Importancia del sitio de terminación de la vena cefálica del antebrazo / Importance of the cephalic antebrachial vein termination site

RESUMEN: Las venas superficiales de la fosa cubital se han estudiado con varios fines, venopunciones, cateterismos, fístulas, entre otros. Se han descrito varios patrones venosos en esta región en diferentes poblaciones. En uno de estos la vena cefálica termina en la vena basílica a nivel del antebrazo generando posibles riesgos de lesiones durante la canalización. En el presente estudio se evaluaron 200 miembros superiores de 100 personas colombianas, 50 mujeres y 50 hombres, 70 de ellas nacidas en la ciudad de Bucaramanga y 30 en la ciudad de Villavicencio. Se registró el número de venas cefálicas y su sitio de terminación, en el brazo o antebrazo. El patrón venoso que predominó en ambos miembros superiores fue el tipo I. El patrón IV en el cual la vena cefálica termina en la vena basílica se presentó en 12 casos (6 %) en el miembro superior derecho y en 17 casos (8,5 %) en el miembro superior izquierdo. Se encontró dos venas cefálicas entre el 13 % y 13,5 % dependiendo del lado y tres venas cefálicas entre el 1 % y 2 %. Conocer esta particularidad de los patrones venosos podría disminuir el riesgo de complicaciones durante la venopunción.

SUMMARY: The superficial veins of the ulnar fossa have been studied for various purposes, venipuncture, catheterization, fistulae, among others. Various venous patterns have been described in this region in different populations. In one of these, the cephalic vein ends in the basilic vein at the level of the forearm, generating possible risks of injury during cannulation. In the present study, 200 upper limbs of 100 Colombians, 50 women and 50 men, were evaluated, 70 of them born in the city of Bucaramanga and 30 in the city of Villavicencio. The number of cephalic veins and their termination site, on the arm or forearm, were recorded. The venous pattern that predominated in both upper limbs was type I. Pattern IV in which the cephalic vein ends in the basilic vein occurred in 12 cases (6 %) in the right upper limb and in 17 cases (8.5 %) in the left upper limb. Two cephalic veins were found between 13 % and 13.5 % depending on the side and three cephalic veins between 1 % and 2 %. Knowing this particularity of venous patterns could reduce the risk of complications during venipuncture.

Arteria ulnar superficial, bilateral y antebraquial: similitudes y diferencias / Superficial ulnar artery, bilateral and antebrachial: similarities and differences

Describimos un hallazgo infrecuente de arteria ulnar superficial en ambos antebrazos de un cadáver, con origen en la arteria braquial, a nivel de la fosa cubital. Las arterias presentan un trayecto que dividimos en cuatro segmentos, a causa de sus flexuosidades. Ambos antebrazos presentan ausencia del músculo palmaris longus. Se resumen las principales teorías sobre su desarrollo y las complicaciones que pueden ser ocasionadas por su presencia y el eventual beneficio de la misma. Hasta el momento, no hemos encontrado en la literatura, una disposición morfológica de arterias ulnares superficiales como las aquí descritas.

We describe an infrequent finding of a superficial ulnar artery in both cadaver forearms, which originates in the brachial artery at cubital fossa level. The arteries have a path that we divided into four segments, because of their flexuosities. Both forearms showed an absence of the palmaris longus muscle. This summarizes the main theories about its development and the complications and eventual benefits that can be caused by its presence. So far, we have not found in the literature, a morphological disposition of superficial ulnar arteries such as those described here.

Elementos morfológicos implicados en la enseñanza de las competencias para lograr una adecuada venopunción periférica / Morphological elements involved in the teaching of competences to achieve adequate peripheral venipuncture

RESUMEN: La venopunción periférica es un procedimiento muy común y necesario para la administración de múltiples sustancias. Cada enfermero(a) debe recibir la capacitación en varios aspectos que le permitan adquirir la competencia de realizar una venopunción segura. Uno de los elementos de mayor relevancia se relaciona con la anatomía aplicada, particularmente con la descripción de varios patrones de organización de las venas superficiales del antebrazo y su relación con estructuras neurovasculares cercanas. Los patrones de acuerdo a su distribución, podrían jugar a favor o en contra de las complicaciones durante o después de la punción. En este artículo describimos las respuestas de docentes de las escuelas de Enfermería de varias regiones de Colombia frente a la enseñanza de estos temas anatómicos. Sobresale el hecho que solamente en el 56,5 % de la escuela de Enfermería se realiza la enseñanza completa de los conceptos anatómicos que servirán para mejorar la seguridad del paciente en el momento de una venopunción periférica.

SUMMARY: Peripheral venipuncture is a very common and necessary procedure for the administration of multiple substances. Each Nurse must receive training in several aspects that allows him/her to acquire the competence to perform a safe venipuncture. One of the most relevant elements is related to applied anatomy, particularly with the description of various organization patterns of the superficial veins of the forearm, and their relation to nearby neurovascular structures. These patterns according to their distribution, could play for, or against complications during or after puncture. In this article, we describe the responses of teachers from the Nursing Schools of several regions of Colombia while teaching these anatomical subjects. It is noteworthy, that only 56,5 % of Nursing Schools included complete instruction of anatomical concepts that improve patient safety at the time of a peripheral venipuncture. Therefore, nearly 50 % of students do not receive information on updated anatomical terminology.

Relación entre el patrón venoso superficial del antebrazo y las complicaciones de los cateterismos venosos periféricos y centrales en una muestra de niños atendidos en una unidad de cuidados intensivos pediátricos de Santander Colombia / Relationship between surface forearm vein pattern and complications of peripheral and central venous catheterization in a sample of children treated in the pediatric intensive care unit of Santander Colombia

Desde hace varias décadas se han adelantado estudios anatómicos que muestran como las poblaciones en diversos países mantienen una representación de los diferentes patrones venosos superficiales en el antebrazo. Esto contrasta con el concepto arraigado en los textos clásicos de anatomía que mantuvieron la idea de una poca variabilidad de las venas y un predominio del llamado patrón en "M". El presente estudio descriptivo, en niños que ingresaron a la Unidad de Cuidados Intensivos Pediatricos (UCIP) y requirieron acceso venoso en miembro superior, busca determinar si existe asociación entre las venas y el patrón venoso superficial del antebrazo y la necesidad de retirar los catéteres superficiales (bránula y epicutáneo). Se incluyeron 54 pacientes: 23 niñas y 31 niños. Se valoraron las indicaciones de venopunción y el tipo de patrón venoso. Se presentaron 22 cambios en la venopunción principalmente en los patrones II y IV. Pero aunque el patrón IV tuvo un porcentaje de presentación menor comparado con el patrón II, fue el único patrón en el cual se presentó la necesidad de cambiar la venopunción en 3 ocasiones consecutivas. Consideramos de gran importancia darle una aplicación clínica al concepto anatómico de los patrones venosos; fomentar en las escuelas de Enfermería y Medicina la enseñanza de los patrones venosos y sus implicaciones de riesgo, y valorar con estudios posteriores si el patrón tipo IV puede aumentar el riesgo de iatrogenia en poblaciones infantiles.

For several decades there have been advanced anatomical studies showing how populations in different countries maintain a representation of the different surface vein patterns in the forearm. This contrasts with the concept rooted in the classical texts of anatomy that kept the idea of a low variability of veins and a predominance of pattern called "M". This descriptive study in children admitted to the Pediatric Intensive Care Unit (PICU) and required upper limb venous access, seeks to determine whether there is an association between the veins and superficial venous pattern of the forearm and the need to remove the catheter surface (branule and epicutaneous). Fifty-four patients were included: 23 girls and 31 boys. Directed by venipuncture and type of vein patterns were assessed. Twenty-two changes occurred mainly in venipuncture patterns II and IV. But although the pattern IV had a lower percentage compared to the standard presentation II, it was the only pattern which showed the need to change the venipuncture on 3 consecutive occasions. We assign great importance to give a clinical application to the anatomical concept of vein patterns; encouraging nursing schools and those teaching Medicine vein patterns and associated risk implications, and titrate with further studies if the IV pattern can increase iatrogenic risks in pediatric populations.

Implicancias clínico-quirúrgicas del origen alto de la arteria radial / Clinical and surgical implications of the radial artery high origin

Las variaciones arteriales del miembro superior tienen su justificación en el origen embriológico. El nacimiento de la arteria radial por proximal a la interlínea articular del codo es una de las variaciones anatómicas más frecuentes y su importancia radica en el aumento de los procedimientos percutáneos sobre la arteria radial en cateterismos coronarios y en el cada vez más utilizado colgajo radial en las cirugías reconstructivas. Su trayecto superficial favorece los traumatismos y la posibilidad de confusión con las venas puede ocasionar la realización de inyecciones medicamentosas accidentales en estas arterias con sus graves consecuencias. El conocimiento de las variaciones arteriales del miembro superior, y en especial de la arteria radial presentada en esta investigación, es fundamental al momento de planear abordajes clínicos y quirúrgicos que los involucre.

The upper limb arterial variations are justified by the embryological origin of all the limb. The birth of the radial artery above the joint line of the elbow is one of the most frequent anomalies and its importance is increasing in percutaneous procedures on the radial artery, in coronary catheterizations and the increasingly used of the ra- dial flap in reconstructive surgery. Its superficial way favors injuries and the possibility of confusion with veins that can cause accidental drug performing injections in these arteries with serious consequences. Knowledge of arterial variations of the upper limb, especially the radial artery presented in this research, is essential when planning clinical and surgical approaches that involves them.

Coupled multiple musculo-neurovascular variations in same upper limb: a case report and clinical significances / Múltiples variaciones músculo-neurovasculares conectados en el mismo miembro superior: reporte de un caso y significados clínicos

Variants of the median nerve, extra forearm flexor muscles heads are relationships of the persistent median artery (PMA) that have been extensively reported. We report the findings of a PMA (diam. 3.25 mm), a pierced median nerve, and accessory heads of the flexor digitorum profundus (FDP) and flexor policis longus (FPL) muscles coexisting with a brachioradial artery (BRA) (diam.1.8mm) in the left upper limb of a 65 year-old male cadaver. The median nerve provided a ring for the passage of the PMA about the junction of the proximal and middle thirds of the forearm. Both accessory muscles were placed anterior to the ulnar artery, with the brachioradial artery coursing superficially in the brachium and antebrachium. The notable diameter of the PMA may be etiological in the causation of a carpal tunnel syndrome, while the hypoplastic BRA may pose some challenges inits selection as good conduit for catheterization and other surgical interventions like CABG in the upper limb. Additional clinical interest include the possible reduction in blood supply to the hand from the compressive effect of the 2 accessory muscles on the ulnar artery and possible inadvertent drug injection due to the superficial placement of the brachioradial artery close to veins.

Variantes del nervio mediano y cabezas adicionales de los músculos flexores del antebrazo, se relacionan con la arteria mediana persistente (AMP). Presentamos los resultados de una AMP (diámetro 3,25 mm), un nervio mediano pinzado y cabezas accesorias de los músculos flexor profundo de los dedos (FPD) y flexor largo del pulgar (FLP) que coexisten con una arteria braquiorradial (ABR) (diámetro 1,8 mm) en el miembro superior izquierdo de un cadáver de sexo masculino de 65 años. El nervio mediano proporciona un anillo para el paso de la AMP sobre la unión de los tercios proximal y medio del antebrazo. Ambos músculos accesorios se colocaron por delante de la arteria ulnar, con la arteria braquiorradial ubicada superficialmente en el brazo y en el antebrazo. El diámetro notable de la AMP puede ser la causa del síndrome del túnel carpiano, mientras que la ABR hipoplásica puede plantear algunos desafíos en su selección como buen conducto para la cateterización y otras intervenciones quirúrgicas como la cirugía de revascularización coronaria a partir del miembro superior. De interés clínico se considera la posible reducción en el suministro de sangre debido a la compresión de los 2 músculos accesorios a la arteria ulnar y la posible inyección fallida de drogas debido a la ubicación superficial de la arteria braquiorradial, cercana a las venas.

Evaluation of the Forearm Dominancy Artery for Invasive Vascular Procedure with 3D-CT Angiography

The aim of this study was to evaluate the vascular dominance in the forearm as a factor in determining the choice of invasive vascular procedures in arteries of the forearm, using 3D-computerized tomography (3D-CT) angiographies of 92 forearms. The diameters of the ulnar and radial arteries were measured just distal to the bifurcation of the brachial artery, at the midpoint between the bifurcation and the wrist, and at the wrist crease. In 79 cases, the ulnar artery was larger than the radial artery after the bifurcation of the brachial artery. However, no statistically significant difference was observed at either the mid-forearm or the wrist crease. In the remaining 13 cases, the diameter of the radial artery was larger or the same as that of the ulnar artery after the bifurcation, but at the more distal sites no regular pattern could be detected. The findings suggest that 3D-CT angiography offers valuable preoperative details of the forearm vessels for cases requiring invasive vascular procedures on the forearm.

Medial antebrachial cutaneous nerve: anatomical relationship with the medial epicondyle, basilic vein and brachial artery / Nervio cutáneo antebraquial medial: relación anatómica con el epicóndilo medial, vena basílica y arteria braquial

Medial antebrachial cutaneous nerve (MACN) courses in the medial arm to provide sensory innervation to the medial forearm. Its anatomy has been partly described since data regarding its branching pattern and distances to adjacent landmarks are still lacking. The purpose of this study was to provide morphometric anatomy of the MACN with comparisons between sides and sexes. Ninety-six upper extremities from 26 males and 22 females were dissected. We found that up to 5 branches of MACN pierced the deep fascia with the maximum of 4 reaching the interepicondylar line (IEL). Presence of 2 and 3 branches was found in the majority of cases (> 80%). The distances from these branches to the landmarks varied considerably. In case of no branch, the mean distances to the medial epicondyle (ME) and brachial artery (BA) were approximately 1.5 cm while those to the basilic vein (BV) were 0.7 cm in both sexes. Regardless of the branching pattern, the MACN could pass over or close (within 0.5 cm) to the ME, BV and BA. Asymmetry in the branching pattern was found in 50% of specimens. Sex but not side differences were observed in some measurement parameters. These data are crucial for not only localizing the MACN during nerve block and graft harvest but also avoiding the nerve injury during surgical procedures.

El recorrido del nervio cutáneo antebraquial medial (NCAM) proporciona la inervación sensorial medial del antebrazo. Su anatomía se ha descrito en parte, porque los datos relativos a su patrón de ramificación y distancias a puntos de referencia adyacentes son insuficientes. El propósito de este estudio fue proporcionar datos morfométricos sobre la anatomía del NCAM, comparando entre lados y sexos. Se disecaron 96 miembros superiores de 26 hombres y 22 mujeres. Se encontró que 5 ramos del NCAM traspasaron la fascia profunda y llegaron 4 hasta la línea interepicondilar (LIE). Presencia de 2 y 3 ramos se encontró en la mayoría de los casos (>80%). Las distancias de estos ramos a los puntos anatómicos variaron considerablemente. En caso de ausencia de ramos, la distancia medial al epicóndilo medial (EM) y arteria braquial (AB) fueron de aproximadamente 1,5 cm, mientras que a la vena basílica (VB) fueron 0,7 cm en ambos sexos. Independientemente del patrón de ramificación, el NCAM podría pasar sobre o cerca (a menos de 0,5 cm ) del EM, VB y AB. Asimetría en el patrón de ramificación se encontró en 50% de las muestras. Diferencias en algunos de los parámetros de medición se observaron según sexo, pero no por lado. Estos datos son relevantes para localizar el NCAM durante el bloqueo del nervio y la toma de injertos, sino también para evitar la lesión del nervio durante los procedimientos quirúrgicos.

Estudio morfométrico de la arteria radial y su implicación en la cirugía de revascularización miocárdica / Morphometric study of the radial artery and its involvement in bypass surgery grafting

La arteria radial (AR) es utilizada en la práctica médica para la realización de diversos procedimientos quirúrgicos, entre los que destaca la cirugía de revascularización miocárdica. En la literatura actual hay poca información acerca de la compatibilidad de esta arteria con otros conductos vasculares. El objetivo fue determinar las características anatómicas, morfométricas y distribución de la arteria radial en el antebrazo. Se disecó la arteria radial de 10 antebrazos de cadáveres embalsamados; se identificaron y registraron los ramos musculares y vasa nervorum emitidos por la arteria, se midió la longitud total y obtuvieron tres muestras (proximal, media y distal) de cada una para ser procesadas mediante técnicas histológicas y se determinaron los grosores de la túnica media y los diámetros. Se observaron modas de 8 ramos arteriales para el músculo braquiorradial, 4 para los músculos flexor superficial de los dedos y flexor radial del carpo, un ramo arterial único para el músculo pronador cuadrado y una moda de 1 vasa nervorum para el ramo superficial del nervio radial. La longitud total de la arteria fue de 21,94 cm (+/-3,34). Los grosores encontrados fueron de 196,16 µm (+/-72,35), 148,25 µm (+/-40,40) y 158,96 µm (+/-45,74) en los segmentos proximal, medio y distal respectivamente. Los diámetros luminales mostraron una media de 1,48 mm (+/-0,70) en la región proximal, 1,01mm (+/-0,35) en la media y 1,43 mm (+/-0,47) en la distal. Considerando las características morfométricas, la arteria radial es una opción que satisface los criterios de longitud, diámetro luminal y grosor para ser utilizada como injerto.

The radial artery (RA) is used in medical practiceto performdifferentsurgical procedures, of which most realized is the coronary artery bypass graftsurgery. In the current literature there is little information about the compatibility of this artery with other vascular conduits. Therefore the aim of this study was to determine the anatomical, morphometric and distribution characteristics of radial artery on the forearm. Radial artery was dissected from the forearms of 10 embalmed cadavers, muscular branches and vasa nervorum were identified and registered, total length was measured. Three samples of each artery were obtained(proximal, middle and distal) to be processedby histological techniques and to determinethe thickness of its tunica mediaand its diameters. The results show a mode of 8 arterial branches to the brachioradialis, a mode of 4 for thesuperficial flexor muscles of the fingers and flexor carpi radialis, we found an unique arterial branch to the pronator quadratus and a mode of 1 vasa nervorum of superficial branch of radial nerve. The total length of the artery was 21.94 cm (+/- 3.34). The vascular wall thickness we found were 196.16 mm (+/-72.35), 148.25 mm (+/-40.40) and 158.96 mm (+/-45.74) in the proximal, middleand distal segments respectively. The luminal diameters showed an average of 1.48 mm (+/-0.70) in the proximal region, 1.01 mm (+/-0.35) in the middle region and 1.43 mm (+/-0.47) in the distal region. In the present study we concludedthat considering the morphometric characteristics, the radial artery is an option that satisfied the criteria of length, thickness and luminal diameterto be used as a graft in the coronary artery bypass graft surgery.

Resposta cardiovascular ao teste ergométrico e a capacidade vasodilatadora periférica quanto a polimorfismos genéticos da enzima sintetase do óxido nítrico endotelial e dos receptores alfa-adrenérgicos / Cardiovascular responses during treadmill exercise test, peripheral vasodilatation and genetic polymorphisms of endothelial nitric oxide synthase and alpha-adrenergic receptors

Introdução: O desempenho cardiovascular durante o teste ergométrico varia entre indivíduos sem doença cardiovascular estabelecida. As variáveis que influenciam estas diferenças interindividuais na resposta ao exercício podem estar associadas à saúde cardiovascular. Formulamos a hipótese de que a resposta cardiovascular ao teste ergométrico possa variar quanto à capacidade de vasodilatação periférica e que ambas possam ser influenciadas por polimorfismos genéticos da enzima sintetase do óxido nítrico endotelial, dos receptores alfaadrenérgicos e do receptor B2 da bradicinina. Objetivos: 1 - Estudar as associações entre variáveis da resposta cardiovascular ao teste ergométrico e a vasodilatação muscular do antebraço em homens e mulheres sem doença cardiovascular estabelecida; 2 - Estudar as associações de variáveis da resposta cardiovascular ao teste ergométrico e da vasodilatação muscular do antebraço com polimorfismos genéticos da enzima sintetase do óxido nítrico endotelial, dos receptores alfa-adrenérgicos e do receptor B2 da bradicinina. Métodos: Seiscentos e oitenta e nove indivíduos de ambos os sexos, sem doença cardiovascular estabelecida, submetidos à avaliação médica cardiológica. O teste ergométrico foi realizado em esteira rolante e limitado por sintomas. A resposta cardiovascular ao teste ergométrico foi representada pelas seguintes variáveis: capacidade de exercício, reserva cronotrópica, recuperação da frequência cardíaca, pressão arterial sistólica máxima, pressão arterial diastólica máxima e recuperação da pressão arterial sistólica. A capacidade vasodilatadora periférica foi estimada pela resposta da condutância vascular do antebraço ao exercício isométrico (área total sobre a curva e variação dos valores absolutos durante 3 minutos de exercício em relação ao basal) durante o exame de pletismografia de oclusão venosa. Os polimorfismos genéticos da enzima sintetase do óxido nítrico endotelial (eNOS) 786T > C (rs2070744) e Glu298Asp (rs1799983)...

Purpose: The cardiovascular performance during exercise stress test may vary among individuals without overt cardiovascular disease. The variables associated with this variability between apparently healthy individuals may also influence the cardiovascular health. We hypothesized that cardiovascular responses during exercise stress test may vary according the peripheral vasodilator capacity and that both pathways may be influenced by genetic polymorphisms of endothelial nitric oxide synthase, alpha-adrenergic receptors and type B2 bradykinin receptor. Aim: 1- to study associations between the cardiovascular responses during exercise stress test and forearm muscle vasodilation in men and women without overt cardiovascular disease. 2- to study the influence of genetic polymorphisms of endothelial nitric oxide synthase, alpha adrenergic receptors and type B2 bradykinin receptor on the exercise test responses and forearm muscle vasodilation. Methods: Six hundred eighty nine individuals of both sexes, without overt cardiovascular disease, that underwent a cardiovascular check-up. The cardiovascular performance during exercise stress test was estimated by the following variables: exercise capacity, chronotropic reserve, heart-rate recovery, exercise systolic blood pressure, exercise diastolic blood pressure and systolic blood pressure recovery. The peripheral vasodilator capacity was estimated by forearm vascular conductance response to handgrip exercise (area under the curve and absolute changes during the 3-minute handgrip exercise) during venous occlusion plethysmography. The genetic polymorphisms of endothelial nitric oxide synthase (eNOS) 786T>C (rs2070744) and Glu298Asp (rs1799983), of adrenoceptors alpha1A (ADRA1A) Arg347Cys (rs1048101), alpha2A (ADRA2A) 1780 C>T (rs553668), alpha2B (ADRA2B) Ins/Del 301-303 (rs28365031) and of type B2 bradykinin receptor (rs5810761) were genotyped with High Resolution Melting...

Estudio de las venas de la fosa cubital a través de la tomografía computada helicoidal y su aplicación clínica / Study of the veins of the cubital fossa by helical computed tomography and its clinical application

Las venas superficiales de la fosa cubital, constituyen uno de los sitios más importantes de punción venosa. La disposición de estas venas presenta numerosas variaciones. Su anatomía no ha sido estudiada aplicando los avances tecnológicos en el campo de la medicina, como la tomografía computada helicoidal. Fueron analizadas mediante tomografía axial computada helicoidal, las formaciones venosas de la fosa cubital en 60 individuos chilenos de ambos sexos, de edades entre 10 y 86 años, de la IX Región de La Araucanía, Chile. El estudio fue realizado en un tomógrafo General Electric, modelo CT/e, perteneciente al Centro de Imagenología del Hospital del Trabajador, Temuco, Chile, en individuos ambulatorios. Basados en la clasificación de del Sol et al. (1988) para las formaciones venosas de la fosa cubital, se obtuvo los siguientes resultados: Tipo I (46,7 por ciento), la vena cefálica del antebrazo (VCA), se divide en vena mediana basílica (VMB) y vena mediana cefálica (VMC), las que se unen a la vena basílica del antebrazo (VBA) y vena cefálica del accesoria del antebrazo (VCAA), respectivamente. Tipo II (13,3 por ciento), la VCA originó la vena mediana del codo (VMCo), que se une a la VBA. Tipo III (20 por ciento), no existe comunicación entre la VBA y VCA a nivel de la fosa cubital. Tipo IV (8,3 por ciento), la VCA drenaba en la VBA. Tipo V (11,7 por ciento). Otras disposiciones, donde se incluye la "M" clásica, que resulta de la división de la vena mediana del antebrazo. La utilización de la VMC o de la VCA, se recomienda ya que previene los riesgos de punción de otras estructuras anatómicas importantes como el ramo anterior del nervio cutáneo antebraquial medial.

The superficial veins of the cubital fossa, is one of the most important sites of venipunctures. There are many variations in the arrangement of these veins. Their anatomy has not been studied using technology available in the field of medicine such, as helical computed tomography. The vein formation of the cubital fossa in 60 Chilean subjects of both sexes, between 10 and 86 years of age of the IX Region of Araucania, Chile, were analyzed by helical computed tomography. The study was realized on a General Electric scanner, model CT / e, belonging to the Imaging Center of the Hospital del Trabajador, Temuco, Chile, in ambulatory subjects. Based on the classification of del Sol et al. (1988) for the vein formation of the cubital fossa, we obtained the following results: Type I (46.7 percent), the cephalic vein of forearm (CVF), is divided into median basilic vein (MBV) and median cephalic vein (MCV), then anastomosis the basilic vein of forearm (BVF) and cephalic vein accessory (CVA), respectively. Type II (13.3 percent), the CVA originates at the median cubital vein (MCuV), which anastomoses to the BVF. Type III (20 percent), there is no communication between BVF and CVF at the cubital fossa. Type IV (8.3 percent), CVF drains into the BVF. Type V (11.7 percent) - Other disposition, which include the "M" classical, resulting from the division of the median antebrachial vein. Using the MCV or CVF, is recommended, since there are risks of puncture of other important anatomical structures such as the anterior branch of the medial antebrachial cutaneous nerve.

Efeito agudo dos exercícios resistidos sobre a reatividade vascular e adipocitocinas de mulheres com sobrepeso e obesidade / Acute effect of resistance exercises on vascular reactivity and adipocytokines in overweight and obese women

Introdução - O exercício resistido (ER) agudo parece resultar em importantes efeitos sobre a liberação de substâncias vasoativas e sobre o controle endotélio-dependente do tônus vascular. Objetivos - O objetivo do presente estudo foi avaliar os efeitos agudos de um ER isolado sobre a pressão arterial (PA), frequência cardíaca (FC), fluxo sanguíneo do antebraço (FSA), condutância vascular (CV), respostas endotelial e inflamatória de mulheres jovens com sobrepeso/obesidade (Sp/Ob). Materiais e Métodos - As voluntárias foram separadas em grupos: controle (n=16) e Sp/Ob (n=16). Ambos os grupos realizaram cinco séries de 10 repetições com 70% de uma repetição máxima (1-RM) no exercício de flexão unilateral do cotovelo. A PA, FC e o FSA (medido por pletismografia por oclusão venosa), foram avaliados em repouso e durante uma hora após o ER em ambos os grupos. Adipocitocinas e endotelina-1 (ET-1) foram avaliadas em repouso nos dois grupos e após o ER apenas no grupo Sp/Ob. Resultados - O grupo Sp/Ob apresentou massa corporal e IMC significativamente maiores que o controle (p<0,05). Surpeendentemente, o grupo Sp/Ob apresentou relação cintura-quadril significativamente menor (p<0,05). As diferenças entre grupos nas PAs diastólica e média observadas antes do ER (repouso) foram também observadas imediatamente e 20 minutos após a sessão de ER (p<0,05). Ambos os grupos apresentaram reduções significativas na PA diastólica imediatamente após a sessão de ER (p<0,01). A PA média apresentou redução significativa imediatamente após a sessão de ER apenas no grupo controle (p<0,05). O grupo Sp/Ob apresentou valores de FSA significatimentente maiores que o controle em repouso (p<0,05), em 20 (p<0,01) e em 40 (p<0,01) minutos após o ER. A CV apresentou diferença em repouso, porém em 20 e 40 minutos após o ER, o grupo Sp/Ob apresentou valores significativamente maiores (p<0,01). Em repouso e imediatamente após a sessão de ER, não foram observadas diferenças entre o grupo controle ...

Introduction - Acute resistance exercise (RE) seems to have important effects on release of vasoactive substances and on endothelium-dependet control of vascular tone. Objectives - The aims of our study were to the acute effects of an isolated RE on blood pressure (BP), heart rate (HR), forearm blood flow (FBF), vascular conductance (VC), endothelial and inflammatory responses of overweight/obese (Ow/Ob) young women. Materials and Methods - The volunteers were assigned in two groups: controls (n=16) and Ow/Ob (n=16). Both groups performed five sets of 10 repetitions with 70% of 1-RM in the unilateral elbow flexion exercise. BP, HR and FBF (determined by venous occlusion plethysmography) were evaluated at rest and along one hour after resistance exercise. Adipocytokines and endothelin-1 (ET-1) were evaluated at rest in both groups and after RE only in the Ow/Ob. Results - The Ow/Ob group presented significant higher body weight and BMI than controls. Of interest, the former group had significant lower waist-to-hip ratio (p<0.05). The significant differences between groups on diastolic and mean BP before resistance exercise (at resting) were observed immediately after and at 20 minutes post-exercise (P<0.05). Differences as a resultant of exercise in each group separately were noted and expressed as significant reduction in diastolic BP immediately post-exercise in both groups (p<0.01). Mean BP reduced immediately post-exercise only in controls (p<0.05). Significant higher basal FBF not only at resting (p<0.05) but also at 20 (p<0.01) and 40 minutes post-exercise (p<0.01) were evident in Ow/Ob group. Although basal FBF was different between groups at resting, basal VC was not. Of note, VC at 20 (p<0.01) and 40 minutes (p<0.01) post-exercise was higher in the Ow/Ob group compared to controls. At resting and immediately post-exercise, no differences between controls and Ow/Ob were observed in endothelial-dependent vasodilatation. We should emphasize ...

Bilateral high division of the brachial artery in one human male cadaver: case report

ABSTRACT: In general, the brachial artery divides into the radial and ulnar arteries at the level of the cubital fossa (elbow), just proximal to or right over the cubital anastomosis and these arteries are the main responsible for the irrigation of the forearm. After revising an extensive bibliographical literature, we found out that only few authors admit that divisions can appear below the cubital fossa (low division) and at the upper, middle or lower third of the arm (high divisions), but these are considered rare events. While dissecting one male cadaver on an ordinary practical class in the Laboratory of Gross Anatomy, we observed a high division of the brachial artery, located at the level of the superior part of the upper third in both arms, close to the axilla. We decided to report this anatomical variation because a bilateral event such as that is rarer yet.

Vitamina C restaura pressão arterial e a resposta vasodilatadora no antebraço em crianças obesas / Vitamin C restores blood pressure and vasodilator response during mental stress in obese children / Vitamina C restaura presión arterial y respuesta vasodilatadora en el antebrazo en niños obesos

FUNDAMENTO: A resposta vasodilatadora periférica tem um papel importante na fisiopatologia da obesidade e das doenças cardíacas. OBJETIVO: Avaliar o efeito crônico da suplementação de vitamina C (VitC) sobre a pressão arterial e na resposta vasodilatadora ao estresse mental. MÉTODOS: Neste estudo prospectivo, randomizado e duplo cego foram avaliadas crianças obesas, de ambos os gêneros e com idade entre 8 a 12 anos divididas em 2 grupos: 1) grupo de crianças suplementadas com 500 mg de vitamina C (n = 11) e, 2) substância placebo (n = 10) durante 45 dias. Oito crianças eutróficas, pareadas por idade também foram arroladas no estudo. Foi avaliada a pressão arterial média (PAM), frequência cardíaca (ECG) e fluxo sanguíneo no antebraço pela plestimografia de oclusão venosa. A condutância vascular no antebraço (CVA) foi obtida através da relação entre o fluxo sanguíneo no antebraço e a PAM (X100). RESULTADOS: Antes da intervenção, as crianças obesas apresentaram PAM maior e CVA menor quando comparadas às crianças eutróficas. Pós-intervenção, o Grupo VitC apresentou redução da PAM no repouso (81 ± 2 vs 75 ± 1 mmHg, p = 0,01), enquanto no Grupo Placebo não houve alteração da PAM (p = 0,58). Adicionalmente, VitC promoveu um aumento da CVA no repouso (3,40 ± 0,5 vs 5,09 ± 0,6 un, p = 0,04) e durante o estresse mental (3,92 ± 0,5 vs 6,68 ± 0,9 un, p = 0,03). Além disso, pós suplementação com VitC, os níveis da CVA foram estatisticamente semelhantes aos das crianças eutróficas no repouso (5,09 ± 0,6 vs 5,82 ± 0,4 un, p > 0,05) e durante o estresse mental (6,68 ± 0,9 vs 7,35 ± 0,5 un, p > 0,05). CONCLUSÃO: Suplementação com VitC reduziu a pressão arterial e restabeleceu a resposta vasodilatadora periférica em crianças obesas.

BACKGROUND: Peripheral vasodilation response plays an important role in the pathophysiology of obesity and heart disease. OBJECTIVE: To evaluate the chronic effect of vitamin C (VitC) supplementation on blood pressure and on vasodilation response to mental stress. METHODS: In a double-blind, randomized and prospective study we evaluated obese children with 8 to 12 years in 2 similar groups: 1) supplemented with 500 mg VitC (n = 11) and 2) placebo (n = 10) for 45 days. Eight age-matched lean control children were also studied. We evaluated: mean blood pressure (MBP), heart rate (HR) and forearm blood flow by venous occlusion plethismography. Forearm vascular conductance (FVC) was calculated by: (forearm blood flow/PAM) X100. RESULTS: On pre-intervention evaluations obese children showed higher MBP and lower FVC compared to lean control children. After intervention VitC diminished MBP at rest (81 ± 2 vs 75 ± 1 mmHg, p = 0.01), whereas placebo did not promote changes in MBP (p = 0.58). In addition, VitC promoted FVC increase at rest (3.40 ± 0.5 vs 5.09 ± 0.6 un, p = 0.04) and during the mental stress (3.92 ± 0.5 vs 6.68 ± 0.9 un, p = 0.03). Moreover, after VitC supplementation FVC levels were similar to the lean control children at rest (5.09 ± 0.6 vs 5.82 ± 0.4 un, p > 0.05) and during mental stress (6.68 ± 0.9 vs 7.35 ± 0.5 un, p > 0.05). CONCLUSION: VitC supplementation reduced the MBP and restored peripheral vasodilatation response during mental stress in obese children.

FUNDAMENTO: La respuesta vasodilatadora periférica tiene un papel importante en la fisiopatología de la obesidad y de las enfermedades cardíacas. OBJETIVO: Evaluar el efecto crónico de la suplementación de vitamina C (VitC) sobre la presión arterial y en la respuesta vasodilatadora al estrés mental. MÉTODOS: En este estudio prospectivo, randomizado y doble ciego fueron evaluados niños obesos, de ambos géneros, con edades entre 8 y 12 años divididos en 2 grupos: 1) grupo de niños suplementados con 500 mg de vitamina C (n = 11) y, 2) substancia placebo (n = 10) durante 45 días. Ocho niños eutróficos, pareados por edad también fueron incluidos en el estudio. Fueron evaluados la presión arterial media (PAM), la frecuencia cardíaca (ECG) y el flujo sanguíneo en el antebrazo por plestimografía de oclusión venosa. La conductancia vascular en el antebrazo (CVA) fue obtenida por medio de la relación entre el flujo sanguíneo en el antebrazo y la PAM (X100). RESULTADOS: Antes de la intervención, los niños obesos presentaron PAM mayor y CVA menor cuando fueron comparados con el Grupo C. Post intervención, el Grupo VitC presentó reducción de la PAM en reposo (81 ± 2 vs 75 ± 1 mmHg, p = 0,01), mientras en el Grupo Placebo no hubo alteración de la PAM (p = 0,58). Adicionalmente, VitC promovió un aumento de la CVA en reposo (3,40 ± 0,5 vs 5,09 ± 0,6 un, p = 0,04) y durante el estrés mental (3,92 ± 0,5 vs 6,68 ± 0,9 un, p = 0,03). Además de eso, post suplementación con VitC, los niveles de la CVA fueron estadísticamente semejantes a los del Grupo C en reposo (5,09 ± 0,6 vs 5,82 ± 0,4 un, p > 0,05) y durante el estrés mental (6,68 ± 0,9 vs 7,35 ± 0,5 un, p > 0,05). CONCLUSIÓN: Suplementación con VitC redujo la presión arterial y restableció la respuesta vasodilatadora periférica en niños obesos.

Impaired hemodynamic response to mental stress in subjects with prehypertension is improved after a single bout of maximal dynamic exercise

INTRODUCTION: High blood pressure during mental stress in subjects with prehypertension is associated with blunted vasodilation in skeletal muscles, which might be improved by an acute bout of exercise. OBJECTIVE: To investigate the hemodynamic responses to mental stress before and after a bout of exercise in subjects with prehypertension. METHOD: Eighteen subjects with prehypertension and 16 with normotension underwent a mental stress test before and after a maximal cardiopulmonary exercise test on a treadmill. Blood pressure was measured by auscultation, and forearm blood flow was measured by venous occlusion plethysmography; from these measurements, the vascular conductance was calculated. RESULTS: Subjects with prehypertension had a higher mean blood pressure during mental stress (prehypertension 112±2 vs. normotension 101±3 mm Hg, p<0.05), and their vascular conductance did not increase (baseline 0.025±0.004 vs. mental stress 0.022±0.003 a.u., p.0.05). After the exercise bout, the mean blood pressure during mental stress was lower in subjects with prehypertension (before exercise 112±2 vs. after exercise 107±2 mm Hg, p<0.05), and vascular conductance increased (baseline 0.011±0.001 vs. mental stress 0.024±0.004 a.u., p<0.05). CONCLUSION: Subjects with prehypertension had elevated blood pressure and a blunted vasodilator response during mental stress, but their blood pressure was attenuated and their vasodilator response was normalized after a single bout of maximal dynamic exercise.

Comparison of Blood Glucose Measurements Using Samples Obtained from the Forearm, Finger Skin Puncture, and Venous Serum / 대한진단검사의학회지

BACKGROUND: Blood glucose testing (BGT) at the forearm minimizes the pain experienced during sampling of capillary blood. We compared the BGT results for forearm sampling with those for standard finger skin puncture and venous serum to evaluate the clinical validity of forearm BGT. METHODS: BGT was performed on the finger (G(F)) and forearm (G(A)) with a portable glucometer in 555 subjects, including 61 diabetic patients, under fasting conditions. BGT with venous serum (G(V)) was followed within an hour in 514 subjects. Simple linear regression, intraclass correlation, and Passing-Bablok regression analyses were performed using the G(A)-G(F) and G(A)-G(V) data. RESULTS: G(A) showed an excellent linear relationship with both G(F) and G(V) with a Pearson correlation coefficient (r) of 0.97 (P<0.0001) in the patient group, which was similar to the findings in the normal group except for the lower r values. The mean bias between G(A) and G(F) and between G(A) and G(V) were within +/- 10 mg/dL in both groups. The intraclass correlation coefficients were slightly smaller than the corresponding r values, but they showed the same tendency in both groups. In the Passing-Bablok analyses, the 95% confidence intervals of the slope and intercept parameters were <+/-20% of unity and <+/-20 mg/dL, respectively, which were within the acceptable ranges. All 3 statistical analyses supported the satisfactory agreement of G(A) with G(F) or G(V). CONCLUSIONS: BGT at the forearm was highly consistent with the standard BGT, thereby confirming its applicability in clinical practice for self-testing under steady fasting conditions.

Microneurografia e pletismografia de oclusão venosa na insuficiência cardíaca: correlação com prognóstico / Microneurografía y pletismografía de oclusión venosa en la insuficiencia cardiaca: correlación con pronóstico / Microneurography and venous occlusion plethysmography in heart failure: correlation with prognosis

FUNDAMENTO: Microneurografia e pletismografia de oclusão venosa podem ser considerados métodos de avaliação da atividade simpática. OBJETIVO: Avaliar a intensidade da atividade simpática através da microneurografia e da pletismografia de oclusão venosa em pacientes com insuficiência cardíaca, e correlacionar essa intensidade com prognóstico. MÉTODOS: 52 pacientes com insuficiência cardíaca (FE <45 por cento ao ecocardiograma), sendo 12 em CFII e quarenta em CFIV. Após compensação avaliou-se a atividade nervosa simpática muscular (ANSM) no nervo peronero (microneurografia), e o fluxo sanguíneo muscular (FSM) no antebraço (pletismografia de oclusão venosa). Após seguimento de 18 meses os pacientes foram divididos em três grupos: 12 em CFII, 19 em CFIV que não morreram e 21 em CFIV que morreram. A intensidade da atividade da simpática foi comparada nos três diferentes grupos. RESULTADOS: CFII apresentaram menor ANSM (Atividade Nervosa Simpática Muscular) (p=0,026) e maior FSM (p=0,045) que os CFIV que não morreram. CFIV que morreram apresentaram maior ANSM (p<0.001) e menor FSM (p=0,002) que os CFIV que não morreram. Curva ROC: valor de corte >53,5 impulsos/min para ANSM (S=90,55. E=73,68 por cento) e <1,81 ml/mn/100gr para FSM (S=90,4 por cento. E=73,7 por cento). Curva Kaplan-Meier: sobrevida maior com ANSM <53,5 impulsos/min (p<0,001), e ou FSM >1,81 ml/min/100gr (P<0,001). Análise de regressão logística: quanto maior a ANSM e menor o FSM, maior é a probabilidade de morte. CONCLUSÃO: A intensidade da ANSM e do FSM podem ser considerados marcadores prognósticos na insuficiência cardíaca avançada.

BACKGROUND: Microneurography and venous occlusion plethysmography can be considered methods of assessment of the sympathetic activity. OBJECTIVE: To evaluate the intensity of the sympathetic activity through microneurography and venous occlusion plethysmography in patients with heart failure (HF) and correlate this intensity with prognosis. METHODS: 52 patients with HF (ejection fraction < 45 percent at the echocardiogram): 12 with FCII and 40 with FCIV. After compensation, the muscular sympathetic nervous activity (MSNA) in the peroneal nerve (microneurography) and the muscular blood flow (MBF) in the forearm were evaluated (venous occlusion plethysmography). After an 18-month follow-up, the patients were divided in 3 groups: 12 with FCII, 19 with FCIV that did not die and 21 with FCIV that died. The intensity of the sympathetic activity was compared in the three different groups. RESULTS: Patients with FCII presented lower MSNA (p=0.026) and higher MBF (p=0.045) than the ones with FCIV that did not die. The patients with FCIV that died presented higher MSNA (p<0.001) and lower MBF (p=0.002) than the patients with FCIV that did not die. ROC curve: cutoff >53.5 impulses/min for MSNA (S=90.55. E=73.68 percent) and < 1.81 ml/min/100gr for MBF (S=90.4 percent. E=73.7 percent). Kaplan-Meier curve: higher survival with MSNA < 53.5 impulses/min (p<0.001), and/or MBF >1.81 ml/min/100gr (P<0.001). Logistic regression analysis: the higher the MSNA and the lower the MBF, the higher is the probability of death. CONCLUSION: The intensity of the MSNA and the MBF can be considered prognostic markers in advanced HF.

FUNDAMENTO: Microneurografía y pletismografía de oclusión venosa se pueden considerar como métodos de evaluación de la actividad simpática. OBJETIVO: Evaluar la intensidad de la actividad simpática a través de la microneurografía y de la pletismografía de oclusión venosa en pacientes con insuficiencia cardiaca, y correlacionar esa intensidad con pronóstico. MÉTODOS: Un total de 52 pacientes con insuficiencia cardiaca (FE <45 por ciento al ecocardiograma), 12 de ellos en clase funcional II (CFII) y 40 en clase funcional IV (CFIV). Tras la compensación, se evaluaron la actividad nerviosa simpática muscular (ANSM) en el nervio peronero (microneurografía), y el flujo sanguíneo muscular (FSM) en el antebrazo (pletismografía de oclusión venosa). Tras el seguimiento de 18 meses, se dividieron a los pacientes en tres grupos: 12 individuos en CFII, 19 en CFIV que no murieron y 21 en CFIV que murieron. La intensidad de la actividad simpática se la comparó en los tres diferentes grupos. RESULTADOS: Los pacientes en CFII presentaron menor actividad nerviosa simpática muscular (p=0,026) y mayor FSM (p=0,045) que los en CFIV que no murieron. Los individuos en CFIV que murieron presentaron mayor ANSM (p<0.001) y menor FSM (p=0,002) que los en CFIV que no murieron. Curva ROC: valor de corte >53,5 impulsos/min para ANSM (S=90,55. E=73,68 por ciento) y <1,81 ml/mn/100gr para FSM (S=90,4 por ciento. E=73,7 por ciento). Curva Kaplan-Meier: sobrevida mayor con ANSM <53,5 impulsos/min (p<0,001), y/ó FSM >1,81 ml/min/100gr (P<0,001). Análisis de regresión logística: cuanto mayor sea la ANSM y menor el FSM, mayor será la probabilidad de muerte. CONCLUSIONES: La intensidad de la ANSM y del FSM puede considerarse como marcadores pronósticos en la insuficiencia cardiaca avanzada.

Formaciones Venosas de la Fosa Cubital en el Individuo Mapuche: Estudio Bioscópico / Venous Formations in the Cubital Fossa of Mapuche: Bioscopy Study

Las venas superficiales de la fosa cubital constituyen uno de los sitios más importantes para punción venosa. La disposición de esas venas presenta numerosas variaciones y, la disposición de ellas no ha sido estudiada en el grupo étnico mapuche. Debido a esto, y considerando a este grupo como el mayor conglomerado étnico de América del Sur, efectuamos este estudio. Fueron analizadas las venas superficiales de la fosa cubital, en 300 miembros superiores (150 derechos y 150 izquierdos) de individuos de ambos sexos (30 hombres y 120 mujeres), chilenos del grupo étnico mapuche, con edades entre 15 y 84 años. El estudio fue realizado en las postas rurales adyacentes a la ciudad de Temuco. Basados en la clasificación de del Sol et al. (1988) para las formaciones venosas de la fosa cubital, obtuvimos los siguientes resultados: Tipo I (38,7%), la vena cefálica (VC) se divide en vena intermedia basílica (VIB) y vena intermedia cefálica (VIC), uniéndose a la vena basílica (VB) y vena cefálica accesoria (VCA), respectivamente. La VIB era de mayor calibre y la vena intermedia del antebrazo (VIA) drenaba, generalmente, en la VB; Tipo II (28,3%), la VC origina la vena intermedia del codo (VICo), que se une a la VB. No existe VCA, siendo la VICo de mayor calibre y la VIA drena en la VB; Tipo III (24%), no existe comunicación entre la VB y VC a nivel de la fosa cubital. La VIA drena en la VB; Tipo IV (4,3%), la VC drena en la VB y la VIA drena en la VC; Tipo V otras disposiciones, donde se incluye la M clásica (1%) que resulta de la división de la VIA. La utilización de las VIC y VC se recomienda cuando ellas tienen un calibre semejante a la VIB o a la VICo ya que los riesgos de punción de otras estructuras anatómicas importantes, como ramos anteriores del nervio cutáneo medial del antebrazo o arteria braquial, son mínimos.

The superficial veins of the cubital fossa constitute one of the most important sites for vein puncture. The availability of those veins present numerous variations, and the availability of these has not been studied in the Mapuche ethnic group. In view of the above, and considering this group as the greatest ethnic conglomerate in South America the study took place. The superficial veins of the cubital fossa were analized in 300 superior members (150 right and 150 left) in subjects of both sexes (30 men and 120 women) Chileans of the Mapuche ethnic group between 15 and 84 years of age. The study was realized in rural clinics near the city of Temuco. Based on the classification of del Sol et al. (1988) for the vein formation of the cubital fossa, the following results were obtained: type I (38.7%), the cephalic vein (VC) is divided in the intermediate basilic vein (VIB) and intermediate cephalic vein (VIC), joining thebasilic vein (VB)and accessory cephalic vein (VCA) respectively. The VIB was of a major caliber and the intermediate vein of the forearm (VIA) generally drained in the VB, Type II (28,3%), the VC originates the intermediate vein of the elbow (VICo), that joins the VB. VCA does not exist, th VICo being of a mayor caliber and the VIA drains in to VB, Type III (24%) no communication exists between the VB and VC at the level of the cubital fossa, the VIA drains into VB, Type IV (4,3%), the VC drains in the VB and VIA drins in the VC; Type V other dispositions where the classic M is included (1%) which results in the division of the VIA. The use of the VIC and VC is recommended when they have a similar caliber to that of the VIB of VICo. Because the puncture risks of other important anatomic structures, such as anterior branches of the medial cutaneous nerve of the forearm or brachial artery are minimal.

Mannitol extravasation during partial nephrectomy leading to forearm compartment syndrome

We present the first known complication of forearm compartment syndrome after mannitol infusion during partial nephrectomy. We stress the importance of excellent intravenous catheter access and constant visual monitoring of the intravenous catheter site during and after mannitol infusion as ways to prevent this complication. Prompt recognition of compartment syndrome with appropriate intervention can prevent long-term sequelae.

Punciones repetidas de la arteria radial para cateterismo cardíaco / Repeated radial artery puncture for cardiac catheterization

La punción percutánea de la arteria radial para la realización de procedimientos por cateterismo ha ganado aceptación debido a una eficacia similar a la obtenida con el acceso femoral. En el presente trabajo evaluamos los resultados obtenidos con la punción repetida de esta arteria. En un total de 182 accesos radiales se realizaron 17 punciones repetidas, y mediante ellas, 20 procedimientos (9 coronariografías y 11 angioplastias). Se obtuvo éxito del acceso en 15 punciones repetidas (88.2%) y éxito del procedimiento en todos los casos cuando logramos éxito del acceso. Si bien el grupo es pequeño es suficiente para mostrar que la punción repetida de la arteria radial es factible y permite una alta tasa de éxito de los procedimientos con una disminución ostensible de las complicaciones locales.

The radial artery approach for percutaneous cardiac interventions has gained worldwide acceptance due to the similar results obtained by the femoral artery access. In this paper, we report our experience with repeated puncture of the radial artery. One hundred and eighty two radial artery access procedures were performed, in 17 interventions the puncture was repeated once or twice, with a total of 20 therapeutic catheterizations (9 coronary angiographies, 11 angioplasties). There was no therapeutic failure through the radial approach but, we successfully gained access in 88.2% (15/17) of the re-interventions cases. Although an experience with a low number of cases, we had a very high successful therapeutic rate, and also a remarkable lowering of local complications, this shows the feasibility and potential of this technique.