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Alokaili HR, Bhat TA, Alhablany TM, Alsinan TA, Almansour DN, AlMarshad FA, Altamimi A, Ouhlous M, Alnaqaa J. Index Digit Necrosis as a Complication of Radial Artery Cannulation. Cureus 2022; 14:e28469. [PMID: 36176833 PMCID: PMC9512076 DOI: 10.7759/cureus.28469] [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] [Accepted: 08/27/2022] [Indexed: 11/25/2022] Open
Abstract
Arterial access is therapeutically and diagnostically useful. Its clinical utility is vast, and associated complications are infrequent. However, some unfortunate patients progress to disastrous outcomes. Luckily, ischemic hand complications are rare. Hand ischemia threatens independence and quality of life, thus warranting vigilance. We present a case of index digit necrosis as a complication of arterial cannulation in a 30-year-old patient with end-stage renal disease admitted to an intensive care unit.
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2
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Ren G, Qiang X, Yu H. Observation on Application Effect of Arterial Puncture and Catheterization under Guidance of Intelligent Medical Care Ultrasound in Clinical Anesthesia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6970274. [PMID: 35388318 PMCID: PMC8979703 DOI: 10.1155/2022/6970274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
In clinical anesthesia and the rescue of critically ill patients, arterial puncture and catheterization are the most commonly chosen ways to establish central arterial access for patients. Invasive arterial puncture and catheterization facilitate the grasp of real-time vital sign information of patients during surgery, which strengthens patient monitoring during surgery and improves safety. However, the traditional method of arterial puncture and cannulation through palpation of the radial artery is often prone to complications related to mechanical injury, such as hemorrhage, hematoma, and accidental perforation of the artery. Studies have shown that ultrasound-guided radial artery puncture and cannulation can shorten the puncture cannulation time, reduce the incidence of complications related to puncture cannulation, and improve the success rate of puncture cannulation. In order to verify it, this paper uses the experimental group and the control group to conduct comparative experiments and uses the neural network method to evaluate the effects of the two methods. As a more mature method of artificial intelligence, BP neural network is widely used in a wide range of applications and has the characteristics of strong generalization ability and fast convergence, so we choose it as the base model. The specific work of this paper is as follows: (1) in-depth study of the relevant theory of BP neural network (BPNN), focusing on the structure of BPNN and the working principle of algorithm; the problems to be solved in the clinical anesthesia effect evaluation have laid a theoretical foundation for the establishment of an improved BPNN evaluation model in the following chapters. (2) introduce the basic principle of genetic neural network, analyze the benefits of combining genetic neural network and BPNN; introduce in detail the process of genetic algorithm to optimize the weights and thresholds of BPNN, and establish a GA-BP evaluation model. The test proves the feasibility and superiority of the model.
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Affiliation(s)
- Guozhang Ren
- Department of Anesthesiology, Yantai Hospital of Traditional Chinese Medicine, Yantai 264000, Shandong, China
| | - Xiancheng Qiang
- Department of Anesthesiology, Qingdao Eighth Peolpe's Hospital, Qingdao 266100, Shandong, China
| | - Hui Yu
- Department of Anesthesiology, Qingdao Eye Hospital Affiliated to Shandong First Medical Universty, Qingdao, 266071, Shandong, China
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3
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Alshehri H, Dmytriw AA, Bhatia K, Bickford S, Rea V, Shkumat N, Muthusami P. Transradial Neuroendovascular Procedures in Adolescents: Initial Single-Center Experience. AJNR Am J Neuroradiol 2021; 42:1492-1496. [PMID: 33958331 DOI: 10.3174/ajnr.a7142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The feasibility and safety of transradial angiography is not established outside the adult literature. The objective of this study was to assess the feasibility and safety of transradial access for neuroangiography in adolescents. MATERIALS AND METHODS A retrospective case-control study was performed, comparing transradial neuroendovascular procedures in adolescents (age range, 10-18 years) with an age- and procedure-matched cohort of transfemoral neuroendovascular procedures. Clinical and procedural details, including type of procedure, conversion rate, fluoroscopy time, radiation dose, complications, and readmissions, were reported by descriptive statistics or measures of central tendency and compared using a t test or nonparametric equivalent. A P value < .05 was considered statistically significant. RESULTS Twenty adolescents (mean age, 14.6 [SD, 1.7] years, M/F ratio = 9:11) who underwent transradial neuroangiography were compared against 20 adolescents (mean age, 14.4 [SD, 2.1 ] years, M/F ratio = 12:8) who underwent transfemoral neuroangiography. We found no significant difference in procedural success (0% conversion rate), fluoroscopy times (33.7 [SD, 40.2] minutes versus 23.3 [SD, 26.2] minutes, P = .34) and radiation dose (150.9 [SD, 133.7] Gy×cm2 and 122.9 [SD, 79.7] Gy×cm,2 P = .43) There were 2 self-limiting postprocedural complications in the transradial group. There were no major hemorrhages, need for further interventions, or readmissions in either group. CONCLUSIONS The benefits of transradial angiography described for adults can likely be safely extended to adolescents. These are important data before transitioning to smaller children and should be prospectively evaluated in a larger cohort.
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Affiliation(s)
- H Alshehri
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - A A Dmytriw
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - K Bhatia
- Department of Medical Imaging (K.B.), Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - S Bickford
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - V Rea
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - N Shkumat
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - P Muthusami
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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4
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Huzmeli I, Ozer AY, Akkus O, Katayıfcı N, Sen F, Yurdalan SU, Polat MG. Comparison of functional exercise capacity, quality of life and respiratory and peripheral muscle strength between patients with stable angina and healthy controls. J Int Med Res 2021; 48:300060520979211. [PMID: 33334226 PMCID: PMC7750767 DOI: 10.1177/0300060520979211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective We aimed to compare functional exercise capacity, respiratory and peripheral
muscle strength, pulmonary function and quality of life between patients
with stable angina and healthy controls. Methods We compared 33 patients with stable angina (55.21 ± 6.12 years old, Canada
Class II–III, left ventricular ejection fraction: 61.92 ± 7.55) and 30
healthy controls (52.70 ± 4.22 years old). Functional capacity (6-minute
walk test (6-MWT)), respiratory muscle strength (mouth pressure device),
peripheral muscle strength (dynamometer), pulmonary function (spirometer)
and quality of life (Short Form 36 (SF-36)) were evaluated. Results 6-MWT distance (499.20 ± 51.91 m versus 633.05 ± 57.62 m), maximal
inspiratory pressure (85.42 ± 20.52 cmH2O versus
110.44 ± 32.95 cmH2O), maximal expiratory pressure
(83.33 ± 19.05 cmH2O versus 147.96 ± 54.80 cmH2O)
and peripheral muscle strength, pulmonary function and SF-36 sub-scores were
lower in the angina group versus the healthy controls, respectively. Conclusion Impaired peripheral and respiratory muscle strength, reduction in exercise
capacity and quality of life are obvious in patients with stable angina.
Therefore, these parameters should be considered in stable angina
physiotherapy programmes to improve impairments.
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Affiliation(s)
- Irem Huzmeli
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Aysel-Yildiz Ozer
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Oguz Akkus
- Department Of Cardiology, Tayfur Ata Sokmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Nihan Katayıfcı
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Fatih Sen
- Department Of Cardiology, Tayfur Ata Sokmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Saadet Ufuk Yurdalan
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Mine Gulden Polat
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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5
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McHugh S, Noory A, Mishra S, Vanchiere C, Lakhter V. Vascular Access for Large Bore Access. Interv Cardiol Clin 2021; 10:157-167. [PMID: 33745666 DOI: 10.1016/j.iccl.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
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Affiliation(s)
- Stephen McHugh
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Ali Noory
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Suraj Mishra
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Catherine Vanchiere
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street (9PP), Philadelphia, PA 19140, USA.
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Hollander MR, Jansen MF, Schumacher SP, Stuijfzand WJ, van Leeuwen MAH, van de Ven PM, Horrevoets AJ, Nap A, Knaapen P, van Royen N. Coronary Collateral Flow Index Is Correlated With the Palmar Collateral Flow Index: Indicating Systemic Collateral Coherence in Individual Patients-Brief Report. Arterioscler Thromb Vasc Biol 2021; 41:1830-1836. [PMID: 33730875 DOI: 10.1161/atvbaha.121.316092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maurits R Hollander
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Matthijs F Jansen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Wijnand J Stuijfzand
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Maarten A H van Leeuwen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.,Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics (P.M.v.d.V.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Anton J Horrevoets
- Department of Molecular Cell Biology and Immunology (A.J.H.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Alex Nap
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology (M.R.H., M.F.J., S.P.S., W.J.S., M.A.H.v.L., A.N., P.K., N.v.R.), Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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7
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The Impact of Using a Larger Forearm Artery for Percutaneous Coronary Interventions on Hand Strength: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10051099. [PMID: 33800778 PMCID: PMC7961765 DOI: 10.3390/jcm10051099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 01/14/2023] Open
Abstract
(1) Background: The exact mechanism underlying hand strength reduction (HSR) after coronary angiography with transradial access (TRA) or transulnar access (TUA) remains unknown. (2) Methods: This study aimed to assess the impact of using a larger or smaller forearm artery access on the incidence of HSR at 30-day follow-up. This was a prospective randomized trial including patients referred for elective coronary angiography or percutaneous coronary intervention. Based on the pre-procedural ultrasound examination, the larger artery was identified. Patients were randomized to larger radial artery (RA) or ulnar artery (UA) or a group with smaller RA/UA. The primary endpoint was the incidence of HSR, while the secondary endpoint was the incidence of subjective HSR, paresthesia, and any hand pain. (3) Results: We enrolled 200 patients (107 men and 93 women; mean age 68 ± 8 years) between 2017 and 2018. Due to crossover between TRA and TUA, there were 57% (n = 115) patients in larger RA/UA and 43% (n = 85) patients in smaller RA/UA. HSR occurred in 29% (n = 33) patients in larger RA/UA and 47% (n = 40) patients in smaller RA/UA (p = 0.008). Subjective HSR was observed in 10% (n = 12) patients in larger RA/UA and 21% (n = 18) patients in smaller RA/UA (p = 0.03). Finally, paresthesia was noted in 7% (n = 8) patients in larger RA/UA and 22% (n = 15) in smaller RA/UA (p = 002). Independent factors of HSR were larger RA/UA (OR 0.45; 95% CI, 0.24-0.82; p < 0.01) and the use of TRA (OR 1.87; 95% CI, 1.01-34; p < 0.05). (4) Conclusions: The use of a larger artery as vascular access was associated with a lower incidence of HSR at 30-day follow-up.
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8
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Golamari R, Gilchrist IC. Collateral Circulation Testing of the Hand- Is it Relevant Now? A Narrative Review. Am J Med Sci 2020; 361:702-710. [PMID: 33947584 DOI: 10.1016/j.amjms.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/20/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022]
Abstract
Testing for collateral circulation of the hand before any radial artery procedure has been a subject of many controversies. Neither the Allen's test (AT) nor the plethysmography based Barbeau test, adequately and reliably test for collateral circulation. With growing interest in radial approaches for vascular procedures, its common use for arterial monitoring and blood gas sampling, there has been a growing interest in the relevance of assessing collateral hand circulation. Multiple studies now refute the utility of collateral testing, yet it continues to be propagated as an essential triaging assessment tool by educators. Allen's, or modified Allen tests (MAT) are operator dependent and often subjected to observational bias. Barbeau test is more objective, however, it fails to show added benefit in assessing pre-procedural patency. Despite studies questioning the validity of collateral circulation assessment, these tests continue to preclude radial approach. There is no standardization for being considered an abnormal test across literature and the significance of an abnormal test translating into a clinical outcome has not been investigated in prior studies. This may be attributed to the robust vascular supply of the hand, connections at the digital circulation level and vessel recruitment in an event of occlusion. We reviewed this topic extensively and make an argument that non-invasive collateral testing should be abandoned as a triage tool for radial artery procedures such as arterial punctures, arterial monitoring, and transradial vascular procedures.
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Affiliation(s)
- Reshma Golamari
- Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Ian C Gilchrist
- Department of Cardiovascular Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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9
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van Leeuwen MAH, van der Heijden DJ, Hollander MR, Mulder MJ, van de Ven PM, Ritt MJPF, Kiemeneij F, van Mieghem NM, van Royen N. ACRA Perfusion Study. Circ Cardiovasc Interv 2020; 12:e007641. [PMID: 30929508 DOI: 10.1161/circinterventions.118.007641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Transradial intervention (TRI) may impair digital perfusion with hand dysfunction as a result. However, the effect of TRI on digital perfusion has never been investigated, including the influence of variations of the collateral arterial network and the effect on hand dysfunction. METHODS AND RESULTS We investigated the effect of TRI on digital perfusion by laser Doppler perfusion imaging. Laser Doppler perfusion imaging was performed at baseline, during radial access, TR band application, and at discharge. We compared tissue perfusion of the homolateral thumb (access site) with the contralateral thumb (comparator) during radial access as primary outcome. The hand circulation was assessed with angiography. Upper extremity function was evaluated with the validated QuickDASH questionnaire at baseline and follow-up. A significant reduction of tissue perfusion was observed during radial access and TR band application in the homolateral thumb (-32%, -32%, respectively) and contralateral thumb (-34%, -21%, respectively). We detected no perfusion difference between the homolateral and contralateral thumb during radial access (217; interquartile range, 112-364 versus 209; interquartile range, 99-369 arbitrary flux units; P=0.59). Reduced perfusion of the thumb during radial access was not associated with incompleteness of the superficial palmar arch ( P=0.13). Digital perfusion improved at discharge, though it remained below baseline levels (homolateral -11% and contralateral -14%). Hand dysfunction at 18 months was not associated with TRI-induced perfusion reduction ( P=0.54). CONCLUSIONS TRI is safe. Digital perfusion is reduced in both hands during radial access and TR band application but is not associated with future loss of hand function and variations of the arterial hand supply.
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Affiliation(s)
- Maarten A H van Leeuwen
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands (D.J.v.d.H.)
| | - Maurits R Hollander
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Mark J Mulder
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.)
| | - Marco J P F Ritt
- Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Ferdinand Kiemeneij
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | | | - Niels van Royen
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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10
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Chang EI, Liu J. Prospective Comparison of Donor-Site Morbidity following Radial Forearm and Ulnar Artery Perforator Flap Harvest. Plast Reconstr Surg 2020; 145:1267-1274. [PMID: 32332551 DOI: 10.1097/prs.0000000000006790] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap. METHODS All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. RESULTS A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Edward I Chang
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
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11
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Hage F, Badaoui G, Routledge H, Benamer H, Cheaito R, Monségu J. [Radial artery occlusion ofter coronarography: is it really a problem?]. Ann Cardiol Angeiol (Paris) 2020; 69:46-50. [PMID: 32127196 DOI: 10.1016/j.ancard.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
The use of transradial access for cardiac procedures has increased worldwide over the past two decades. Despite the many advantages this technique offers, there remains some concern that radial artery occlusion, a potential complication of radial cannulation, might lead to significant ischemic sequelae in the hand. This paper reviews the major causes, its possible consequences and the strategies for its prevention and treatment. It appears however from multiple studies that there is little or no correlation between radial occlusion and symptomatic hand ischemia.
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Affiliation(s)
- F Hage
- Département de cardiologie, hôtel Dieu de France, université Saint-Joseph De Beyrouth, Achrafieh/Beyrouth, Liban.
| | - G Badaoui
- Département de cardiologie, hôtel Dieu de France, université Saint-Joseph De Beyrouth, Achrafieh/Beyrouth, Liban
| | - H Routledge
- Département de cardiologie, Worcestershire acute hospitals NHS trust, Worcestershire, Grande-Bretagne
| | - H Benamer
- Département de cardiologie, institut cardiovasculaire Paris-Sud Jacques-Cartier, France
| | - R Cheaito
- Département de cardiologie, Beirut cardiac institute, Beyrouth, Liban
| | - J Monségu
- Institut cardiovasculaire, groupe hospitalier mutualiste de Grenoble, Grenoble, France
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12
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Petroglou D, Didagelos M, Alkagiet S, Koutouzis M, Karvounis H, Bertrand OF, Ziakas A. Manual Radial Artery Compression After Transradial Coronary Procedures: Is It Safe to Go Bare-Handed? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:912-916. [PMID: 31864953 DOI: 10.1016/j.carrev.2019.11.013] [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: 08/19/2019] [Revised: 10/15/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022]
Abstract
Although the superiority of manual compression of the radial, mainly due to its selectivity and progressive grading, had been hypothesized from the early days of the transradial use, data on efficacy and safety of this method are only scarce. This review tries to delineate the aspects of manual hemostasis in transradial catheterization. Current data demonstrate that manual compression of the radial artery is a possible (second line) hemostatic option in transradial catheterization with main advantage the shorter hemostasis duration, and major disadvantage the need for larger involvement of post-procedural care team in hemostasis. Manual compression of the radial artery is a possible (second line) hemostatic option with main advantage the shorter hemostasis duration, and major disadvantages the need for larger involvement of post-procedural care team in hemostasis.
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Affiliation(s)
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece.
| | - Stelina Alkagiet
- Cardiology Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Michael Koutouzis
- Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Olivier F Bertrand
- Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
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13
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Petroglou D, Didagelos M, Chalikias G, Tziakas D, Tsigkas G, Hahalis G, Koutouzis M, Ntatsios A, Tsiafoutis I, Hamilos M, Kouparanis A, Konstantinidis N, Sofidis G, Pancholy SB, Karvounis H, Bertrand OF, Ziakas A. Manual Versus Mechanical Compression of the Radial Artery After Transradial Coronary Angiography: The MEMORY Multicenter Randomized Trial. JACC Cardiovasc Interv 2019; 11:1050-1058. [PMID: 29880098 DOI: 10.1016/j.jcin.2018.03.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The aim of this study was to compare manual versus mechanical compression of the radial artery after coronary angiography via transradial access regarding radial artery occlusion (RAO), access-site bleeding complications, and duration of hemostasis. BACKGROUND Hemostasis of the radial artery after sheath removal can be achieved either by manual compression at the puncture site or by using a mechanical hemostasis device. Because mechanical compression exerts a more stable, continuous pressure on the artery, it could be hypothesized that it is more effective compared with manual compression regarding hemostasis time, bleeding, and RAO risks. METHODS A total of 589 patients undergoing diagnostic coronary angiography by transradial access with a 5-F sheath were randomized in a 1:1 ratio to receive either manual or mechanical patent hemostasis of the radial artery. Radial artery patency was evaluated by color duplex ultrasonography 24 h after the procedure. The primary endpoint was early RAO at 24 h. Secondary endpoints included access-site bleeding complications and duration of hemostasis. RESULTS Thirty-six (12%) early RAOs occurred in the manual group, and 24 (8%) occurred in the mechanical group (p = 0.176). There were no significant differences between the 2 groups regarding access-site bleeding complications (hematoma, 52 [17%] vs. 50 [18%]; p = 0.749; bleedings, 8 [3%] vs. 9 [3%]; p = 1.000). Duration of hemostasis was significantly shorter in the manual group (22 ± 34 min vs. 119 ± 72 min with mechanical compression; p < 0.001). CONCLUSIONS Manual and mechanical compression resulted in similar rates of early RAO, although the total duration of hemostasis was significantly shorter in the manual group.
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Affiliation(s)
- Dimitrios Petroglou
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Grigorios Tsigkas
- Cardiology Department, School of Medicine, University of Patras, Rion, Greece
| | - Georgios Hahalis
- Cardiology Department, School of Medicine, University of Patras, Rion, Greece
| | - Michael Koutouzis
- Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Antonios Ntatsios
- Department of Cardiology, General Hospital of Veroia, Veroia, Greece
| | - Ioannis Tsiafoutis
- Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Michael Hamilos
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Antonios Kouparanis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Konstantinidis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Sofidis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Samir B Pancholy
- The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, Pennsylvania
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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14
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Kiang SC, Nasiri AJ, Strilaeff RR, Prasad VS, Bharadwaj AS, Miller PA, Abou-Zamzam AM, Tomihama RT. Analysis of Subjective and Objective Screening Techniques as Predictors of Safety for Radial Artery Intervention. Ann Vasc Surg 2019; 65:33-39. [PMID: 31726202 DOI: 10.1016/j.avsg.2019.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND There is no currently accepted standard in safety evaluation for radial artery intervention. We sought to compare the accuracy of various subjective and objective screening techniques in predicting safety for radial artery intervention. METHODS Fifty-four patients in a prospective cohort study at a single institution underwent subjective Allen's test, objective Barbeau test, and several objective hand ultrasound techniques to assess safety for radial artery intervention. These results were then compared to the gold standard of conventional hand angiography to document complete palmar arch. Statistical analysis including sensitivity, specificity, positive predictive values, negative predictive values, and accuracy were calculated. RESULTS Compared to hand angiography, the subjective Allen's test and the objective Princeps Pollicis Artery ultrasound demonstrated the comparable levels of sensitivity (100% vs. 96.7%, respectively), specificity (100% vs. 100%, respectively), and accuracy (97.2% vs. 97.1%, respectively). The objective Barbeau test demonstrated similar results (sensitivity of 100%, accuracy of 98.2%) with the exception of a lower specificity (50%). CONCLUSIONS There is no currently accepted standard in safety evaluation for radial artery intervention. However, preliminary data suggest that certain subjective and objective techniques such as Allen's testing, Princeps Pollicis artery ultrasound, and Barbeau testing are comparable options in predicting palmar arch patency.
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Affiliation(s)
- Sharon C Kiang
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA; Division of Vascular Surgery, Department of Surgery, VA Loma Linda Healthcare System, Loma Linda, CA
| | - Arian J Nasiri
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA
| | - Ryan R Strilaeff
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA
| | - Vinoy S Prasad
- Division of Cardiology, Department of Medicine, Linda University School of Medicine, Loma Linda, CA
| | - Aditya S Bharadwaj
- Division of Cardiology, Department of Medicine, Linda University School of Medicine, Loma Linda, CA
| | - Paul A Miller
- Division of Vascular Surgery, Department of Surgery, VA Loma Linda Healthcare System, Loma Linda, CA
| | - Ahmed M Abou-Zamzam
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA
| | - Roger T Tomihama
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA.
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15
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Bigler MR, Buffle E, Siontis GC, Stoller M, Grossenbacher R, Tschannen C, Seiler C. Invasive Assessment of the Human Arterial Palmar Arch and Forearm Collateral Function During Transradial Access. Circ Cardiovasc Interv 2019; 12:e007744. [DOI: 10.1161/circinterventions.118.007744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The present study aimed to quantitatively measure the pressure-derived function of the palmar arch and forearm arterial collateral circulation during transradial access.
Methods and Results:
Palmar arch and forearm collateral function was determined using radial artery pressure signals in the nonobstructed vessel and during brief manual occlusions of the more proximal radial artery and of the radial plus ulnar arteries. Collateral flow index (CFI), the ratio of mean occlusive divided by mean nonocclusive arterial blood pressure, both subtracted by central venous pressure, was determined for CFI during radial artery occlusion (CFI
rad
) and CFI during radial plus ulnar artery occlusion. Before invasive CFI measurements, arterial palmar arch and forearm function was tested noninvasively by the modified Allen test (MAT). Two hundred fifty patients undergoing transradial access coronary angiography were included in the study. CFI
rad
was equal to 0.802±0.150 (95% CI, 0.783–0.820). CFI during radial plus ulnar artery occlusion was equal to 0.424±0.188 (95% CI, 0.400–0.447). There was an inverse linear relation between CFI
rad
and MAT in seconds (s): MAT=64−63×CFI
rad
(
r
2
=0.229;
P
<0.0001). Two hundred eleven patients had a normal and 39 patients an abnormal (>15 seconds) MAT. The group with normal MAT had a CFI
rad
of 0.830±0.111, and patients with abnormal MAT had a CFI
rad
of 0.648±0.224 (
P
<0.0001).
Conclusions:
Direct invasive hemodynamic assessment of the palmar arch and forearm arterial function reveals collateral supply to the briefly occluded in comparison to the patent radial artery of 0.802. During external occlusion of both radial and ulnar artery, CFI amounts to an unexpectedly high value of 0.424.
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Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eric Buffle
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - George C.M. Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michael Stoller
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Raphael Grossenbacher
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christine Tschannen
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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16
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Reddy S, Pancholy PS, Pandya KP, Rai A, Patel AT, Chauhan S, Gilchrist IC. Variability of forearm collateral circulation: An observational study of serial hand plethysmography testing. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:766-770. [DOI: 10.1016/j.carrev.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
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17
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Wiemer M, Schäufele T, Schmitz T, Hoffmann S, Comberg T, Eggebrecht H, Langer C. Herzkatheter: Diagnostik und Intervention über die Arteria radialis. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-018-0264-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Brancheau D, Jain SKA, Alexander PB. Same-day dual radial artery puncture examination in patients requiring percutaneous coronary intervention and the incidence of radial artery occlusion. Ther Adv Cardiovasc Dis 2018; 12:77-84. [PMID: 29307269 DOI: 10.1177/1753944717749738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND We sought to investigate the rate of radial artery occlusion (RAO) after same-day dual radial artery puncture. The trans-radial arterial approach (TRA) for diagnostic and interventional procedures has risen significantly in the United States. Although becoming more commonly performed, TRA is not without risk, and a potential complication is RAO. The rate of RAO after same-day dual artery puncture is unknown. METHODS A retrospective analysis of 27 patients who underwent same-day dual radial artery puncture for percutaneous coronary intervention (PCI) at our institution (Providence Heart Institute in Southfield, MI, USA) from November 2011 to December 2013 were included after initially presenting for cardiac catheterization at a non-PCI-capable facility. The study patients were asked to follow up for evaluation of the radial artery, including obtaining a duplex ultrasound evaluation. RESULTS The mean age of the patients was 65 years old with 66% of the patients being male. Of the 27 study participants, there were no symptoms reported that were related to RAO. Overall, one (3.7%) patient had an absent radial pulse. The modified Allen's test was normal in all of the patients with a mean return of palmar flush time of 4 seconds. Duplex ultrasound revealed subtotal RAO in four (14.8%) patients and no patients experienced total occlusion following the intervention. CONCLUSION Dual radial artery puncture appears to be a well-tolerated and viable strategy in patients that are transferred to a PCI-capable hospital for coronary interventions.
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Affiliation(s)
- Daniel Brancheau
- Division of Cardiology, Providence Heart Institute, Providence Hospital and Medical Centers, Southfield, MI, USA Division of Internal Medicine, Providence Hospital and Medical Centers, Southfield, MI, USA
| | - Sachin Kumar Amruthlal Jain
- Division of Cardiology, Providence Heart Institute, Providence Hospital and Medical Centers, Southfield, MI, USA Division of Internal Medicine, Providence Hospital and Medical Centers, Southfield, MI, USA
| | - Patrick B Alexander
- Providence Heart Institute, Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, MI 48075, USA
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19
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Transradial access for cerebrovascular angiography: Evaluation of palmar collateral circulation with hand angiography and its correlation with Allen test. Clin Neurol Neurosurg 2018; 164:14-18. [DOI: 10.1016/j.clineuro.2017.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/29/2017] [Accepted: 10/29/2017] [Indexed: 11/19/2022]
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20
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Bossard M, Mehta SR, Welsh RC, Bainey KR. Utility of Unfractionated Heparin in Transradial Cardiac Catheterization: A Systematic Review and Meta-analysis. Can J Cardiol 2017; 33:1245-1253. [DOI: 10.1016/j.cjca.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022] Open
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21
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Chong AY, Lo T, George S, Ratib K, Mamas M, Nolan J. The effect of pre-procedure sublingual nitroglycerin on radial artery diameter and Allen's test outcome - Relevance to transradial catheterization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:163-167. [PMID: 28923695 DOI: 10.1016/j.carrev.2017.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The radial artery is increasingly used for cardiac procedures, but is a relatively small vessel that is prone to spasm when instrumented. Intra-arterial nitroglycerine has been shown to reduce radial spasm but first requires arterial access. We investigated the effect of pre-procedure sublingual nitroglycerin (NTG) on the diameter of the radial artery in a large cohort of patients. METHODS 305 subjects underwent ultrasound measurement of their radial and ulnar arteries in both arms before and after the administration of 800μg of sublingual NTG. The Allen's test was also performed in the subjects prior to and after NTG. RESULTS Radial artery diameter in this Caucasian study group is larger than that reported for other populations. The administration of sublingual NTG significantly increased the size of the right radial artery from 2.88±0.36mm to 3.36±0.40mm in men and from 2.23±0.37 up to 2.74±0.36mm in women. There were also significant increases in left radial, right and left ulnar artery diameters in males and females with NTG. There was no significant effect of NTG on blood pressure. In all patients with an unfavourable Allen's test, retesting following sublingual NTG resulted in transition to a favourable Allen's. CONCLUSION Caucasian populations have larger calibre radial arteries compared to other geographic areas. Sublingual NTG is effective at dilating the radial artery in both men and women. This may make radial artery puncture and cannulation less challenging and should be considered in all patients in the absence of contraindications. The results of Allen's testing are dynamic and its usefulness for screening prior to transradial access is undetermined.
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Affiliation(s)
| | - Ted Lo
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Sudhakar George
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
| | - Karim Ratib
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - James Nolan
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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22
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Hahalis G, Deftereos S, Bertrand OF. Ulnar artery: The Ulysses ultimate resort for coronary procedures. Hellenic J Cardiol 2016; 57:S1109-9666(16)30146-4. [PMID: 27712911 DOI: 10.1016/j.hjc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.
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23
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Goswami R, Oliphant CS, Youssef H, Morsy M, Khouzam RN. Radial Artery Occlusion After Cardiac Catheterization: Significance, Risk Factors, and Management. Curr Probl Cardiol 2016; 41:214-227. [DOI: 10.1016/j.cpcardiol.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Wagener JF, Rao SV. Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 2015; 17:489. [PMID: 25651786 DOI: 10.1007/s11883-015-0489-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Radial artery occlusion (RAO) is the most common complication of the transradial approach (TRA) to cardiac catheterization, with a reported incidence between 0.8 % and 30 %. RAO is likely the result of acute thrombus formation and complicated by neointimal hyperplasia. Most RAO are asymptomatic with rare cases of acute hand or digit ischemia reported in the literature. The role of testing for dual circulation to the hand in determining the safety of TRA as it relates to symptomatic RAO is controversial; however, modifiable risk factors like low sheath-to-artery ratio, adequate anticoagulation, and non-occlusive ("patent") hemostasis are likely to prevent RAO. This review examines the incidence of RAO, potential mechanisms leading to RAO, and strategies to prevent and treat RAO.
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Affiliation(s)
- John F Wagener
- Duke University Medical Center, 1828 Country Lane, Durham, NC, 27713, USA,
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25
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Edris A, Gordin J, Sallam T, Wachsner R, Meymandi S, Traina M. Facilitated patent haemostasis after transradial catheterisation to reduce radial artery occlusion. EUROINTERVENTION 2015; 11:765-71. [PMID: 26603985 PMCID: PMC4777335 DOI: 10.4244/eijv11i7a153] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS This study sought to evaluate the feasibility of a rapid deflation technique (RDT) after transradial catheterisation to achieve patent haemostasis and to assess whether this could reduce radial artery occlusion (RAO). Ensuring patent haemostasis is the most important factor in reducing RAO. The use of larger sheath sizes and antiplatelet and antithrombotic agents limits achieving patent haemostasis immediately after transradial intervention. METHODS AND RESULTS A feasibility assessment was first performed in 105 patients to assess whether RDT could be performed safely and consistently achieve patent haemostasis after transradial catheterisation. Prospective data were then collected on 201 patients who underwent either rapid or standard deflation technique and had RAO assessment at 24 hours. Acute coronary syndrome was the indication for transradial catheterisation in 62.7% of patients. Baseline patent haemostasis increased from 40% to 95% after RDT. RAO at 24 hours was seen in two (2.0%) patients in the RDT group and 15 (14.9%) in the standard deflation group (OR 0.117; 95% CI: 0.026 to 0.526, p=0.005). Other independent predictors of RAO included body surface area (OR 0.022; 95% CI: 0.002 to 0.273, p=0.003) and male sex (OR 0.298; 95% CI: 0.108 to 0.824, p=0.020). No significant difference was found in safety outcomes: need to re-inflate compression band (2% versus 1.8%) or haematoma (0% versus 0.9%). CONCLUSIONS Rapid deflation of the compression band after transradial catheterisation is a safe and effective method of achieving patent haemostasis that reduces RAO.
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Affiliation(s)
| | - Jonathan Gordin
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tamer Sallam
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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26
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Sciahbasi A, Rigattieri S, Sarandrea A, Cera M, Di Russo C, Fedele S, Romano S, Penco M, Rocco Pugliese F. Radial artery occlusion and hand strength after percutaneous coronary procedures: Results of the HANGAR study. Catheter Cardiovasc Interv 2015; 87:868-74. [PMID: 26269451 DOI: 10.1002/ccd.26142] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/27/2015] [Accepted: 07/17/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this prospective study was to evaluate muscle force of the hand, thumb, and forefinger in patients with prolonged radial occlusion after transradial percutaneous coronary procedures. BACKGROUND There are no data on hand strength and function in patients with prolonged radial occlusion after percutaneous coronary procedures. METHODS Elective patients with chronic stable angina undergoing percutaneous coronary procedures were evaluated the day before the procedure for radial artery patency, Allen test, hand grip, and thumb and forefinger pinch tests. The same measures were performed the day after the procedure and at follow-up. At follow-up, patients were divided in two groups according to the radial patency (group 1) or occlusion (group 2). RESULTS Of the 99 patients included in the study, 90 patients had a patent radial artery (group 1), and nine (9.1%) patients had an occluded artery (group 2). At baseline, there were no significant differences in hand grip test between the two groups (42 ± 11 kg in group 1 and 41 ± 17 kg in group 2, P = 0.74). In both groups, after the procedure, the hand grip test values was significantly reduced compared with baseline values (40 ± 11 kg in group 1, P < 0.0001 and 37 ± 17 kg in group 2, P = 0.007). Finally, at follow-up, in both groups, the hand grip test values returned to baseline values. Thumb and forefinger pinch tests did not show significant differences after the procedure and at follow-up, compared with baseline. CONCLUSIONS Radial artery occlusion after percutaneous coronary procedures was not associated with a reduction in hand and finger strength.
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Affiliation(s)
| | | | | | - Maria Cera
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Cristian Di Russo
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Silvio Fedele
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Silvio Romano
- Department of Cardiology, University of L'aquila, L'aquila, Italy
| | - Maria Penco
- Department of Cardiology, University of L'aquila, L'aquila, Italy
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27
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Chugh SK, Chugh Y, Chugh S. How to tackle complications in radial procedures: Tip and tricks. Indian Heart J 2015; 67:275-81. [PMID: 26138190 DOI: 10.1016/j.ihj.2015.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/18/2022] Open
Abstract
Transradial interventions (TRI) are becoming increasingly popular because of accumulating recent evidence suggesting improved survival and reduced morbidity. Complications, though rare, do occur, especially for operators on their learning curve. The complications are best prevented by utilization of proper technique. Forearm hematoma are preventable and easy to treat, but a delay in detecting and managing them can lead to disastrous consequences compartment syndrome being the most dreaded one. This review deals with tips and tricks to prevent as also treat the common and rare complications.
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Affiliation(s)
| | - Yashasvi Chugh
- Resident, Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Sunita Chugh
- Consultant in Non-invasive Cardiology at TMH, India
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van Leeuwen MAH, van Mieghem NM, Lenzen MJ, Selles RW, Hoefkens MF, Zijlstra F, van Royen N. The effect of transradial coronary catheterization on upper limb function. JACC Cardiovasc Interv 2015; 8:515-23. [PMID: 25819177 DOI: 10.1016/j.jcin.2014.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/08/2014] [Accepted: 10/23/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the change of upper limb function when percutaneous coronary procedures were performed through the radial artery. BACKGROUND It is currently unknown if upper limb function is affected by transradial (TR) catheterization. METHODS Between January 2013 and February 2014, upper limb function was assessed in a total of 338 patients undergoing coronary catheterization in an ambulatory setting (85% radial approach, 15% femoral approach). Upper limb function was assessed with the self-reported shortened version of the Disabilities of Arm, Shoulder, and Hand questionnaire. The presence and severity of upper extremity cold intolerance was assessed with the self-reported Cold Intolerance Symptom Severity questionnaire. Both questionnaires were completed before the catheterization and at 30-day follow-up. Higher scores represent worse upper limb functionality or symptoms. The nonparametric Wilcoxon signed-rank test was used to assess the change of upper limb function and symptoms over time. RESULTS Upper limb function did not change significantly over time when catheterization was performed through the radial artery (p=0.06). The number of procedure-related extremity complaints that persisted during 30-day follow-up were not different between both access groups (TR access 10.5%, transfemoral access 11.5%; p=0.82). The upper extremity was not affected by cold intolerance after TR access at 30-day follow-up (p=0.91). CONCLUSIONS Upper limb function was not affected when coronary catheterizations and interventions were performed through the radial artery.
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Affiliation(s)
| | - Nicolas M van Mieghem
- Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mirjam F Hoefkens
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
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Gokhroo R, Bisht D, Padmanabhan D, Gupta S, Kishor K, Ranwa B. Feasibility of ulnar artery for cardiac catheterization: AJmer ULnar ARtery (AJULAR) catheterization study. Catheter Cardiovasc Interv 2015; 86:42-8. [DOI: 10.1002/ccd.25806] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/25/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Rajendra Gokhroo
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Devendra Bisht
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Deepak Padmanabhan
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Sajal Gupta
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Kamal Kishor
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Bhanwar Ranwa
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
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Truesdell AG, Delgado GA, Blakeley SW, Bachinsky WB. Transradial peripheral vascular intervention: challenges and opportunities. Interv Cardiol 2015. [DOI: 10.2217/ica.14.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chim H, Bakri K, Moran SL. Complications related to radial artery occlusion, radial artery harvest, and arterial lines. Hand Clin 2015; 31:93-100. [PMID: 25455360 DOI: 10.1016/j.hcl.2014.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent publications have suggested that there may be an important role for the radial artery regarding long-term perfusion of the hand. The increasing popularity of the radial artery as an access site for cardiac catheterization has also resulted in the recognition of acute and chronic radial artery occlusion, and cardiologists have placed renewed emphasis on preserving the patency of this artery for future interventional procedures. This article reviews the present literature on radial artery harvest and occlusion. Also discussed are the complications associated with radial artery occlusion and treatment options to prevent such complications.
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Affiliation(s)
- Harvey Chim
- Division of Plastic Surgery, University of Miami Medical Center, 1600 Northwest 10th Avenue #1140, Miami, FL 33136, USA
| | - Karim Bakri
- Division of Plastic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Transradial coronary catheterization and intervention across the whole spectrum of Allen test results. J Am Coll Cardiol 2014; 63:1833-41. [PMID: 24583305 DOI: 10.1016/j.jacc.2013.12.043] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the safety and feasibility of transradial coronary catheterization across the whole spectrum of Allen test (AT) results. BACKGROUND Whether the AT can predict ischemic complications after transradial access (TRA) is controversial. No prospective assessment exists on the safety and feasibility of TRA across the whole spectrum of AT results. METHODS From October 2007 to June 2009, a total of 942 patients undergoing TRA were screened, and 203 were recruited, of whom 83, 60, and 60 had normal, intermediate, and abnormal AT results, respectively. Patients underwent serial assessments of thumb capillary lactate (the primary endpoint), thumb plethysmography, and ulnar frame count to investigate the patency of the ulnopalmar arches, as well as handgrip strength tests to examine the isometric strength of the hand and forearm muscles and discomfort ratings. RESULTS Lactate did not differ among the 3 study groups after the procedure (1.85 ± 0.93 mmol/l in patients with normal AT results, 1.85 ± 0.66 mmol/l in those with intermediate results, and 1.97 ± 0.71 mmol/l in those with abnormal results; p = 0.59) or at other time points during the study. Plethysmographic readings showed improvements of ulnopalmar collateralization in patients with non-normal AT results, whereas the ulnar frame count was decreased, suggesting enhanced ulnar flow, in patients with abnormal AT results after TRA. Handgrip strength test results and discomfort ratings did not differ across AT groups. No hand ischemic complications occurred. CONCLUSIONS This study provides proof of concept for a paradigm shift in cardiovascular intervention, suggesting the safety and feasibility of TRA across the whole spectrum of AT results. Given the multiple implications of our findings, a broader clinical validation is needed. (Predictive Value of Allen's Test Result in Elective Patients Undergoing Coronary Catheterization Through Radial Approach [RADAR]; NCT00597324).
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Kotowycz MA, Johnston KW, Ivanov J, Asif N, Almoghairi AM, Choudhury A, Nagy CD, Sibbald M, Chan W, Seidelin PH, Barolet AW, Overgaard CB, Džavík V. Predictors of Radial Artery Size in Patients Undergoing Cardiac Catheterization: Insights From the Good Radial Artery Size Prediction (GRASP) Study. Can J Cardiol 2014; 30:211-6. [DOI: 10.1016/j.cjca.2013.11.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/02/2013] [Accepted: 11/21/2013] [Indexed: 11/26/2022] Open
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[Is the Allen test still useful in patients undergoing transradial cardiac coronary angiography?]. Ann Cardiol Angeiol (Paris) 2013; 62:419-23. [PMID: 24200351 DOI: 10.1016/j.ancard.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The last decade has seen an increasing use of the radial artery access for coronary angiography as it combines low rates of vascular complications and early mobilization. Since its description by Campeau the percutaneous transradial access was associated with low rates of occlusion but although the incidence of ischemia is uncommon, consequences can be disastrous. That's why assessment of collateral circulation of the hand is required. Traditionally the modified Allen test was used as a tool to assess palmar arch collaterals but no consensus exists about its proper role. So the purpose of our review is to see if the modified Allen test can predict ischemic complications of the hand and if it still should be done.
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Gokhroo RK, Kaushik SK, Padmanabhan D, Bisht D, Gupta S. A single center multioperator initial experience of 4,195 patients at a primary radial intervention program in a tertiary level center. Indian Heart J 2013; 66:169-75. [PMID: 24814110 DOI: 10.1016/j.ihj.2013.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 05/27/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There has been an increase the acceptability and the number of the procedures via the radial approach. We present our experience pertaining to the clinical characteristics, procedural details and post procedural outcome of patients undergoing radial artery access, coronary angiographies over a period of 4 years at a primary care tertiary level center. MATERIALS AND METHODS A retrospective analysis of all the coronary artery procedures during the last 4 years was done and the various parameters related to these procedures noted. RESULTS In 4195 procedures performed, success in radial artery procedures was achieved in 3975 (94.8%) procedures. The average puncture time and total procedure time was 9.5 + 3 min (min) and 15 + 2.5 min in the initial 500 patients, whereas the times taken in the final 695 patients were just 1.5 + 0.5 min and 3.0 + 1.5 min respectively. The total fluoroscopy time was not significantly different among the groups, when performed by an operator with training in the femoral route for angiography. Cardiology fellows needed more fluoroscopy time when mastering the radial route. Crossover of access sites was seen in 220 patients (5.2%). CONCLUSIONS After 100 procedures, radial access coronary angiographies take less than 4.5 min, with first attempt radial artery access and negligible complication rates. Prior experience of coronary angiography helps in the reduction of fluoroscopy time during the learning curve.
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Affiliation(s)
- Rajendra K Gokhroo
- Professor & Head of Department, Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan 301009, India
| | - Satish K Kaushik
- Principal and Controller, Professor & Head of Department, Post Graduate Department of Cardiology, R.N.T Medical College, Udaipur, Rajasthan 313001, India
| | - Deepak Padmanabhan
- Fellow Cardiology, Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan 301009, India.
| | - Devendra Bisht
- Fellow Cardiology, Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan 301009, India
| | - Sajal Gupta
- Fellow Cardiology, Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan 301009, India
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Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, Sabate M, Mauri-Ferré J, Huber K, Niemelä K, Haude M, Wijns W, Dudek D, Fajadet J, Kiemeneij F. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EUROINTERVENTION 2013; 8:1242-51. [PMID: 23354100 DOI: 10.4244/eijv8i11a192] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.
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Affiliation(s)
- Martial Hamon
- Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France.
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Hahalis G, Tsigkas G, Xanthopoulou I, Deftereos S, Ziakas A, Raisakis K, Pappas C, Sourgounis A, Grapsas N, Davlouros P, Galati A, Plakomyti TE, Mylona P, Styliadis I, Pyrgakis V, Alexopoulos D. Transulnar compared with transradial artery approach as a default strategy for coronary procedures: a randomized trial. The Transulnar or Transradial Instead of Coronary Transfemoral Angiographies Study (the AURA of ARTEMIS Study). Circ Cardiovasc Interv 2013; 6:252-61. [PMID: 23735472 DOI: 10.1161/circinterventions.112.000150] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ulnar artery is rarely selected for coronary angiography or percutaneous coronary intervention despite the expanding use of the transradial approach. We aimed to establish noninferiority of a default transulnar relative to transradial approach in terms of feasibility and safety. METHODS AND RESULTS This was a prospective, randomized, multicenter, parallel-group study involving 902 patients at 5 sites eligible to undergo diagnostic coronary angiography and percutaneous coronary intervention. Patients were randomized in a 1:1 ratio to either transradial approach (reference intervention) or transulnar approach (experimental intervention) regardless of the Allen test results. The primary end point was a composite of cross-over to another arterial access, major adverse cardiovascular events, and major vascular events of the arm at 60 days. The study was prematurely terminated after the first interim analysis because of inferiority of the transulnar approach. Although the difference in the primary end point became inconclusive after adjustment for operator clustering (24.30%; 99.99% confidence interval [CI], -7.98% to 56.58%; P=0.03 at α=0.0001), need for cross-over in the transulnar group remained inferior to transradial access site with a difference of 26.34% (95% CI, 11.96%-40.69%; P=0.004). CONCLUSIONS As a result of higher cross-over rates, a first-line transulnar strategy was proven inferior to the transradial approach for coronary procedures. At present, the transulnar route should not be regarded as an acceptable alternative to the transradial access site.
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Affiliation(s)
- George Hahalis
- Department of Cardiology, Patras University Hospital, Patras, Greece.
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Nibber A, Whayne TF. Advantages and concerns regarding transradial cardiac catheterization. Angiology 2013; 65:95-7. [PMID: 23580617 DOI: 10.1177/0003319713483541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amisha Nibber
- 1Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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40
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Romagnoli E, Mann T, Sciahbasi A, Pendenza G, Biondi-Zoccai GGL, Sangiorgi GM. Transradial approach in the catheterization laboratory: Pros/cons and suggestions for successful implementation. Int J Cardiol 2013; 163:116-24. [PMID: 22137451 DOI: 10.1016/j.ijcard.2011.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 09/07/2011] [Accepted: 11/01/2011] [Indexed: 02/05/2023]
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41
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Wang S, Asif A. Transradial approach for cardiovascular interventions and its implications for hemodialysis vascular access. Semin Dial 2012; 26:E20-9. [PMID: 23174026 DOI: 10.1111/sdi.12044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Because of its advantages, the transradial approach for cardiovascular interventions has gained significant popularity. However, this approach can be associated with radial artery thrombosis and occlusion. The complication generates a major concern for its potential impact on the future creation of an arteriovenous hemodialysis access. The issue gains more importance as a significant number of patients with cardiovascular disease suffer from underlying chronic kidney disease (CKD) and might need an arteriovenous access for hemodialysis therapy. In this context, the preservation of the arterial system is of equal importance to the frequently highlighted venous conservation for the successful creation of an arteriovenous access. It is for this reason that the Fistula First Breakthrough Initiative recommends avoiding the use of the radial artery for performing percutaneous interventions in patients with advanced CKD. Furthermore, there is scarce clinical data and publication regarding the impact of transradial approach on hemodialysis access. Is it possible to utilize the potential benefits and minimize the potential risks of transradial approach in chronic kidney disease patients? On the basis of current knowledge, this review discusses related issues of transradial approach to raise awareness and understanding, which are essential to proper caring of CKD patients undergoing cardiovascular interventions.
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Affiliation(s)
- Shouwen Wang
- AKDHC-ASC, Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona 85012, USA.
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Rao SV, Bernat I, Bertrand OF. Remaining challenges and opportunities for improvement in percutaneous transradial coronary procedures. Eur Heart J 2012; 33:2521-6. [DOI: 10.1093/eurheartj/ehs169] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Affiliation(s)
- Mark A. Kotowycz
- From the Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Vladimír Džavík
- From the Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012; 4:65-93. [PMID: 22980117 PMCID: PMC4777042 DOI: 10.5539/gjhs.v4n1p65] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 12/29/2011] [Indexed: 12/17/2022] Open
Abstract
Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading.
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Dandekar VK, Vidovich MI, Shroff AR. Complications of transradial catheterization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:39-50. [DOI: 10.1016/j.carrev.2011.08.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/19/2011] [Accepted: 08/24/2011] [Indexed: 01/30/2023]
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Babunashvili A, Dundua D. Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure. Catheter Cardiovasc Interv 2011; 77:530-6. [PMID: 20939038 DOI: 10.1002/ccd.22846] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Late radial artery (RA) thrombosis occurs in 3-9% after transradial interventions. RA occlusion has made this approach unsuitable for repeat interventions and obviated the need for alternative vascular access for catheterization, e.g., left RA (with certain risk of bilateral RA occlusion) or femoral artery with its shortcomings and, sometimes, life-threatening complications requiring surgical treatment (large groin hematoma, arterio-venous fistula or false aneurysm, retroperitoneal hemorrhage). We demonstrate the possibility of retrograde RA recanalization, dilatation, and restoration of the RA patency within 6 days after first transradial coronary diagnostic catheterization complicated with acute RA occlusion. Thus we were able to recanalize previously occluded RA and reuse it for repeat transradial coronary interventions.
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Hamon M, Mehta S, Steg PG, Faxon D, Kerkar P, Rupprecht HJ, Tanguay JF, Afzal R, Yusuf S. Impact of transradial and transfemoral coronary interventions on bleeding and net adverse clinical events in acute coronary syndromes. EUROINTERVENTION 2011; 7:91-7. [DOI: 10.4244/eijv7i1a16] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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de Bucourt M, Teichgräber U. Digital Ischemia and Consecutive Amputation After Emergency Transradial Cardiac Catheter Examination. Cardiovasc Intervent Radiol 2011; 35:1242-4. [DOI: 10.1007/s00270-011-0157-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ruzsa Z, Pintér L, Kolvenbach R. Anterograde recanalisation of the radial artery followed by transradial angioplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:266.e1-4. [DOI: 10.1016/j.carrev.2010.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/08/2010] [Accepted: 01/12/2010] [Indexed: 11/28/2022]
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Wilson SR, Grunstein I, Hirvela ER, Price DD. Ultrasound-Guided Radial Artery Catheterization and the Modified Allen's Test. J Emerg Med 2010; 38:354-8. [DOI: 10.1016/j.jemermed.2008.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 10/04/2007] [Accepted: 11/07/2007] [Indexed: 10/21/2022]
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