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2.
Anesthesiology ; 133(1): 53-63, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33377921

RESUMO

BACKGROUND: Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation. METHODS: This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 µg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm. RESULTS: A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, -25.2%; 95% CI, -39.6 to -10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P < 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%). CONCLUSIONS: Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.


Assuntos
Cateterismo Periférico/métodos , Nitroglicerina/administração & dosagem , Nitroglicerina/uso terapêutico , Artéria Radial , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêutico , Anestesia Geral , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Lactente , Injeções Subcutâneas , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Artéria Radial/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção
3.
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
4.
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
5.
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
6.
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
7.
J Vasc Interv Radiol ; 31(8): 1328-1333, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631733

RESUMO

PURPOSE: To assess safety and efficacy of a modified rapid hemostasis protocol for distal transradial access (TRA). MATERIALS AND METHODS: A single-center retrospective study of patients undergoing percutaneous image-guided procedures from a distal TRA with rapid deflation hemostasis protocol was performed. Between March 2017 and August 2019, 593 procedures in 434 patients were performed. Mean patient age was 63.5 y (range, 18-94 y). RESULTS: The most common procedures were transarterial chemoembolization (218; 36.8%), abdominal and pelvic embolization (116; 19.6%), yttrium-90 mapping (115; 19.4%), yttrium-90 administration (84; 14.2%), and diagnostic angiography (44; 7.4%). Mean (range) values for clotting parameters were international normalized ratio 1.2 (0.9-3.2), partial thromboplastin time 33.5 s (26-44 s), and platelets 23.4 × 109/L (37-552 × 109/L). A hematoma developed in 7 (1.2%) patients. No radial artery occlusions were encountered during follow-up. Nursing intensity was defined as the number of minutes after the procedure required for assessing and managing the access site for bleeding. The mean nursing intensity was 25.1 min (range, 25-40 min). CONCLUSIONS: The rapid deflation hemostasis protocol for distal TRA at the anatomical snuffbox was feasible and safe. No significant difference or association was found between hematoma formation and clotting parameters after the procedure or type of vascular access equipment used.


Assuntos
Algoritmos , Cateterismo Periférico , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Punções , Artéria Radial/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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.
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
10.
Herz ; 45(6): 548-556, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32548776

RESUMO

Coronary angiography and percutaneous coronary intervention (PCI) represent the recommended revascularization strategy for patients presenting with acute coronary syndrome (ACS). However, periprocedural bleeding events, of which up to 50% are related to the access site, remain an important complication of PCI and are associated with higher costs, prolonged hospital stays, and increased mortality. Several randomized trials have demonstrated that PCI performed via radial artery (RA) access is associated with a reduction in bleeding events, and perhaps a reduction in mortality compared with femoral artery (FA) access. As a result, current practice guidelines from the European Society of Cardiology and the Canadian Cardiovascular Society recommend that RA be the default strategy for PCI in patients presenting with ACS. The recently published Safety and Efficacy of Femoral Access vs. Radial Access in ST-Segment Elevation Myocardial Infarction (SAFARI-STEMI) trial challenges the benefits of a default RA approach in a contemporary setting where additional bleeding-reduction strategies (i.e., avoidance of glycoprotein IIb/IIIa inhibitors, routine use of bivalirudin for procedural anticoagulation, and vascular closure devices) were employed. In order to better understand the evidence that has shaped the current recommendations, we present a review of the background studies and major randomized trials comparing RA with FA in patients presenting with ACS.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/terapia , Canadá , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Artéria Radial/diagnóstico por imagem , Resultado do Tratamento
12.
Int J Oral Maxillofac Surg ; 49(11): 1402-1407, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32402690

RESUMO

The radial forearm free flap (RFFF) and ulnar forearm free flap (UFFF) are used in head and neck reconstruction because they provide a thin and pliable skin paddle as well as a long vascular pedicle. However, in spite of several studies showing the safety of the UFFF, the RFFF is more popular among reconstructive surgeons based on concerns about hand ischaemia. A prospective study was designed in which 10 UFFF and 11 RFFF surgeries were performed in 20 patients undergoing oral cavity reconstruction between January 2017 and July 2018. Hand vascular parameters were evaluated preoperatively and postoperatively using Doppler ultrasound and plethysmography. The preoperative and postoperative diameters of the radial and ulnar arteries, and the flow velocities through the remainder of the forearm artery were measured preoperatively and at 3 months postoperative. Additionally, a comparison was performed between the preoperative and postoperative fingertip perfusion values according to impedance plethysmography. The preoperative mean diameter of the radial artery (2.89±0.47mm) was significantly greater than that of the ulnar artery (2.35±0.48mm) at the level of the wrist; however, 3 months after the surgery, the mean diameters of the two arteries did not differ significantly. There were no differences in digital perfusion when a UFFF was used compared with an RFFF.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Antebraço/cirurgia , Humanos , Boca , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem
13.
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
14.
J Vasc Interv Radiol ; 31(6): 993-999.e1, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376177

RESUMO

PURPOSE: To compare outcomes of transradial access for endovascular treatment of nonmaturing hemodialysis fistulae compared to brachial arteriography followed by unidirectional or bidirectional fistula access for intervention. MATERIALS AND METHODS: In this institutional review board-approved, retrospective, case-control study, 56 consecutive patients with nonmaturing arteriovenous fistulae underwent percutaneous intervention between 2015 and 2018. The transradial group (n = 28) underwent radial artery access for diagnostic fistulography and intervention. The control group (n = 28) underwent retrograde brachial artery access for fistulography followed by unidirectional/bidirectional fistula access for intervention. Both groups had similar demographics, fistula characteristics, and stenosis locations. RESULTS: Fewer punctures were required in the transradial group compared to controls (1.2 vs 2.4, P < .0001), and procedure time was shorter (64.9 vs 91.3 minutes, P = .0016). Anatomic, technical, and clinical success rates trended higher in the transradial group compared to controls (93% vs 86%, 96% vs 89%, and 82% vs 64%, respectively). Nonmaturation resulting in fistula abandonment was lower in the transradial group (3.7% vs 25%, P = .025). Primary unassisted patency at 3, 6, and 12 months was 77.1% ± 8.2%, 73.1% ± 8.7%, and 53.3% ± 10.6% in the transradial group, respectively, and 63.0% ± 9.3%, 55.6% ± 9.6%, and 48.1% ± 9.6% in the control group, respectively (P = .76). Primary assisted patency at 12 months was 92.3% ± 5.3% in the transradial group compared to 61.8% ± 9.6% at 12 months in the control group (P = .021). No major complications occurred. Minor complications were lower in the transradial group than in the control group (14% vs 39%, P = .068). CONCLUSIONS: Treatment of nonmaturing fistulae via a transradial approach was safe, improved midterm patency, and was associated with lower rates of fistula abandonment.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Artéria Braquial , Cateterismo Periférico , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/terapia , Artéria Radial , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
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
16.
J Stroke Cerebrovasc Dis ; 29(7): 104853, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389556

RESUMO

Giant thrombosed middle cerebral artery (MCA) aneurysms are difficult to treat and sometimes require complex revascularization using allografts. We describe a technical method using revascularization with a natural Y-shaped graft that provides a normal variation for a complex MCA aneurysm. A 65-year-old man with a giant thrombosed MCA aneurysm presented with right hemiparesis and aphasia. The patient had a history of clipping surgery for the ipsilateral side of the MCA aneurysm 25 years before, and a de novo aneurysm developed over the previous 18 years. For the giant thrombosed aneurysm, trapping and revascularization were performed. A natural radial artery Y-graft was used as the graft and anastomosed to both M2 trunks. The symptoms improved after surgery, and the patient was discharged 3 weeks later. This is the first report of a double-barrel bypass using a natural Y-graft. This method attained a normal variation, and the flow of the Y-graft was physiological. For the radical cure of giant thrombosed MCA aneurysms, multiple revascularizations might be required. With this natural Y-graft, complex transpositions could be avoided.


Assuntos
Bioprótese , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Revascularização Cerebral/instrumentação , Aneurisma Intracraniano/cirurgia , Trombose Intracraniana/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Idoso , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/fisiopatologia , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Resultado do Tratamento
17.
Stroke Vasc Neurol ; 5(1): 103-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411415

RESUMO

Background and purpose: Radial artery catheterisation is an alternate route of access that has recently started to gain more widespread use for neuroendovascular procedures, including acute stroke intervention. In this small case series, we present our institution's outcomes in patients undergoing acute stroke interventions via transradial access. Materials and methods: We present a retrospective study of 15 patients who underwent acute stroke intervention via radial artery access. We analyse these patients' periprocedural and clinical outcomes after undergoing mechanical thrombectomy. Results: A total of 15 consecutive patients were included in the study (9 males and 6 females), and all patients were able to successfully undergo mechanical thrombectomy via radial artery access. The mean time of arterial puncture to reperfusion was 50±28 min (range: 15-104). A TICI 2b/3 revascularisation was achieved in 13/15 patients (87%); a TICI 1 and TICI 2a outcome was achieved on the other two patients. One patient incurred an iatrogenic vessel dissection during the procedure. Eight of out 15 patients (53%) had favourable mRS (0-3) at the time of discharge from the hospital. Conclusion: Radial artery catheterisation is technically feasible for performing acute stroke interventions with favourable time to revascularisation and good overall clinical outcomes.


Assuntos
Cateterismo Periférico , Artéria Radial , Acidente Vascular Cerebral/terapia , Trombectomia , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Artéria Radial/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Trombectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
18.
Sci Rep ; 10(1): 7104, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32346022

RESUMO

Medical radiation exposure is a significant concern for interventional cardiologists (IC). This study was aimed at estimating the radiation exposure of IC operators and assistants in real clinical practice. The radiation exposure of the operator and assistant was evaluated by conducting two types of procedures via coronary angiography (CAG) and percutaneous coronary intervention (PCI) on 1090 patients in 11-cardiovascular centers in Korea. Radiation exposure was measured using an electronic personal dosimeter (EPD). EPD were attached at 3 points on each participant: on the apron on the left anterior chest (A1), under the apron on the sternum (A2), and on the thyroid shield (T). Average radiation exposure (ARE) of operators at A1, A2, and T was 19.219 uSv, 4.398 uSv, and 16.949 uSv during CAG and 68.618 uSv, 15.213 uSv, and 51.197 uSv during PCI, respectively. ARE of assistants at A1, A2, and T was 4.941 uSv, 0.860 uSv, and 5.232 uSv during CAG and 20.517 uSv, 4.455 uSv, and 16.109 uSv during PCI, respectively. AED of operator was 3.4 times greater during PCI than during CAG.


Assuntos
Angiografia Coronária , Artéria Femoral/diagnóstico por imagem , Exposição Ocupacional , Intervenção Coronária Percutânea , Artéria Radial/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Neurointerv Surg ; 12(9): 893-896, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32241922

RESUMO

BACKGROUND: Diagnostic cerebral angiograms are increasingly being performed by transradial access (TRA) in adults, following data from the coronary literature supporting fewer access-site complications. Despite this ongoing trend in neuroangiography, there has been no discussion of its use in the pediatric population. Pediatric TRA has scarcely been described even for coronary or other applications. This is the first dedicated large study of transradial access for neuroangiography in pediatric patients. METHODS: A multi-institutional series of consecutively performed pediatric transradial angiograms and interventions was collected. This included demographic, procedural, outcomes, and safety data. Data was prospectively recorded and retrospectively analyzed. RESULTS: Thirty-seven diagnostic angiograms and 24 interventions were performed in 47 pediatric patients. Mean age, height, and weight was 14.1 years, 158.6 cm, and 57.1 kg, respectively. The radial artery measured 2.09+/-0.54 mm distally, and 2.09+/-0.44 mm proximally. Proximal and distal angiography were performed for both diagnostic and interventional application (17 distal angiograms, two distal interventions). Clinically significant vasospasm occurred in eight patients (13.1%). Re-access was successfully performed 11 times in seven patients. Conversion to femoral access occurred in five cases (8.2%). The only access-related complication was a small asymptomatic wrist hematoma after TR band removal. CONCLUSIONS: Transradial access in pediatric patients is safe and feasible. It can be performed successfully in many cases but carries some unique challenges compared with the adult population. Despite the challenge of higher rates of vasospasm and conversion to femoral access, it is worth exploring further, given the potential benefits.


Assuntos
Cateterismo Periférico/métodos , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Artéria Radial/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Estudos Retrospectivos
20.
Anesthesiology ; 133(1): 53-63, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32282432

RESUMO

BACKGROUND: Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation. METHODS: This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 µg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm. RESULTS: A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, -25.2%; 95% CI, -39.6 to -10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P < 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%). CONCLUSIONS: Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.


Assuntos
Cateterismo Periférico/métodos , Nitroglicerina/uso terapêutico , Artéria Radial , Vasodilatadores/uso terapêutico , Anestesia Geral/métodos , Cateterismo Periférico/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Lactente , Injeções Subcutâneas , Masculino , Nitroglicerina/administração & dosagem , Artéria Radial/diagnóstico por imagem , Ultrassonografia de Intervenção , Vasodilatadores/administração & dosagem
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