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BACKGROUND: Thoracic computed tomography scans (CT) are used by several study groups to investigate the circulatory structures (heart and vessels) located behind the pressure point for chest compressions. Yet, it remains unclear how the positioning of these structures is influenced by factors such as intubation, the respiratory cycle and arm positioning. METHODS: We retrospectively analyzed data of adult patients with in- or out-of-hospital cardiac arrest who underwent thoracic CT imaging within one year before or up to six months after arrest. A region of interest (ROI) behind the pressure point was defined. The largest structure within this region was defined as "leading circulatory structure", which was the primary outcome. Airway status (intubated versus spontaneous breathing), respiratory cycle (inspiration, expiration, resting expiratory position), and arm position (up over the head versus down beside the trunk) served as covariates in an ordinal regression model. RESULTS: Among 500 initially screened patients, 411 (82.2 %) were included in the analysis. There was a significant association between the arm position and the leading circulatory structure behind the pressure point. However, no association was found with airway status or respiratory cycle. The most frequently identified leading circulatory structure was the left atrium (arms up: 41.8 %, down: 50.7 %), followed by the ascending aorta (up: 23.8 % vs. down: 16.7 %). The left ventricle was the leading structure in only one case (0.2 %, arms down). CONCLUSION: This study shows that arm position is significantly associated with the leading circulatory structure behind the pressure point for chest compressions in cardiac arrest.
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Reanimación Cardiopulmonar , Posicionamiento del Paciente , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Reanimación Cardiopulmonar/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Posicionamiento del Paciente/métodos , Tomografía Computarizada por Rayos X/métodos , Paro Cardíaco/terapia , Paro Cardíaco/diagnóstico por imagen , Paro Cardíaco/fisiopatología , Brazo/diagnóstico por imagen , Brazo/irrigación sanguínea , Presión , Adulto , Radiografía Torácica/métodosRESUMEN
INTRODUCTION: The aim of the presented prospective observational study was to evaluate the effect of fistula flow on peripheral wave morphology and pulse wave velocity by means of the oscillometric Vicorder®-device with the purpose of fistula surveillance. METHODS: Digitized and normalized curves of 53 haemodialysis patients at the fistula and non-fistula arm were analysed. Slope parameters and the areas under the curve of characteristic sections of pulse waves as well as the power spectrum of the pulse waves and their first and second derivatives were computed. Furthermore, the amplitude of volumetric change (AMP) was assessed. Duplex sonography served as a reference method. RESULTS: In the comprehensive set of novel pulse wave parameters significant inter-arm differences were demonstrated and a significant delay of the systolic maximum at the fistula arm in comparison to the non-fistula arm (204 ± 3.4 vs. 162 ± 5.3 ms, p < 0.001) was proven. Unexpectedly, pulse wave velocity apparently did not differ between both arms (7.85 vs. 8.05 m/s at the fistula/non-fistula side, p = 0.942). The inter-arm differences of the slope parameters were more pronounced in forearm than in upper arm fistulas. Finally, we showed that the inter-arm difference of AMP correlated with volume flow (r = 0.326 with p = 0.017). CONCLUSION: Pulse waves as assessed by oscillometric pulse wave analysis have distinct features at fistula and non-fistula arms. This is due to enhanced arteriovenous flow, i.e. in both the brachial artery and the fistula vein. The analysis of those alterations has the potential to assess fistula function.
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Pletismografía , Análisis de la Onda del Pulso , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pletismografía/métodos , Análisis de la Onda del Pulso/métodos , Anciano , Diálisis Renal , Oscilometría/métodos , Derivación Arteriovenosa Quirúrgica , Brazo/irrigación sanguínea , AdultoRESUMEN
As one of a major public health issue in China, the number of new cases and deaths of malignant tumors has been climbing year by year. Implantable venous access port (IVAP) is used as a safe infusion route in the treatment of malignant tumor patients such as infusion of antitumor drugs and intravenous nutrition. With the widespread application of ultrasound-guided Sedinger puncture techniques and intracardiac electrocardiogram positioning technology, IVAP in the upper arm has been recognized by the majority of medical personnel and cancer patients due to its advantages of hiding scars and completely avoiding the risk of hemothorax and pneumothorax. In order to standardize the clinical application of IVAP via the upper arm approach in cancer patients, improve the success rate of implantation, reduce complications and improve patient satisfaction, the Breast Cancer Expert Committee of the National Cancer Quality Control Center consulted guidelines and the latest evidence-based evidences and established the expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients through literature research and expert discussions, in order to provide reference for the standard application of IVAP in the upper arm. The consensus mainly introduces the indications, contraindications, preoperative evaluation, implantation site, operation procedure, utilization and maintenance, complications and management, medical staff training and patient education of IVAP in the upper arm, in order to provide reference for clinical staff.
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Brazo , Catéteres de Permanencia , Neoplasias , Humanos , Brazo/irrigación sanguínea , Antineoplásicos/administración & dosificación , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/efectos adversos , Consenso , China , Neumotórax/etiología , Hemotórax/etiología , Neoplasias de la MamaRESUMEN
The human forearm model is commonly employed in physiological investigations exploring local vascular function and oxygen delivery; however, the effect of arm dominance on exercising forearm hemodynamics and skeletal muscle oxygen saturation (SmO2) in untrained individuals is poorly understood. Therefore, the purpose of this study was to explore the effect of self-identified arm dominance on forearm hemodynamics and SmO2 in untrained individuals during submaximal, non-ischemic forearm exercise. Twenty healthy individuals (23±4 years, 50% female; 80% right-handed) completed three-minute bouts of supine rhythmic (1 second contraction: 2 second relaxation duty cycle) forearm handgrip exercise at both absolute (10kg; 98N) and relative (30% of maximal voluntary contraction) intensities in each forearm. Beat-by-beat measures of forearm blood flow (FBF; ml/min), mean arterial blood pressure (MAP; mmHg) and flexor digitorum superficialis SmO2 (%) were obtained throughout and averaged during the final 30 seconds of rest, exercise, and recovery while forearm vascular conductance was calculated (FVC; ml/min/100mmHg). Data are Δ from rest (mean±SD). Absolute force production did not differ between non-dominant and dominant arms (97±11 vs. 98±13 N, p = 0.606) whereas relative force production in females did (69±24 vs. 82±25 N, p = 0.001). At both exercise intensities, FBFRELAX, FVCRELAX, MAPRELAX, and the time constant tau for FBF and SmO2 were unaffected by arm dominance (all p>0.05). While arm dominance did not influence SmO2 during absolute intensity exercise (p = 0.506), the non-dominant arm in females experienced an attenuated reduction in SmO2 during relative intensity exercise (-14±10 vs. -19±8%, p = 0.026)-though exercise intensity was also reduced (p = 0.001). The present investigation has demonstrated that arm dominance in untrained individuals does not impact forearm hemodynamics or SmO2 during handgrip exercise.
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Ejercicio Físico , Antebrazo , Hemodinámica , Músculo Esquelético , Humanos , Femenino , Músculo Esquelético/fisiología , Músculo Esquelético/irrigación sanguínea , Antebrazo/irrigación sanguínea , Antebrazo/fisiología , Hemodinámica/fisiología , Masculino , Ejercicio Físico/fisiología , Adulto , Adulto Joven , Fuerza de la Mano/fisiología , Brazo/fisiología , Brazo/irrigación sanguínea , Flujo Sanguíneo Regional/fisiología , Oxígeno/metabolismo , Consumo de Oxígeno/fisiologíaRESUMEN
OBJECTIVES: In the trans-radial era, arm venous access for right heart catheterization (RHC) is rising. Procedural success is affected by many factors, including subclavian/innominate vein stenosis (SVS) and pre-existing wires or catheters. In a study published previously by the same authors, 2% of cases had unsuccessful RHC through the arm, predominantly due to SVS. Since that study, techniques to improve RHC success rates have been developed, including crossing the stenosis with a coronary guidewire, followed by balloon dilatation. We aimed to determine whether subclavian/innominate venoplasty allows successful RHC in patients with SVS. METHODS: Our retrospective study included patients who had RHC from the arm between November 1, 2019, and December 31, 2022 that was unsuccessful due to the inability to pass a catheter through the SVS, and then underwent balloon venoplasty. The success rate of completed RHC was then assessed. RESULTS: Out of 2506 RHCs via arm access, 2488 were successful with a catheter alone or over a guidewire. In 18 patients, venoplasty was needed for catheter passage over a guidewire. Post-dilatation, all 18 cases (100%) had successful RHC with a mean procedural time of 35.2 (SD = 15.5) minutes. The most common stenosis site was the subclavian vein in 13 patients (72.2%), and 12 patients (66.7%) had pacemaker/ implantable cardioverter defibrillator wires present. CONCLUSIONS: Balloon dilatation of SVS is an efficacious method to improve the success rate of RHC from the arm. It is a safe technique that may prevent cross-over to a different access site, thereby improving patient satisfaction and reducing the possibility of alternate site complications.
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Cateterismo Cardíaco , Vena Subclavia , Humanos , Masculino , Femenino , Estudios Retrospectivos , Cateterismo Cardíaco/métodos , Vena Subclavia/cirugía , Persona de Mediana Edad , Anciano , Constricción Patológica , Brazo/irrigación sanguínea , Resultado del Tratamiento , Síndrome del Robo de la Subclavia/cirugía , Síndrome del Robo de la Subclavia/terapia , Síndrome del Robo de la Subclavia/diagnóstico , Venas Braquiocefálicas/cirugíaRESUMEN
Spectral imaging has the potential to become a key technique in interventional medicine as it unveils much richer optical information compared to conventional RBG (red, green, and blue)-based imaging. Thus allowing for high-resolution functional tissue analysis in real time. Its higher information density particularly shows promise for the development of powerful perfusion monitoring methods for clinical use. However, even though in vivo validation of such methods is crucial for their clinical translation, the biomedical field suffers from a lack of publicly available datasets for this purpose. Closing this gap, we generated the SPECTRAL Perfusion Arm Clamping dAtaset (SPECTRALPACA). It comprises ten spectral videos (â¼20 Hz, approx. 20,000 frames each) systematically recorded of the hands of ten healthy human participants in different functional states. We paired each spectral video with concisely tracked regions of interest, and corresponding diffuse reflectance measurements recorded with a spectrometer. Providing the first openly accessible in human spectral video dataset for perfusion monitoring, our work facilitates the development and validation of new functional imaging methods.
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Piel , Humanos , Piel/irrigación sanguínea , Piel/diagnóstico por imagen , Grabación en Video , Mano/irrigación sanguínea , Brazo/irrigación sanguínea , Brazo/diagnóstico por imagenRESUMEN
BACKGROUND: The medial arm flap (MAF) has been used as a pedicle flap and free flap to reconstruct various deformities, including those of the head and neck, axilla, elbow, chest, and hand. This study reviews the anatomy of the flap, the technique of flap harvest, its clinical applications, and a systematic review of the current published literature. METHODS: An online systematic review of MEDLINE, EMBASE, PubMed, and The Cochrane Library from inception to September 30, 2023, was completed. Studies that investigate the anatomy, technique or clinical outcomes of medial arm flaps were included. Clinical data extracted includes patient, defect, flap characteristics, complications, and take-back procedures. Anatomic data extracted includes anatomical variations, and vascular characteristics and patterns. RESULTS: Between 1980 and 2023, 50 papers were published outlining the medial arm flap. Anatomic studies detail the anatomy of 384 medial arms, and outcomes are reported for 283 MAFs (75 free flaps and 208 pedicle flaps). The superior ulnar collateral artery is most commonly cited as the dominant arterial supply to the middle third of the medial arm. The majority of patients required reconstruction post-burn (39.2%), trauma (17.7%), and tumor excision (12.4%). MAFs were mostly used to reconstruct defects of the head and neck (41.7%), the hand and wrist (21.9%), and the elbow (16.3%). Eleven flaps (4.1%) suffered partial flap failure, and two flaps (0.7%) suffered total flap failure. CONCLUSION: This manuscript demonstrates that the MAF is a reliable and underutilized flap option with a well-hidden donor scar and a low complication rate.
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Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Brazo/irrigación sanguínea , Brazo/cirugíaRESUMEN
BACKGROUND AND AIMS: Few studies have compared arm and ankle blood pressures (BPs) with regard to peripheral artery disease (PAD) and mortality. These relationships were assessed using data from three large prospective clinical trials. METHODS: Baseline BP indices included arm systolic BP (SBP), diastolic BP (DBP), pulse pressure (arm SBP minus DBP), ankle SBP, ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). These measurements were categorized into four groups using quartiles. The outcomes were PAD (the first occurrence of either peripheral revascularization or lower-limb amputation for vascular disease), the composite of PAD or death, and all-cause death. RESULTS: Among 40 747 participants without baseline PAD (age 65.6 years, men 68.3%, diabetes 50.2%) from 53 countries, 1071 (2.6%) developed PAD, and 4955 (12.2%) died during 5 years of follow-up. Incident PAD progressively rose with higher arm BP indices and fell with ankle BP indices. The strongest relationships were noted for ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, adjusted hazard ratios (95% confidence interval) for each lower fourth were 1.64 (1.31-2.04), 2.59 (2.10-3.20), and 4.23 (3.44-5.21) for ankle SBP; 1.19 (0.95-1.50), 1.66 (1.34-2.05), and 3.34 (2.75-4.06) for ABI; and 1.41 (1.11-1.78), 2.04 (1.64-2.54), and 3.63 (2.96-4.45) for APPD. Similar patterns were observed for mortality. Ankle BP indices provided the highest c-statistics and classification indices in predicting future PAD beyond established risk factors. CONCLUSIONS: Ankle BP indices including the ankle SBP and the APPD best predicted PAD and mortality.
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Índice Tobillo Braquial , Brazo , Presión Sanguínea , Enfermedad Arterial Periférica , Humanos , Masculino , Femenino , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/mortalidad , Anciano , Presión Sanguínea/fisiología , Brazo/irrigación sanguínea , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
The occurrence of variations in human arterial branching of the upper limb has been commonly reported in peer-reviewed literature. However, the variability of upper limb arterial patterns may be underappreciated in medical practice, which can result in clinical and surgical errors. Here we report a case of a rare, unilateral arterial variation of the left upper limb of a 76-year-old Caucasian male cadaver, discovered during a routine educational dissection. Observed characteristics of the variation include a high brachial artery bifurcation into a superficial brachioulnoradial artery and brachial artery continuing as the interosseous artery and then a bifurcation of the superficial brachioulnoradial artery into a superficial radial and a superficial ulnar artery, which eventually contribute to the formation of the superficial palmar arch. The anatomical characteristics, prevalence, embryological origin, and clinical significance of the variation are discussed.
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Arteria Braquial , Arteria Cubital , Masculino , Humanos , Anciano , Extremidad Superior , Brazo/irrigación sanguínea , Disección , Cadáver , Arteria RadialRESUMEN
To evaluate the accuracy of the DBP-1333b upper-arm blood pressure (BP) measuring device in the adult population according to the AAMI/ESH/ISO universal standard (ISO 81060-2:2018+Amd.1:2020). Subjects were recruited in the adult population. The test device was an arm-type electronic sphygmomanometer (DBP-1333b) and the reference device was a desktop sphygmomanometer (XJ11D). Using the BP data measured by the desktop sphygmomanometer as reference BP, the accuracy of the non-invasive BP module of the test device was evaluated to determine whether it met the requirements. Data from 90 individuals were analysed. According to Criterion 1, the mean difference of SBP between the test and reference device was 0.19â mmHg and the SD was 7.45â mmHg. The mean difference of DBP was -0.59â mmHg and the SD was 6.47â mmHg. The mean difference of both SBP and DBP was less than 5â mmHg, and the SD was less than 8â mmHg, which met the requirements. According to Criterion 2, SD of SBP was 5.79â mmHg, which was less than 6.95â mmHg and met the requirements. The SD of DBP was 5.58â mmHg, which was less than 6.93â mmHg and met the requirements. It was concluded that the DBP-1333b complies with the AAMI/ESH/ISO universal standard (ISO 81060-2:2018+Amd.1:2020) and can be recommended for use by the adults.
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Monitores de Presión Sanguínea , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Brazo/irrigación sanguínea , Presión Sanguínea , Determinación de la Presión Sanguínea/instrumentación , Monitores de Presión Sanguínea/normas , Esfigmomanometros/normasRESUMEN
INTRODUCTION: Lower-body aerobic exercise with blood flow restriction (BFR) offers a unique approach for stimulating improvements in muscular function and aerobic capacity. While there are more than 40 reports documenting acute and chronic responses to lower-body aerobic exercise with BFR, responses to upper-body aerobic exercise with BFR are not clearly established. PURPOSE: We evaluated acute physiological and perceptual responses to arm cranking with and without BFR. METHODS: Participants (N = 10) completed 4 arm cranking (6 × 2 min exercise, 1 min recovery) conditions: low-intensity at 40%VO2peak (LI), low-intensity at 40%VO2peak with BFR at 50% of arterial occlusion pressure (BFR50), low-intensity at 40%VO2peak with BFR at 70% of arterial occlusion pressure (BFR70), and high-intensity at 80%VO2peak (HI) while tissue oxygenation, cardiorespiratory, and perceptual responses were assessed. RESULTS: During exercise, tissue saturation for BFR50 (54 ± 6%), BFR70 (55 ± 6%), and HI (54 ± 8%) decreased compared to LI (61 ± 5%, all P < 0.01) and changes in deoxyhemoglobin for BFR50 (11 ± 4), BFR70 (15 ± 6), and HI (16 ± 10) increased compared to LI (4 ± 2, all P < 0.01). During recovery intervals, tissue saturation for BFR50 and BFR70 decreased further and deoxyhemoglobin for BFR50 and BFR70 increased further (all P < 0.04). Heart rate for BFR70 and HI increased by 9 ± 9 and 50 ± 15b/min, respectively, compared to LI (both P < 0.02). BFR50 (8 ± 2, 1.0 ± 1.0) and BFR70 (10 ± 2, 2.1 ± 1.4) elicited greater arm-specific perceived exertion (6-20 scale) and pain (0-10 scale) compared to LI (7 ± 1, 0.2 ± 0.5, all P < 0.05) and pain for BFR70 did not differ from HI (1.7 ± 1.9). CONCLUSION: Arm cranking with BFR decreased tissue saturation and increased deoxyhemoglobin without causing excessive cardiorespiratory strain and pain.
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Brazo , Ejercicio Físico , Consumo de Oxígeno , Flujo Sanguíneo Regional , Humanos , Masculino , Brazo/irrigación sanguínea , Brazo/fisiología , Flujo Sanguíneo Regional/fisiología , Consumo de Oxígeno/fisiología , Ejercicio Físico/fisiología , Femenino , Adulto , Músculo Esquelético/fisiología , Músculo Esquelético/irrigación sanguínea , Adulto Joven , Percepción/fisiología , Frecuencia Cardíaca/fisiologíaRESUMEN
Cephalic arch stenosis (CAS) is critical point to maintain functional arteriovenous fistula (AVF) in patients undergoing hemodialysis with brachio-cephalic AVFs. In this study, we aimed to determine the effectiveness of dual outflow (cephalic and basilic veins) as a surgical method to prevent CAS. Between July 2016 and December 2019, 369 patients underwent upper arm AVF creation. Among them the 251 patients were enrolled in this retrospective study. Two hundred seven underwent brachio-cephalic arteriovenous fistula (BCAVF) and 44 underwent brachio-cephalicbasilic arteriovenous fistula (BCBAVF). From the 251 patients, diabetes mellitus (66.7% vs 36.4%, Pâ <â .001) and hypertension (91.3% vs 75%, Pâ =â .002) were more common in the patient group who underwent BCAVF surgery; however, the difference in volume flow to the fistula did not differ between the 2 groups. CAS (30.4% vs 9.1%, Pâ =â .004) and fistula occlusion (15.9% vs 4.5%, Pâ =â .048) were likely to occur in the BCAVF group. The primary patency rates at 12 months were 74.3% and 86.4% for the BCAVFs and BCBAVFs, respectively (Pâ =â .075). The primary-assisted patency rates at 12 months were 87.0% for BCAVFs and 93.2% for BCBAVFs, respectively (Pâ =â .145). Secondary patency rates at 12 months were 92.2% for BCAVFs and 93.2% for BCBAVFs, respectively (Pâ =â .023). Compared to BCAVF, traditional upper arm AVF, upper arm AVF with cephalic and basilic vein dual drainage can be optimal surgical method to preventing CAS.
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Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Humanos , Brazo/cirugía , Brazo/irrigación sanguínea , Estudios Retrospectivos , Constricción Patológica/prevención & control , Constricción Patológica/etiología , Grado de Desobstrucción Vascular , Resultado del Tratamiento , Derivación Arteriovenosa Quirúrgica/efectos adversos , Diálisis Renal , Fístula Arteriovenosa/prevención & control , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/etiologíaRESUMEN
INTRODUCTION: Laser lead extraction is a well-established method for removing unwanted leads with low morbidity and mortality. In this small series of cases, we documented our experience with venous thrombosis after laser lead extraction. METHODS: Retrospective data of patients who underwent laser lead extraction with postoperative axillo-subclavian vein thrombosis between May 2010 and January 2020 were analyzed. Demographic, operative, clinical, and follow-up characteristics of those patients were collected from our medical database. RESULTS: Six patients underwent percutaneous laser lead extraction. Mean age of the patients was 64±7 years. And four of them were male. A total of 11 leads with a mean age of 92±43.8 months were extracted. Patients presented with painful arm swelling postoperatively. CONCLUSION: Laser lead extraction may lead to symptomatic upper extremity deep venous occlusion.
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Vena Subclavia , Trombosis de la Vena , Humanos , Masculino , Persona de Mediana Edad , Anciano , Preescolar , Niño , Femenino , Vena Subclavia/cirugía , Estudios Retrospectivos , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Brazo/irrigación sanguínea , Extremidad SuperiorRESUMEN
PURPOSE: Morphological variations of the brachial artery are quite commonly discovered in routine dissection and have been the subject of many studies. However, there is a need for a clear classification. This work presents morphological variations of the brachial artery, based on numerous case reports and studies created for the appropriate classification and interpretation among surgeons and radiologists. It also discusses the most important clinical aspects of the given varieties. METHODS: The research method is based on the combined interpretation of the researches based on numerous publications concerning both the principles of correctly classifying the described morphological variations of the brachial artery and the resulting clinical implications. This work considers atypical variations such as the presence of the superficial brachial artery, brachoradial artery, accessory brachial artery and absence of the brachial artery. Variations of the brachial artery in relation to the external and internal diameter of the vessel have also been discussed. RESULTS: After conducting a complex analysis of the collected data, the fundamental principles for classifying such variability as superficial brachial artery, brachioradial artery and accessory brachial artery were defined. Additionally, clinical implications resulting from the above like the impact of the superficial brachial artery on the median nerve neuropathy and the positive correlation between the brachioradial artery and increased danger of incorrect transradial catheterization were demonstrated. CONCLUSIONS: The clinical implications of the atypical arterial pattern within the upper limb are crucial during the angiography and surgical procedures so the variations affect the appropriate diagnosis and surgical intervention. Hence, the knowledge about the morphological variations of the brachial artery should be constantly broadened by radiologists and surgeons to improve the accuracy and effectiveness of the treatment process.
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Arteria Braquial , Extremidad Superior , Humanos , Brazo/irrigación sanguínea , Arteria Radial , Arteria AxilarRESUMEN
We aimed to explore whether the cuff/arm (C/A) circumference ratio within the suggested range (> 80%) affects the accuracy of mercury cuff blood pressure (BP) measurement (cuff BP) using intrabrachial BP (IABP) as a reference.A total of 253 patients aged 62.42 ± 9.70 years were included. After coronary angiography, the catheter in the right arm was gradually withdrawn toward the cubital fossa, and the IABP was continuously recorded. The cuff BP of the right arm was measured based on the artery blood flow using a special method similar to the traditional mercury method. The cuff was replaced using another C/A ratio after one minute, and the test was performed again. We used three different cuffs for each participant to meet the C/A ratios of 80%-84%, 85%-89%, and 90%-100%. We calculated the percentage deviation degree (DD) between the cuff BP and IABP values: DD = difference/IABP × 100%. The agreement between the values was evaluated using the Bland-Altman method.The IABP values were 138.52 ± 16.89/79.67 ± 9.81 mmHg. The DD of the systolic BP (SBP), with a ratio of 80%-84% (3.06%), was the smallest. The DD of the diastolic BP (DBP) was lowest at a ratio of 85%-89% (2.47%). Men and women had the lowest DD of the SBP at a C/A ratio of 80%-84% and the lowest DD of the DBP at a C/A ratio of 85%-89%. Regardless of whether the participants had coronary heart disease, the DD of the SBP at a C/A ratio of 80%-84% was the lowest, and the DD of the DBP at a C/A ratio of 85%-89% was the lowest.Even in the suggested range of > 80%, when the C/A ratio was 80%-84%, the difference in the SBP between the cuff and IABP was the lowest, but when the C/A ratio was 85%-89%, the difference in the DBP was the lowest.
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Brazo , Mercurio , Masculino , Humanos , Femenino , Presión Sanguínea/fisiología , Brazo/irrigación sanguínea , Brazo/fisiología , Determinación de la Presión Sanguínea/métodos , Presión ArterialRESUMEN
PURPOSE: To analyze the complex shoulder vasculature and identify potential challenges during adhesive capsulitis embolization (ACE). MATERIALS AND METHODS: Two interventional radiologists evaluated angiographic findings from 21 ACE procedures. The suprascapular artery (SSA), thoracoacromial artery (TAA), coracoid branch (CB), circumflex scapular artery (CSA), and anterior/posterior circumflex humeral artery (ACHA/PCHA) were assessed for their presence, course, diameter within 1 cm of origin, angle to the proximal parent vessel, and distance from the clavicle. RESULTS: 83 arteries were embolized: CB (20.5%), TAA (19.3%), PCHA (19.3%), ACHA (16.9%), CSA (14.5%), and SSA (9.6%). The CSA had the largest diameter (4.3 mm), while CB had the smallest diameter (1.0 mm). An acute angle to the parent vessel was noted with the SSA, TAA, ACHA, and PCHA. A common origin for CSA and PCHA was noted in 2 patients. A common origin for TAA and SSA was also noted in one patient. The CB appears perpendicular to the axillary artery and courses vertically toward the coracoid process. The TAA branches off the axillary artery and courses along the medial border of the pectoralis minor. The PCHA and ACHA originate from the axillary artery. The CSA is located on the medial side of axillary artery. The SSA originates from the thyrocervical trunk and courses laterally toward the superior border of the scapula. CONCLUSION: An anatomical-technical guide is provided to help interventional radiologists during ACE to treat adhesive capsulitis.
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Brazo , Arteria Axilar , Humanos , Brazo/irrigación sanguínea , Escápula/irrigación sanguínea , Arteria Subclavia , ClavículaRESUMEN
OBJECTIVES: Successful haemodialysis is dependent on optimal arteriovenous (AV) access flow. Although 600 ml/min is frequently quoted as the critical level for functional flow volume (Qa) according to the National Kidney Foundation guideline, this may not be applicable for the different configurations of AV fistulas (AVF) or AV grafts (AVG). This study evaluates ultrasound derived Qa measurement in the inflow brachial artery to autologous AVF in the forearm radiocephalic and arm brachiocephalic/basilic configurations in relation to significant flow related AV dysfunction. METHODS: Five hundred and eleven duplex ultrasound (DUS) scans were analysed in 193 patients. The end points were therapeutic intervention and/or thrombosis of AVF versus no complication within 3 months of the scan. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold Qa of the brachial artery supplying the AVF. RESULTS: Of the 511 scans, 155 scans were assigned to the intervention group, that is, AVF requiring intervention or thrombosing within 3 months of the DUS. Using ROC curve analysis, the area under the curve (AUC) for all AVF is 0.90 (CI: 0.88-0.93) with an optimal threshold Qa of 686 ml/min. In forearm AVF, the threshold Qa is 589 ml/min while in arm AVF the threshold Qa is 877 ml/min. Forearm Qa is statistically different from arm Qa. CONCLUSION: Forearm AVF Qa threshold at 589 ml/min is distinct from arm AVF Qa at 877 ml/min and these are predictive of the need for impending intervention or thrombosis due to flow-limiting stenosis.
Asunto(s)
Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Trombosis , Humanos , Antebrazo/irrigación sanguínea , Brazo/irrigación sanguínea , Derivación Arteriovenosa Quirúrgica/efectos adversos , Grado de Desobstrucción Vascular , Velocidad del Flujo Sanguíneo , Diálisis Renal/efectos adversos , Trombosis/etiología , Fístula Arteriovenosa/complicacionesRESUMEN
OBJECTIVE: Free flap transfer is a safe and reliable technique for soft tissue reconstruction. However, impaired flap perfusion with consecutive microcirculatory failure leading to partial or total flap failure remains a clinically relevant problem. Remote ischemic conditioning (RIC) has been shown to improve microcirculation in adipo-cutaneous tissues in healthy humans as well as in free flaps. Yet, little is known about its effects on different perfusion zones in free flaps and the duration of these effects. METHODS: Twenty-five patients with free perforator-based adipo-cutaneous flap transfer were included in the study. RIC (3 cycles: 10/10 min ischemia/reperfusion) was applied via an inflatable tourniquet placed on the upper arm. Continuous measurement of flaps' microcirculation on postoperative day (POD) 1, 3, and 5 was performed by utilizing an O2C device ("Oxygen-to-see" ©LEA Medizintechnik Germany) during RIC and for the following 4 h. Probes were located both in the flaps' center and on its distal edge. RESULTS: Twenty patients were included in the final analysis. RIC significantly improved flaps' blood flow (BF) by a max. of + 19.6% and oxygen saturation of + 15.7%. Changes affected the entire flap, without significant difference between zones. The increase in flap perfusion could be observed for at least 4 h after the completion of RIC. CONCLUSION: Postoperative application of RIC might serve as an additional treatment to enhance whole flap perfusion and prevent microcirculatory disorders, therefore reducing the risk for potential tissue necrosis, especially in the distal parts of the flaps.
Asunto(s)
Isquemia , Colgajos Quirúrgicos , Humanos , Microcirculación , Isquemia/prevención & control , Colgajos Quirúrgicos/irrigación sanguínea , Brazo/irrigación sanguínea , PielRESUMEN
PURPOSE: There are few studies searching for possible perforator flap donor sites on the arm. This study aimed to identify the locations of cutaneous perforators of the arm according to anatomical landmarks. METHODS: Thirteen Thiel-fixed and latex-filled upper extremities of bodies donated to science were used. The distance between the acromion and medial or lateral epicondyle of the humerus was defined as the Y-axis, and the axis that cut the Y-axis perpendicularly through the epicondyles of the humerus was identified as the X-axis. The Y-axis was then divided into three parts Cutaneous arterial perforators were found using surgical dissection. The locations of the perforators were determined according to the defined lines and regions. RESULTS: On the lateral side, there were 6.00 ± 2.08 perforators per arm, of which 56.4% were septocutaneous and 43.6% muscular. In all extremities, with in the distal 1/3 of the lateral arm, there were 1-4 radial collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.16 ± 0.53 cm. On the medial side, there were 5.05 ± 1.44 perforators per arm, which were all septocutaneous perforators. In 85% of the extremities, within the middle 1/3 of the medial arms, there were 1-2 superior ulnar collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.53 ± 0.61 cm. CONCLUSION: There are always perforators from the radial collateral artery with in the distal third of the lateral arm. Within the middle third of the medial arm, it is usually possible to find a perforator from the superior ulnar collateral artery.
Asunto(s)
Brazo , Colgajo Perforante , Brazo/irrigación sanguínea , Disección , Humanos , Colgajo Perforante/irrigación sanguínea , Piel/irrigación sanguínea , Arteria CubitalRESUMEN
The branches of the porcine subclavian artery are frequently used in endovascular stroke training and research. This study aimed to determine a porcine weight group, in which the arterial diameters most closely match human cerebral artery diameters, and thus optimize the porcine in-vivo model for neuroendovascular purposes. A group of 42 German Landrace swine (45-74 kg) was divided into four subgroups according to their weight. Angiographic images of the swine were used to determine the arterial diameter of the main branches of the subclavian artery: axillary artery, brachial artery, external thoracic artery, subscapular artery (at two different segments), suprascapular artery, caudal circumflex humeral artery, thoracodorsal artery, and circumflex scapular artery. The porcine arterial diameters were correlated with animal weight and compared to luminal diameters of human arteries which are commonly involved in stroke: internal carotid artery, basilar artery, vertebral artery, middle cerebral artery and M2 branches of the middle cerebral artery. Swine weight was positively correlated with porcine arterial diameter. The most conformity with human arterial diameters was found within the two heavier porcine groups (55-74 kg). We suggest the use of swine with a weight between 55-59.7 kg, as lighter animals show less similarity with human arterial diameters and heavier animals could cause more problems with manipulation and handling.