Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case-control study

Background

Radial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail.

Aim

The objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization.

Patients and methods

Overall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination.

Results

Eight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229).

Conclusion

RAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.

[Malperfusion in aortic dissection: diagnostic problems and therapeutic procedures]

Malperfusion of the thoracoabdominal aorta and its side branches is a common complication of aortic dissection, often proving fatal. Vital organ malperfusion accompanying acute aortic dissection is a major cause of mortality and morbidity and requires timely reperfusion of the ischemic organs as well as adequate management of the aortic dissection. Ischemic damage to vital organs supplied by the thoracoabdominal aorta greatly increases the overall risk of aortic dissection. As initial symptoms may be subtle, malperfusion tends to be recognized late, and therefore accounts for a considerable percentage of fatalities.Effective reperfusion is not readily achieved by central aortic surgery alone in a certain number of patients. Various strategies have been used, including entry closure by central aortic surgery or stent grafting, surgical or catheter fenestration, bypass grafting and percutaneous stenting.Endovascular bare-metal stent placement is an attractive and promising treatment option since it is readily available, is less invasive and presents fewer risks to the patient.

[Successful implementation of an "in-hospital resuscitation team" in a university hospital]

BACKGROUND AND OBJECTIVE

Resuscitation is the most important emergency action in a life-threatening cardiopulmonary arrest. The organizational, personnel and equipment requirements for an optimal treatment of emergency patients in a university hospital are described, as well as the short- and mid-term results.

PATIENTS AND METHODS

Retrospective analysis of 132 cases of cardiopulmonary resuscitation based on a two-pages reporting form whose completion by the involved physician and intensive care nurse is mandatory after each event.

RESULTS

About 65 % of all events were triggered by cardiac and respiratory causes. In 50 % of all cases there was an acute life-threatening situation, requiring an intubation in 46 % and mechanical reventilation in 42 % of all cases. One third of all patients who were successfully reanimated were discharged alive from hospital after the intensive care treatment.

CONCLUSION

A well organized and adequately equipped resuscitation team is the basis for achieving optimal chances of survival in life-threatening emergencies. This is especially so in large university hospitals with often care for patients with multiple morbidities.

Role of echocardiography in the diagnosis of acute aortic syndrome

Acute aortic syndrome (AAS) comprises a variety of pathologically distinct life-threatening conditions such as aortic dissection, intramural hematoma (IMH) of the aorta, penetrating aortic ulcer (PAU), traumatic transection as well as symptomatic aortic aneurysm. Patients presenting with AAS require immediate diagnosis in order to rapidly initiate adequate therapeutic measures. Echocardiography is a rapidly available imaging technique which detects AAS with high sensitivity and specificity. Compared to computed tomography (CT) and magnetic resonance imaging (MRI), echocardiography allows emergency examination of unstable patients at bedside or even directly in the operating room. Transthoracic echocardiography (TTE) may be used initially in the emergency setting to gain information about left ventricular function as well as the presence of aortic regurgitation and pericardial effusion, but has only limited diagnostic accuracy for diagnosing AAS. Transoesophageal echocardiography (TOE) is used to directly visualise the aortic pathology in both the ascending and descending aorta. This article reviews the role of echocardiography in the emergency assessment of patients presenting with acute aortic syndrome.