Radial Artery

Among patients undergoing coronary procedures, patients with coronary artery bypass grafts represent an important, high risk subgroup. Routine transradial approach may be successfully adopted in these patients to reduce access-site complications. However, transradial cannulation of the grafts may result technically demanding. In this article we discuss the specific technical issues and we present a series of tips and tricks which may facilitate angiography and interventions on both internal mammary and aorto-coronary grafts. © 2008 Wiley-Liss, Inc.

This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Six hundred forty-four patients were randomized to either transradial or transfemoral PTCA using 6 Fr equipment. Patients were triaged to outpatient management based on a predefined set of predictors of an adverse outcome in the first 24 hr after initially successful coronary angioplasty. Three hundred seventy-five patients (58%) were discharged 4–6 hr after PTCA; 42% stayed in hospital overnight. In the outpatient group, one adverse event occurred (subacute stent thrombosis 7 hr postdischarge, nonfatal myocardial infarction). There were no major vascular complications. In the hospital group, 19 patients (7%) sustained an adverse cardiac even in the first 24 hr; 1 patient died. Patients treated via the femoral route had more (minor) bleeding complications (19 patients; 6%); in 17 of these, this was the sole reason that discharge was delayed. PTCA on an outpatient basis, performed via the radial or the femoral artery with low-profile equipment, is safe and feasible in a considerable part of a routine PTCA population. A larger proportion of transradial patients can be discharged due to a reduction in (minor) bleeding complications. Catheter Cardiovasc Interv 2005;64:421–427. © 2005 Wiley-Liss, Inc.

Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested en...

A novel algorithm to detect the dicrotic notch in arterial pressure signals is proposed. Its performance is evaluated using both aortic and radial artery pressure signals, and its robustness to variations in design parameters is investigated. Most previously published dicrotic notch detection algorithms scan the arterial pressure waveform for the characteristic pressure change that is associated with the dicrotic notch. Aortic valves, however, are closed by the backwards motion of aortic blood volume. We developed an algorithm that uses arterial flow to detect the dicrotic notch in arterial pressure waveforms. Arterial flow is calculated from arterial pressure using simulation results with a three-element windkessel model. Aortic valve closure is detected after the systolic upstroke and at the minimum of the first negative dip in the calculated flow signal. In 7 dogs ejection times were derived from a calculated aortic flow signal and from simultaneously measured aortic flow probe d...

Background: Transradial access is the approach of choice in many laboratories for diagnostic coronariography or percutaneous coronary interventions (PCI) because of its lower vascular complication rate than the femoral approach. However, this approach has a higher rate (5–10%) of asymptomatic radial artery (RA) occlusion. Methods: We conducted a prospective, controlled, single-centre trial study. We investigated whether the pneumatic compression (using “TR Band of Terumo®”) of the radial artery guided by the mean artery pressure (MAP) after the procedure (group A) is efficient in reducing radial occlusion in patients under a coronary angiography by transradial access for diagnostic coronariography or PCI compared to use of standard procedure (group B, 15 cm3 of air in the device). Results: The study was suspended after analyzing the results of 50% of the scheduled patients. An analysis of the results of 351 consecutive random patients in Group A showed significantly (P = 0.0001) lower rate (1.1%) of occlusion than Group B (12.0%) without significant differences in the rate of other complications. Other variables associated with RA occlusion in univariate analysis were previous or active smoker (P < 0.04), absence of anti-aggregant treatment (P < 0.04), and the presence of RA flow postprocedure (PFP, P < 0.001). Independent predictors with logistic regression analysis were PFP (HR = 0.06, 95% CI 0.01–0.2), presence of hematoma (HR = 3.7, 95% CI 1.2–11.0), and standard pneumatic compression in group B patients (HR = 18.8, 95% CI 3.8–92.2). Conclusions: Use of pneumatic compression guided by MAP is safe and efficient, and it can significantly lower the incidence of radial artery occlusion. © 2009 Wiley-Liss, Inc.

Traffic congestion is a growing problem in Nairobi, Kenya, resulting from rapidly increasing population and the crowding of motorized traffic onto a limited street network. This report includes analysis of the traffic conditions in Nairobi, the expected effects of further growth in demand, and a set of recommendations for how to improve the performance of the street network. Data describing

The superficial location of critical structures, including tendons, nerves and vessels, in the volar surface of the wrist makes them vulnerable to penetrating trauma. Extensive injuries to these structures are described as "spaghetti wrist". The main objective of this study was to report functional outcome in spaghetti-wrist injuries. The records of patients presenting to our clinic with extensive volar wrist injuries between January 2016 and January 2019 were reviewed retrospectively. Age, gender, comorbidities, date of injury, injury mechanism, affected hand and transected structures were noted. Tendon function, opposition, intrinsic hand function, deformity and sensitivity were evaluated following the Noaman report. The Michigan Hand Outcomes Questionnaire (MHOQ) was used to evaluate hand-specific outcomes. Twenty patients were included. Mean age was 32.7 years (range, 18-47 years). Mean follow-up was 21.9 months (range, 12-50 months). Mean number of injured structures was 11.9 (range, 10-16 structures) per patient. Physiotherapy duration had an effect on postoperative outcome in all six MHOQ domains (r = 0.821, p = 0.00001). However, no significant difference in overall hand function was found according to the number of injured structures (r = -0.105, p = 0.661). Precise initial evaluation, meticulous surgical treatment within 24 h and early physical therapy are essential after spaghetti-wrist injury. Good functional results are associated with prolonged physical therapy, but not with the number of structures injured.

... E-mail hyoshi{at}cardiol.med.kyushu-u.ac.jp. ... General Procedures The study was conducted with the participants in a supine position and in a postabsorptive state in an air-conditioned room at 25°C to 26°C. Under local anesthesia with 2% procaine, the left brachial artery was ...

To examine the use and outcomes of balloon-assisted tracking (BAT) technique for dealing with complexities of arm and chest vasculature during transradial approach (TRA) at a single high volume radial center. TRA has been used for coronary angiography and percutaneous coronary interventions (PCI) around the world. Different techniques have been described to address the anatomical issues and tortuosities for successful completion of coronary angiography and PCI. This study describes the use of BAT technique and associated outcomes during real world clinical practice. Subjects comprised 63 patients, (out of total 8,245 patients between January 2011 and December 2012) in whom we encountered significantly complex anatomical course in radial, brachial, or subclavian region, leading to difficult advancement of a diagnostic or a guide catheter despite trying all standard maneuvers. In all of them BAT technique was used and they were retrospectively analyzed for the purpose of this study. A...

4 Kardiyoloji E. Profesörü Özet Situs inversus totalis az rastlanan bir durum olmas›na ramen, bu ters organ yerleflimine sahip kiflilerde koroner arteryel rahats›zl›klar›n görülme oran› genel nüfusla ayn›d›r. ‹skemik kalp hastal›¤› nedeniyle koroner cerrahi uygulanacak bu hastalarda kalbin pozisyonu greft ter- cihine etki etse de, küçük teknik deiflikliklerle yüz güldürücü sonuçlar al›nabilmektedir. Sunaca¤›m›z olgu, 55 yafl›nda dekstrokardi ve situs inversuslu