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Int. j. morphol ; 41(2): 548-554, abr. 2023. ilus
Article in Spanish | LILACS | ID: biblio-1440318


Los avances en el área de la salud, con el desarrollo de nuevos procedimientos diagnósticos y quirúrgicos, requieren un conocimiento cada vez más preciso de la anatomía humana. La difusión de la disposición variable de la anatomía resulta primordial no sólo en el campo de la especialización o el postgrado, sino por sobre todo, en el pregrado, desde donde se formarán los especialistas que luego desarrollarán esas nuevas prácticas clínicas y quirúrgicas que requerirán una sólida formación anatómica. Es por esto que la aplicación correcta de técnicas anatómicas en las muestras anatómicas es fundamental para que esta enseñanza en el pregrado pueda desarrollarse de manera eficiente, teniendo la plastinación un rol fundamental en este sentido. El objetivo de este trabajo consistió en dar a conocer el hallazgo de variaciones anatómicas arteriales en los miembros superiores de una muestra humana sometida al proceso de plastinación para fomentar, por un lado, la importancia del conocimiento anatómico en el pregrado, el postgrado y las especialidades, como así también la relevancia de la preservación a largo plazo de material biológico para la difusión continua de la anatomía.

SUMMARY: Advances in the area of health with the development of new diagnostic and surgical procedures require an increasingly precise knowledge of human anatomy. The diffusion of the variable arrangement of anatomy is essential not only in the field of specialization or postgraduate, but above all, in the undergraduate, from where the specialists will be trained who will later develop these new clinical and surgical practices that will require a solid anatomical background. This is why the correct application of anatomical techniques in anatomical samples is essential for this undergraduate teaching to be developed efficiently, plastination having a fundamental role in this regard. The aim of this work was to report the discovery of anatomical variations in the upper limbs of a human sample subjected to the plastination process to promote, on one hand, the importance of anatomical knowledge in undergraduate, postgraduate and specialties, as well as the relevance of long- term preservation of biological material for the continued dissemination of anatomy.

Humans , Ulnar Artery/anatomy & histology , Radial Artery/anatomy & histology , Upper Extremity/blood supply , Anatomic Variation , Plastination
Chinese Critical Care Medicine ; (12): 658-661, 2023.
Article in Chinese | WPRIM | ID: wpr-982649


OBJECTIVE@#To summarize the application experience and clinical effect of radial artery in total arterial coronary revascularization (TAR) in elderly patients.@*METHODS@#Retrospectively analyzed the clinical data of patients who underwent TAR at the University of Hong Kong Shenzhen Hospital from July 1, 2020 to May 30, 2022. Patients were divided into ≥ 65-year-old group and < 65-year-old group according to age. The radial artery blood flow, diameter, intimal integrity and Allen test were evaluated by ultrasound before operation. The distal ends of radial artery were collected for pathological examination during operation. Coronary artery CT angiography (CTA) was examined postoperatively and follow up. The safety and reliability of ultrasonic assessment of radial artery and application of radial artery in elderly patients with TAR were summarized and analyzed.@*RESULTS@#A total of 101 patients received TAR, including 35 cases aged ≥ 65 years old, 66 cases aged < 65 years old; 78 cases used bilateral radial arteries, and 23 cases used unilateral radial arteries. 4 cases of bilateral internal mammary arteries. All the proximal ends of the radial artery were anastomosed to the proximal end of the ascending aorta, 34 cases were performed of "Y" grafts, and 4 cases were sequential anastomoses. There was no in-hospital death and perioperative cardiovascular events. Perioperative cerebral infarction occurred in 3 patients. 1 patients was reoperated for bleeding. Intra-aortic balloon pump (IABP) assistance was used in 21 patients. Poor wound healing occurred in 2 cases and healed well after debridement. Follow-up of 2 to 20 months after discharge showed no internal mammary artery occlusion and 4 radial artery occlusions; no major adverse cardiovascular and cerebrovascular event (MACCE) occurred, and the survival rate was 100%. There was no significant difference in the above perioperative complications and follow-up endpoints between the two age groups.@*CONCLUSIONS@#By adjusting the order of bypass anastomosis and optimizing the preoperative evaluation method, radial artery combined with internal mammary artery can obtain better outcome early in TAR, and can be safely and reliably applied to elderly patients.

Aged , Humans , Radial Artery/transplantation , Coronary Vessels , Coronary Artery Bypass/methods , Retrospective Studies , Reproducibility of Results , Treatment Outcome
Chinese Critical Care Medicine ; (12): 1070-1073, 2023.
Article in Chinese | WPRIM | ID: wpr-1010907


OBJECTIVE@#To explore the feasibility of snuff pot arterial pressure measurement for patients undergoing routine elective surgery during anesthesia.@*METHODS@#A prospective randomized controlled trial was conducted. Patients undergoing elective surgery admitted to the Handan Hospital of Traditional Chinese Medicine from June 1, 2020 to June 1, 2022 were enrolled. Patients who needed arterial pressure measurement for hemodynamic monitoring were randomly divided into routine radial artery puncture group and snuff pot artery puncture group with their informed consent. The patients in the routine radial artery puncture group were placed a catheter at the styloid process of the patient's radius to measure pressure. In the snuff pot artery puncture group, the snuff pot artery, that was, the radial fossa on the back of the hand (snuff box), was selected to conduct the snuff pot artery puncture and tube placement for pressure measurement. The indwelling time of arterial puncture catheter, arterial blood pressure, and complications of puncture catheterization of patients in the two groups were observed. Multivariate Logistic regression analysis was used to screen the relevant factors that affect the outcome of arterial catheterization.@*RESULTS@#Finally, a total of 252 patients were enrolled, of which 130 patients received routine radial artery puncture and 122 patients received snuff pot artery puncture. There was no statistically significant difference in general information such as gender, age, body mass index (BMI), and surgical type of patients between the two groups. There was no significant difference in the indwelling time of artery puncture catheter between the routine radial artery puncture group and the snuff pot artery puncture group (minutes: 3.4±0.3 vs. 3.6±0.3, P > 0.05). The systolic blood pressure (SBP) and the diastolic blood pressure (DBP) measured in the snuff pot artery puncture group were significantly higher than those in the conventional radial artery puncture group [SBP (mmHg, 1 mmHg ≈ 0.133 kPa): 162.3±14.3 vs. 156.6±12.5, DBP (mmHg): 85.3±12.6 vs. 82.9±11.3, both P < 0.05]. There was no statistically significant difference in the incidence of complications such as arterial spasm, arterial occlusion, and pseudoaneurysm formation between the two groups. However, the incidence of hematoma formation in the snuff pot artery puncture group was significantly lower than that in the conventional radial artery puncture group (2.5% vs. 4.6%, P < 0.05). Based on the difficulty of arterial puncture, multivariate Logistic regression analysis showed that gender [odds ratio (OR) = 0.643, 95% confidence interval (95%CI) was 0.525-0.967], age (OR = 2.481, 95%CI was 1.442-4.268) and BMI (OR = 0.786, 95%CI was 0.570-0.825) were related factors that affect the outcome of arterial catheterization during anesthesia in patients undergoing elective surgery (all P < 0.05).@*CONCLUSIONS@#Catheterization through the snuff pot artery can be a new and feasible alternative to conventional arterial pressure measurement.

Humans , Arterial Pressure/physiology , Feasibility Studies , Radial Artery/physiology , Prospective Studies , Tobacco, Smokeless , Catheterization, Peripheral , Punctures
Rev. méd. Maule ; 37(2): 70-75, dic. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1428534


SPeripheral sympathectomy is a procedure which has shown high rates of decreasing ischemic pain, recover functionality and wound healing, preventing the progression of the disease and further complications. We present a female patient with severe Raynaud´s phenomenon secondary to localized cutaneous systemic sclerosis complicated who presented digital ulcer treated with a sympathectomy of the radial and ulnar artery at the wrist level, undergoing post-operative follow-up.

Humans , Female , Middle Aged , Raynaud Disease/surgery , Sympathectomy/methods , Ulnar Artery/innervation , Osteomyelitis , Raynaud Disease/etiology , Regional Blood Flow/physiology , Scleroderma, Localized , Scleroderma, Systemic , Follow-Up Studies , Radial Artery/innervation
Acta Academiae Medicinae Sinicae ; (6): 332-337, 2022.
Article in Chinese | WPRIM | ID: wpr-927884


Arterial cannulation can be used to monitor blood pressure in real time and facilitate frequent arterial blood gas analysis.It is one of the commonly used clinical techniques in anesthesia,emergency,and intensive care units.Studies have demonstrated that ultrasound guidance can increase the success rate of arterial cannulation and reduce the incidence of related complications.In recent years,ultrasound guidance technology has developed rapidly and is increasingly used in clinical practice.This article reviews the latest advances in the application of ultrasound guidance in radial artery cannulation.

Blood Pressure , Catheterization, Peripheral/methods , Radial Artery/diagnostic imaging , Ultrasonography , Ultrasonography, Interventional/methods
Journal of Biomedical Engineering ; (6): 1127-1132, 2022.
Article in Chinese | WPRIM | ID: wpr-970650


The radial artery pulse wave contains a wealth of physiological and pathological information about the human body, and non-invasive studies of the radial artery pulse wave can assess arterial vascular elasticity in different age groups.The piezoelectric pulse wave transducers were used to non-invasively acquire radial artery pulse waves at different contact pressures in young and middle-aged and elderly populations. The radial artery waveforms were decomposed using a triangular blood flow model fitting method to obtain forward and reflected waves and calculate reflection parameters. Finally a correlation analysis and regression analysis of the contact pressure Psensor with the reflection parameters was carried out. The results showed that the reflection parameters RM, RI and Rd had a strong negative correlation with Psensor in both types of subjects, and the correlation coefficients and slopes of the regression curves were significantly different between the two types of subjects (P<0.05). Based on the results of this study, excessive contact pressure on the transducer should be avoided when detecting radial artery reflection waves in clinical practice. The results also show that the magnitude of the slope of the regression curve between the reflection parameters and the transducer contact pressure may be a potentially useful indicator for quantifying the elastic properties of the vessel.

Middle Aged , Aged , Humans , Blood Pressure/physiology , Arteries , Blood Flow Velocity/physiology , Elasticity , Pulse Wave Analysis , Radial Artery/physiology
J. vasc. bras ; 21: e20210081, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1360565


Resumo O tamanduá-bandeira é um mamífero encontrado na América Central e na América do Sul. Esse animal possui garras que podem chegar a 6,5 cm de comprimento, utilizadas para escavar formigueiros e obter alimento, além de servir para sua defesa. Relatamos o caso de paciente masculino de 52 anos, com histórico de epilepsia, que foi levado desacordado ao pronto-socorro, devido a lesões no seu braço direito causadas por um tamanduá. Frente à suspeita de trauma vascular, o paciente foi submetido a exploração cirúrgica, que evidenciou uma lesão combinada de vasos braquiais, submetida a reparo. Apresentou boa evolução do quadro, recebendo alta hospitalar no segundo dia de pós-operatório e, no seguimento ambulatorial, evoluiu sem sequelas neurológicas ou vasculares.

Abstract The giant anteater is a mammal found in Central and South America. These animals have claws that can reach 6.5 centimeters in length, which they use to dig anthills to obtain food and for defense. We report the case of a 52-year-old male patient with a history of epilepsy who was taken unconscious to the emergency room due to injuries to his right arm caused by an anteater. He underwent surgical exploration to investigate suspected vascular trauma, revealing a combined (arterial and venous) injury of the brachial vessels, which were repaired. He recovered well and was discharged on the second postoperative day. During outpatient follow-up he continued to improve, with no neurological or vascular sequelae.

Humans , Male , Middle Aged , Brachial Artery/injuries , Ulnar Artery/injuries , Radial Artery/injuries , Vascular System Injuries/surgery , Vermilingua , Embolectomy , Vascular System Injuries/drug therapy , Accidental Injuries , Hoof and Claw
Rev. colomb. anestesiol ; 49(3): e202, July-Sept. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1280178


Abstract Introduction: In-line positioning of an ultrasound image provides higher success rates and less time to completion for radial arterial cannulation. But preferable size and distance of ultrasound display has not been previously discussed. Objective: To assess the ideal visual distance and display size when using a smart phone or tablet as the ultrasound image display. Methods: Four smart phones or tablets were used as ultrasound displays in six different configurations in a simulated radial artery puncture. In a questionnaire, 116 anaesthesiologists working in Ibaraki Prefecture, Japan, were asked which of the six configurations was preferable for radial artery cannulation. Results: Sixty anaesthesiologists answered the questionnaire. About half (53%) preferred the smaller display (4- or 5.5-inch) fixed at a distance of 30 to 40 cm, and most of the rest (44%) preferred the larger display (7.9- or 9.7-inch) placed posterior to the probe with a visual distance of 45 to 60 cm. Conclusions: Among the anaesthesiologists, the preferable size and visual distance for ultrasound-guided radial artery cannulation varied using a smart phone or tablet for in-line display.

Resumen Introducción: El posicionamiento en línea con una imagen ecográfica permite mayores tasas de éxito y reduce el tiempo para realizar la canalización de la arteria radial. Sin embargo, no se ha hablado sobre cuál es el tamaño y la distancia preferibles para la imagen en pantalla. Objetivo: Evaluar la distancia visual y el tamaño de la imagen en pantalla cuando se utiliza un teléfono inteligente o una tableta para visualizar la imagen ecográfica. Métodos: Se utilizaron cuatro teléfonos inteligentes o tabletas como pantalla para visualizar las imágenes ecográficas en seis configuraciones distintas, en una simulación de la canalización de la arteria radial. Mediante un cuestionario se preguntó a 116 anestesiólogos que trabajan para la Prefectura de Ibaraki, Japón, cuál de las seis configuraciones era preferible para la canalización de la arteria radial. Resultados: Sesenta anestesiólogos respondieron el cuestionario. Aproximadamente la mitad (53%) prefirieron la imagen más pequeña (4 o 5,5 pulgadas), fija a una distancia de 30 a 40 cm, y la mayoría de los otros (44%) prefirieron la imagen más grande (7,9- o 9,7 pulgadas), colocada en la parte posterior al transductor, con una distancia visual de 45 a 60 cm. Conclusiones: Entre los anestesiólogos, el tamaño preferido y la distancia visual para la canalización de la arteria radial guiada por ecografía, varió utilizando un teléfono inteligente o una tableta para su visualización en línea.

Humans , Catheterization , Ultrasonography , Radial Artery , Anesthesiologists , Punctures , Prospecting Probe , Smartphone , Methods
Int. j. morphol ; 39(3): 915-919, jun. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1385392


RESUMEN: Se presentan 3 casos de variación de origen de la arteria digital palmar propia radial del índice, dos de los cuales tienen su origen en la rama palmar superficial de la arteria radial, no detalladas previamente en la literatura, junto a variaciones vasculares en uno de ellos, mientras que en el tercero, su origen en la arteria digital palmar propia ulnar del pulgar, es fuente de controversia. Esto es discutida en la presente comunicación. Se describen anastomosis vasculares entre la arteria ulnar superficial, la rama palmar superficial de la arteria radial, la primera arteria interósea dorsal y la arteria digital palmar propia radial del índice, como circuitos anastomóticos alternativos.

SUMMARY: We present 3 cases of variation of origin of the index radial proper palmar digital artery, two of which have their origin in the superficial palmar branch of the radial artery, not previously detailed in the literature, together with vascular variations in one of them, while in the third, its origin in the palmar proper ulnar digital artery of thumb, is a source of controversy. This is discussed in this communication. Vascular anastomoses between the superficial ulnar artery, the superficial palmar branch of the radial artery, the first dorsal interosseous artery, and the radial index palmar digital artery are described as alternative anastomotic circuits.

Humans , Radial Artery/anatomy & histology , Anatomic Variation , Hand/blood supply
Int. j. morphol ; 39(2): 347-354, abr. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1385357


RESUMEN: El objetivo de este trabajo consiste en el análisis de la posición del arco palmar superficial en la palma de la mano, con identificación del origen, forma de disposición, anastomosis presentes y terminación del mismo, proporcionando la experiencia propia y comparándola con los referentes del área, sin llevar adelante una comparación de clasificaciones, sino por el contrario, buscando analizar la información desde un punto de vista clínico-quirúrgico, demostrando la importancia del conocimiento de la anatomía real del arco palmar superficial al momento de abordar la anatomía vascular de la mano en todo tipo de situaciones patológicas.

SUMMARY: The objective of this work consists in the analysis of the position of the superficial palmar arch in the palm of the hand, with identification of the origin, form of disposition, present anastomosis and termination of the same, providing the own experience and comparing it with the referents of the area, without carrying out a comparison of classifications, but on the contrary, seeking to analyze the information from a clinical-surgical point of view, demonstrating the importance of knowledge of the real anatomy of the superficial palmar arch when addressing the vascular anatomy of the hand in all kinds of pathological situations.

Humans , Middle Aged , Aged , Aged, 80 and over , Ulnar Artery/anatomy & histology , Radial Artery/anatomy & histology , Anatomic Variation , Hand/blood supply , Cadaver
Rev. cuba. angiol. cir. vasc ; 22(1): e281, ene.-abr. 2021. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1251684


Los traumas vasculares periféricos poseen una frecuencia elevada en relación con las lesiones vasculares y conllevan a una incapacidad significativa a pacientes relativamente jóvenes. La identificación oportuna y el manejo inicial adecuado de este tipo de lesión son muy importantes para su posterior evolución. Este artículo tuvo como objetivo exponer la importancia del tratamiento oportuno del trauma vascular en dos pacientes llegados el mismo día al servicio de urgencias del Hospital Militar Central "Dr. Luis Díaz Soto". Se presenta como primer caso a un paciente masculino de 44 años de edad, con antecedentes de salud aparente. Sufrió una herida de aproximadamente 12 cm en el brazo izquierdo, que se acompañó de sangramiento e hipotensión arterial. Se le colocó injerto protésico y se le realizó anastomosis término-terminal en la arteria humeral porque presentaba sección completa de esta; su evolución fue favorable. El segundo caso se trata de un paciente masculino de 60 años de edad, con antecedentes de salud aparente. Sufrió un trauma en el antebrazo izquierdo que le provocó una herida de alrededor de 8 cm, con sangramiento, palidez y frialdad del tercio distal del antebrazo, cianosis reversible de la mano, impotencia funcional, ausencia de pulso radial e hipotensión arterial. Se le realizó anastomosis término-terminal de arteria radial porque presentaba sección completa de esta y su evolución resultó favorable. El tratamiento oportuno y acertado del trauma vascular evitó la pérdida de la vida de los pacientes, disminuyó la presencia de complicaciones, aseguró una evolución rápida y redujo incapacidades en estos(AU)

Peripheral vascular traumas have a high frequency in relation to vascular lesions, and lead to significant disability in relatively young patients. Timely identification and adequate initial management of this type of lesion are very important for its subsequent evolution. This article aimed to show the importance of timely treatment of vascular trauma in two patients who arrived on the same day at the emergency service of Dr. Luis Díaz Soto Central Military Hospital. The first case presented corresponds to a 44-year-old male patient apparently without previous heath conditions. He had a wound of approximately twelve centimeters on the left arm, which was accompanied by bleeding and arterial hypotension. The patient was placed a prosthetic graft and performed an end-to-end anastomosis in the brachial artery because it was completely sectioned. The patient's evolution was favorable. The second case corresponds to a 60-year-old male patient with an apparent health history. He suffered a trauma to his left forearm that caused a wound of about 8 cm, with bleeding, paleness and coldness of the distal third of the forearm, reversible cyanosis of the hand, functional impotence, absence of radial pulse and arterial hypotension. End-to-end anastomosis of the radial artery was performed because the patient presented complete section of the artery and his evolution was favorable. Timely and correct treatment of vascular trauma prevented the loss of life in both patients, reduced the presence of complications, ensured a rapid evolution, and reduced their disabilities(AU)

Humans , Male , Female , Middle Aged , Pulse , Brachial Artery , Radial Artery , Transplants , Emergencies , Vascular System Injuries
Chinese Journal of Medical Instrumentation ; (6): 26-31, 2021.
Article in Chinese | WPRIM | ID: wpr-880417


In order to obtain the three-dimensional pulse information and blood pressure waveform needed in the study, a radial artery simulation platform with programmable controlled injection pump as the core was constructed by using the circulation theory of human cardiovascular system and pulse wave formation mechanism. Gaussian function model was selected to synthesize multi-type pulse wave to program and drive the platform. The three-dimensional pulse information and blood pressure waveform of the simulated radial artery were collected by binocular visual pulse detection system and pressure transmitter respectively, and the platform stability and repeatability were tested by Pearson correlation. The experimental results show that the radial artery simulation platform is stable, reliable and repeatable, and can generate multiple types of three-dimensional pulse information and blood pressure waveform at the simulated radial artery. The platform is simple in structure, low in cost, and produces many types of pulsating flow. It provides an experimental research platform for revealing the relationship between the three-dimensional pulse information of radial artery and the change of pressure inside the vessel, as well as the prediction of blood pressure waveform from the three-dimensional pulse information.

Humans , Blood Pressure , Computer Simulation , Heart Rate , Radial Artery , Vital Signs
Rev. colomb. anestesiol ; 48(4): e302, Oct.-Dec. 2020. graf
Article in English | LILACS, COLNAL | ID: biblio-1149789


Patients with Essential Thrombocythemia pose a variety of anesthetic challenges including a heightened risk of perioperative thrombosis. This condition is also associated with perioperative hemorrhage, risk for developing heparin induced thrombocytopenia type 2 during cardiac surgery and digital gangrene from radial artery catheterization.

Los pacientes con trombocitemia esencial plantean una variedad de desafíos anestésicos, incluido un mayor riesgo de trombosis perioperatoria. Esta condición también se asocia con hemorragia perioperatoria, riesgo de desarrollar trombocitopenia tipo 2 inducida por heparina durante la cirugía cardíaca y gangrena digital por cateterismo de la arteria radial.

Humans , Thrombocytopenia , Thrombosis , Catheterization , Thrombocythemia, Essential , Thoracic Surgery , Radial Artery , Hemorrhage , Anesthetics
Arch. cardiol. Méx ; 90(4): 442-451, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1152819


Abstract Background: One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods: A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results: Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; −3.831 mL [−6.165 mL to −1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], −72.471 s [−99.694 s to −45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions: One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.

Resumen Antecedentes: La estrategia de catéter único permite explorar ambas coronarias con un solo catéter. Nuestro objetivo es realizar la primera revisión sistemática y meta-análisis de ensayos clínicos aleatorizados para cuantificar adecuadamente los beneficios de la estrategia de catéter único, con catéteres multipropósito, sobre la estrategia convencional de dos catéteres. Métodos: Se realizó una búsqueda en PubMed, CINALH y CENTRAL, identificando ensayos aleatorizados que compararan estrategias de un catéter y dos catéteres. El resultado primario fue volumen de contraste administrado. Los secundarios, que evaluaron el rendimiento del cateterismo, incluyeron: espasmo radial, tiempo de fluoroscopia y de procedimiento. Resultados: Se incluyeron cinco ensayos, totalizando 1,599 pacientes (802 con estrategia de un catéter y 797 con estrategia de dos catéteres). La estrategia de catéter único requirió menos contraste (diferencia-de-medias; −3.831 mL [−6.165 mL a −1.496 mL], p = 0.001), presentando menos espasmo radial (odds ratio, 0.484 [0.363 a 0.644], p < 0.001) y menos tiempo de procedimiento (diferencia-de-medias; −72.471 s [−99.694 s a −45.249 s], p < 0.001). No hubo diferencias en el tiempo de fluoroscopia. Conclusiones: La estrategia de catéter único induce una reducción mínima en la administración de contraste, pero mejora el rendimiento del cateterismo al reducir el espasmo radial y el tiempo de procedimiento en comparación con la estrategia convencional.

Humans , Cardiac Catheterization/methods , Coronary Angiography/methods , Cardiac Catheters , Fluoroscopy , Cardiac Catheterization/instrumentation , Randomized Controlled Trials as Topic , Coronary Angiography/instrumentation , Radial Artery , Contrast Media/administration & dosage , Coronary Vessels/diagnostic imaging
Rev. colomb. cardiol ; 27(5): 414-419, sep.-oct. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289251


Resumen Objetivo: describir la experiencia de un servicio en angiografía coronaria en cuanto al abordaje radial distal izquierdo a través de la tabaquera anatómica. Material y método: de abril a agosto de 2018 se asignaron 40 pacientes a angiografía coronaria por vía radial izquierda distal a través de la tabaquera anatómica. Se hizo un análisis de tipo descriptivo de las principales variables cuantitativas asociadas al procedimiento (frecuencia de acceso fallido, procedimiento fallido, tiempo de procedimiento, tiempo de fluoroscopia, nivel de dolor en el paciente, sensación de comodidad para el paciente y para el operador, cantidad de medio de contraste empleado y algunas variables demográficas). Se incluyeron pacientes mayores de 18 años con indicación de arteriografía coronaria para estudio diagnóstico y con pulso palpable en la zona de la tabaquera anatómica. Resultados y conclusión: la cantidad de medio de contraste en promedio empleada fue de 49 ml (SD ± 13), el tiempo promedio de procedimiento fue de 11,3 minutos (SD ± 4.3) y el tiempo de fluoroscopia promedio fue de 3,3 minutos (SD ± 2.8). La mediana para el nivel de dolor en los pacientes fue de 4, la mediana para la comodidad del operador fue de 10 y la mediana para la comodidad en el paciente fue de 10. Se concluye así que el acceso radial distal izquierdo es una alternativa técnicamente factible, ofrece comodidad para el paciente y el operador, y arroja bajas tasas de falla y complicaciones en pacientes seleccionados.

Abstract Objective: To present the experience of one Department in coronary angiography as regards the left distal radius approach through the anatomical snuff box. Material and Method: A total of 40 patients were subjected to coronary angiography through the anatomical snuff box, from April to August 2018. A descriptive analysis was performed on the quantitative variables associated with the procedure (frequency of failed access, failed procedure, procedure time, fluoroscope time, patient pain level, feeling of comfort for the patient and for the operator, amount of contrast used, and some demographic variables). The study included patients over 18 years-old with an indication for coronary angiography for a diagnostic study, and with a palpable pulse in the anatomic snuff box area. Results and conclusion: The mean amount of contrast media employed was 49 ml (SD ± 13), the mean procedure time was 11.3 minutes (SD ± 4.3), and the mean fluoroscope time was 3.3 minutes (SD ± 2.8). The median for the pain level in patients was 4, the median for comfort of the operator was 10, and the median for comfort of the patient was also 10. It was able to be concluded that the left distal radial access is a technically feasible alternative. It is comfortable for the patient and the operator, with low failure rates and complications in selected patients.

Humans , Male , Aged , Coronary Angiography , Radial Artery , Cardiac Catheterization , Heart Failure
Int. j. morphol ; 38(4): 853-856, Aug. 2020. graf
Article in Spanish | LILACS | ID: biblio-1124865


La arteria recurrente radial nace en el extremo proximal de la arteria radial y desde ahí asciende oblicuamente para anastomosarse con la arteria colateral radial, entregando en ese trayecto una serie de ramas para los músculos cercanos. Dicha arteria junto con sus ramas fueron descritas (por su importancia en abordajes quirúrgicos) por Arnold K. Henry como "the radial leash". Actualmente en clínica se utiliza el nombre "leash of Henry" para referirse a una o más ramas musculares de la arteria recurrente radial, sobretodo cuando cuando se encuentran en relación con el ramo profundo del nervio radial, pudiendo llegar a causar compresiones de dicho nervio en algunos casos. Se realizó una descripción de caso de una leash of Henry atípica, encontrada en una muestra cadavérica del laboratorio de anatomía de la Universidad Católica del Maule, de sexo masculino y nacionalidad chilena. La arteria encontrada corresponde a la rama de mayor calibre de la arteria recurrente radial, que se dirige directamente al músculo extensor de los dedos, dibujando un trayecto horizontal y cruzando por anterior al ramo profundo del nervio radial. Esta hallazgo difere a lo descrito por Henry y otros autores más recientes, y por lo tanto aporta información potencialmente útil a la hora de realizar procedimientos quirúrgicos que requieran un abordaje posterior o lateral de la cabeza del radio, como también descompresiones del nervio radial en esta zona.

The radial recurrent artery originates at the proximal end of the radial artery and from there ascends obliquely to anastomosing with the radial collateral artery. It gives off several branches for nearby muscles on its path. This artery along with its branches were described (due to its importance in surgical approaches) by Arnold K. Henry as "the radial leash". Currently, in clinical terms, the name "Leash of Henry" is used to refer to one or more muscular branches of the radial recurrent artery, especially when they are in relation to the deep branch of the radial nerve, and may cause compression of the nerve in some cases. A case description of an atypical Leash of Henry was found, found in a Chilean, male cadaveric sample of the anatomy laboratory, Universidad Católica del Maule. The artery corresponds to the branch of greater caliber of the recurrent radial artery, which goes directly to the extensor digitorum muscle. It draws a horizontal path and crosses the deep branch of the radial nerve anteriorly. This finding differs from what was described by Henry and other more recent authors. Therefore, this is potentially useful information when performing surgical procedures that require a posterior or lateral approach to the radius head, as well as radial nerve decompressions in this area.

Humans , Male , Middle Aged , Radial Nerve/anatomy & histology , Radial Artery/anatomy & histology , Elbow/anatomy & histology , Cadaver , Elbow/innervation , Elbow/blood supply , Anatomic Variation
Int. j. morphol ; 38(3): 592-595, June 2020. graf
Article in Spanish | LILACS | ID: biblio-1098292


El arco palmar superficial (APS) resulta de la unión de la arteria ulnar y la rama palmar superficial de la arteria radial. Por su convexidad nacen las arterias digitales comunes. Esta descripción es la única que distintos autores han tomado como válida, por lo que se espera encontrarla durante la disección con mayor frecuencia. Esto no ha sido verificado en nuestra experiencia. Nos proponemos llevar a cabo una revisión de la descripción del APS poniéndolo en contraposición con las disecciones realizadas. Se disecaron y analizaron 61 manos cadavéricas. Estudio del arco palmar superficial: Variante clásica del APS: 23 casos (37,7 %). Variante no clásica del APS: 15 casos (24,6 %). Tipo A: 13 casos (86,7 %). Anastomosis entre arterias ulnar y metacarpiana dorsal del primer espacio. Tipo B: 2 casos (13,3 %). Anastomosis entre arterias ulnar y satélite del nervio mediano. Ausencia del arco: 23 casos (37,7 %) Tipo A: 19 casos (82,6 %). La arteria ulnar es la única estructura en el plano del APS. Tipo B: 3 casos (13 %). La arteria ulnar y la rama palmar superficial de la arteria radial están en el plano del APS sin anastomosarse entre sí. Tipo C: 1 caso (4,4 %). La arteria ulnar y la satélite del nervio mediano están en el plano del APS sin anastomosarse. Estudio de la quinta arteria digital palmar común: La quinta arteria digital palmar común se originó de las distintas variantes en 41 casos (67,2 %). Recomendamos al momento de la disección considerar que: la variante clásica no es la más frecuente de hallar; la ausencia del arco se verifica en el mismo porcentaje que la variante clásica; incluso cuando se comprueba la presencia del APS, el porcentaje de la variante no clásica es contundente; la quinta arteria digital palmar común es una rama colateral constante del APS.

The superficial palmar arch (SPA) is formed by the union of the ulnar artery and the superficial palmar branch of the radial artery. From its convexity four branches emerge, known as the common palmar digital arteries. We propose to carry out a review of the description of the SPA in contrast to the dissections carried out. Sixty-one hands were dissected and studied. Analysis of the SPA: Classic variant of the SPA: 23 cases (37.7 %). Nonclassic variant of the SPA: 15 cases (24.6 %). Type A: 13 cases (86.7 %). Anastomosis between the ulnar artery and the first dorsal metacarpal artery. Type B: 2 cases (13.3 %). Anastomosis between the ulnar artery and the satellite artery of the median nerve. Absence of the arch: 23 cases (37.7 %) Type A: 19 cases (82.6 %). The ulnar artery is the only one present in the plane of the SPA. Type B: 3 cases (13 %). The ulnar artery and the superficial palmar branch of the radial artery are in the plane of the superficial palmar arch, there is no anastomosis between them. Type C: 1 case (4.4 %). The ulnar artery and the satellite artery for the median nerve are in the plane of the SPA, there is no anastomosis between them. Analysis of the fifth common palmar digital artery: The fifth common palmar digital artery originates from the different variants in 41 cases (67.2 %). Based on the results, we recommend at the time of dissecting consider that: The classic variant is not the most frequent to find. The absence of the arch is verified in the same percentage rate as the classic variant. Even when the SPA is present, the percentage rate of the non-classic variant is significant. The fifth common palmar digital artery is a constant collateral branch of the superficial palmar arch.

Humans , Male , Female , Adult , Ulnar Artery/anatomy & histology , Hand/blood supply , Radial Artery/anatomy & histology , Anatomic Variation
Philippine Journal of Internal Medicine ; : 161-164, 2020.
Article in English | WPRIM | ID: wpr-961216


OBJECTIVE@#This report aims to raise physician clinical awareness of radial artery pseudoaneurysm (RAP) and promote early recognition of this potentially serious complication. The article highlights various proposed treatment strategies in the management of this condition. @*BACKGROUND@#Radial artery pseudoaneurysm is a rare potentially serious complication following transradial artery coronary angiography for left heart catheterization and percutaneous coronary intervention. Risk factors associated with the development of RAP include multiple arterial puncture attempts, use of systemic anticoagulation, inadequate hemostasis following post-procedural compression, vascular site infection, use of larger sheaths, female gender, age of 70 years and older, diabetes mellitus, obesity and/or patients with high body mass index.1-3 Conservative medical treatment and/or surgical repair are the primary therapeutic approaches in the management of RAP. @*CONCLUSION@#Transradial artery access is associated with a significantly lower risk of major bleeding and vascular access site complications, reduces morbidity and mortality compared with the transfemoral approach. It is important to recognize though that complications do still occur with the transradial approach. RAP is one such entity wherein prevention is key - with adequate post-procedural compression, frequent observation, and careful assessment of the radial access site.

Aneurysm, False , Radial Artery
Chinese Journal of Cardiology ; (12): 1053-1059, 2020.
Article in Chinese | WPRIM | ID: wpr-941219


Objective: To investigate the effects of femoral approach versus radial approach on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with coronary heart disease, who received twice contrast agents within a short interval. Methods: A total of 322 patients with coronary heart disease, who admitted to the General Hospital of Northern Theater Command from January 2010 to January 2015, were included in this retrospective analysis. All patients exposed to contrast agents twice within 30 days. The patients were divided into two groups according to the approach of interventional operation: radial artery group (n=235) and femoral artery group (n=87). Serum creatinine (SCr) values were detected at 48 and 72 hours post procedure. Endpoint events were CI-AKI, which was defined as SCr increased>0.5 mg/dl (44.2 μmol/L) or relative ratio ((postoperative SCr-preoperative SCr)/preoperative SCr×100%>25%) within 72 hours after contrast agent use after excluding other causes. Clinical characteristics and the incidence of CI-AKI were compared between the two groups, multivariate logistic regression analysis was used to detect the risk factors of postoperative CI-AKI in these patients. Results: The proportion of smoking, PCI history, STEMI patients and levels of fibrinogen, fasting blood glucose, troponin T was significantly higher in femoral artery group than in radial artery group (all P<0.05). The interval between two procedure sessions was significantly longer in the femoral artery group than in the radial artery group (P=0.001). The incidence of CI-AKI tended to be higher in femoral artery group than in radial artery group after the first operation (18.6% (16/87) vs. 11.9% (28/235), P=0.133). CI-AKI incidence after the second operation was similar between the two groups (P>0.05). Multivariate logistic regression analysis showed that interventional approach was not an independent risk factor for postoperative CI-AKI in patients with coronary heart disease undergoing interventional procedures twice within 30 days (P>0.05);STEMI (OR=2.854, 95%CI 1.100-7.404, P=0.031) and diuretics use (OR=4.002, 95%CI 1.470-10.893, P=0.007) were independent risk factors for CI-AKI after the first operation. Conclusion: There is no correlation between the risk of CI-AKI and interventional approaches in patients with coronary heart disease who undergo interventional surgery twice within 30 days.

Humans , Acute Kidney Injury/epidemiology , Contrast Media/adverse effects , Coronary Disease , Femoral Artery/surgery , Incidence , Percutaneous Coronary Intervention/adverse effects , Radial Artery , Retrospective Studies , Risk Factors