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Onodera K, Yoshimura M, Azekami K, Kimura R, Yahagi N, Kajimoto R, Kohyama S. Feasibility and radial artery occlusion rate of sheathless distal transradial access using balloon guide catheters. Neurosurg Rev 2024; 47:795. [PMID: 39400610 DOI: 10.1007/s10143-024-02994-w] [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: 08/09/2024] [Revised: 09/26/2024] [Accepted: 10/02/2024] [Indexed: 10/15/2024]
Abstract
Distal transradial access (dTRA), performed through an anatomical snuffbox, minimizes post-procedural burdens of endovascular treatments. However, despite the benefits of balloon-guide catheters (BGCs), their use in dTRA is limited by their small radial artery diameter. Herein, we evaluated the feasibility and radial artery occlusion (RAO) rate of 8Fr BGCs used in sheathless dTRA. This retrospective study reviewed patients treated with sheathless dTRA using an 8Fr Optimo at a single center between July 2023 and May 2024. dTRA procedures were performed under general anesthesia in patients not requiring urgent treatment. The RAO was assessed using ultrasonography 24 h after the procedure. The demographic and procedural characteristics were compared between the radial artery patency and occlusion groups. Of 170 patients, 50 underwent dTRA, and 43 (86%) completed the procedure. RAO occurred in 12/43 (28%) patients with dTRA. Univariate and receiver operating characteristic curve analyses demonstrated that the median radial artery diameter was significantly smaller in the RAO group (P < 0.001), with an optimal cut-off value of 2.4 mm to predict RAO. Complications included minor cerebral ischemia in two patients, but no severe ischemia was observed. Sheathless dTRA using an 8Fr Optimo BGC is feasible, but the risk of RAO should be noted, particularly in patients with small radial artery diameters. This study suggests a radial artery diameter cutoff value of 2.4 mm to predict RAO, aiding access decisions for large-bore BGC. Further multicenter prospective studies are warranted to confirm these findings and assess long-term outcomes.
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Affiliation(s)
- Koki Onodera
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan.
| | - Masataka Yoshimura
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan
| | - Kuya Azekami
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan
| | - Ryutaro Kimura
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan
| | - Noriyuki Yahagi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan
| | - Ryuta Kajimoto
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama Prefecture, 350-1298, Japan
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Xu X, Wang Z, He H, Shi W, Zeng W, Zhu Z, Liu X, Wang Z, Zhang Y. Compensatory response of the radial and ulnar arteries after radial artery cannulation in hypertensive patients. J Clin Anesth 2024; 99:111646. [PMID: 39383729 DOI: 10.1016/j.jclinane.2024.111646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/17/2024] [Accepted: 09/28/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Limited literature exists on the vascular reactivity of the radial and ulnar arteries in hypertensive patients following radial artery cannulation. This study assessed the vascular reactivity of the radial and ulnar arteries by comparing Doppler images and laser speckle contrast imaging (LSCI) obtained from both normotensive and hypertensive patients after radial artery cannulation under general anesthesia. METHODS This study recruited 99 normotensive and 99 hypertensive patients who required arterial cannulation under general anesthesia. In the course of research, to evaluate the impact of hypertension on arterial reactivity, we employed duplex Doppler ultrasonography to measure the inner diameter (ID), resistance index (RI) and mean volume flow (MVF) of both arteries at five different time points. We equally performed perfusion of thumb and little finger by laser speckle contrast imaging. RESULTS After radial artery cannulation, the hypertensive group showed less increase in radial ID and less decrease in RI compared to the normotensive group. The MVF increase was also less pronounced in hypertensive patients, while both groups demonstrated equivalent ulnar ID changes, and the normotensive group exhibited a more significant decrease in RI and a greater MVF increase. Thumb perfusion decreased post-cannulation in both groups, with the hypertensive group showing a less robust recovery. Little finger perfusion increased after artery cannulation in both groups, but the hypertensive group's increase was lower. The incidence of vasospasm in the hypertensive group is higher than that in the normotensive group. CONCLUSIONS The radial and ulnar arteries in hypertensive patients may lack a compensatory response to radial artery cannulation during general anesthesia.
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Affiliation(s)
- Xinpeng Xu
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Zhiwei Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Hongying He
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Wenyan Shi
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Wei Zeng
- Department of Ultrasound, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Zhaoqiong Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Xingkui Liu
- School of Anesthesiology, Zunyi Medical University, ZunYi, GuiZhou, China
| | - Zhao Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China
| | - Yi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, GuiZhou, China.
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Didagelos M, Pagiantza A, Papazoglou AS, Moysidis DV, Petroglou D, Daios S, Anastasiou V, Theodoropoulos KC, Kouparanis A, Zegkos T, Kamperidis V, Kassimis G, Ziakas A. Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization. J Clin Med 2024; 13:3276. [PMID: 38892987 PMCID: PMC11173088 DOI: 10.3390/jcm13113276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05-2.83)), (ii) access site cross-over (aOR = 4.33 (1.02-18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00-1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40-4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28-4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29-20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01-3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70-40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06-0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96-0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31-1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42-14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67-32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46-9.87)), either pain (aOR = 2.93 (1.05-8.15)) or numbness (aOR = 4.66 (1.17-18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04-0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.
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Affiliation(s)
- Matthaios Didagelos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - Areti Pagiantza
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
- 424 General Military Hospital, 56429 Thessaloniki, Greece; (D.V.M.); (D.P.)
| | | | | | | | - Stylianos Daios
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - Vasileios Anastasiou
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - Konstantinos C. Theodoropoulos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - Antonios Kouparanis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - Thomas Zegkos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
| | - George Kassimis
- 2nd Department of Cardiology, Hippokration Hospital, 54942 Thessaloniki, Greece;
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.P.); (S.D.); (V.A.); (K.C.T.); (A.K.); (T.Z.); (V.K.); (A.Z.)
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Ying Y, Lin XJ, Chen MJ, Cao Y, Yao YT. Severe ischemia after radial artery catheterization: A literature review of published cases. J Vasc Access 2024; 25:767-773. [PMID: 36267019 DOI: 10.1177/11297298221101784] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Severe ischemia is a rare complication of radial artery catheterization (RAC). This study aims to summarize risk factors of RAC-elicited severe hand ischemia, preventive, and therapeutic management. METHODS Literature search was conducted in eight electronic English and Chinese databases to identify relevant published cases. Data of interest was extracted and analyzed. RESULTS Database search identified 28 articles reporting cases of 57 patients developing hand ischemia following RAC. Patients aged between 1 day and 88 years. The indications for RAC included surgery, shock, cardiac arrest, and Neonatal Intensive Care Unit (NICU) admission. Identified risk factors included pre-existing vascular diseases, hypotension, arterial anatomical abnormality or small diameter, vasoconstrictors, and catheter-related problems. Totally, 18 patients complained pain; 32 developed discoloration; 19 pulselessness; 3 paresthesia; 13 swolleness and 19 coldness. Eventually, 30 patients recovered well, but 20 patients unfortunately underwent digital amputation and three patients deceased due to non-RAC-related causes. CONCLUSION Severe hand ischemia following RAC is a rare complication, with the reported incidence of approximately 0.09%. There is no definite predictor for RAC-related hand ischemia, but patients with risk factors are prone to the occurrence of hand ischemia. It's vital to initiate early recognition and proactive strategies for a best practice RAC insertion.
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Affiliation(s)
- Ying Ying
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xian-Ju Lin
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Min-Juan Chen
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Cao
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Schaeffer CV, Cooke HL, Ghareeb PA. Radial Artery Reconstruction After Iatrogenic Cannulation-Related Occlusion: A Case Report. Cureus 2024; 16:e58214. [PMID: 38741851 PMCID: PMC11090679 DOI: 10.7759/cureus.58214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
A 59-year-old male, with a history of angiogram via the left radial artery during the workup for multi-trauma, presented to the hand clinic with a 14-day history of progressive critical ischemia in the left thumb and index finger, along with dry gangrene of the distal index fingertip. Radial artery occlusion was confirmed on imaging. The patient underwent radial artery thrombectomy, arterial reconstruction with vein graft, and amputation of the index fingertip. Postoperatively, perfusion to the thumb and index finger was restored, resulting in the resolution of associated pain and hypersensitivity. This case demonstrates the delayed presentation of ischemia following radial artery cannulation, which was successfully managed with radial artery thrombectomy and a saphenous vein graft.
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Affiliation(s)
- Christine V Schaeffer
- Department of Plastic and Reconstructive Surgery, University of Kentucky College of Medicine, Lexington, USA
| | - Hayden L Cooke
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Paul A Ghareeb
- Department of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, USA
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6
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Shu HT, Covarrubias O, Shah MM, Muquit ST, Yang VB, Zhao X, Kagabo W, Shou BL, Kalra A, Whitman G, Kim BS, Cho SM, LaPorte DM, Shafiq B. What Factors Are Associated With Arterial Line-Related Limb Ischemia in Patients on Extracorporeal Membrane Oxygenation? A Single-Center Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2023; 37:2489-2498. [PMID: 37735020 DOI: 10.1053/j.jvca.2023.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES The primary purpose of this study was to identify factors associated with the development of arterial line-related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line-related limb ischemia. DESIGN Retrospective cohort study. SETTING A single academic tertiary referral ECMO center. PARTICIPANTS Consecutive patients who were treated with ECMO over 6 years. INTERVENTIONS Use of arterial line. MEASUREMENTS AND MAIN RESULTS A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line-related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation-II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line-associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line-related limb ischemia. CONCLUSIONS Arterial line-related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line-related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results.
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Affiliation(s)
- Henry T Shu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Oscar Covarrubias
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Manuj M Shah
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Siam T Muquit
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor B Yang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiyu Zhao
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Whitney Kagabo
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dawn M LaPorte
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Babar Shafiq
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Muacevic A, Adler JR. An Overview of the Treatment Strategies of Extremities Ischemia in the Intensive Care Unit. Cureus 2023; 15:e33454. [PMID: 36751165 PMCID: PMC9899499 DOI: 10.7759/cureus.33454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate the effect of the peripheral block on peripheral ischemia on the extremities of patients in the intensive care unit (ICU). MATERIALS AND METHODS Sixty-two patients with ischemic peripheral vascular disease were divided retrospectively into two groups; Group 1 (patients who underwent USG-guided infraclavicular or femoral block, n=20) and Group 2 (patients who did not experience any block, n=42). The demographic characteristics of the patients, the diagnosis of hospitalization, the day when the circulatory disorder developed, laboratory tests at the time of diagnosis, other medical treatments applied, presence of inotropic support, the response of ischemia on extremities, amputation, duration of hospital stay, discharge and mortality were compared. RESULTS The most common reason for hospitalization was cerebrovascular disease. There was no statistical difference between the groups regarding age, gender, height, body weight, and diagnosis. There was no statistical difference between the groups regarding hematocrit, lactate, creatinine, and albumin values, the day when the peripheral ischemia developed in extremities, inotropic and prednisolone use, presence of cannulation, length of hospital stays, and mortality. The number of patients discharged from the intensive care unit in Group 1 was significantly higher than in Group 2 (p=0.048). Amputation was performed on one patient in Group 1 and two patients in Group 2. There was a decrease in peripheral ischemia in 14 (70%) of the patients in Group 1 and 25 (59.5%) of the patients in Group 2. CONCLUSIONS Targeted peripheral block techniques for peripheral circulatory disorders for selected ICU patients in conjunction with preventive and medical treatments may decrease peripheral ischemia in extremities and increase ICU discharge.
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8
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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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Dabas A, Katiyar A, Srivastava S, Chadha A, Janardhanapillai R, Bhat K, Chadha D. A single-center 5-year experience of iatrogenic vascular injuries and their outcomes. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Riangwiwat T, Blankenship JC. Vascular Complications of Transradial Access for Cardiac Catheterization. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2020.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transradial access has been increasingly adopted for cardiac catheterization. It is crucial for operators to recognize potential vascular complications associated with radial artery access. Prevention, early detection, and prompt treatment of vascular complications are essential to prevent serious morbidities. This review aims to raise awareness of transradial access vascular complications. Radial artery spasm is treated with intra-arterial verapamil and/or nitroglycerine. Hemorrhagic complications, such as perforation, hematoma, arteriovenous fistula, and pseudoaneurysm, are treated with prolonged compression. Patent hemostasis and adequate anticoagulation are used to prevent radial artery occlusion. Hand ischemia is a rare complication not associated with abnormal results of the Allen or Barbeau test, and can be treated with intra-arterial verapamil, IV heparin, and IV diltiazem. Finally, an attentive monitoring protocol for the timely detection of vascular complications should be implemented in daily practice.
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11
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Kim D, Arbra CA, Simon Ivey J, Burchett P, Gonzalez G, Herrera FA. Iatrogenic Radial Artery Injuries: Variable Injury Patterns, Treatment Times, and Outcomes. Hand (N Y) 2021; 16:93-98. [PMID: 31043063 PMCID: PMC7818042 DOI: 10.1177/1558944719844348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The radial artery is commonly accessed for arterial blood sampling, invasive blood pressure monitoring, and vascular access for cardiac catheterization. Iatrogenic radial artery injury is a rare complication with potentially devastating outcomes. The purpose of our study was to identify the timing of these injuries and define a treatment algorithm. Methods: A retrospective chart review of all patients with iatrogenic radial artery injuries were identified between the years 2008 and 2018. Patient demographics, mechanism of injury, interventions, and outcomes were recorded. Results: A total of 18 patients were identified with iatrogenic radial artery injury over a 10-year period. Fifty percent of these resulted from arterial line cannulation, and 50% occurred after transradial cardiac catheterization. Thirty-three percent resulted in radial artery pseudoaneurysm (RAP), and 66% had acute radial artery thrombosis (RAT). Eleven of the 18 patients underwent operative intervention. Of the 12 patients with RAT, 4 were treated with systemic anticoagulation for 3 months. All patients with RAP who were surgically treated had resolution of symptoms on follow-up evaluation. Of the patients with RAT, 2 had persistent sensorimotor deficits after treatment, and 1 patient had multiple necrotic fingers requiring amputation. Conclusion: Radial artery injuries are an uncommon but potentially devastating complication of common invasive procedures resulting in thrombosis, pseudoaneurysm, or overt hand ischemia. The treatment options vary depending on presenting symptoms.
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Affiliation(s)
- Doris Kim
- Medical University of South Carolina,
Charleston, USA
| | - Chase A. Arbra
- The University of Illinois College of
Medicine, Chicago, USA
| | - J. Simon Ivey
- Medical University of South Carolina,
Charleston, USA
| | | | | | - Fernando A. Herrera
- Medical University of South Carolina,
Charleston, USA,Ralph H. Johnson VA Medical Center,
Charleston, SC, USA,Fernando A. Herrera, Division of Plastic,
Reconstructive and Hand Surgery, Medical University of South Carolina, 96
Jonathan Lucas Street, Charleston, SC 29425, USA.
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12
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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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13
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Dorigo W, Fargion A, Paperetti L, Falso R, Bonizzoli M, Fontanari P, Poggesi L, Pratesi C. Increased rates of hand ischemia following arterial cannulation in patients with severe COVID19-related pneumonia. Thromb Res 2020; 194:33-35. [DOI: 10.1016/j.thromres.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 12/30/2022]
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14
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Earl TJ. Acute Hand Ischemia and Digital Amputation After Transradial Coronary Intervention in a Patient With CREST Syndrome. Tex Heart Inst J 2020; 47:319-321. [PMID: 33472228 DOI: 10.14503/thij-19-6988] [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 radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.
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Affiliation(s)
- Thomas J Earl
- Michigan Heart & Vascular Specialists, McLaren Northern Michigan, Petoskey, Michigan 49770
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15
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Miller TJ, Lin WC, Safa B. Radial Artery Occlusion in a Patient With Lupus, Antiphospholipid Syndrome, and Raynaud Phenomenon: A Multimodal Approach. J Hand Surg Am 2020; 45:664.e1-664.e5. [PMID: 31585746 DOI: 10.1016/j.jhsa.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/09/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023]
Abstract
Radial artery occlusion (RAO) is a known complication of transradial catheterization for cardiac procedures. The transradial approach has decreased bleeding complications compared with the transfemoral approach, but risks provoking hand ischemia. We present a case of a 29-year-old peripartum woman with a history of lupus, antiphospholipid syndrome, and Raynaud phenomenon who developed RAO with hand-threatening ischemia despite therapeutic anticoagulation. Given the patient's medical history, a multimodal approach was applied including thrombectomy, arterial bypass, venous arterialization, and onobotulinum toxin A sympathectomy. The patient's ischemia improved after the procedure, and she regained normal use of the hand.
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Affiliation(s)
- Travis J Miller
- The Buncke Clinic, San Francisco, CA; Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA.
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16
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Agarwal T, Agarwal V, Agarwal P, Thakur S, Bobba R, Sharma D. Assessment of collateral hand circulation by modified Allen's test in normal Indian subjects. J Clin Orthop Trauma 2020; 11:626-629. [PMID: 32684700 PMCID: PMC7355091 DOI: 10.1016/j.jcot.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Allen's test (AT) and Modified Allen's Test (MAT) are used as screening methods for assessment of the hand circulation. Few people lack the dual blood supply of hand and are at risk of hand ischemia after any intervention on radial artery. The Purpose of the study was to assess the collateral circulation of hand using MAT in normal Indian subjects and in elderly population to know the prevalence of positivity of Allen's test. METHODS 900 participants (1800 hands) were divided in two groups. Group I had participants with age <50 years and group II had participants with age ≥50 years. MAT was performed in all participants and results were compared between the two groups. RESULTS In group I (n = 450, 900 hands), 313 were males and 137 were females, with mean age of 35.04 years. The relative percentages of a normal, equivocal, borderline and abnormal MAT were 77.8%, 16.6%, 3.7% and 1.6%, respectively. In group II (n = 450, 900 hands), 248 were males and 202 were females, with mean age of 60.4 years. The relative percentages of a normal, equivocal, borderline and abnormal MAT were 69.0%, 18.6%, 6.60% and 5.66%, respectively. A positive/abnormal test was significantly more common (5.66% Vs 1.66%, P < 0.00001) in older group. CONCLUSION MAT is simple, time tested and non invasive test to assess collateral circulation of the hand. A negative MAT safely selects patients for radial artery harvest; however, if the test is positive and in older patients then a second objective test may be needed.
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Affiliation(s)
| | - Vrinda Agarwal
- DY Patil Medical College Pimpri, Pune, 411018, MS, India
| | - Pawan Agarwal
- NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Sharad Thakur
- NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Rajesh Bobba
- Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Dhananjaya Sharma
- Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India
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17
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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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18
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Elwali A, Moussavi Z. The modified Allen test and a novel objective screening algorithm for hand collateral circulation using differential photoplethysmography for preoperative assessment: a pilot study. J Med Eng Technol 2020; 44:82-93. [DOI: 10.1080/03091902.2020.1723729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ahmed Elwali
- Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada
- Electrical and Computer Engineering Department, University of Manitoba, Winnipeg, Canada
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19
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Hadad MJ, Puvanesarajah V, Deune EG. Complications of Transradial Catheterization and Cannulation. J Hand Surg Am 2019; 44:973-979. [PMID: 31445696 DOI: 10.1016/j.jhsa.2019.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
Transradial catheterization and cannulation are typically well-tolerated procedures, but they are associated with various vascular, infectious, and orthopedic complications. Potential complications include radial artery occlusion, hematoma formation, radial artery laceration, pseudoaneurysm, abscess formation, and compartment syndrome. Hand surgeons are commonly consulted to treat such complications. We review recent evidence available to guide decisions about nonsurgical and surgical interventions to treat and prevent the complications associated with transradial access procedures.
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Affiliation(s)
- Matthew J Hadad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - E Gene Deune
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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20
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Landry GJ, Mostul CJ, Ahn DS, McLafferty BJ, Liem TK, Mitchell EL, Jung E, Abraham CZ, Azarbal AF, McLafferty RB, Moneta GL. Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit. J Vasc Surg 2019; 68:1499-1504. [PMID: 29685512 DOI: 10.1016/j.jvs.2018.01.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. METHODS All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded. ICU patients were compared with concurrently evaluated non-ICU inpatients with finger ischemia. RESULTS There were 98 ICU patients (55 male, 43 female) identified. The mean age was 57.1 ± 16.8 years. Of these patients, 42 (43%) were in the surgical ICU and 56 (57%) in the medical ICU. Seventy (72%) had abnormal findings on finger photoplethysmography, 40 (69%) unilateral and 30 (31%) bilateral. Thirty-six (37%) had ischemia associated with an arterial line. Twelve (13%) had concomitant toe ischemia. Eighty (82%) were receiving vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (31%), epinephrine (26%), and vasopressin (24%). Treatment was with anticoagulation in 88 (90%; therapeutic, 48%; prophylactic, 42%) and antiplatelet agents in 59 (60%; aspirin, 51%; clopidogrel, 15%). Other frequently associated conditions included mechanical ventilation at time of diagnosis (37%), diabetes (34%), peripheral arterial disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Only five patients (5%) ultimately required finger amputation. The 30-day, 1-year, and 3-year survival was 84%, 69%, and 59%. By Cox proportional hazards modeling, cancer (hazard ratio, 2.4; 95% confidence interval, 1.1-5.6; P = .035) was an independent predictor of mortality. There were 50 concurrent non-ICU patients with finger ischemia. Non-ICU patients were more likely to have connective tissue disorders (26% vs 13%; P = .05) and hyperlipidemia (42% vs 24%; P = .03) and to undergo finger amputations (16% vs 5%; P = .03). CONCLUSIONS Finger ischemia in the ICU is frequently associated with the presence of arterial lines and the use of vasopressor medications, of which phenylephrine and norepinephrine are most frequent. Anticoagulation or antiplatelet therapy is appropriate treatment. Whereas progression to amputation is rare, patients with finger ischemia in the ICU have a high rate of mortality, particularly in the presence of cancer. Non-ICU patients hospitalized with finger ischemia more frequently require finger amputations, probably because of more frequent connective tissue disorders.
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Affiliation(s)
- Gregory J Landry
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore.
| | - Courtney J Mostul
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Daniel S Ahn
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Bryant J McLafferty
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Timothy K Liem
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Erica L Mitchell
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Enjae Jung
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Cherrie Z Abraham
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Amir F Azarbal
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Robert B McLafferty
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Gregory L Moneta
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
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21
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Tanwar G, Singariya G, Ujwal S. Gangrene and finger amputation after radial artery cannulation. J Clin Anesth 2018; 54:126. [PMID: 30445413 DOI: 10.1016/j.jclinane.2018.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/09/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Gayatri Tanwar
- Deptt. of Anesthesiology, SP Medical college, Bikaner, Rajasthan, India.
| | - Geeta Singariya
- Deptt. of Anesthesiology, SN Medical college, Jodhpur, Rajasthan, India
| | - Shobha Ujwal
- Deptt. of Anesthesiology, SN Medical college, Jodhpur, Rajasthan, India
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22
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van Leeuwen MAH, Hollander MR, van der Heijden DJ, van de Ven PM, Opmeer KHM, Taverne YJHJ, Ritt MJPF, Kiemeneij F, van Mieghem NM, van Royen N. The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access): A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005753. [PMID: 29127118 DOI: 10.1161/circinterventions.117.005753] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown. METHODS AND RESULTS The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77). CONCLUSIONS Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization.
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Affiliation(s)
- Maarten A H van Leeuwen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Maurits R Hollander
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Peter M van de Ven
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Kim H M Opmeer
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Yannick J H J Taverne
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Marco J P F Ritt
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Ferdinand Kiemeneij
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Nicolas M van Mieghem
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Niels van Royen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.).
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23
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Khalifeh A, Khashab T, Huffner M, Rezvani ZN, Kwan J, Toursavadkohi S. Radial neuropathy following arterial line removal: A rare complication from a routine ICU procedure. SAGE Open Med Case Rep 2018; 6:2050313X18760740. [PMID: 29511544 PMCID: PMC5833207 DOI: 10.1177/2050313x18760740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
Radial artery thrombosis is a rare complication of cannulation. There are no reported cases of acute thrombosis and severe acute neuropathy in the setting of cannula discontinuation. We report a case of acute radial nerve mono-neuropathy following thrombosis after radial arterial line removal. The thrombus was immediately evident on exam and diagnostic imaging after cannula discontinuation. The patient was consented and promptly taken to OR for immediate repair. Mild radial neuropathy persisted despite immediate repair. Immediate recognition of signs and symptoms is essential for diagnosis and management, especially in the high-risk population.
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Affiliation(s)
- Ali Khalifeh
- Division of Vascular Surgery, Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Tamara Khashab
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Michael Huffner
- Division of Vascular Surgery, Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Zahra N Rezvani
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Justin Kwan
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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Mycotic pseudoaneurysm following radial artery catheterization. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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O'Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72:ii1-ii90. [DOI: 10.1136/thoraxjnl-2016-209729] [Citation(s) in RCA: 316] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
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26
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Bojakowski K, Zawadzki M, Mruk B, Andziak P, Walecki J. Critical Hand Ischemia After Radial Access for Coronary Angiography - Case Report. Pol J Radiol 2017; 82:19-23. [PMID: 28144386 PMCID: PMC5248565 DOI: 10.12659/pjr.899334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/10/2016] [Indexed: 11/09/2022] Open
Abstract
Background Radial artery is now the most frequent access for coronary angiography and intervention. Despite the common opinion that it is safer than femoral access, it has the potential for serious complications. One of them is upper limb ischemia caused by radial artery thrombosis. Case Report We are presenting a case of critical hand ischemia after coronary angiography performed through radial access despite existing risk factors, which may be considered as relative contraindications. Conclusions In the presented case, decision was made to use radial access despite several risk factors of upper limb ischemia – diabetes, end-stage renal failure, hyperparathyroidism, or even symptoms of left upper limb ischemia. Furthermore, for diagnostic coronary angiography 5F instead of 4F introducer was used.
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Affiliation(s)
- Krzysztof Bojakowski
- Department of General and Vascular Surgery, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Michał Zawadzki
- Department of Diagnostic and Interventional Radiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Bartosz Mruk
- Department of Diagnostic and Interventional Radiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Piotr Andziak
- Department of General and Vascular Surgery, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Jerzy Walecki
- Department of Diagnostic and Interventional Radiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland; Department of Diagnostic and Interventional Radiology, Medical Centre for Postgraduate Education, Warsaw, Poland
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Han YS, Song S, Sung TJ, Chun J. Successful Management of Severe Peripheral Tissue Ischemia after Arterial Catheterization in Micro Preemies using Humidification & Topical Nitroglycerin. NEONATAL MEDICINE 2017. [DOI: 10.5385/nm.2017.24.4.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yea-Seul Han
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Songyi Song
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Tae-Jung Sung
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Jiyoung Chun
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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Hsueh SK, Cheng CI, Fang HY, Omran MM, Liu WH, Chung WJ, Chen CJ, Yang CH, Fang CY, Wu CJ. Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion. Int Heart J 2017; 58:313-319. [DOI: 10.1536/ihj.16-244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | | | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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Low rate of access site complications after transradial coronary catheterization: A prospective ultrasound study. IJC HEART & VASCULATURE 2016; 14:46-52. [PMID: 28616563 PMCID: PMC5454178 DOI: 10.1016/j.ijcha.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/17/2016] [Accepted: 12/16/2016] [Indexed: 01/16/2023]
Abstract
Background Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the incidence of access site complications in the current interventional era. Methods and results A total of 507 procedures were performed under standardized conditions. Each procedure was performed using high levels of anticoagulation, hydrophilic sheaths, and short post-procedural compression times. Vascular complications were assessed one day after TRA catheterization using Duplex sonography and classified according to the necessity of additional medical intervention. A simple questionnaire helped identifying upper extremity neurologic or motor complications. Vascular complications were detected in 12 patients (2.36%): radial artery occlusion was detected in 9 patients (1.77%), 1 patient developed an AV-fistula (0.19%), and 2 patients had pseudoaneurysms (0.38%). None of the patients required specialized medical or surgical intervention. Under our procedural conditions, small radial artery diameter was the only significant predictor for the development of post-procedural vascular complications (2.11 ± 0.42 mm vs 2.52 ± 0.39 mm, p = 0.001). None of the previously reported risk factors, namely, advanced renal failure, diabetes, acuteness/complexity of procedure, or sheath and catheter size significantly influenced the rate of vascular complications. No major hematoma or local neurologic or motor complications were identified. Conclusions Using current techniques and materials, we report a very low rate of local complications associated with TRA catheterization.
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Erden I, Golcuk E, Bozyel S, Erden EC, Balaban Y, Yalın K, Turan B. Effectiveness of Handmade "Jacky-Like Catheter" As a Single Multipurpose Catheter in Transradial Coronary Angiography: A Randomized Comparison With Conventional Two-Catheter Strategy. J Interv Cardiol 2016; 30:24-32. [PMID: 27910134 DOI: 10.1111/joic.12350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate safety and efficacy of specialized hand-modified "Jacky-Like" catheter (JLC) as a single dual-purpose catheter in transradial coronary angiography. METHODS Patients over 18 years undergoing diagnostic CAG through right radial artery (RRA) were prospectively enrolled. Procedures were performed with a single JLC modified from a left Judkins (JL) 3.5 catheter or by using 2-catheter approach (2C). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded from the study. Three hundred and eighty-seven transradial procedures were performed successfully. One hundred and ninety-four procedures were performed with 2C and 193 procedures with a JLC. Inability to use intended catheters, total fluoroscopic time in minutes, the consumption of contrast medium in milliliter, development of radial artery spasm (RAS), and radial artery occlusion (RAO) were evaluated. RESULTS In the 2C group, angiography was successfully performed on the RCA of 191 patients (98.9%) and on LCA in 192 patients (99.4%). In the JLC group, angiography was successfully performed on the RCA and LCA of 193 (99.4%) and 174 (89.6%) patients, respectively. Utilization of supplemental catheters was significantly greater in the JLC group (21; 10.8%) versus the 2C group (3; 1.5% P = 0.001). Mean fluoroscopy time was shorter in the JLC group (2.0 ± 2.3 min vs. 2.3 ± 1.5 min; P = 0.043). Mean procedure time was also decreased with JLC but did not reach statistical significance (5.7 ± 3.1 min vs. 6.2 ± 2.5 min; P = 0.081). When additional time for reshaping the JLC was not taken into account, mean procedure time was significantly decreased in the JLC group (5.6 ± 2.9 min vs. 6.2 ± 2.4 min; P = 0.031). There was a trend toward lower incidence of consumption of contrast medium in the 2C group (49 ± 13 mL vs. 52 ± 18 mL; P = 0.061). RAS was observed more frequently in the 2C group (11.3% vs. 21.7%, P = 0.005). There was a trend toward high incidence of RAO in the 2C group (4.1 vs. 8.3% P = 0.064). CONCLUSION In transradial procedures from RRA, a JLC catheter can be very effective when dedicated dual-purpose catheter is not available.
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Affiliation(s)
- Ismail Erden
- Department of Cardiology, VM Medicalpark Kocaeli Hospital, Kocaeli, Turkey
| | - Ebru Golcuk
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Emine Cakcak Erden
- Department of Cardiology, VM Medicalpark Kocaeli Hospital, Kocaeli, Turkey
| | - Yakup Balaban
- Department of Cardiology, VM Medicalpark Kocaeli Hospital, Kocaeli, Turkey
| | - Kivanc Yalın
- Department of Cardiology, Bayrampaşa Kolan Hospital, Istanbul, Turkey
| | - Burak Turan
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Halbach J, Lowry D, Nelles M, Ayers J. Extensor pollicis longus tendon compression as the etiology of a true aneurysm of the radial artery in the anatomical snuff box. J Vasc Surg Cases Innov Tech 2016. [DOI: 10.1016/j.jvscit.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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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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Onal O, Salman E, Yetisir F, Kilic M. Hand ischaemia after radial artery cannulation. BMJ Case Rep 2015; 2015:bcr-2015-211145. [PMID: 26243748 DOI: 10.1136/bcr-2015-211145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Arterial cannulation for haemodynamic monitoring has become a routine procedure in the clinical management of critically ill adults. Thrombosis is the most common complication of this procedure. We report the case of a patient with multiple traumatic injuries in which radial artery cannulation was associated with compartment syndrome of the forearm and hand.
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Affiliation(s)
- Ozkan Onal
- Department of Anesthesiology and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Ebru Salman
- Department of Anesthesiology and Intensive Care, Ataturk Educational and Training Hospital, Ankara, Turkey
| | - Fahri Yetisir
- Department of General Surgery, Ataturk Educational and Training Hospital, Ankara, Turkey
| | - Mehmet Kilic
- Department of General Surgery, Ataturk Educational and Training Hospital, Ankara, Turkey
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34
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Yun K, Jeon W, Kang B, Kim G. Effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization. Clin Exp Emerg Med 2015; 2:104-109. [PMID: 27752580 PMCID: PMC5052858 DOI: 10.15441/ceem.14.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 01/11/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate the effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization. Methods A prospective randomized trial was conducted on subjects receiving the standard taping method (group S) compared to a compressive device method (group C) after removal of the cannula in radial artery catheterization. Primary outcomes were the success rate of hemostasis and complication rate after cannula removal. Secondary outcomes were the cost of compression and the level of convenience. Results A total of 250 subjects were enrolled in this study. Hemostasis after removal was successful in 122 of 125 (97.6%) subjects in group S and 116 of 125 (92.8%) subjects in group C (P=0.18). Complication rates in group S and group C were 55.2% (69/125) and 48% (60/125), respectively (P=0.35). The cost of compression for group C (approximately 6,740 Korean won) was approximately two times cheaper than for group S (approximately 14,140 Korean won). The level of convenience was significantly higher in group C than in group S (7.4±2.1 vs. 3.7±1.9, p < 0.001). Conclusion These findings suggest that hemostasis using a compressive device may be a suitable alternative method to the standard taping method in controlling hemorrhage following radial artery cannulation.
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Affiliation(s)
- Kiho Yun
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Woochan Jeon
- Department of Emergency Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Bora Kang
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Giwoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
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35
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Ayan M, Smer A, Azzouz M, Abuzaid A, Mooss A. Hand ischemia after transradial coronary angiography: resulting in right ring finger amputation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:367-9. [PMID: 26152848 DOI: 10.1016/j.carrev.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 11/15/2022]
Abstract
Critical hand ischemia is an extremely rare and serious complication of transradial coronary angiography. It is almost always associated with radial artery occlusion. Early recognition and involvement of vascular surgery is imperative for optimal management. Up to our knowledge, there have been only 5 cases reported in the medical literature. Herein, we describe a case of an 81-year-old male who had undergone transradial coronary intervention complicated by critical hand ischemia requiring amputation of the right 4th finger.
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Affiliation(s)
- Mohamed Ayan
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68164, USA.
| | - Aiman Smer
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68164, USA
| | - Muhammad Azzouz
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68164, USA
| | - Ahmed Abuzaid
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68164, USA
| | - Aryan Mooss
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68164, USA
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36
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Awad H, Quevedo E, Abas M, Brown M, Satiani B, Capers Q, Starr JE. Can the Anesthesiologist Use the Radial Artery for Monitoring After Transradial Artery Catheterization? ACTA ACUST UNITED AC 2015; 4:159-62. [PMID: 26050247 DOI: 10.1213/xaa.0000000000000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of transradial coronary angiography and intervention is growing because of its advantages over the femoral approach. However, the small size of the radial artery can contribute to complications. We present a case of an in situ access complication of transradial coronary artery catheterization. It is important for the anesthesiologist to know about the short-term and long-term consequences of this intervention, which could lead to narrowing of the artery even beyond the site of puncture. Understanding these changes could help anesthesiologists make better decisions about using the radial artery for monitoring after transradial coronary artery catheterization procedures.
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Affiliation(s)
- Hamdy Awad
- From the *Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio; †Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio; and ‡Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Wong VW, Katz RD, Higgins JP. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected]. Hand Clin 2015; 31:121-34. [PMID: 25455362 DOI: 10.1016/j.hcl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction.
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Affiliation(s)
- Victor W Wong
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA.
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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: 29] [Impact Index Per Article: 3.2] [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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Kang JS, Lee TR, Cha WC, Shin TG, Sim MS, Jo IJ, Song KJ, Rhee JE, Jeong YK. Finger necrosis after accidental radial artery puncture. Clin Exp Emerg Med 2014; 1:130-133. [PMID: 27752565 PMCID: PMC5052832 DOI: 10.15441/ceem.14.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/23/2022] Open
Abstract
Radial artery puncture, an invasive procedure, is frequently used for critical patients. Although considered safe, severe complications such as finger necrosis can occur. Herein, we review the clinical course of finger necrosis after accidental radial artery puncture. A 63-year-old woman visited the emergency department (ED) with left second and third finger pain after undergoing intravenous (IV) access in her wrist for procedural sedation. During the IV access, she experienced wrist pain, which increased during the 12 hours prior to her ED presentation. Emergency angiography revealed a pseudoaneurysm in her left radial artery and absence of blood flow to the proper palmar digital artery. Subsequent angiointervention and urokinase thrombolysis failed. The second finger was eventually amputated owing to gangrene. Radial artery puncture can occur accidentally during IV wrist access, resulting in severe morbidity. Providers should carefully examine the puncture site and collateral flow, followed by multiple examinations to ensure distal circulation.
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Affiliation(s)
- Jun Sik Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Rim Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun Jeong Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Eui Rhee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Kwon Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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40
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Acute hand ischemia after radial artery cannulation resulting in amputation. ACTA ACUST UNITED AC 2014; 33:299-302. [DOI: 10.1016/j.main.2014.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/10/2014] [Accepted: 05/03/2014] [Indexed: 11/17/2022]
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Marmagkiolis K, Lendel V, Best JF, Cilingiroglu M. Management of transradial access complications in the cardiac catheterization lab. Int J Cardiol 2014; 173:521-4. [DOI: 10.1016/j.ijcard.2014.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
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Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology 2014; 120:650-64. [PMID: 24424071 DOI: 10.1097/aln.0000000000000008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists. METHODS The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter. RESULTS Our cohort included 334,123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008]; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P < 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9-72.3%]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8-76.2%]; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5-49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9-72.9%], AMOR, 1.69; vasopressors: 71.4% (59.5-85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9-27.3%), AMOR, 1.90). CONCLUSIONS Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.
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Raurell-Torredà M, Del Llano-Serrano C, Almirall-Solsona D, Nicolás-Arfelis JM. Arterial catheter setup for glucose control in critically ill patients: a randomized controlled trial. Am J Crit Care 2014; 23:150-9. [PMID: 24585164 DOI: 10.4037/ajcc2014536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. OBJECTIVES To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia. METHODS In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). RESULTS No patient had catheter-related infection in the intervention group (an estimated 12776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. CONCLUSIONS Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.
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Affiliation(s)
- Marta Raurell-Torredà
- Marta Raurell-Torredà is a professor in the School of Nursing at University of Girona, Spain. César Del Llano-Serrano and Dolors Almirall-Solsona are nurses in the intensive care unit at Consorci Hospitalari de Vic–Hospital General, Vic, Barcelona, Spain. José M. Nicolás-Arfelis is a physician in the intensive care unit, at Hospital Clínic, Barcelona, Spain
| | - César Del Llano-Serrano
- Marta Raurell-Torredà is a professor in the School of Nursing at University of Girona, Spain. César Del Llano-Serrano and Dolors Almirall-Solsona are nurses in the intensive care unit at Consorci Hospitalari de Vic–Hospital General, Vic, Barcelona, Spain. José M. Nicolás-Arfelis is a physician in the intensive care unit, at Hospital Clínic, Barcelona, Spain
| | - Dolors Almirall-Solsona
- Marta Raurell-Torredà is a professor in the School of Nursing at University of Girona, Spain. César Del Llano-Serrano and Dolors Almirall-Solsona are nurses in the intensive care unit at Consorci Hospitalari de Vic–Hospital General, Vic, Barcelona, Spain. José M. Nicolás-Arfelis is a physician in the intensive care unit, at Hospital Clínic, Barcelona, Spain
| | - José M. Nicolás-Arfelis
- Marta Raurell-Torredà is a professor in the School of Nursing at University of Girona, Spain. César Del Llano-Serrano and Dolors Almirall-Solsona are nurses in the intensive care unit at Consorci Hospitalari de Vic–Hospital General, Vic, Barcelona, Spain. José M. Nicolás-Arfelis is a physician in the intensive care unit, at Hospital Clínic, Barcelona, Spain
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Bhat T, Teli S, Bhat H, Akhtar M, Meghani M, Lafferty J, Gala B. Access-site complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther 2014; 10:627-34. [DOI: 10.1586/erc.12.16] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Radial artery occlusion after percutaneous coronary interventions - an underestimated issue. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2013; 9:353-61. [PMID: 24570753 PMCID: PMC3927109 DOI: 10.5114/pwki.2013.38865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/15/2013] [Accepted: 10/30/2013] [Indexed: 12/18/2022] Open
Abstract
The femoral approach is the most common arterial access for percutaneous coronary artery interventions. Despite the convenience and simplicity of this approach, it is burdened with a high risk of arterial puncture bleeding, which worsens the prognosis of the patient. An alternative approach through the radial artery has been gaining more and more popularity in recent years. This is due to a significant reduction of local bleeding complications as compared with the femoral artery approach. The use of the radial approach in patients with ST-segment elevation myocardial infarction improves outcome, reducing the risk of death, subsequent myocardial infarction and stroke, and is the preferred approach according to the latest ESC guidelines. In addition to improving safety, it is beneficial for improving patient comfort, with a shorter recovery after the procedure, shorter hospitalization and lower medical costs. One of the major complications of procedures performed through the radial approach is radial artery occlusion (RAO). Although it usually has an asymptomatic course, RAO eliminates the ability to use the radial artery as an access in the future. A number of factors that contribute to the occurrence of RAO have been identified, such as the size of the sheath and the catheter, diameter ratio of the sheath to the diameter of the radial artery, insufficient anticoagulation and, above all, the way of obtaining hemostasis at the puncture site: the duration of artery compression after sheath removal and the preservation of artery patency during compression (so-called patent hemostasis). This paper presents the current state of the art about the factors that contribute to the occurrence of RAO and methods for preventing this complication.
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Coluccia V, Burzotta F, Trani C, Brancati MF, Niccoli G, Leone AM, Schiavoni G, Crea F. Management of the access site after transradial percutaneous procedures. J Cardiovasc Med (Hagerstown) 2013; 14:705-13. [DOI: 10.2459/jcm.0b013e3283577374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Garg K, Howell BW, Saltzberg SS, Berland TL, Mussa FF, Maldonado TS, Rockman CB. Open surgical management of complications from indwelling radial artery catheters. J Vasc Surg 2013; 58:1325-30. [PMID: 23810262 DOI: 10.1016/j.jvs.2013.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/02/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cannulation of the radial artery is frequently performed for invasive hemodynamic monitoring. Complications arising from indwelling catheters have been described in small case series; however, their surgical management is not well described. Understanding the presentation and management of such complications is imperative to offer optimal treatment, particularly because the radial artery is increasingly accessed for percutaneous coronary interventions. METHODS We conducted a retrospective review to identify patients who underwent surgical intervention for complications arising from indwelling radial artery catheters from 1997 to 2011. RESULTS We identified 30 patients who developed complications requiring surgical intervention. These complications were categorized into ischemic and nonischemic, with 15 patients identified in each cohort. All patients presenting with clinical hand or digital ischemia underwent thrombectomy and revascularization. Complications in the nonischemic group included three patients with deep abscesses with concomitant arterial thrombosis, two with deep abscesses alone, and 10 with pseudoaneurysms. Treatment strategy in this group varied with the presenting pathology. Among the entire case series, three patients required reintervention after the initial surgery, all in individuals initially presenting with ischemia who developed recurrent thrombosis of the radial artery. There were no digital or hand amputations in this series. However, the overall in-hospital mortality in these patients was 37%, reflecting the severity of illness in this patient cohort. Three patients who were positive for heparin-induced thrombocytopenia antibody had 100% mortality compared with those who were negative (P = .04, Fisher exact test). In-hospital mortality was higher in patients presenting with initial ischemia than in those with nonischemic complications (53% vs 20%; P = .06). Among 10 patients who presented with pseudoaneurysms, five (50%) were septic at presentation with positive blood cultures, and six (60%) had positive operating room cultures. Staphylococcus aureus was identified as the causative organism in all of these patients. CONCLUSIONS Complications of radial artery cannulation requiring surgical intervention can represent infectious and ischemic sequelae and have the potential to result in major morbidity, including digital or hand amputation and sepsis, or death. Although surgical treatment is successful and often required in these patients to treat severe hand ischemia, hemorrhage, or vascular infection, these complications tend to occur in critically ill hospitalized patients with an extremely high mortality. This must be taken into consideration when planning surgical intervention in this patient cohort. Finally, radial arterial cannulation sites should not be overlooked when searching for occult septic sources in critically ill patients.
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Affiliation(s)
- Karan Garg
- Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY
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Bauer S, Savundra J. Temporary arterial stenting in a full-house spaghetti wrist injury in a remote rural setting: benefit for hand perfusion or risk of increased morbidity? BMJ Case Rep 2013; 2013:bcr-2013-008575. [PMID: 23505277 DOI: 10.1136/bcr-2013-008575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of temporary arterial plastic tube stenting of the ulnar and radial artery in a complete spaghetti wrist injury in a remote rural setting. Exploration in a specialist centre 18 h postinjury revealed that the tubes were clotted off with adjacent thrombi but hand perfusion was maintained. Intimal damage required vein grafting of both arteries 24 h postinjury. Hand perfusion was not compromised at follow-up. This case highlights that arterial hand perfusion can be maintained without the ulnar and radial artery. Arterial manipulation and tube insertion outside a specialist centre bears the risk of increased morbidity and potential microembolism and must therefore not be attempted.
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Affiliation(s)
- Stefan Bauer
- Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia.
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Pasternak I, Rees M, Steinauer A, Plaschy S, Hillermann T. [Actually a routine matter: ischemia after catheterization of the radial artery]. Anaesthesist 2013; 62:193-6. [PMID: 23483231 DOI: 10.1007/s00101-013-2148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/18/2013] [Accepted: 01/19/2013] [Indexed: 11/26/2022]
Abstract
A 76-year-old patient developed necrosis of the index finger after placement of a radial artery catheter. This article discusses the risks associated with invasive blood pressure monitoring and treatment options in cases of critical ischemia. The authors conclude that there is no consensus concerning optimal treatment and that a discussion on options for preoperative risk assessment and quickest possible recognition of such complications is worthwhile. Despite the risk of ischemia invasive blood pressure monitoring is an indispensable procedure.
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Affiliation(s)
- I Pasternak
- Chirurgische Klinik, Spital Uster, Uster, Schweiz
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