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1.
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
2.
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
3.
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
4.
J Cardiothorac Surg ; 15(1): 217, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795345

RESUMO

BACKGROUND: With the ageing of China's population, the incidence and mortality of coronary atherosclerotic heart disease (CAD) is increasing year by year, which brings a heavy burden to the family and society [1]. We aimed to analyse the strategy of coronary artery bypass grafting (CABG) in the right coronary artery and to compare the haemodynamic characteristics of the sequential grafts with those of single grafts and to observe the patency rate of those grafts for 1 week after the operation. METHODS: A total of 242 patients (178 men, mean age 62.6 ± 8.8 years) underwent right coronary artery bypass grafting in our hospital from October 2016 to January 2019. The blood flow (Q, ml/min), pulsatility index (PI) and related parameters of the grafts were measured and recorded by TTFM during the CABG. The patency of the grafts was evaluated by coronary computed tomography (CT) for 1 week after the operation. RESULTS: The most common material used for the graft in the right coronary system of CABG is the greater saphenous vein (92.3%), followed by the radial artery (5.5%) and the internal mammary artery (1.9%). The highest frequency target of the right coronary artery is the posterior descending artery (PDA) (47.6%), followed by the right main coronary artery (RCA) (29.1%) and the posterior branch of the left ventricle (PL) (23.3%). The proportion of single grafts was the highest for the right coronary artery in CABG (178 cases, 67.9%), followed by a graft of the PDA-PL (42 cases, 16.0%) and other sequential grafts among the different coronary artery systems (including the system of the left anterior descending artery (LAD) and the left circumflex (LCX)). Whether there were sequential grafts of the PDA-PL or other sequential grafts among the different systems of the coronary artery, the instantaneous flow of a group of sequential grafts was higher than that of a single graft, and the difference had statistical significance (P < 0.01). However, there were no significant differences in the flow between the groups of sequential grafts (P = 0.410). Diastolic flow (DF) in the group of sequential grafts of the right coronary system was better than that in the non-sequential group (P < 0.001), and the difference had statistical significance. There was no significant difference between the DF of the groups of the other system of sequential grafts and that of the right coronary sequential grafts. Coronary artery CT suggested that there were 11 cases of poorly developing grafts or stenosis and occlusion a week after the operation, and those phenomenon mainly occurred in the group with a single graft. There was only one case that was occluded in the group of other systems of sequential grafts, and statistically significant differences existed between the two groups (P < 0.01). CONCLUSIONS: In our centre, the most common form of CABG in the right coronary artery system is a non-sequential vein bridge to the PDA. Whether there are sequential grafts of the PDA-PL or other sequential grafts among the different coronary artery systems, the instantaneous flow of a group of sequential grafts is higher than that of a single graft. DF in the group of sequential grafts of the right coronary system was better than that in the non-sequential group.


Assuntos
Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Idoso , Velocidade do Fluxo Sanguíneo , Circulação Coronária , Doença das Coronárias/cirurgia , Vasos Coronários/diagnóstico por imagem , Feminino , Coração , Hemodinâmica , Humanos , Masculino , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Período Perioperatório , Fluxo Pulsátil , Artéria Radial/cirurgia , Estudos Retrospectivos , Veia Safena/transplante , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
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
7.
PLoS One ; 15(7): e0236499, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706808

RESUMO

We analyzed the clinical outcomes of open radial artery harvesting (OAH) and endoscopic radial artery harvesting (EAH) undergoing coronary artery bypass grafting (CABG). We designed this meta-analysis conducted using Pubmed, Medline, the Cochrane Library, and EMBASE. Articles with comparisons of OAH and EAH undergoing CABG were included. Primary outcomes included the wound infection rate, the wound complication rate, neurological complications of the forearm, in-hospital mortality, long-term survival, and the patency rate. The results of our study included six randomized controlled trials (RCTs), two non-randomized controlled trials (NRCTs) with matching, and 10 NRCTs. In total, 2919 patients were included in 18 studies, while 1187 (40.7%) and 1732 (59.3%) patients received EAH and OAH, respectively. EAH was associated with a lower incidence of wound infection (RR = 0.29, 95% confidence interval (CI) = 0.14 to 0.60, p = 0.03), and neurological complications over the harvesting site (RR = 0.41, 95% CI = 0.27 to 0.62, p < 0.0001). There was no significant difference in 30-day mortality, long-term survival (over one year), and the graft patency rate. According to our analysis, endoscopic radial artery harvesting can improve the outcome of the harvesting site, without affecting the mortality, long-term survival, and graft patency.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Endoscopia , Artéria Radial/cirurgia , Infecção da Ferida Cirúrgica , Idoso , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Endoscopia/métodos , Endoscopia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Artéria Radial/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Artigo em Russo | MEDLINE | ID: mdl-32649818

RESUMO

A 30-year-old woman with giant fusiform aneurysm of the azygos anterior cerebral artery is reported. Clipping of the aneurysm followed by modeling of pericallosal artery was performed in 2017. However, further enlargement of the aneurysm has been observed for subsequent 2 years. The patient underwent redo surgery with excision of the aneurysm followed by «hemi-bonnet bypass¼ procedure (anastomosis between superficial temporal artery and anterior cerebral artery with radial artery as an interposition graft). Literature data on reconstructive surgery in the treatment of complex pericallosal artery aneurysms are reviewed.


Assuntos
Revascularização Cerebral , Aneurisma Intracraniano/cirurgia , Adulto , Anastomose Cirúrgica , Artéria Cerebral Anterior/cirurgia , Feminino , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia
9.
PLoS One ; 15(6): e0234567, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525955

RESUMO

BACKGROUND: We evaluated whether a simulation-based training with a vessel phantom improves the basic skills of a novice required for ultrasound-guided radial artery cannulation in real patients. In addition, we analysed whether repeated simulation training sets with an inter-training interval would accelerate the learning curve. METHODS: From March 2019 to July 2019, twenty-one anesthesiology residents were randomized into either a simulation group (n = 11) or control group (n = 10). Residents performed a total of 84 ultrasound-guided radial artery cannulations in real patients. The simulation group participated in two sets of simulation training on a vessel phantom (10 sessions per set) with a one-month inter-training interval. Trainee's performance proficiency was scored using a developed checklist, and a learning curve for each training set was constructed. To evaluate the effectiveness of our training curriculum in skill transfer, each resident performed four ultrasound-guided radial artery cannulations in real patients. The primary outcome was first attempt success rate and the secondary outcome was dynamic needle-tip positioning ability in real patients. RESULTS: The first attempt success rate and dynamic needle-tip positioning ability by ultrasound transducer were significantly higher in the simulation group than the control group (81.8% vs. 50%, P = 0.002 and 68.2% vs. 7.5%, P < 0.001, respectively). A reduced number of sessions was required to reach a plateau score on the learning curve in the repeated training set compared in the first-set (7 (5-8) vs. 3 (2-4), P = 0.003, respectively). CONCLUSIONS: Simulation-based training using a vessel phantom effectively improved the first attempt success rate for ultrasound-guided radial artery cannulation in real patients and the dynamic needle-tip positioning ability by ultrasound transducer in novice anesthesiology residents. In addition, repeated training curriculum accelerated the learning curve for recall skill proficiency and reduced inter-individual variability for skill acquisition. CLINICAL TRIAL REGISTRATION: Clinical Research Information Service (KCT0003471, Principle investigator: Jeong Jin Min, Date of registration: 06/March/2019).


Assuntos
Cateterismo Periférico/métodos , Artéria Radial/cirurgia , Treinamento por Simulação/métodos , Cirurgia Assistida por Computador/educação , Adulto , Cateterismo Periférico/instrumentação , Cateteres , Feminino , Humanos , Masculino , Estudantes de Medicina/estatística & dados numéricos , Cirurgia Assistida por Computador/métodos , Ultrassonografia/métodos
11.
J Cardiovasc Pharmacol Ther ; 25(6): 556-563, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32578435

RESUMO

OBJECTIVE: Although prevention of radial artery thrombosis and cardiac complications after interventions using radial access is well investigated, there is yet no clinical study that completely evaluated access-related complications. However, there is still no consensus on what exact treatment should be used in these patients. In clinical practice, analgesic, anticoagulant, and antiplatelet treatments usually improve symptoms in patients with pain; however, in some patients, complaints may persist and may not respond to these treatments. In these patients, low-risk embolectomy with a small skin incision may be beneficial. METHODS: A total of 102 patients with radial artery thrombosis after cardiac catheterization were included in the study between 2016 March and 2018 December. After the patients' initial evaluation, anticoagulation with enoxaparin or tinzaparin and antiplatelet therapy with acetylsalicylic acid and oral/local analgesic/anti-inflammatory and local anesthetic therapy were administered for 1 month. Patients whose symptoms resolved after medical treatment were followed up as outpatients. Embolectomy was performed in consenting patients who did not respond to the medical treatment. RESULTS: Of 102 patients included in the study, 33 underwent embolectomy, whereas 69 received only medical treatment. None of the patients experienced any complications, morbidity, or mortality in the peroperative period and during the medical treatment. The pretreatment symptom scores of patients who actively use their hands in daily life and profession were significantly higher than the scores of patients who are relatively less active (P = .013). Pretreatment symptom scores were negatively correlated with age (r = -0.584); symptom scores increased significantly with the decrease of patient age. No benefit from medical treatment and need for surgery was significantly greater in patients who are younger and use their hands actively in daily life and profession (P = .028). The decrease in symptom scores after treatment was significantly greater in the surgical group than in the medical group (P = .003). CONCLUSION: Radial access should be exercised with care in patients who may develop significant thrombosis-related complaints and it is necessary to decide whether radial access is essential. If patients have ongoing symptoms despite medical treatment, embolectomy can be considered as a treatment option.


Assuntos
Anestesia Local , Anticoagulantes/uso terapêutico , Arteriopatias Oclusivas/terapia , Cateterismo Cardíaco , Cateterismo Periférico/efeitos adversos , Embolectomia , Artéria Radial/cirurgia , Trombose/terapia , Idoso , Anestesia Local/efeitos adversos , Anticoagulantes/efeitos adversos , Arteriopatias Oclusivas/etiologia , Embolectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Trombose/etiologia , Falha de Tratamento , Turquia
13.
Angiol Sosud Khir ; 26(2): 76-83, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597887

RESUMO

The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.


Assuntos
Angiografia , Artéria Radial/cirurgia , Humanos , Radiografia , Federação Russa , Extremidade Superior
14.
Ann Vasc Surg ; 69: 43-51, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32479883

RESUMO

BACKGROUND: Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques. METHODS: The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and "trapped" directly under the dermis by closing the superficial fascia and adipose tissue beneath it. RESULTS: Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8-10 weeks after superficialization. CONCLUSIONS: This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Dissecação , Artéria Radial/cirurgia , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Artéria Braquial/diagnóstico por imagem , Cateterismo , Dissecação/efeitos adversos , Feminino , Humanos , Masculino , Artéria Radial/diagnóstico por imagem , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem
15.
J Vasc Access ; 21(6): 963-968, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32372684

RESUMO

BACKGROUND: Many studies suggested that the optimal cephalic vein diameter for wrist radio-cephalic arteriovenous fistula construction should be at least 2 mm to predict successful maturation and primary patency. However, our experience has shown that many patients with smaller cephalic vein diameter (≤2 mm) in the neutral state (without a tourniquet) also have good clinical outcomes. The aim of this study was to identify predictors that affect primary survival of new wrist radio-cephalic arteriovenous fistula in patients with cephalic vein diameter ≤2 mm. METHODS: We performed a retrospective review of 50 patients with preoperative cephalic vein diameters ≤2 mm in the neutral state who underwent wrist radio-cephalic arteriovenous fistula construction between September 2016 and October 2019. Internal diameters of the cephalic vein and radial artery, venous distensibility, peak systolic velocity, and resistance index of the radial artery were determined by ultrasound examination before wrist radio-cephalic arteriovenous fistula placement. Patients were divided into two groups: failure and survival. RESULTS: The radio-cephalic arteriovenous fistula survival rate was 68% from the time of radio-cephalic arteriovenous fistula creation until the end of the study. Univariate analysis showed that larger venous distensibility (p < 0.001), non-diabetic kidney disease (p = 0.009), and slower peak systolic velocity of the radial artery (p = 0.033) were predictive factors for primary radio-cephalic arteriovenous fistula survival. Multivariate regression analysis revealed good venous distensibility (odds ratio = 9.637, 95% confidence interval = 1.893-49.050, p = 0.006) and non-diabetic kidney disease (odds ratio = 0.148, 95% confidence interval = 0.033-0.660, p = 0.012) to be independent predictors for primary radio-cephalic arteriovenous fistula survival. Receiver operating characteristic analysis showed that venous distensibility >0.52 mm (sensitivity: 70.6%, specificity: 68.8%) was the best cut-off value to predict primary radio-cephalic arteriovenous fistula survival. CONCLUSION: When cephalic veins with diameter ≤2 mm are found, venous distensibility should be used to aid in the surgery decision-making process. The outcome of wrist radio-cephalic arteriovenous fistula survival would be significantly improved through the use of cephalic vein with venous distensibility >0.52 mm.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Radial/cirurgia , Grau de Desobstrução Vascular , Veias/cirurgia , Punho/irrigação sanguínea , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Resistência Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia , Pressão Venosa
16.
J Vasc Access ; 21(6): 990-996, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32375582

RESUMO

BACKGROUND: The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency. METHODS: Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5-10 min after the creation of a standardized anastomosis using 3-6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (< 200 mL/min) were enrolled. Patients were assessed clinically and with ultrasound every 3 months. Data were analyzed retrospectively. RESULTS: In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p < 0.005) (11). CONCLUSION: The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
17.
Handchir Mikrochir Plast Chir ; 52(4): 280-288, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32464680

RESUMO

BACKGROUND: Anomalies of the radial arterial system can be of importance during harvesting of a radial forearm flap. In particular when using the forearm flap for phalloplasty due to the required dimensions of the flap, sufficient arterial supply is of fundamental importance. In case of a persistent median artery perfusion conditions in the supply area of ​​the A. radialis and the A. ulnaris may have been altered or even completely regressed. METHODS: A retrospective evaluation of all phalloplasties performed in our institution was carried out from January 2016 to December 2018. In all patients technique according to Gottlieb and Levine or Chang was applied. RESULTS: In the retrospectively evaluated population of 48 patients, a persistent arteria mediana was found intraoperatively in two patients, corresponding to an incidence of 4.2 %. In both patients, the phalloplasty was accomplished without restriction of flap perfusion or hand perfusion. A review of the literature provides an overview of the incidence of aberrant vascularization of the forearm and the consequences that can be derived for the planning of a radial artery flap. CONCLUSION: Variations in the arterial anatomy of the forearm, as the presence of a persistent median artery, are sufficiently common to warrant careful preoperative evaluation when planning a free vascularized forearm flap for reconstructive surgery. The preoperative performed Allen-test provides no clear inference possibility and therefore often requires intraoperative random findings. The reconstructive surgeon should be aware of these possible variations because it can affect the harvest and the survival of the forearm flap as well as causing ischaemia of the hand.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Masculino , Pênis/cirurgia , Artéria Radial/cirurgia , Estudos Retrospectivos , Uretra/cirurgia
18.
Ann Vasc Surg ; 68: 451-459, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32278869

RESUMO

BACKGROUND: Hemodynamics has been known to play a major role in the development of intimal hyperplasia leading to arteriovenous fistula failure. The goal of our study is to investigate the influence of different angles of side-to-end radiocephalic anastomosis on the hemodynamic parameters that promote intimal dysfunction and therefore intimal hyperplasia. METHODS: Realistic three-dimensional meshes were reconstructed using ultrasound measurements from distal side-to-end radiocephalic fistulas. The velocity at the proximal and distal radial inflows and at specific locations along the anastomosis and cephalic vein was measured through duplex ultrasound performed by a single examiner. A computational parametric study, virtually changing the inner angle of anastomosis, was performed. For this purpose, we used advanced computational models that include suitable tools to capture the pulsatile and turbulent nature of the blood flow found in arteriovenous fistulas. The results were analyzed in terms of velocity fields, wall shear stress distribution, and oscillatory shear index. RESULTS: Results show that the regions with high oscillatory shear index, which are more prone to the development of hyperplasia, are greater and progressively shift toward the anastomosis area and the proximal vein segment with the decrease of the inner angle of anastomosis. These results are specific to distal radiocephalic fistulas because they are subject to proximal and distal radial inflow. CONCLUSIONS: The results of this study show that inner anastomosis angles approaching 60-70° seem to yield the best hemodynamic conditions for maturation and long-term patency of distal radiocephalic fistulas. Inner angles greater than 90°, representing the smooth loop technique, did not show a clear hemodynamic advantage.


Assuntos
Derivação Arteriovenosa Cirúrgica , Antebraço/irrigação sanguínea , Hemodinâmica , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Artéria Radial/cirurgia , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Humanos , Hiperplasia , Neointima , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estresse Mecânico , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
19.
J Clin Neurosci ; 78: 403-405, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32336640

RESUMO

One of the treatment options for long segment common carotid artery (CCA) occlusion is bypass surgery with different combinations of donors and receipts. Using vertebral artery (VA) as the donor for CCA occlusion was uncommonly reported. The reported cases were using jump graft to connect V3 segment of VA to either CCA or ICA. We describe our patient using V2 segment as the donor for VA-CCA bypass as treatment for CCA occlusion. Our patient was a 51 years old gentleman with Marfan syndrome and had multiple operations that included total arch replacement. He presented with sudden onset of spontaneous right frontal subarachnoid haemorrhage and repeated episodes of TIA with left upper limb numbness. CTA showed occluded right CCA and anastomosis between branches from subclavian artery and occipital artery. CT perfusion showed hypoperfusion of right hemisphere. To avoid damaging the anastomosis at subclavian artery and occipital artery, we decided for V2-RAG (radial artery graft)-CCA bypass. It was done by exposing the V2 segment at C4/5 level, performing end-to-side anastomoses at V2-RAG and RAG-CCA junctions where the RAG was underneath the internal jugular vein. Patient had no new deficits after surgery and no more TIAs. CTA performed one week after surgery showed patent RAG. In conclusion, using V2 for VA-CCA bypass is technically feasible and may have theoretical advantages over using V3. V2-CCA bypass is an option for CCA occlusion in very selected patients.


Assuntos
Anastomose Cirúrgica , Doenças das Artérias Carótidas/cirurgia , Trombose das Artérias Carótidas/terapia , Artéria Carótida Primitiva/cirurgia , Artéria Vertebral/cirurgia , Revascularização Cerebral , Humanos , Ataque Isquêmico Transitório , Masculino , Síndrome de Marfan/terapia , Pessoa de Meia-Idade , Artéria Radial/cirurgia , Artéria Radial/transplante , Hemorragia Subaracnóidea , Trombose/cirurgia , Procedimentos Cirúrgicos Vasculares
20.
Angiology ; 71(7): 602-608, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32319299

RESUMO

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.


Assuntos
Artéria Femoral/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Artéria Radial/cirurgia , Idoso , Feminino , Hemorragia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/métodos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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