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de Launay D, Shiga S, Laschuk M, Brandys T, Roberts DJ. Extra-Anatomic Temporary Intravascular Shunting to Assist with Replantation of An Amputated Hand with Prolonged Ischemic Time. J Vasc Surg Cases Innov Tech 2022; 8:598-601. [PMID: 36248399 PMCID: PMC9556574 DOI: 10.1016/j.jvscit.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022] Open
Abstract
Although temporary intravascular shunting has been reported to assist with hand revascularization and replantation after traumatic amputation, most reports have described using ipsilateral upper limb inflow. We present a case of a traumatic hand amputation in a patient who had presented with 4 to 5 hours of warm ischemic time. Because the replantation team believed that extra-anatomic revascularization would be necessary, we performed a novel type of temporary intravascular shunting by connecting two arterial sheaths placed in the ulnar and superficial femoral arteries. This permitted the hand to be successfully replanted away from the inflow source and resulted in a good long-term functional outcome.
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Affiliation(s)
- David de Launay
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Sarah Shiga
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Laschuk
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Timothy Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Correspondence: Derek J. Roberts, MD, PhD, FRCSC, Division of Vascular and Endovascular Surgery, Department of Surgery, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Civic Campus, Room A-280, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
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Coderech Carretero J, Corella Montoya F, Grande Barez M, Corella Montoya MÁ, Ocampos Hernández M, Larrainzar-Garijo R. Description and analysis of the dynamic and morphological flow pattern of the main arteries of the wrist and hand in a healthy Spanish population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Coderech Carretero J, Corella Montoya F, Grande Barez M, Corella Montoya MÁ, Ocampos Hernández M, Larrainzar-Garijo R. Descripción y análisis del patrón de normalidad de flujo dinámico y morfológico de las arterias principales de la muñeca y mano en población sana española. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:167-176. [DOI: 10.1016/j.recot.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 10/24/2022] Open
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Effect of transient ulnar artery compression on radial artery diameter. Exp Ther Med 2018; 16:3735-3739. [PMID: 30250527 DOI: 10.3892/etm.2018.6632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/26/2018] [Indexed: 11/05/2022] Open
Abstract
The transradial approach is widely preferred in coronary procedures. A small radial artery diameter (RAD) is the most important factor affecting successful access. Various maneuvers and medications have been used to increase the RAD and thereby facilitate RA cannulation. Ulnar artery compression (UAC) for 30 min has been indicated to be effective in increasing the RAD and facilitating RA access. The aim of the present preliminary study was to assess the effect of transient UAC for 1 min on the RAD. A total of 151 patients were included in the present study. RA ultrasonography was performed at the level of the wrist. The UA was compressed for 1 min. The RAD was measured at baseline, at the end of UAC and at 1 min thereafter. The results indicated that the RAD was significantly smaller in diabetic vs. non-diabetic patients (2.35±0.43 vs. 2.50±0.39 mm, P=0.024) and in women vs. men (2.25±0.38 vs. 2.56±0.38 mm, P<0.001). At the end of UAC, the RAD was increased compared with that at baseline (2.45±0.41 vs. 2.62±0.41 mm, P<0.001), but it started to decrease thereafter, and the RAD measured at 1 min after stopping UAC was significantly smaller (2.62±0.41 vs. 2.55±0.40 mm, P<0.001), while remaining significantly larger than that at baseline (P<0.001). The RA peak systolic flow velocity also increased significantly during UAC (35.3±8.9 vs. 60.3±19.2 cm/sec; P<0.001). In conclusion, Transient UAC for 1 min significantly increased the RAD and the peak systolic flow velocity. Further studies with clinical endpoints are required for further exploration of the feasibility of this approach.
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