Asunto(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/fisiopatología

RESUMEN

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 , Adulto

RESUMEN

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 imagen

RESUMEN

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 38 924 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 adversos

RESUMEN

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 & dosificación

RESUMEN

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 imagen

RESUMEN

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.

Asunto(s)

Cateterismo Cardíaco , Angiografía Coronaria , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Oclusión de Injerto Vascular , Arteria Radial , Grado de Desobstrucción Vascular , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Radial/trasplante , Arteria Radial/fisiopatología , Masculino , Femenino , Puente de Arteria Coronaria/efectos adversos , Anciano , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Persona de Mediana Edad , Resultado del Tratamiento , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/diagnóstico por imagen , Factores de Tiempo , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/cirugía , Factores de Riesgo , Estudios Retrospectivos , Cateterismo Periférico/efectos adversos , Punciones , Medición de Riesgo

Asunto(s)

Angiografía Coronaria , Arteria Radial , Humanos , Angiografía Coronaria/métodos , Arteria Radial/diagnóstico por imagen , Masculino , Valor Predictivo de las Pruebas , Persona de Mediana Edad

RESUMEN

Aim: The aim is to evaluate the relationship between C-reactive protein (CRP) to albumin ratio (CAR) and radial artery thrombosis in patients undergoing radial angiography. Patients & methods: We prospectively included 261 consecutive patients undergoing radial angiography, assessing radial artery diameter and thrombosis presence. Results: The CRP values were significantly higher in radial artery thrombosis group compared with group without thrombosis (13.01 vs. 4.33 mg/l, p < 0.001, respectively). Also CAR was statistically significantly different between the group with thrombosis and the group without thrombosis (0.102 vs. 0.349, p < 0.001). Conclusion: Our study is the first to assess CAR in radial thrombus development post-procedure in patients undergoing radial angiography. CAR can be useful in determining radial artery thrombosis after the coronary angiography.

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[Box: see text].

Asunto(s)

Proteína C-Reactiva , Arteria Radial , Trombosis , Humanos , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Arteria Radial/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Trombosis/etiología , Trombosis/diagnóstico por imagen , Anciano , Estudios Prospectivos , Angiografía Coronaria/efectos adversos , Angiografía Coronaria/métodos , Albúmina Sérica/análisis , Albúmina Sérica/metabolismo , Angiografía/métodos , Biomarcadores/sangre

RESUMEN

CASE: This case report describes a patient with paresthesia in the distribution of the superficial sensory branch of the radial nerve that was treated with surgery. Intraoperatively, there was a unique cause of internal compression by a rare superficial radial artery variant running adjacent to it. The nerve was mobilized from the artery with fascial releases. The patient had symptom resolution postoperatively. CONCLUSION: To our knowledge, this cause of compression has not been described before and should be considered in a differential diagnosis. In addition, clinicians should be aware of this anatomical variant during venipunctures and surgical approaches.

Asunto(s)

Síndromes de Compresión Nerviosa , Arteria Radial , Humanos , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Arteria Radial/diagnóstico por imagen , Nervio Radial , Neuropatía Radial/etiología , Neuropatía Radial/cirugía

Asunto(s)

Arteria Radial , Humanos , Angiografía Coronaria , Diagnóstico Diferencial , Arteria Radial/diagnóstico por imagen

RESUMEN

AIM: This study aimed to evaluate the correlation between the elasticity of the anterior and posterior walls of the radial artery in different sections using velocity vector imaging. MATERIAL AND METHODS: In this retrospective analysis, 30 healthy people who underwent physical examination in our hospital from January 2022 to January 2023 were analyzed offline by velocity vector imaging technology. The following parameters were assessed: peak systolic strain (Ss; %), peak diastolic strain (Sd; %), peak systolic strain rate (SRs; 1/s), and peak diastolic strain rate (SRd; 1/s). Elastic function was evaluated by analyzing the systolic and diastolic motion of the arterial walls. RESULT: In the long-axis sections, there was a significant positive correlation between Ss, SRs, and SRd of both the anterior and posterior walls (r=0.531, r=0.803, and r=0.898, all p<0.01). Additionally, Sd showed a positive correlation (r=0.402, p<0.05). In the short-axis sections, there was a significant and positive correlation between SRs and SRd of both walls (r=0.762, r=0.667, both p<0.01). Furthermore, a positive correlation was found between SRd in the long-axis and short-axis sections of the anterior wall (r=0.382, p<0.05). CONCLUSIONS: Velocity vector imaging is a valuable tool for assessing the elasticity of the radial artery in different sections, and the longitudinal SRd in the long-axis section may serve as a highly sensitive and accurate parameter for assessing changes in wall elastic function during the occurrence of radial artery lesions.

Asunto(s)

Elasticidad , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiología , Masculino , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Diagnóstico por Imagen de Elasticidad/métodos , Velocidad del Flujo Sanguíneo/fisiología , Reproducibilidad de los Resultados

Asunto(s)

Arteria Radial , Tomografía de Coherencia Óptica , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Radial/lesiones , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Valor Predictivo de las Pruebas , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/efectos adversos

RESUMEN

BACKGROUND: The radial artery is the standard access for coronary intervention; however, it is essential to have alternative accesses as it may be used as a conduit during coronary artery bypass grafting or for dialysis fistula. Ulnar and distal radial artery accesses have emerged as alternative accesses for traditional radial artery. AIM: To compare distal radial artery access and ulnar artery access as alternatives to traditional radial artery access regarding safety, efficacy, and success rate. METHODS: Two-hundred patients were included (100 traditional radial [TRA], 50 distal radial [DRA] and 50 ulnar). Access artery follow up ultrasound was performed up to 28 days. RESULTS: Procedural success rate was 97%, 74%, and 92% in the TRA, DRA and ulnar groups, respectively (p < 0.001). Crossover occurred in 3 patients (3%) in TRA, 13 patients (26%) in DRA and 4 cases (8%) in ulnar group (p < 0.001). The most common cause of crossover was failure of artery cannulation. Regarding cannulation time, the mean access time in seconds was 80.19 ± 25.98, 148.4 ± 29.60, 90.5 ± 21.84 in TRA, DRA and ulnar groups, respectively (p < 0.001). CONCLUSIONS: Our study concluded that these new approaches proved to be potential alternatives to traditional radial approach; however, ulnar artery access proved to be superior to distal radial artery access as regards success rate and cannulation time.

Asunto(s)

Cateterismo Periférico , Arteria Radial , Arteria Cubital , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Cubital/diagnóstico por imagen , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Resultado del Tratamiento , Factores de Tiempo , Anciano , Cateterismo Periférico/efectos adversos , Punciones , Intervención Coronaria Percutánea/efectos adversos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/cirugía , Factores de Riesgo , Grado de Desobstrucción Vascular

RESUMEN

OBJECTIVES: The popularity of trans-radial access (TRA) for cerebral angiography is growing. Potential benefits of TRA over traditional trans-femoral access (TFA) are multitude. This study aimed to evaluate discharge outcomes and patient opinion of TRA compared to TFA in patients undergoing cerebral angiography prior to stereotactic radiosurgery (SRS) treatment for cerebral arteriovenous malformations. METHODS: Consecutive patients treated at the National Centre for Stereotactic Radiosurgery (Sheffield, United Kingdom) over a 22-month period were included. All patients underwent cerebral angiography with either TRA or TFA as part of treatment planning prior to SRS. TRA patients who had previously undergone TFA in other centres were surveyed for their experience of cerebral angiography using a questionnaire. SRS staff at our centre was approached for their opinion. RESULTS: 492 patients were included (median age = 43 years, 57.5% male, median lesions treated = 1). More patients underwent angiography with TFA (75.2%) than TRA (24.8%). No difference was found in accumulated dose for angiography between the groups (p>0.05). There was 17.6% reduction in overnight stay between TRA and TRF, the proportion of patients requiring overnight admission was higher for the TFA (35.2%) than TRA (17.6%, p<0.05). 101 patients were surveyed, with a response rate of 47%. Most respondents (79%) indicated preference for TRA over TFA. CONCLUSIONS: Use of TRA in pre-SRS cerebral angiography is feasible and improves both patient and staff experience. The adoption of TRA could have important implications for department resources and costs by reducing the proportion of overnight admissions.

Asunto(s)

Angiografía Cerebral , Malformaciones Arteriovenosas Intracraneales , Radiocirugia , Humanos , Radiocirugia/métodos , Masculino , Femenino , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Adulto , Angiografía Cerebral/métodos , Arteria Radial/diagnóstico por imagen , Persona de Mediana Edad , Resultado del Tratamiento , Encuestas y Cuestionarios , Anciano , Adolescente , Arteria Femoral/diagnóstico por imagen , Estudios Retrospectivos

Asunto(s)

Arteriopatías Oclusivas , Cateterismo Periférico , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Factores de Riesgo , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/fisiopatología , Arteriopatías Oclusivas/etiología , Cateterismo Periférico/efectos adversos , Resultado del Tratamiento , Punciones , Medición de Riesgo , Masculino , Femenino , Anciano , Persona de Mediana Edad , Grado de Desobstrucción Vascular , Constricción Patológica , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/efectos adversos

Asunto(s)

Cateterismo Periférico , Punciones , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Cateterismo Periférico/instrumentación , Resultado del Tratamiento , Factores de Riesgo

Asunto(s)

Cateterismo Periférico , Arteria Radial , Arteria Radial/diagnóstico por imagen , Humanos , Cateterismo Periférico/efectos adversos , Resultado del Tratamiento , Factores de Riesgo , Punciones , Intervención Coronaria Percutánea/instrumentación

RESUMEN

PURPOSE: Atherosclerotic disease of the forearm arteries can impede the maturation of distal fistulas in diabetic patients. The goal of this study was to look at the maturity of diabetic hemodialysis patients' distal forearm (radiocephalic snuffbox or distal forearm) arteriovenous fistulas. MATERIALS AND METHODS: Patients with chronic renal failure who were candidates for distal forearm radiocephalic arteriovenous fistula implantation were evaluated in this cross-sectional study. Patients' demographic details, underlying disorders, laboratory measurements, vital signs, and information on their surgery were all noted. Patients were checked for fistula development 1 week, 1 month, 2 months, and then monthly until 6 months after surgery. Arteriovenous fistula maturation characterized by optimal blood flow, vessel dilation, and structural adaptations. RESULTS: Among 343 patients (56% male, 44% female, mean age: 57.32 ± 12.48 years), hypertension prevailed (81.9%), followed by hyperlipidemia (42.3%) and coronary artery disease history (25.9%). AVFs achieved 58.3% maturation in 64.98 ± 11.05 days; higher BP during creation correlated with successful maturation (17.02 ± 1.46 mmHg vs 13.90 ± 1.93 mmHg, P < .05). No significant statistical difference found in distal forearm arteriovenous fistula maturation between males (57.8%) and females (58.9%) (P > .005). However, 41.7% of AVFs failed in 18.83 ± 17.89 days. Failed AVFs exhibited lower BP during operation and failure (11.75 ± 1.86 mmHg). Kaplan-Meier analysis depicted maturation probabilities over 90 days post-surgery. CONCLUSION: Diabetes and patient sex did not affect the maturation time of distal forearm AVFs in hemodialysis patients. Increased blood pressure during and after surgery correlated with shorter maturation time.

Asunto(s)

Derivación Arteriovenosa Quirúrgica , Nefropatías Diabéticas , Antebrazo , Fallo Renal Crónico , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Masculino , Femenino , Derivación Arteriovenosa Quirúrgica/efectos adversos , Persona de Mediana Edad , Antebrazo/irrigación sanguínea , Anciano , Resultado del Tratamiento , Factores de Tiempo , Estudios Transversales , Fallo Renal Crónico/terapia , Fallo Renal Crónico/diagnóstico , Nefropatías Diabéticas/terapia , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/etiología , Adulto , Factores de Riesgo , Flujo Sanguíneo Regional , Arteria Radial/cirugía , Arteria Radial/fisiopatología , Arteria Radial/diagnóstico por imagen

RESUMEN

BACKGROUND: The effectiveness of head mounted real-time ultrasound displays (hereafter referred to as 'smart glasses') in improving hand-eye coordination in less experienced individuals, such as trainees in anaesthesia, is unclear. OBJECTIVES: To compare the first-attempt success rate of smart glasses-assisted ultrasound-guided paediatric radial artery catheterisation with conventional ultrasound guided catheterisation performed by anaesthesiology trainees. DESIGN: Prospective randomised controlled trial. SETTINGS: Tertiary university hospital from September 2021 to February 2023. PATIENTS: One hundred and twenty-two paediatric patients (age <7 years, weight ≥3 kg) who required radial artery cannulation during general anaesthesia. INTERVENTIONS: The participants were randomly assigned to either the ultrasound screen group (control) or the smart glasses group prior to radial artery catheterisation. MAIN OUTCOME MEASURES: The primary outcome was the first attempt success rate. Secondary outcomes included the number of attempts, use of transfixion technique, overall complication rate, and clinical anaesthesiology (CA) year of the operators. RESULTS: A total of 119 paediatric patients were included in the analysis. The smart glasses group exhibited higher first-attempt success rate than did the control group (89.8% [53/59] vs. 71.7% [43/60]; P  = 0.023; odds ratio (OR) 3.49; (95% confidence interval (CI) 1.27-9.6). The overall number of attempts [median, 1; interquartile range (IQR), 1-1; range, 1-3 vs. median, 1; IQR, 1-2; range, 1-4; P   =  0.006], use of transfixion technique (12/59 [20.3%] vs. 28/60 [46.7%]; P  = 0.002), and overall complication rate (6.8% [4/59] vs. 30.0% [18/60]; P  = 0.002) were lower in the smart glasses group than in the control group. However, among paediatric anaesthesiology fellows (CA 5 years), the first- (89.3% [25/28] vs. 80.8% [21/26]; P  = 0.619) and second-attempt success rates (96.4% [27/28] vs. 80.8% [21/26]; P  = 0.163) did not differ between the two groups. CONCLUSIONS: Smart glasses-assisted ultrasound guided radial artery catheterisation improved the first attempt success rate among anaesthesiology trainees, reducing the number of attempts and overall complication rates in small paediatric patients. Smart glasses were more effective for anaesthesia residents (CA 2-4 years) but were not effective for paediatric anaesthesiology fellows (CA 5 years). TRIAL REGISTRATION: ClinicalTrials.gov (NCT05030649) ( https://classic.clinicaltrials.gov/ct2/show/NCT05030649 ).

Asunto(s)

Anestesiología , Cateterismo Periférico , Arteria Radial , Ultrasonografía Intervencional , Humanos , Arteria Radial/diagnóstico por imagen , Femenino , Masculino , Estudios Prospectivos , Ultrasonografía Intervencional/métodos , Cateterismo Periférico/métodos , Anestesiología/educación , Preescolar , Niño , Lactante , Gafas Inteligentes , Anestesia General , Competencia Clínica , Cabeza