RESUMEN
BACKGROUND: The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. METHODS: From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. RESULTS: Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. CONCLUSIONS: The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.
Asunto(s)
Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Arteria Radial , Humanos , Femenino , Masculino , Colgajo Perforante/irrigación sanguínea , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Arteria Radial/trasplante , Traumatismos de la Mano/cirugía , Mano/cirugía , Mano/irrigación sanguínea , Adulto Joven , Estudios de Seguimiento , Resultado del Tratamiento , Estudios de FactibilidadRESUMEN
Controversy still exists regarding how much the inflow arterial percutaneous transluminal angioplasty (PTA) contributed to maintaining fistula function for hemodialysis. We aimed to analyze patency and risk factors after inflow arterial PTA. Hemodialysis patients with inflow arterial primary stenosis who were admitted to our institution from January 2017 to December 2022 were examined. One group had arterial-venous fistula with inflow artery stenosis alone (AVF + iAS) and another group had AVF with inflow artery stenosis and any vein stenosis (AVF + iAS + VS). The characteristics of patients, stenotic lesions, and PTA procedures were recorded. Kaplan-Meier analysis was used to compare primary patency, assisted primary patency, and secondary patency in the two groups. Cox proportional hazard analysis was used to identify risk factors associated with patency. We examined 213 patients, 53 in the AVF + iAS group (51 radial arterial stenosis and 2 ulnar arterial stenosis) and 160 in the AVF + iAS + VS group (159 radial arterial stenosis and 1 ulnar arterial stenosis). Kaplan-Meier analysis indicated the AVF + iAS group had better primary patency and assisted primary patency (both P < 0.05), but the groups had similar secondary patency. Cox proportional hazard analysis indicated that none of the analyzed clinical and biochemical indexes had clinically meaningful effects on primary patency, assisted primary patency, or secondary patency in either group. The patency and safety after PTA for inflow arterial stenosis were satisfactory, and none of the examined risk factors had a major clinical impact on patency. We recommend PTA as treatment for inflow stenosis of an AVF.
Asunto(s)
Angioplastia , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Masculino , Femenino , Estudios Retrospectivos , Angioplastia/métodos , Angioplastia/efectos adversos , Persona de Mediana Edad , Anciano , Constricción Patológica , Derivación Arteriovenosa Quirúrgica/efectos adversos , Factores de Riesgo , Estimación de Kaplan-Meier , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Arteria Radial , Arteriopatías Oclusivas/terapia , Arteriopatías Oclusivas/etiologíaRESUMEN
PURPOSE: The purpose of this study is to retrospect and summarize clinical efficiency and experience of the free superficial palmar branch of radial artery (SPBRA) flap for soft-tissue reconstruction in distal digital injury. METHOD: 13 patients with soft-tissue defect of finger, reconstructed by the free superficial palmar branch of radial artery (SPBRA) flap in our department from January 2020 to January 2022, were reviewed. After 6-12 months of follow-up, evaluated the treatment effect of the fingers reconstructed by SPBRA flap. RESULTS: All the flaps in our series application were survival uneventful, and all the donor sites were closed primarily without complications or obvious scarring. The flaps were soft in texture and satisfactory in appearance and function. The flaps with the median nerve palmar cutaneous branch had a good sensation recovery. Measurement of two-point discrimination (TPD) ranged from 6 to 10 mm. All patients were satisfied with the aesthetic appearance. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, the results were graded as excellent in 11 cases and good in 2 cases. CONCLUSION: The SPBRA perforator flap has the advantages of simple operation, soft texture, good appearance and function, and is credible and useful for reconstructing various finger injuries.
Asunto(s)
Traumatismos de los Dedos , Procedimientos de Cirugía Plástica , Arteria Radial , Traumatismos de los Tejidos Blandos , Humanos , Arteria Radial/trasplante , Masculino , Procedimientos de Cirugía Plástica/métodos , Adulto , Persona de Mediana Edad , Traumatismos de los Dedos/cirugía , Femenino , Traumatismos de los Tejidos Blandos/cirugía , Estudios Retrospectivos , Colgajo Perforante/irrigación sanguínea , Adulto Joven , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
BACKGROUND: Coronary artery disease (CAD) is a major global cardiovascular health threat and the leading cause of death in many countries. The disease has a significant impact in China, where it has become the leading cause of death. There is an urgent need to develop non-invasive, rapid, cost-effective, and reliable techniques for the early detection of CAD using machine learning (ML). METHODS: Six hundred eight participants were divided into three groups: healthy, hypertensive, and CAD. The raw data of pulse wave from those participants was collected. The data were de-noised, normalized, and analyzed using several applications. Seven ML classifiers were used to model the processed data, including Decision Tree (DT), Random Forest (RF), Gradient Boosting Decision Tree (GBDT), Extra Trees (ET), Extreme Gradient Boosting (XGBoost), Light Gradient Boosting (LightGBM), and Unbiased Boosting with Categorical Features (CatBoost). RESULTS: The Extra Trees classifier demonstrated the best classification performance. After tunning, the results performance evaluation on test set are: 0.8579 accuracy, 0.9361 AUC, 0.8561 recall, 0.8581 precision, 0.8571 F1 score, 0.7859 kappa coefficient, and 0.7867 MCC. The top 10 feature importances of ET model are w/t1, t3/tmax, tmax, t3/t1, As, hf/3, tf/3/tmax, tf/5, w and tf/3/t1. CONCLUSION: Radial artery pulse wave can be used to identify healthy, hypertensive and CAD participants by using Extra Trees Classifier. This method provides a potential pathway to recognize CAD patients by using a simple, non-invasive, and cost-effective technique.
Asunto(s)
Enfermedad de la Arteria Coronaria , Aprendizaje Automático , Análisis de la Onda del Pulso , Arteria Radial , Humanos , Enfermedad de la Arteria Coronaria/clasificación , Persona de Mediana Edad , Masculino , Femenino , Anciano , Adulto , Hipertensión/clasificación , ChinaRESUMEN
OBJECTIVE: Although mechanical thrombectomy (MT) is primarily performed via transfemoral access (TFA), transradial access (TRA) is a potential alternative in older patients or those with tortuous vessels. However, the small radial artery diameter restricts the use of large-bore balloon guides and aspiration catheters, a limitation that may be overcome using the sheathless technique. Thus, we aimed to explore the feasibility, efficacy, and safety of sheathless TRA-MT as a first-line treatment approach for acute ischemic stroke. METHODS: This single-center retrospective case series included patients who underwent TRA-MT as first-line treatment between September 2020 and June 2023. Per our MT protocol, TRA was not the first-line approach in cases of left anterior circulation lesions with a type 3 aortic arch. We evaluated treatment effectiveness based on the successful recanalization rate, puncture-to-recanalization time, and modified first-pass effect; access route effectiveness based on the puncture-to-first-pass time and switch-to-TFA rate; and procedure safety based on procedure-related and severe puncture site complications. RESULTS: Sheathless 8-F guide catheters were used in 68â¯% and large-bore aspiration catheters in 70â¯% of the procedures. Successful recanalization was achieved in 98â¯% of the patients, with a modified first-pass effect in 54â¯% of them. The median puncture-to-first-pass and puncture-to-recanalization times were 20.5 and 33â¯min, respectively. The rate of procedure-related complications was low (4â¯%), with no severe puncture site complications. CONCLUSION: Sheathless TRA-MT enabled the use of large-bore guide and aspiration catheters, providing a swift approach to the target and satisfactory outcomes, and might be an effective first-line treatment for acute ischemic stroke.
Asunto(s)
Estudios de Factibilidad , Accidente Cerebrovascular Isquémico , Arteria Radial , Trombectomía , Humanos , Masculino , Anciano , Femenino , Arteria Radial/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Resultado del Tratamiento , Accidente Cerebrovascular Isquémico/cirugía , Accidente Cerebrovascular Isquémico/terapia , Trombectomía/métodos , Trombectomía/instrumentación , Anciano de 80 o más AñosRESUMEN
Common arterial grafts used in coronary artery bypass grafting include internal thoracic artery (ITA), radial artery (RA) and right gastroepiploic artery (RGA) grafts; of these, the ITA has the best clinical outcome. Here, by analyzing the single-cell transcriptome of different arterial grafts, we suggest optimization strategies for the RA and RGA based on the ITA as a reference. Compared with the ITA, the RA had more lipid-handling-related CD36+ endothelial cells. Vascular smooth muscle cells from the RGA were more susceptible to spasm, followed by those from the RA; comparison with the ITA suggested that potassium channel openers may counteract vasospasm. Fibroblasts from the RA and RGA highly expressed GDF10 and CREB5, respectively; both GDF10 and CREB5 are associated with extracellular matrix deposition. Cell-cell communication analysis revealed high levels of macrophage migration inhibitory factor signaling in the RA. Administration of macrophage migration inhibitory factor inhibitor to mice with partial carotid artery ligation blocked neointimal hyperplasia induced by disturbed flow. Modulation of identified targets may have protective effects on arterial grafts.
Asunto(s)
Arterias Mamarias , Animales , Humanos , Arterias Mamarias/trasplante , Arterias Mamarias/metabolismo , Análisis de la Célula Individual , Arteria Radial/trasplante , Arteria Radial/metabolismo , Arteria Gastroepiploica/metabolismo , Arteria Gastroepiploica/trasplante , Miocitos del Músculo Liso/metabolismo , Masculino , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/citología , Modelos Animales de Enfermedad , Ratones Endogámicos C57BL , Neointima/patología , Neointima/metabolismo , Puente de Arteria Coronaria/métodos , Comunicación Celular , Fibroblastos/metabolismo , Células Endoteliales/metabolismo , Ratones , Transducción de Señal , Transcriptoma , Vasoconstricción/efectos de los fármacos , Células Cultivadas , Hiperplasia/metabolismo , Hiperplasia/patología , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/metabolismoRESUMEN
BACKGROUND Vertebral artery origin stenosis (VAOS) has recently gained increased attention, with endovascular treatments like stent implantation showing high success and low complication rates, although less is known about VAOS compared to carotid artery stenosis. This study evaluated the safety and effectiveness of transradial (TRA) and transfemoral (TFA) approaches for VAOS stent placement. MATERIAL AND METHODS We recruited a total of 102 patients undergoing vertebral artery stenting in our hospital between January 2020 and November 2022. Patients were randomly assigned to undergo either radial or femoral approach for stent implantation in the vertebral artery, and the radial approach group secondary divided into 2 groups by patients' consent: ipsilateral or contralateral radial approach. The success rates of VAOS stent implantation, operation time, and postoperative hospitalization time were compared between the 3 groups. In addition, we compared the outcomes of stroke within 30 days, transient ischemic attack (TIA) within 30 days, and other indicators. RESULTS Of the 102 patients, the final success rate of stent implantation was not significantly different between the 3 groups. The time from sheath insertion to stent insertion in the ipsilateral TRA group (median time: 19 min [interquartile range (IQR): 12-24.5 min]) was significantly shorter than in the transfemoral approach (TFA) group (median time: 29 min [IQR: 21-35.5 min]) (P<0.01; 95% confidence interval (95% CI): 10 min [6-14 min]). There were no statistically significant differences between the 3 groups in terms of cerebrovascular events within 1 month, and patient satisfaction and preference favored the radial approach. CONCLUSIONS The postoperative hospitalization time and operation time associated with the ipsilateral TRA were shorter, and patient acceptance and satisfaction were higher.
Asunto(s)
Procedimientos Endovasculares , Arteria Femoral , Arteria Radial , Stents , Arteria Vertebral , Humanos , Femenino , Masculino , Arteria Radial/cirugía , Arteria Femoral/cirugía , Estudios Prospectivos , Persona de Mediana Edad , Anciano , Arteria Vertebral/cirugía , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Insuficiencia Vertebrobasilar/cirugíaRESUMEN
Background and Objectives: Silent cerebral ischemia (SCI) is defined as a condition that can be detected by biochemical markers or cranial imaging methods but does not produce clinical symptom. This study aims both to compare the frequency of SCI in PCIs performed with right transradial access and left transradial access and to evaluate the influencing factors. Materials and Methods: A prospective, single-center study included 197 patients undergoing PCI via transradial access between November 2020 and July 2022. The patients were categorized into right radial and left radial groups. Neuron-specific enolase (NSE) values were measured and recorded before and 18 h after the procedure. A post-procedure NSE level higher than 20 ng/dL was defined as SCI. Results: SCI occurred in 60 of the 197 patients. NSE elevation was observed in 37.4% (n = 37) of the right radial group and in 23.5% (n = 23) of the left radial group (p = 0.032). Patients with SCI had higher rates of smoking (p = 0.043), presence of subclavian tortuosity (p = 0.027), and HbA1c (p = 0.031). In the multivariate logistic regression analysis, the level of EF (ejection fraction) (OR: 0.958 95% CI 0.920-0.998, p = 0.039), right radial preference (OR: 2.104 95% CI 1.102-3.995 p = 0.023), and smoking (OR: 2.088 95% CI 1.105-3.944, p = 0.023) were observed as independent variables of NSE elevation. Conclusions: Our findings suggest that PCI via right radial access poses a greater risk of SCI compared to left radial access. Anatomical considerations and technical challenges associated with right radial procedures and factors such as smoking and low ejection fraction contribute to this elevated risk.
Asunto(s)
Isquemia Encefálica , Intervención Coronaria Percutánea , Arteria Radial , Humanos , Femenino , Masculino , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/efectos adversos , Persona de Mediana Edad , Arteria Radial/cirugía , Anciano , Estudios Prospectivos , Isquemia Encefálica/etiología , Fosfopiruvato Hidratasa/sangre , Fosfopiruvato Hidratasa/análisis , Factores de Riesgo , Modelos LogísticosRESUMEN
BACKGROUND: The introduction of radial-specific equipment has made transradial (TR) aortoiliac (AI) endovascular therapy (EVT) more convenient. OBJECTIVES: The authors aimed to investigate the perioperative outcomes of the TR approach in patients undergoing AI EVT for symptomatic peripheral artery disease. METHODS: The COMFORT (Contemporary Strategy for Aortoiliac Intervention) registry was a prospective, multicenter, observational study enrolling patients with symptomatic peripheral artery disease undergoing AI EVT between January 2021 and June 2023. The primary outcome was perioperative complications, whereas the secondary outcomes included core laboratory-evaluated residual stenosis >30%, time to hemostasis, time to ambulation, 30-day patency, and 30-day limb symptoms. These outcomes were compared between TR and non-TR AI EVT after propensity score matching. RESULTS: The TR approach was selected for 231 of the 947 patients (24.3%). The TR approach was chosen more in patients with a higher ankle-brachial index, chronic total occlusion, aortic lesion, bare nitinol stent implantation, and plain angioplasty, whereas it was chosen less in patients with dialysis, a history of AI EVT, chronic limb-threatening ischemia, bilateral calcification, and simultaneous infrainguinal EVT (all P < 0.05). After propensity score matching, the incidence of perioperative complications did not differ significantly between the groups (TR group: 6.0% vs non-TR group: 5.1%; P = 0.69). The proportions of residual stenosis, 30-day patency, and 30-day limb symptoms were not significantly different (all P > 0.05); however, the time to hemostasis and the time to ambulation were shorter in the TR group (both P < 0.05). CONCLUSIONS: Non-TR AI EVT and TR AI EVT using radial-specific equipment were associated with a similar risk of perioperative complications. The TR approach helps shorten the time required for hemostasis and ambulation.
Asunto(s)
Procedimientos Endovasculares , Arteria Ilíaca , Enfermedad Arterial Periférica , Arteria Radial , Sistema de Registros , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Anciano , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Estudios Prospectivos , Arteria Radial/fisiopatología , Resultado del Tratamiento , Factores de Tiempo , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Arteria Ilíaca/cirugía , Persona de Mediana Edad , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Factores de Riesgo , Medición de Riesgo , Anciano de 80 o más Años , Cateterismo Periférico/efectos adversos , Stents , PuncionesAsunto(s)
Cateterismo Periférico , Procedimientos Endovasculares , Arteria Ilíaca , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Cateterismo Periférico/efectos adversos , Procedimientos Endovasculares/instrumentación , Resultado del Tratamiento , Punciones , Factores de Riesgo , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/fisiopatologíaRESUMEN
RATIONALE: Timely treatment and recovery of cardiac arrest in out-of-hospital settings present significant challenges. This report describes a novel method of integrating advanced monitoring techniques such as radial artery cannulation in the treatment of an 85-year-old male patient who suffered an out-of-hospital cardiac arrest (OHCA). PATIENT CONCERNS: The patient, an 85-year-old man, experienced sudden cardiac arrest at home around 4:10â pm on November 22, 2023, characterized by immediate loss of consciousness and absence of pulse, and no response when called by name, necessitating urgent medical intervention. DIAGNOSES: The patient was diagnosed with OHCA by the emergency doctor, which was further confirmed by the absence of spontaneous circulation and respiratory failure. INTERVENTIONS: The patient was treated with manual cardiopulmonary resuscitation (CPR), ventilator-assisted ventilation, internal jugular venous catheterization, medical treatment, mechanical CPR, and supplemented by radial artery cannulation for invasive blood pressure monitoring. This technique was pivotal for real-time hemodynamic assessment. OUTCOMES: The invasive monitoring facilitated the early detection of the return of spontaneous circulation, allowing for the timely cessation of mechanical CPR. Subsequent treatment in the intensive care unit was optimized based on continuous arterial pressure readings, enhancing the stabilization of the patient's condition. LESSONS: This case underscores the significant role of radial artery cannulation for invasive blood pressure monitoring in improving clinical outcomes for patients experiencing OHCA. Integrating radial artery cannulation with other advanced monitoring techniques aids in the early detection of the return of spontaneous circulation and optimizes subsequent intensive care treatment.
Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Arteria Radial , Humanos , Masculino , Anciano de 80 o más Años , Paro Cardíaco Extrahospitalario/terapia , Reanimación Cardiopulmonar/métodos , Cateterismo Periférico/métodosRESUMEN
BACKGROUND The transradial approach (TRA) for cerebral angiography and neurointerventional treatment has gained popularity, but the narrow diameter and weak pulsation of the radial artery lower the initial puncture success rate compared to femoral artery puncture. This retrospective study from a single center evaluated the incidence of and factors associated with radial artery occlusion (RAO) in 543 patients who underwent transradial approach (TRA) for cerebral angiography. MATERIAL AND METHODS We included 543 patients who underwent TRA from July 2021 to February 2024. Ultrasound was used to determine whether the radial artery was occluded. Relevant clinical data were recorded to assess the incidence of and factors affecting RAO. RESULTS At 24 h after DSA, we performed ultrasound imaging. The patients were divided into an RAO group (n=32) and a non-RAO group (n=511). Results showed that RAO was significantly higher in patients who did not have add heparin to the antispasmodic agents, and they were more likely to have needed more than 3 radial artery puncture attempts, and tended to have received an 11-cm radial artery sheath with the Cordis puncture needles (all P<0.05). Multiple regression logistic analysis showed that adding heparin to the antispasmodic agents (OR=0.076, 95% CI: 0.018-0.321, P<0.001), having fewer than 3 radial artery puncture attempts (OR=0.245, 95% CI: 0.111-0.541, P<0.001), using a 16-cm radial artery sheath (OR=0.195, 95% CI: 0.067-0.564, P=0.003), and using Terumo puncture needles (OR=0.325, 95% CI: 0.148-0.717, P=0.005) can reduce the incidence of radial artery occlusion. CONCLUSIONS Our center found that adding heparin to the antispasmodic agents reduced the number of radial artery punctures attempts, and using a 16-cm radial artery sheath significantly lowered the incidence of early RAO after transradial cerebral angiography.
Asunto(s)
Arteriopatías Oclusivas , Angiografía Cerebral , Punciones , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Angiografía Cerebral/métodos , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/prevención & control , Punciones/efectos adversos , Punciones/métodos , Heparina , Incidencia , Factores de Riesgo , Parasimpatolíticos , AdultoRESUMEN
BACKGROUND: Trans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines. CASE PRESENTATION: Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient's treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm. CONCLUSIONS: This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.
Asunto(s)
Hematoma , Humanos , Masculino , Anciano de 80 o más Años , Hematoma/diagnóstico por imagen , Hematoma/etiología , Angiografía Cerebral/efectos adversos , Angiografía Cerebral/métodos , Enfermedades del Mediastino/diagnóstico por imagen , Enfermedades del Mediastino/etiología , Arteria Radial/diagnóstico por imagen , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estenosis Carotídea/diagnóstico por imagenRESUMEN
BACKGROUND: Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI. METHODS: PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed. RESULTS: From 47 randomized clinical trials that randomized 38â 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35-0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24-0.48]), distal radial (OR, 0.33 [95% CI, 0.20-0.56]), and ulnar (OR, 0.50 [95% CI, 0.31-0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03-2.14]). CONCLUSIONS: Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: 42024512365.
Asunto(s)
Cateterismo Periférico , Angiografía Coronaria , Arteria Femoral , Hemorragia , Intervención Coronaria Percutánea , Arteria Radial , Ensayos Clínicos Controlados Aleatorios como Asunto , Arteria Cubital , Humanos , Arteria Radial/diagnóstico por imagen , Angiografía Coronaria/efectos adversos , Arteria Femoral/diagnóstico por imagen , Cateterismo Periférico/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Arteria Cubital/diagnóstico por imagen , Resultado del Tratamiento , Factores de Riesgo , Punciones , Hematoma/etiología , Masculino , Femenino , Metaanálisis en Red , Persona de Mediana Edad , Anciano , Oportunidad Relativa , Medición de Riesgo , Cateterismo Cardíaco/efectos adversosRESUMEN
INTRODUCTION: Postmortem evaluation of the human vascular system has a long history, with advancements ranging from dissections to modern imaging techniques like computed tomography (CT scan). This study designs a novel combination of Angiofil, a liquid radiopaque polymer, and latex, a flexible cast material, for cadaveric vascular analysis. MATERIAL & METHODS: The aim was to synergize the advantages of both components, providing accurate radiological images and optimal dissection conditions. Three arterial territories (lateral circumflex femoral artery, profunda brachii artery, and radial artery) were injected and assessed through CT scans and dissections. RESULTS: The Angiofil-latex mixture allowed successful visualization of the vascular networks, offering a simple, reproducible, and non-toxic approach. Quantitative assessments of the three territories, including diameters and lengths, showed comparable results between CT scan and dissection. DISCUSSION: The technique precision and versatility make it an accessible and valuable tool for anatomical studies, potentially extending its application to MRI analyses. Overall, the Angiofil-latex combination presents a cost-effective solution for researchers, offering enhanced visibility and detailed anatomical insights for various applications, including anatomical variation studies.
Asunto(s)
Cadáver , Arteria Femoral , Látex , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Arteria Femoral/anatomía & histología , Arteria Femoral/diagnóstico por imagen , Disección/métodos , Extremidades/irrigación sanguínea , Extremidades/diagnóstico por imagen , Extremidades/anatomía & histología , Masculino , Arterias/anatomía & histología , Arterias/diagnóstico por imagen , Arteria Radial/anatomía & histología , Arteria Radial/diagnóstico por imagen , Femenino , Anciano , Medios de Contraste/administración & dosificaciónRESUMEN
Because of its superior safety profile and improved outcomes, trans-radial percutaneous coronary intervention (TRI) has become the preferred access in percutaneous coronary intervention (PCI) of native coronary disease. This study investigated the impact of TRI on in-hospital outcomes after PCI for coronary artery bypass graft vessels (GV-PCI). We analyzed patients who underwent GV-PCI in 2019-2022 from the Japanese nationwide registry. Patients were categorized into the TRI and trans-femoral PCI (TFI) groups. We assessed the association between TRI and in-hospital outcomes. The primary outcome was a composite of in-hospital death and major bleeding. In this study, 2,295 patients were analyzed.. The primary outcomes occurred in 29 patients (1.3%), including 17 deaths (0.7%). Major bleeding occurred in 12 patients (0.5%), and access site bleeding in 7 patients (0.3%). The TRI group (n = 1,521) showed lower crude rates of the primary outcome (0.9% vs 1.9%, p = 0.039), major bleeding (0.3% vs 1.0%, p = 0.027), and access site bleeding (0.1% vs 0.6%, p = 0.047) compared with the TFI group (n = 774). Univariable logistic regression demonstrated a significant association of TRI with reduced primary outcome (odd ratio [OR] 0.47, 95% confidence interval [CI] 0.22 to 0.98), major bleeding (OR 0.25, 95% CI 0.07 to 0.80), and access site bleeding (OR 0.20, 95% CI 0.03 to 0.94). In the multivariable analysis, TRI was still significantly associated with a decrease in major bleeding events (OR 0.29, 95% CI 0.07 to 0.93). In conclusion, the use of TRI was associated with a reduction in bleeding events when referenced to TFI in the context of GV-PCI.
Asunto(s)
Puente de Arteria Coronaria , Mortalidad Hospitalaria , Intervención Coronaria Percutánea , Arteria Radial , Sistema de Registros , Humanos , Masculino , Femenino , Intervención Coronaria Percutánea/métodos , Japón/epidemiología , Anciano , Puente de Arteria Coronaria/métodos , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/cirugía , Arteria Femoral , Bases de Datos Factuales , Resultado del Tratamiento , Hemorragia Posoperatoria/epidemiología , Pueblos del Este de AsiaRESUMEN
OBJECTIVE: There is growing evidence supporting the utilization of the radial artery as a secondary arterial graft in coronary artery bypass grafting (CABG) surgery. However, debates continue over the recovery period of the radial artery following angiography. This study aims to evaluate the clinical outcomes and experiences related to the use of the radial artery post-angiography in total arterial coronary revascularization. METHODS: A retrospective analysis was performed on data from patients who underwent total arterial CABG surgery at the University of Hong Kong Shenzhen Hospital from July 1, 2020, to September 30, 2022. Preoperative assessments included ultrasound evaluations of radial artery blood flow, diameter, intimal integrity, and the Allen test. Additionally, pathological examinations of the distal radial artery and coronary artery CT angiography were conducted, along with postoperative follow-up to assess the safety and efficacy of using the radial artery in patients undergoing total arterial CABG. RESULTS: A total of 117 patients, compromising 102 males and 15 females with an average age of 60.0 ± 10.0 years, underwent total arterial CABG. The internal mammary artery was used in situ in 108 cases, while in 4 cases, it was grafted to the ascending aorta due to length limitations. Bilateral radial arteries were utilized in 88 patients, and bilateral internal mammary arteries in 4 patients. Anastomoses of the proximal radial arteries to the proximal ascending aorta included 42 cases using distal T-anastomosis and 4 using sequential grafts. The interval between bypass surgery and coronary angiography ranged from 7 to 14 days. Pathological examination revealed intact intima and continuous elastic membranes with no significant inflammatory infiltration or hyperplastic lumen stenosis in the radial arteries. There were no hospital deaths, 3 cases of perioperative cerebral infarction, 1 secondary thoracotomy for hemorrhage control, 21 instances of intra-aortic balloon pump (IABP) assistance, and 2 cases of poor wound healing that improved following debridement. CT angiography performed 2 weeks post-surgery showed no internal mammary artery occlusions, but 4 radial artery occlusions were noted. CONCLUSION: Ultrasound may be used within 2 weeks post-angiography to assess the recovery of the radial artery in some patients. Radial arteries with intact intima may be considered in conjunction with the internal mammary artery for total arterial coronary CABG. However, long-term outcomes of these grafts require further validation through larger prospective studies.
Asunto(s)
Angiografía Coronaria , Puente de Arteria Coronaria , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Radial/trasplante , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Angiografía Coronaria/métodos , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/diagnóstico por imagenRESUMEN
Aim: Radial artery occlusion (RAO) is a major complication of catheterization via transradial access (TRA). Our aim is to reveal the ability of high-sensitive C-reactive protein (hs-CRP) and complete blood count (CBC) components, which are inflammation markers, to predict RAO. Methods: Patients were divided into two groups: 103 with RAO and 300 without RAO. The relationship between CRP, CBC components and RAO was evaluated. Results: A significant increase in hs-CRP, monocyte, platelet (PLT), platelet distribution width (PDW) and plateletcrit values was observed after TRA, and only the increase in PDW, PLT and hs-CRP was found to be independent determinants in regression analysis. Conclusion: High PDW and PLT and increased hs-CRP levels are new independent determinants of the development of RAO.
The role of inflammation markers in occurrence of radial artery occlusion that restricts the transradial cardiac catheterization.
Asunto(s)
Arteriopatías Oclusivas , Biomarcadores , Proteína C-Reactiva , Inflamación , Arteria Radial , Humanos , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Masculino , Femenino , Biomarcadores/sangre , Persona de Mediana Edad , Inflamación/sangre , Anciano , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/diagnósticoRESUMEN
BACKGROUND: While transradial access is favored for cardiac catheterization, the radial artery (RA) is increasingly preferred for coronary artery bypass grafting. Whether the RA is suitable for use as a graft following instrumentation for transradial access remains uncertain. METHODS: Consecutive patients from 2015 to 2019 who underwent coronary artery bypass grafting using both the left and right RAs as grafts were included. Instrumented RAs underwent careful preoperative assessment for suitability. The clinical analysis was stratified by whether patients received an instrumented RA graft (instrumented versus noninstrumented groups). Eligible patients with both instrumented and noninstrumented RAs underwent computed tomography coronary angiography to evaluate graft patency. The primary outcome was a within-patient paired analysis of graft patency comparing instrumented to noninstrumented RA grafts. RESULTS: Of the 1123 patients who underwent coronary artery bypass grafting, 294 had both the left and right RAs used as grafts and were included. There were 126 and 168 patients in the instrumented and noninstrumented groups, respectively. Baseline characteristics and perioperative outcomes were comparable. The rate of major adverse cardiac events at 2 years following coronary artery bypass grafting was 2.4% in the instrumented group and 5.4% in the noninstrumented group (hazard ratio, 0.44 [95% CI, 0.12-1.61]; P=0.19). There were 50 patients included in the graft patency analysis. At a median follow-up of 4.3 (interquartile range, 3.7-4.5) years, 40/50 (80%) instrumented and 41/50 (82%) noninstrumented grafts were patent (odds ratio, 0.86 [95% CI, 0.29-2.52]; P>0.99). No significant differences were observed in the luminal diameter or cross-sectional area of the instrumented and noninstrumented RA grafts. CONCLUSIONS: There was no evidence found in this study that RA graft patency was affected by prior transradial access, and the use of an instrumented RA was not associated with worse outcomes in the exploratory clinical analysis. Although conduits must be carefully selected, prior transradial access should not be considered an absolute contraindication to the use of the RA as a bypass graft. REGISTRATION: URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12621000257864.