções , Artéria Radial/diagnóstico por imagem , Radiografia Intervencionista , Estudos Retrospectivos , Stents , Centros de Traumatologia , Resultado do Tratamento , Serviços Urbanos de Saúde , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/fisiopatologia , Adulto Jovem
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