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1.
Medicine (Baltimore) ; 99(2): e18747, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914094

RESUMO

BACKGROUND: A low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults. METHODS: We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time, and incidence of complications. RESULTS: Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001). CONCLUSIONS: Modified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts, and shorten the total cannulation time in adults.


Assuntos
Cateterismo Periférico/métodos , Palpação/métodos , Artéria Radial , Ultrassonografia de Intervenção/métodos , Idoso , Anestesiologistas , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
2.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479795

RESUMO

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Artérias Temporais/cirurgia , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Circulação Cerebrovascular , Transtornos Cognitivos/etiologia , Estudos de Viabilidade , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Adulto Jovem
3.
Artigo em Russo | MEDLINE | ID: mdl-31825378

RESUMO

Among many causes of compression neuropathies involving the radial nerve, compression of the posterior interosseous nerve (PIN) by the returning radial arteries is rare. OBJECTIVE: To describe the clinical instrumental characteristics of cases of mononeuropathy caused by compression of the return radial arteries. MATERIAL AND METHODS: Two observations with neuropathy of the deep branch of the radial nerve, manifested by weakness in the corresponding muscles, inconsistent pain syndrome with previous stereotypic (recurring) physical activity are presented. RESULTS: According to the results of ultrasound examination of posterior interosseous nerve, a local hypoechogenic increase in the cross-sectional area of nerve of different lengths was revealed. During surgical decompression of the nerve, in the first case, a tight arterial loop was found around the nerve, in the second case, expanded arterial trunks, one of which, of small diameter, covered the nerve in the 'loop', and the other, larger, pierced the nerve. After the operation, regression of motor deficiency and relief of pain were noted.


Assuntos
Mononeuropatias , Síndromes de Compressão Nervosa , Neuropatia Radial , Humanos , Artéria Radial , Nervo Radial
4.
Medicine (Baltimore) ; 98(50): e18249, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852092

RESUMO

RATIONALE: Cancer and chemotherapy individually confer hypercoagulability and increased risks of thrombosis. Most thromboembolic complication after breast cancer chemotherapy was venous thrombosis after multiagent chemotherapy. Arterial thrombosis is extremely rare in early breast cancer patients receiving adjuvant chemotherapy. PRESENTING CONCERNS: A 55-year-old woman with right breast cancer presented to the emergency department with sudden pain, numbness, and swelling in her left hand. She underwent breast conserving surgery and sentinel lymph node biopsy 2 months before the visit. She received the second cycle of adjuvant Adriamycin-cyclophosphamide chemotherapy 5 days before. INTERVENTIONS: Computed tomography angiography revealed acute arterial thrombosis in the left brachial, radial, and ulnar arteries. Unfractionated heparin was initiated immediately, followed by brachial and radial-ulnar thrombectomy, restoring perfusion to the extremity. The postoperative course was uncomplicated; she was discharged on warfarin at a daily dose of 4 mg. OUTCOMES: Chemotherapy was discontinued. Anticoagulation with warfarin was continued. She subsequently received adjuvant endocrine therapy with an aromatase inhibitor and adjuvant radiotherapy. MAIN LESSONS: Despite the low risks of arterial thrombosis in breast cancer, it is a devastating complication with significant morbidity and mortality. Thromboprophylaxis should be considered in those at risk. Immediate anticoagulant therapy and surgical intervention should be considered in affected cases.


Assuntos
Artéria Braquial , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Doxorrubicina/efeitos adversos , Artéria Radial , Trombose/induzido quimicamente , Artéria Ulnar , Doença Aguda , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante/efeitos adversos , Angiografia por Tomografia Computadorizada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Trombectomia/métodos , Trombose/diagnóstico , Trombose/cirurgia , Ultrassonografia Doppler
5.
J. Transcatheter Interv ; 27: 1-5, dez., 2019. tab.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1047709

RESUMO

BACKGROUND: The radial approach has been increasingly used worldwide for diagnostic and therapeutic cardiac catheterization. The radial artery caliber is one of the limitations of its use. The objective of this study was to describe the anatomy of the radial and ulnar arteries, as well as to develop a radial artery diameter prediction score using clinical and anthropometric criteria. METHODS: Using vascular ultrasound with bilateral radial and ulnar artery measurements, 1,180 patients who underwent cardiac catheterization or angioplasty procedures were prospectively evaluated. Using the patients' variables, a radial artery diameter prediction score was developed in a cross-sectional fashion, using half of the sample. The score was validated with the half not used for deriving the model. RESULTS: A total of 1,180 patients were evaluated. The mean internal diameter of the right and left radial arteries was 2.69±0.69mm and 2.53±0.64mm (p<0.01), and the mean internal diameter of the right and left ulnar arteries was 2.09±0.59mm and 2.10±0.60mm (p=0.76), respectively. The factors that positively correlated with arterial size were male sex, previous catheterization, height, weight, and body surface area. The risk score developed using clinical and anthropometric variables had unsatisfactory discriminatory capacity (c-statistics 0.64). CONCLUSION: The right radial artery is the largest forearm artery in most cases. Men and patients who had previously undergone catheterization have a larger mean radial artery diameter. The artery diameter prediction score has modest accuracy for clinical use. (AU)


Assuntos
Cateterismo Cardíaco , Artéria Radial/diagnóstico por imagem , Ultrassonografia Doppler , Anatomia
6.
Angiol Sosud Khir ; 25(4): 131-138, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855210

RESUMO

Presented in the article are the results of surgical management of a patient with an extremely rare pathology - a saccular arterial aneurysm of the cavernous-ophthalmic segment of the left internal carotid artery. We performed multistage open surgical intervention in the following scope: osteoplastic pterional craniotomy on the left, creation of a wide-lumen anastomosis between the left external carotid artery and M2 segment of the left middle cerebral artery with the use of the radial artery, ligation of the cervical portion of the left internal carotid artery and clipping of its supraclinoid portion. The chosen surgical policy made it possible to create sufficient volumetric blood flow through the shunt, comparable to the blood flow through the internal carotid artery, which helped avoid ischaemic stroke after exclusion of the aneurysm from circulation. A conclusion was drawn on efficacy of this method of treatment.


Assuntos
Artéria Carótida Externa/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Anastomose Cirúrgica , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Humanos , Aneurisma Intracraniano/complicações , Ligadura , Artéria Radial/transplante , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos
7.
Surg Technol Int ; 35: 253-264, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31687784

RESUMO

BACKGROUND: In 1989, we reported the use of the radial artery as a second target conduit for coronary artery bypass grafting. However, underpowered randomized trials have reported differences in clinical outcomes between the radial artery and other grafts. As we approach 50 years of experience with radial artery grafting, we reviewed the literature to determine the second-best target vessel for coronary operations. METHODS: An electronic review of the literature with an emphasis on randomized controlled trials, propensity-matched observational series, and meta-analyses identified a large population of patients who received arterial conduit and saphenous vein grafts. RESULTS: The radial artery has been proven to be reliable as a second target conduit for coronary artery bypass grafting, with outcomes and patency rates superior to those for saphenous vein graft. It has also been proven to be both safe and effective as a third conduit in the territory of the right coronary artery. A paucity of evidence with few comparable series limits the use of the gastroepiploic artery. CONCLUSION: In its fifth decade of use, we can definitively conclude that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.


Assuntos
Ponte de Artéria Coronária , Artéria Radial , Humanos , Artéria Radial/transplante , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
8.
Int Heart J ; 60(6): 1276-1283, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735768

RESUMO

Consensus has yet to emerge among experts as to whether the radial artery (RA) conduit was superior to the saphenous vein (SV) graft for coronary artery bypass grafting (CABG) in terms of long-term patency. This study aimed to evaluate long-term patency of the RA conduit compared to the SV conduit for off-pump CABG, and to screen the independent predictors of long-term RA graft failure.Patients < 80 years of age with graftable triple-vessel disease undergoing non-emergent, primary, isolated off-pump CABG, using both the RA and the SV conduits, were reviewed. Graft patency, all-cause mortality and repeat revascularization were followed-up. The independent predictors of long-term RA graft failure were identified.A total of 296 out of 320 eligible patients (42 females, 61.3 ± 9.9 years old) received follow-up with an observed period of 93.4 ± 16.5 months. All-cause mortality was 14.5%, and repeat revascularization was conducted on 6 RA grafts and 9 SV grafts. Superior patency of the RA grafts compared to the SV grafts was observed (84.4% versus 78.5%, P = 0.035). Independent predictors of long-term RA graft failure included proximal stenosis of target right coronaries < 90% (OR = 2.35, 95%CI 1.41-5.82) and diabetes mellitus (OR = 1.66, 95%CI 1.17-4.26).The RA graft had a superior long-term patency than the SV graft. Long-term patency of the RA graft may be poor in diabetics or in the case of proximal stenosis of target right coronary <90%. (Trial registration: ChiCTR-OCH-1200212).


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/etiologia , Artéria Radial , Veia Safena , Grau de Desobstrução Vascular , Idoso , Estudos de Coortes , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Zhonghua Yi Xue Za Zhi ; 99(42): 3308-3312, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31715666

RESUMO

Objective: To explore the short-term outcomes of patients with coronary artery disease (CAD) who underwent coronary artery bypass graft (CABG) with sequential radial artery graft. Methods: Clinical data of patients with CAD who underwent CABG with sequential radial artery graft from August to December 2018 in Beijing Anzhen Hospital was retrospectively analyzed. Computer tomography angiography was employed to evaluate the patency of grafts and the incidence of adverse cardiovascular events was followed up 3 months after surgery. Results: A total of thirty patients were included, with an average age of (60.2±7.3) years old, among whom 83.3% were male, and 93.3% had three-vessel disease detected by coronary angiography. All patients had left internal mammary artery (LIMA) anastomosed to the left anterior descending (LAD) and sequential radial artery graft. Among sequential radial artery grafts, the most frequent anastomosis of sequential radial artery graft was aortic artery (AO)-first diagonal branch (D1)-first obtuse marginal branch (OM1) (13 patients, 43.3%), followed by AO-OM1-second obtuse marginal branch (OM2) (9 patients, 30.0%), and 18 patients also underwent saphenous vein graft. None of 30 patients experienced adverse cardiovascular events during postoperative period in hospital. Three-months follow-up outcomes showed that LIMA-LAD in 1 patient (3.3%) occluded, 3 patients had occluded anastomosis of sequential radial artery graft, 1 patient (3.3%) had heart failure, and 1 patient (3.3%) had recurrent angina. Conclusion: The radial artery could be used as the second arterial graft for CAD patients undergoing CABG with a sequential anastomosis technique, and these patients need regular anti-arterial spasm drug treatment after CABG.


Assuntos
Doença da Artéria Coronariana , Artéria Torácica Interna , Idoso , Angiografia Coronária , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial , Estudos Retrospectivos , Grau de Desobstrução Vascular
12.
Zhonghua Yi Xue Za Zhi ; 99(42): 3313-3317, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31715667

RESUMO

Objective: To evaluate the mid-term outcomes of coronary artery bypass grafting (CABG) with left radial artery (RA) graft bypassed to right main coronary artery (RCA) of severe stenosis. Methods: Between September 2014 and April 2019, a total of consecutive 47 patients who had severe stenosis (≥90%) of RCA underwent total arterial revascularization, with left RA bypassed to RCA. There were 31 males and 16 females, with a mean age of (56.5±9.7) years old. The perioperative outcomes were observed and mid-term results were followed up. Results: A total of 46 left internal mammary artery (LIMA) grafts, 47 left radial artery (LRA), and 40 right RA grafts (RRA) were harvested with pedicles. LIMA was bypassed to LAD in 43 patients, RRA was to diagonal branches, ramus or oblique marginal in 37 cases, and LRA was to RCA. All grafts (except 3 composite Y or T grafts) were single. Mean graft number was 2-4 (2.7±0.9). There was one death due to cardiac tamponade. Three patients had postoperative atrial fibrillation, 1 had a forearm hematoma, 1 had acute renal insufficiency, and 2 had acute myocardial infarction. The mean tracheal intubation duration was 3.5-20.3 (8.3±4.7) hours, and the mean hospital stay was 6-13 (7.1±2.9) days. The average follow-up was 3-47 (23.3±7.5) months, with a follow-up rate of 86.96% (40/46). There were no major cardiovascular events during the follow-up. Three month after surgery, the mean left ventricular ejection fraction was significantly improved than that of pre-operation (60.0%±4.0% vs 42.4%±7.5%, P=0.003). Computed tomography angiography (CTA) examination showed that 58.7% (27/46) of patients had patent LRA after a mean follow-up duration of (19.5±7.3) months. Conclusion: CABG with LRA bypassed to RCA of severe stenosis proves to be safe and effective, with good mid-term outcomes.


Assuntos
Ponte de Artéria Coronária , Artéria Torácica Interna , Artéria Radial , Idoso , Constrição Patológica , Vasos Coronários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Zhonghua Yi Xue Za Zhi ; 99(42): 3318-3322, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31715668

RESUMO

Objective: To summarize the application of radial artery (RA) as the second arterial graft in coronary artery bypass grafting (CABG). Methods: From January 1, 2015 to June 11, 2019, the clinical data of all patients undergoing CABG in TEDA International Cardiovascular Hospital was retrospectively reviewed. The patients who underwent RA grafting were included. The application of RA, internal mammary artery (IMA) and the saphenous vein, their target vessels, and the operative results were analyzed. Results: A total of 2 901 patients underwent CABG. Of those, 208 patients (7.2%) had RA grafting, with 197 males and 11 females. The average age was (53±8) years old and the average grafts per patient was 3.79. The target vessel for RA was first obtuse marginal (OM, 102 cases), first diagonal (50 cases), right coronary artery (RCA) or posterior descending artery (PDA) (40 cases), intermediate (22 cases), respectively. Among those, 172 were single distal anastomosis with the proximal end anastomosed to the ascending aorta (168 cases), saphenous vein (SV) graft (3 cases) and IMA (1 case). Seventy-two patients accept sequential grafting with the proximal to the ascending aorta (58 cases), SV graft (13 cases) and IMA (1 case). The left IMA was mainly anastomosed to left descending artery (LAD) (188 cases) and diagonal (10 cases). The target vessels for SV were remaining coronary arteries when the IMA and RA were used. The operative time was (5.0±1.5) h. The hospital stay was (17.4±6.4) d. There were 6 cases undergoing exploratory thoracotomy for bleeding (5 cases) or hemodynamic instability due to ventricular arrhythmia (1 case). There was no death. All patients were successfully discharged. Conclusions: Use of the RA and IMA with additional SV for CABG exhibits good results in the Chinese patients. Currently available clinical protocols are effective and safe.


Assuntos
Artéria Torácica Interna , Artéria Radial , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/cirurgia , Estudos Retrospectivos , Veia Safena , Resultado do Tratamento
14.
J Cardiothorac Surg ; 14(1): 174, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615560

RESUMO

BACKGROUND: Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures. METHODS: This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft. DISCUSSION: This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level). TRIAL REGISTRATION: ClinicalTrials.gov NCT02922088 . Registered October 3, 2016. ETHICS AND DISSEMINATION: The regional ethics committees have approved the registry. Results will be submitted for publication.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Artéria Torácica Interna/transplante , Soluções para Preservação de Órgãos/uso terapêutico , Artéria Radial/transplante , Veia Safena/transplante , Grau de Desobstrução Vascular , Idoso , Endoscopia , Endotélio Vascular , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/epidemiologia , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros , Reoperação/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
15.
Eklem Hastalik Cerrahisi ; 30(3): 289-95, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650927

RESUMO

OBJECTIVES: This study aims to assess the effects of the hematopoietic stem cells and endothelial progenitor cells in peripheral blood and monocyte cluster of differentiation (CD) 34, CD133 and CD309 expression levels on maturation at the repair site in patients who underwent forearm arterial repair. PATIENTS AND METHODS: This prospective study included 30 patients (23 males, 7 females; mean age 28.9±1.8 years; range, 18 to 49 years) with a well-defined cut at the wrist due to a stabbing injury but no comorbid condition who presented to the emergency department of our hospital between November 2014 and November 2017. Vascular patency was assessed by Doppler sonography in patients who underwent forearm arterial repair via micro-vascular techniques. The relationships between patency and hematopoietic stem and endothelial progenitor cell markers such as CD34, CD133 and CD309 were assessed by flow cytometry. RESULTS: The patients were divided into two groups according to presence of sufficient flow in the arteries repaired. The mean CD34 expression level was 72.09±3.00 in the group with maturation whereas it was 54.64±7.34 in the group without maturation, indicating a statistically significant difference (p<0.05). In addition, the likelihood of sufficient flow was increased by 1.075 per one unit increase in CD34 level. Resistive index values were significantly lower in the group with maturation and CD34 level was predictive for maturation of arterial repair. CONCLUSION: In the present study, the findings demonstrated that high CD34 expression level has favorable effects on maturation after arterial repair.


Assuntos
Células Progenitoras Endoteliais/fisiologia , Antebraço/irrigação sanguínea , Células-Tronco Hematopoéticas/fisiologia , Artéria Radial/lesões , Adolescente , Adulto , Biomarcadores , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Radial/fisiopatologia , Artéria Radial/cirurgia , Ferimentos Perfurantes/fisiopatologia , Traumatismos do Punho/fisiopatologia , Adulto Jovem
16.
Zhonghua Yi Xue Za Zhi ; 99(37): 2912-2915, 2019 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-31607020

RESUMO

Objective: To study the effect and safety of vertebral artery stent implantation via femoral artery and radial artery. Methods: Twenty-four patients with vertebral artery stent implantation from December, 2017 to August, 2018 in Beijing Anzhen Hospital were randomized into 2 groups, one was research group with 12 patients, the other was control group with 12 patients. The research group underwent vertebral artery stent implantation via radial artery, the control group underwent vertebral artery stent implantation via femoral artery. The follow-up results of the two groups were analyzed. Results: The success rate of the first puncture in the research group was 100%, significantly higher than 83.33% of the control group, there was no statistical difference (χ(2)=2.528, P>0.05).The implantation time of sheath tube in the research group was (3.2±0.3) min, significantly longer than that in the control group (2.4±0.2) min, the difference was statistically significant (t=7.713, P<0.001). The time from sheath insertion to balloon dilation and bed rest time after operation in the research group were 17.3 (16.2-17.9) min, significantly less than the control group (27.1(26.1-28.3) min), the difference was statistically significant (Z=-4.157, P<0.001). The time of bed rest in the research group was 2.1 (2.0-2.2)h, significantly less than the control group (27.1(25.3- 28.9)h), the difference was statistically significant(Z=-4.167,P<0.001). No cerebrovascular events occurred during the follow-up period. One patient in the control group developed complications of vagal reflex, no patient in the research group developed complications. Conclusions: Vertebral artery stent implantation via radial artery can significantly improve the success rate and safety of the operation. Radial artery approach is a better choice for vertebral artery stent implantation.


Assuntos
Artéria Femoral , Artéria Radial , Stents , Humanos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Artéria Vertebral
17.
J Radiol Case Rep ; 13(2): 34-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31565170

RESUMO

Trans-radial access offers several unique advantages and is being used more frequently for interventional radiology procedures. We report the use of trans-radial arterial access to embolize a large bleeding angiomyolipoma in a 30-year-old pregnant patient presenting in the first trimester. Trans-radial approach was chosen to minimize the effects of radiation on the fetus. Subsequent postprocedural pregnancy course was uneventful with stability of the angiomyolipoma and no further hemorrhage. This case highlights the benefits of trans-radial embolotherapy in gravid patients to reduce the risk of radiation exposure to the fetus.


Assuntos
Angiomiolipoma/complicações , Embolização Terapêutica/métodos , Hemorragia/etiologia , Hemorragia/terapia , Neoplasias Renais/complicações , Complicações Neoplásicas na Gravidez/terapia , Adulto , Angiografia Digital , Angiomiolipoma/diagnóstico por imagem , Feminino , Fluoroscopia , Hemorragia/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Artéria Radial , Tomografia Computadorizada por Raios X , Ultrassonografia
18.
J Stroke Cerebrovasc Dis ; 28(11): 104374, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530480

RESUMO

Traumatic cerebral aneurysms are histologically dissecting aneurysms or pseudoaneurysms, thus requiring parent artery occlusion for cure. Combination of endovascular parent artery occlusion and extracranial-intracranial bypass is considered optimal to obtain complete obliteration of the aneurysm and to avoid hemodynamic hypoperfusion. However, endovascular parent artery occlusion of the supraclinoid internal carotid artery (ICA) is at risk of ischemic complications due to distal coil protrusion to adjacent perforating arteries or distal embolism of the thrombi generated in the coil mass. A 20-year-old man presented with progressive left optic neuropathy following motor vehicle accident. Radiological examination revealed left supraclinoid ICA aneurysmal formation with dissecting change. We treated this traumatic supraclinoid ICA aneurysm by combination of endovascular parent artery occlusion and high-flow bypass in the hybrid operating room. An aneurysmal clip was applied on the ICA just distal to the aneurysm prior to coil embolization, and worked as a scaffold for subsequent filling coils and as a blockade for the distal emboli. This "clip anchor-assisted coil embolization" technique resulted in optimal parent artery occlusion for the traumatic aneurysm of the supraclinoid ICA with minimal risks of residual blood flow, intraoperative rupture, and thromboembolic complications.


Assuntos
Acidentes de Trânsito , Aneurisma Dissecante/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Artéria Radial/transplante , Enxerto Vascular , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Velocidade do Fluxo Sanguíneo , Circulação Cerebrovascular , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Resultado do Tratamento , Adulto Jovem
19.
Clin Nephrol ; 92(5): 233-236, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31496512

RESUMO

OBJECTIVE: To compare the functions and complications of forearm basilic vein transposition-arteriovenous fistula (BVT-AVF) created using the no-touch technique with that of conventional radiocephalic arteriovenous fistula (RC-AVF). MATERIALS AND METHODS: The no-touch technique was used to created basilic vein transposition-radial artery fistula in 22 patients. Another 30 patients received surgeries for RC-AVF. The fistula functions and complications were compared between these two groups. RESULTS: The two groups did not differ significantly in the incidence of postoperative bleeding, limb swelling, infection, steal syndrome, fistula thrombosis, fistula aneurysm, fistula flow, fistula maturation time, Kt/v, and fistula median survival. CONCLUSION: Forearm BVT-AVF created by the no-touch technique is a good alternative access for patients in whom the standard arteriovenous fistula cannot be established.


Assuntos
Derivação Arteriovenosa Cirúrgica , Antebraço/irrigação sanguínea , Artéria Radial/cirurgia , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Humanos , Hemorragia Pós-Operatória/epidemiologia
20.
J Clin Neurosci ; 69: 261-264, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31481292

RESUMO

The distal transradial access in the anatomical snuffbox for neurovascular procedures is a modification of the radial access with an improved safety profile and patient comfort compared to the conventional transradial access. However, its use has been limited to diagnostic cerebral angiography, but not aneurysm treatment. We present the first case of a 53-year-old female whose work-up for headaches showed an anterior communicating artery aneurysm. The patient underwent distal transradial cerebral angiography and subsequent placement of a Woven EndoBridge (WEB) device for treatment of the aneurysm through the same access site. The procedure was uneventful and the patient was discharged home neurologically intact. Her hand remained warm, well-perfused, and with no visible or palpable hematoma. Our report illustrates the feasibility of the distal TRA for the treatment of cerebral aneurysms using the WEB device. Further studies are necessary to confirm the additional benefits of the distal TRA over TRA for neurovascular access.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Artéria Radial/cirurgia , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
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