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Toprak K, Inanır M, Memioğlu T, Palice A, Kaplangoray M, Yesilay AB, Tascanov MB, Altıparmak İH, Demirbağ R. Effect of Hand Dominance on Radial Artery Spasm and Occlusion: A Prospective Observational Study. Angiology 2024; 75:340-348. [PMID: 36745059 DOI: 10.1177/00033197231155599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transradial access has become the most commonly used method for cardiac catheterization. Many medical and technical applications have been proposed to reduce TRA complications. The aim of this study is to examine the effect of hand dominance on radial artery spasm and radial artery occlusionin subjects undergoing CC via TRA. Between April 2020 and August 2022, 1713 subjects who underwent CC via TRA were included in the study. Patient data were obtained in terms of hand dominance of the catheterized side and RAS and RAO during a 1-month follow-up period. RAS was seen in 9.6% of the subjects. The RAS in patients catheterized by the dominant hand was significantly higher than that performed by the non-dominant hand (12 vs 7.8%; P = .004). RAO was seen in 1% of the subjects. RAO was significantly higher in the spasm side than in the no-spasm side (3 vs .8%; P = .009). Hand dominance was determined as an independent predictor of radial artery spasm (P = .006). In our study, RAS and RAO were more common on the dominant hand side than on the non-dominant side. Choosing the non-dominant hand for TRA for CC may reduce the incidence of RAS and RAO.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Mehmet Inanır
- Cardiology Department, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Tolga Memioğlu
- Cardiology Department, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ali Palice
- Sanliurfa Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | - Mustafa Kaplangoray
- Sanliurfa Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | - Asuman Biçer Yesilay
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | | | | | - Recep Demirbağ
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
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Hanaoka Y, Abe D, Koyama JI, Nakamura T, Kitamura S, Horiuchi T. A new very-small-bore Simmons guiding sheath for transradial neurointervention: Technical note and initial experience. J Neuroradiol 2024; 51:214-219. [PMID: 37625629 DOI: 10.1016/j.neurad.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/22/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Transradial access during neurointerventions has increased in popularity because of reduced complications and patient preference. Nevertheless, transradial cannulation into the left common carotid artery can be difficult technically because of the lack of catheter support in the aortic arch. Furthermore, the use of large sheaths can increase the risk of complications at the access site. Here, we developed a new very-small-bore transradial system using a 3F Simmons guiding sheath, to increase the procedural success rate and minimize access-site complications. This system can represent a valuable treatment option for neurointerventions and has the potential to expand the indications for transradial access.
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Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Daishiro Abe
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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Bianchini F, Lombardi M, Ricchiuto A, Paraggio L, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Combined ultrasound and angiographic guidance to facilitate transradial access procedures. Catheter Cardiovasc Interv 2024; 103:443-454. [PMID: 38173287 DOI: 10.1002/ccd.30947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
The introduction of transradial access for percutaneous coronary diagnostic and interventional procedures has led to a decrease in access site complications. The aim of this paper is to propose a combined stepwise technical approach where real time ultrasound ("echo-first" approach) can be used to select the best vascular access and, together with angiography, to manage the potential obstacles that may occur during transradial procedures. In each section, we summarize some tips and tricks based on both our experience and current literature that can be easily implemented in daily practice to increase the success of transradial procedures.
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Affiliation(s)
- Francesco Bianchini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Fan R, Yang Z, Wang R, Liu H, Feng C, Wu F, Fan M. Hemostasis after transradial coronary intervention by rotary compression device with sterile gauze is associated with more adverse events: a retrospective study. Coron Artery Dis 2024; 35:14-22. [PMID: 38085858 DOI: 10.1097/mca.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE We investigated the relationship between using a rotary compression device (RCD) with or without sterile gauze and adverse events in transradial access (TRA) for coronary intervention. METHODS In this study involving 933 patients at Yueyang Hospital, we recorded TRA-related adverse events, such as bleeding, forearm hematoma, swollen palms, radial artery occlusion (RAO) and others. Logistic regression was applied to assess the association. RESULTS Of the 933 patients (66.7% males, average age 67.8 years), 511 used RCD with sterile gauze, whereas 422 used RCD without sterile gauze. The most common adverse events were radial artery hemorrhage (7.4%), hand swelling (4.8%) and RAO (4.6%). Logistic regression analysis revealed that the use of RCD with sterile gauze was associated with a higher prevalence of adverse events [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.22-2.49), even with the adjustment of potential confounders (OR, 1.71; 95% CI, 1.19-2.45). Moreover, patients who used RCD with sterile gauze exhibited an increased risk of radial artery hemorrhage (OR, 1.83; 95% CI, 1.07-3.12), swelling of the hand (OR, 1.96; 95% CI, 1.02-3.75) and RAO (OR, 3.17; 95% CI, 1.49-6.72). CONCLUSIONS The use of RCD with sterile gauze in TRA is associated with a higher incidence of adverse events.
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Affiliation(s)
- Rong Fan
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Zixuan Yang
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Haoqi Liu
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Can Feng
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Feng Wu
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Min Fan
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
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Men X, Wang Q, Chen P, Hu WS, Chai Y, Shou HY, Zhou ZF. Subcutaneous nitroglycerin increased the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section : A randomized controlled trial. DIE ANAESTHESIOLOGIE 2023; 72:28-35. [PMID: 36884054 PMCID: PMC10692033 DOI: 10.1007/s00101-023-01264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Accepted: 11/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications; however, it is difficult for women with gestational hypertension. Subcutaneous nitroglycerin was found to improve the first attempt success rate of radial artery cannulation in pediatric patients. Therefore, this study evaluated the effect of subcutaneous nitroglycerin on the radial artery diameter and area, blood flow rate and the success rate of radial artery cannulation in women with pregnancy-induced hypertension. METHODS A total of 94 women with gestational hypertension and risk of intraoperative bleeding undergoing cesarean section were identified and randomized into the subcutaneous nitroglycerin group and control group. The primary outcome was the success rate of left radial artery cannulation within 3 min after subcutaneous injecting (T2). The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter, cross-sectional area and depth were also recorded before subcutaneous injection (T1), 3 min after subcutaneous injection (T2) and immediately after radial artery cannulation (T3). RESULTS The first attempt success rate of radial artery cannulation was significantly higher (97.9% vs. 76.6%, p = 0.004) and procedure time to success was significantly shorter (111 ± 18 s vs. 171 ± 70 s, p < 0.001) in the subcutaneous nitroglycerin group as compared to the control group. The subcutaneous nitroglycerin group also had a significantly less overall number of attempts as 1/2/3 attempts (n), 46/1/0 vs. 36/7/4 (p = 0.008). Compared with the control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in the subcutaneous nitroglycerin group (p < 0.001), as well as percentage change of radial artery diameter and CSA. Vasospasm (6.4% vs. 31.9%; p = 0.003) was significantly lower in the subcutaneous nitroglycerin group; however, no difference was found in hematoma (2.1% vs. 12.8%; p = 0.111). CONCLUSION Subcutaneous nitroglycerin along with the routine local anesthetic preparation before radial artery cannulation increased the first attempt success rate of radial artery cannulation and decreased the overall number of cannulation attempts in women with gestational hypertension and risks of intraoperative bleeding undergoing cesarean section, it also decreased cannulation times and overall number of vasospasms.
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Affiliation(s)
- Xin Men
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Qian Wang
- Department of Anesthesiology, The Affiliated ZheJiang Hospital, School of Medicine, Zhejiang University, 315014, Hangzhou, China
| | - Pei Chen
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Wen-Sheng Hu
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Yun Chai
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Hong-Yan Shou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China.
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Kazemi Darafshani J, Hosseini SA, Babaei S, Khosravi Farsani A. Comparison of Vascular Complications after Arterial Sheath Removal using Manual Compression Method and ClampEase Method in Patients Undergoing Coronary Angiography. J Caring Sci 2023; 12:235-240. [PMID: 38249998 PMCID: PMC10799271 DOI: 10.34172/jcs.2023.30700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/09/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Angiography stands as the paramount and definitive diagnostic method for coronary artery disease. However, akin to various other invasive procedures, it may carry a multitude of complications. This study sought to assess the incidence of vascular complications post-arterial sheath removal, comparing the use of a ClampEase device against manual compression. Methods This quasi-experimental clinical trial involved patients undergoing angiography at the post-angiography ward in Isfahan, Iran. A total of 91 patients were selected through convenience sampling and randomly assigned to either the manual compression or ClampEase device groups. Monitoring common vascular complications like hemorrhage, hematomas, and ecchymosis occurred up to 24 hours post-arterial sheath removal. Data were collected using a digital scale model DM3, a transparent flexible ruler, and a questionnaire named 'vascular complications after angiography.' Analysis was performed using SPSS software version 13. Results Statistical analysis revealed that, when compared to the manual method, compression with the ClampEase device led to fewer vascular complications in patients and a quicker return to homeostasis. Conclusion The findings underscore that the ClampEase method is a safer alternative with fewer vascular complications than the manual compression method. This discovery has implications for reducing hospital costs and length of stay. The ClampEase device is associated with a swifter time to hemostasis, contributing to enhanced patient comfort and acceptance.
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Affiliation(s)
- Javad Kazemi Darafshani
- Student Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyyed Abbas Hosseini
- Department of Adult Health Nursing, Isfahan University of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Babaei
- Department of Adult Health Nursing, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi Farsani
- Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Hanaoka Y, Koyama JI, Nakamura T, Kitamura S, Yamazaki D, Horiuchi T. Letter: Transradial Carotid Artery Stenting Using Walrus Balloon Guide Catheter: Technical Aspects and Clinical Outcome. Oper Neurosurg (Hagerstown) 2023; 25:e296-e297. [PMID: 37655894 DOI: 10.1227/ons.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto , Japan
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto , Japan
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto , Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto , Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto , Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto , Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto , Japan
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto , Japan
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Zhang K, Hu P, Zhao L, Cai L, Zhang Y. Finger exercise could reduce painfulness and radial artery complications related to coronary artery angiography. Coron Artery Dis 2023; 34:404-409. [PMID: 37335237 DOI: 10.1097/mca.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To estimate if applying a finger exercise during trans-radial coronary artery angiography (CAG) could help to reduce a patient's painfulness and evaluate its protective effects against radial artery complications. METHODS This is a prospective, controlled, single-center trial. Overall, 390 patients who underwent coronary angiography through radial path in our hospital during 2022 were randomized 1 : 1 to the following two groups: test group: finger exercise in addition to routine perioperative care; control group: routine care. The success rate of radial puncture, the incidence of procedural radial artery dissection (RAD) and radial artery spasm (RAS), change of wrist circumference, pain degree related to the operation, occurrence of access site hemorrhagic complications, hemostasis time and postprocedure occurrence of radial artery occlusion (RAO) before discharge were recorded and compared between two groups. RESULTS Compared to the control group, the test group had a higher success rate of radial puncture, lower incidence of RAS, RAD and RAO, slighter swelling of wrist and patients who felt less pain in the test group. There was no difference in prolonged hemostasis time or hemorrhagic complications between the two groups. CONCLUSION Finger exercise could help to make a patient more comfortable and reduce radial artery complications related to CAG.
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Affiliation(s)
- Kai Zhang
- Department of Cardiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Hubei, China
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Romeo D, Salem MM, Sioutas GS, Corral Tarbay A, Ng JJ, Aboutaleb PE, Srinivasan VM, Pukenas B, Jankowitz BT, Burkhardt JK. The impact of Verapamil for radial access in diagnostic cerebrovascular angiograms: A retrospective case-control study. Interv Neuroradiol 2023:15910199231193932. [PMID: 37574785 DOI: 10.1177/15910199231193932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Different combinations of medications are utilized during wrist access for radial artery (RA) or ulnar artery (UA) catheterization in neuroendovascular procedures to preclude vasospasm. These "cocktails" commonly include the calcium channel blocker Verapamil, without established benefit. We analyze outcomes in patients with and without Verapamil in their "cocktail" by using a case-control cohort of our single-center experience. METHODS A prospective log of consecutive patients who underwent diagnostic cerebral angiograms using RA/UA access was retrospectively reviewed, and patients were grouped into Verapamil and non-Verapamil cohorts. The primary outcomes assessed were the presence of forearm skin rashes (hives) and RA/UA spasms. Our initial management included Verapamil (5 mg) in the cocktail, but Verapamil was removed after we noticed the development of hives in multiple patients immediately following its injection. RESULTS A total of 221 patients underwent 241 RA/UA diagnostic cerebral angiograms and were included in our analysis. One hundred and forty-nine patients (61.8%) underwent catheterization with Verapamil and 92 (38.2%) were catheterized without it. Four of the 149 patients in the Verapamil group (2.7%) developed hives during the procedure and were treated with Benadryl (25 mg). Of the 92 patients who did not receive Verapamil, there were zero (0%) cases of hives and one (1.1%) case of vasospasm. CONCLUSION Verapamil in the "cocktail" for wrist access diagnostic cerebral angiograms was associated with periprocedural hives, but not associated with a significant reduction in spasm compared to the non-Verapamil group. Our findings suggest that the administration of prophylactic Verapamil for these procedures may not be necessary.
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Affiliation(s)
- Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jinggang Jenny Ng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Bryan Pukenas
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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Dubosq M, Renard R, Jayet J, Mercier L, Javerliat I, Castier Y, Coggia M, Coscas R. Single Primary Retrograde Access to Treat Femoro-Popliteal Occlusive Lesions. J Endovasc Ther 2023:15266028231188868. [PMID: 37515490 DOI: 10.1177/15266028231188868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
INTRODUCTION The retrograde puncture of a distal artery is considered a bailout procedure in case of anterograde approach failure for peripheral artery disease (PAD) treatment. A single primary retrograde access has been suggested as an efficient and safe option. As scant data are available, we present our results using this approach. MATERIAL AND METHODS Between August 2019 and October 2022, we performed this technique in selected patients with femoro-popliteal PAD. Chronic total occlusions (CTOs) were selected on the basis of the CTOP classification. An ultrasound-guided retrograde puncture of a tibial artery at the ankle level was performed, followed by the preferential use of 4F materials. Hemostasis of the puncture site was obtained using manual compression. Postoperative duplex scan examination systematically included an evaluation of the punctured artery. Demographics, intraoperative, and follow-up data were collected retrospectively. The results are expressed as means with standard deviations and numbers with percentages when appropriate. RESULTS In total, 55 procedures were performed in 46 patients (9 bilateral). Of these, 57% (N=26) were considered at risk for femoral puncture (obesity, history of groin surgery, challenging crossover approach) and 54% (N=25) presented with critical limb-threatening ischemia (CLTI). The TASC-II femoro-popliteal classification was generally B (60%) and also C (33%) or D (7%). Mean lesion length was 105.6±49.4 mm and 65% were CTOs. Most patients were operated in an outpatient setting (N=25; 54%) under potentialized local anesthesia (N=41, 89%). The punctured site was the posterior tibial artery in 73% (N=40). The procedure time was 65.1±25.7 minutes, and the fluoroscopy time was 10.7±8.5 minutes. The technical success rate was 100%. There were no intraoperative complications. All patients could walk the same day. One CLTI patient presented an erysipelas related to the puncture in postoperative period. At 30 days, the primary patency of the treated and the punctured arteries were 98% and 100%, respectively. CONCLUSION A single primary retrograde access can be used safely to treat femoro-popliteal PAD. It represents a valuable alternative to the femoral puncture and allows fast ambulation. Prospective and long-term studies on larger populations are necessary to confirm our results. CLINICAL IMPACT This study demonstrates that a single primary retrograde access can be used safely without damaging the punctured artery to treat femoro-popliteal lesions, especially in claudicant patients. Chronic total occlusions can be treated successfully using this technique. This approach represents a valuable alternative to the femoral puncture and allows fast ambulation without risk of major bleeding.
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Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Régis Renard
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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El Naamani K, Abbas R, Sioutas GS, Amllay A, Tjoumakaris S, Gooch MR, Rosenwasser RH, Jabbour P. A complication of the transradial approach: thyrocervical trunk pseudoaneurysm with hemothorax. BJR Case Rep 2023; 9:20220136. [PMID: 37265746 PMCID: PMC10230224 DOI: 10.1259/bjrcr.20220136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 06/03/2023] Open
Abstract
The transradial approach has gained popularity in the neuroendovascular field after several studies proved its low rate of hemorrhagic and vascular-related complications in both diagnostic and therapeutic procedures. This is a case of a patient who presented for flow diversion treatment of an incidental left carotid ophthalmic aneurysm. The procedure was uneventful. Post-operatively, the patient's neurological exam and vital signs were normal, however the patient complained of abdominal and chest pain that worsened when lying down and improved when sitting up. Radiologic diagnosis confirmed the presence of a thyrocervical trunk pseudoaneurysm which was completely obliterated with Onyx 18 embolization. Thyrocervical trunk pseudoaneurysm formation is a rare complication of the transradial approach. Shedding the light on these entities is essential as symptoms vary in severity and presentation and necessitate swift diagnosis and treatment.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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12
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Meng S, Guo Q, Tong G, Shen Y, Tong X, Gu J, Li X. Development and Validation of a Nomogram for Predicting Radial Artery Spasm During Coronary Angiography. Angiology 2023; 74:242-251. [PMID: 35574924 DOI: 10.1177/00033197221098278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study describes an attempt to develop a user-friendly nomogram incorporating psychological factors to individually predict the risk of radial artery spasm. Patients consecutively recruited between June 2020 and June 2021 constituted the development cohort for retrospective analysis of the development of a prediction model. Least absolute shrinkage and selection operator regression combined with clinical significance was employed to screen out appropriate independent variables. The model's discrimination and calibration were subsequently evaluated and calibrated by using the C-index, receiver operating characteristic (ROC) curve, and calibration plot. Decision curve analysis was also performed to evaluate the net benefit with the nomogram, and internal validation was assessed using bootstrapping validation. The predictors included in the risk nomogram included "body mass index ," "anxiety score," "duration of interventional surgery," "latency time (time spent waiting in the catheterization laboratory)," "vascular circuity (substantial changes in the curvature of vessels)," and "puncture number." The derived model showed good discrimination with an area under the ROC curve of .77, a C-index of .771 (95% CI: .72-.822) and good calibration. Decision curve analysis indicated that the nomogram provided a better net benefit than the alternatives.
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Affiliation(s)
- Shasha Meng
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qixin Guo
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, 74734The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoxin Tong
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Shen
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoshan Tong
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junjie Gu
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinli Li
- Department of Cardiology, 74734The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Mohan R, Cox J, Puri AS, Elnazeir M, Singh J, Mayo S, Gebhardt BR. Supraclavicular Nerve Block Sympathectomy for Refractory Arterial Vasospasm During Subclavian Stenting Procedure and Entrapped Arterial Catheter. J Cardiothorac Vasc Anesth 2023; 37:330-331. [PMID: 36402647 DOI: 10.1053/j.jvca.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Raghav Mohan
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Centerm Worcester, MA
| | - Jessica Cox
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Centerm Worcester, MA
| | - Ajit S Puri
- Department of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, MA
| | - Marwa Elnazeir
- Department of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, MA
| | - Jasmeet Singh
- Department of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, MA
| | - Samantha Mayo
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Centerm Worcester, MA
| | - Brian R Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Centerm Worcester, MA.
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Curtis E, Fernandez R, Khoo J, Weaver J, Lee A, Halcomb L. Clinical predictors and management for radial artery spasm: an Australian cross-sectional study. BMC Cardiovasc Disord 2023; 23:33. [PMID: 36653743 PMCID: PMC9847059 DOI: 10.1186/s12872-023-03042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The transradial approach for coronary artery catheterisation has increased in popularity compared to the transfemoral approach for patients undergoing percutaneous coronary interventions. However, radial artery spasm continues to be a major complication of the procedure. Current management strategies vary concerning radial artery spasm and there is limited evidence of practice in the Australian context. AIM To identify the predictors of radial artery spasm and the medications used for its prevention and management. METHODS A descriptive cross-sectional study was carried out over a three-month period in two tertiary hospitals in NSW, Australia. A self-administered pre-procedural survey was completed by patients undergoing coronary artery catheterisation. This survey collected socio-demographic data and assessed anxiety using the Spielberger State-Trait Anxiety Inventory. Procedural data, including length of procedure, equipment used, occurrence of radial artery spasm, and medications given, were collected post-procedure by the interventionalist. RESULTS Of the 169 participants, over half were male (59.8%) and aged 66 years or older (56.8%). Radial artery spasm was reported in 24 (14.2%) participants. Rates of spasm were significantly higher among females (66.6%, p = 0.004), those aged under 65 years (62.5%, p = 0.001) and those who reported a medical history of anxiety (33.3%, p = 0.0004). There were no significant differences in State and Trait anxiety scores among those who had RAS and those who did not. Logistic regression identified younger age as the only statistically significant predictor of RAS (OR 0.536; 95% CI 0.171-1.684; p = 0.005). To prevent radial artery spasm most patients received midazolam (n = 158; 93.5%), nitrates (n = 133; 78.7%) and/or fentanyl (n = 124; 73.4%) prophylactically. Nitrates were the most frequently administered medication to treat radial artery spasm (78.7%). CONCLUSION This study highlights that there is a need to develop a clearer understanding of the predictors of RAS, as identifying patients at risk can ensure prophylactic measures are implemented. This study identified nitrates as the preferred vasodilator as a preventative measure along with the use of sedation.
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Affiliation(s)
- Elizabeth Curtis
- Faculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW, 2500, Australia.
| | - Ritin Fernandez
- grid.1007.60000 0004 0486 528XFaculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW 2500 Australia ,grid.416398.10000 0004 0417 5393Centre for Research in Nursing and Health, St George Hospital, 28 Gray Street, Kogarah, NSW 2217 Australia
| | - John Khoo
- grid.416398.10000 0004 0417 5393Cardiology Department, St George Hospital, Grey Street, Kogarah, NSW 2217 Australia
| | - James Weaver
- grid.416398.10000 0004 0417 5393Cardiology Department, St George Hospital, Grey Street, Kogarah, NSW 2217 Australia
| | - Astin Lee
- grid.1007.60000 0004 0486 528XFaculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW 2500 Australia ,grid.417154.20000 0000 9781 7439Cardiology Department, The Wollongong Hospital, Crown Street, Wollongong, NSW 2500 Australia
| | - Liz Halcomb
- grid.1007.60000 0004 0486 528XFaculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW 2500 Australia
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Use of the Sheathless Eaucath Is an Effective Strategy to Overcome Resistant Severe Radial Spasm. J Interv Cardiol 2023; 2023:2434516. [PMID: 36873570 PMCID: PMC9977557 DOI: 10.1155/2023/2434516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
Objectives We aimed to assess the effectiveness of the sheathless Eaucath guiding catheter (SEGC) in overcoming severe spasm. Background Radial spasm is a frequent challenge in transradial access (TRA) and can be difficult to manage. Methods We performed a prospective observational study of 1000 consecutive patients undergoing coronary angiography with or without percutaneous coronary intervention. Patients with primary transfemoral access (TFA) or primary use of a sheathless guide catheter were excluded. Patients who developed angiographically confirmed severe spasm were treated with further sedation and vasodilators. If the conventional catheter would still not advance, it was exchanged for a SEGC. The primary endpoint was the successful passage of the SEGC through the radial with successful engagement of the coronary artery in patients with resistant severe spasm. Results Primary TFA access was used in 58 (5.8%) and primary radial access with a SEGC in 44 (4.4%) patients. Of the remaining 898 patients, 888 (98.9%) had a radial sheath successfully inserted. Of these, 49 (5.5%) developed severe radial spasm with inability to advance the catheter. Following treatment with additional sedation and vasodilators, the severe spasm resolved in 5 (10.2%) patients. Passage of a SEGC was attempted in the remaining 44 patients with resistant severe spasm. Passage of the SEGC and engagement of coronary arteries were successful in all cases. There were no complications related to use of the SEGC. Conclusions Our findings suggest that use of the SEGC for resistant severe spasm is highly effective, safe, and may reduce the need for conversion to TFA.
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Abdelazeem B, Abuelazm MT, Swed S, Gamal M, Atef M, Al-Zeftawy MA, Noori MA, Lutz A, Volgman AS. The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta-analysis of randomized controlled trials. Clin Cardiol 2022; 45:1171-1183. [PMID: 36335609 DOI: 10.1002/clc.23906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Radial artery spasm (RAS) is the most common cause of transradial access site crossover and is a common intra-procedural complication. RAS incidence can lead to radial artery occlusion (RAO) postprocedure, preventing the radial artery as a future access site. We evaluated the efficacy of nitroglycerin preventing RAS and RAO during transradial catheterization discussing the different routes of administration, including topical, subcutaneous, and intra-arterial. A systematic review and meta-analysis included all relevant articles until April 23, 2022. We searched six databases Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL. We registered our review protocol in PROSPERO with ID: CRD42022330356. We included 11 trials with 5814 patients. Compared to placebo, the pooled analysis favored subcutaneous nitroglycerin in preventing RAS (risk ratio [RR]: 0.57 with 95% confidence interval [CI] [0.43-0.77], p = .0003) and RAO (RR: 0.39 with 95% CI [0.16-0.98], p = .05). In contrast to the intra-arterial nitroglycerin that showed nonstatistically significant results in preventing RAS and RAO (RR: 0.8 with 95% CI [0.63-1.02], p = .07)- (RR: 0.78 with 95% CI [0.6-1.01], p = .06)), respectively. Also, topical nitroglycerin did not prevent RAS (RR: 0.73 with 95% CI [0.42-1.24], p = .24). Compared with placebo, subcutaneous nitroglycerin during transradial catheterization reduced the incidence of RAS and RAO. Meanwhile, Intra-arterial and topical nitroglycerin did not show statistically significant outcomes. Subcutaneous nitroglycerin may be a practical and cost-effective technique to facilitate transradial catheterization; however, more RCTs are needed to evaluate the subcutaneous versus intra-arterial nitroglycerin administration.
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Affiliation(s)
- Basel Abdelazeem
- McLaren Health Care, Flint, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Mostafa Atef
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Anthony Lutz
- Michigan State University, East Lansing, Michigan, USA
- Division of Cardiology, Beaumont Hospital, Farmington Hills, Michigan, USA
| | - Annabelle S Volgman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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17
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Fuga M, Tanaka T, Tachi R, Wachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. A novel 3-Fr guiding sheath for transradial access in aneurysm embolization: Technical note. Interv Neuroradiol 2022:15910199221142093. [PMID: 36437634 DOI: 10.1177/15910199221142093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Neurointervention via transradial access (TRA) is challenging when the radial artery is narrow. We performed aneurysm embolization via TRA using a novel 3-Fr guiding sheath (GS) (Axcelguide; Medikit, Tokyo, Japan) with an outer diameter of only 1.76 mm for patients with a radial artery of inner diameter less than 2 mm, and described the whole procedure and pitfalls as a technical note. Here, we present two patients with radial arteries less than 2 mm. One patient had a narrow neck intracranial aneurysm at the bifurcation of the left vertebral artery and posterior inferior cerebellar artery, which was embolized with the primary coiling technique. The other was a patient with a wide-necked extracranial aneurysm in the cavernous portion of the right internal carotid artery, which was embolized with the transcell technique with stent. We utilized a 3-Fr GS, distal access catheter, and a 0.0165-inch microcatheter for coil embolization. All aneurysms were completely occluded, without neurological or puncture site-related complications including subcutaneous hematoma, radial artery occlusion, and vasospasm. This report provides the first description of neurointervention using a 3-Fr GS. The 3-Fr GS contributed to successful completion of TRA aneurysm embolization without neurological or puncture site-related complications in patients with radial arteries narrower than 2 mm. The 3-Fr GS may be useful to accomplish aneurysmal embolization via TRA even in patients with a small radial artery.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Ryoto Wachi
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, 12839Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, 12839Jikei University School of Medicine, Tokyo, Japan
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18
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ZENCIRCI E, ESEN ZENCIRCI A, DEGIRMENCIOGLU A. A randomized trial of flow-mediated dilation to prevent radial artery spasm during transradial approach. Minerva Cardiol Angiol 2022; 70:563-571. [DOI: 10.23736/s2724-5683.20.05463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Men X, Wang Q, Hu WS, Chai Y, Ni TT, Sho HY, Zhou ZF. Median nerve block increases the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section. BMC Anesthesiol 2022; 22:248. [PMID: 35931948 PMCID: PMC9354365 DOI: 10.1186/s12871-022-01793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023] Open
Abstract
Background The radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications, however, it is difficult for women with gestational hypertension. Ultrasound-guided median nerve block can cause arterial vasodilation, which may improve the success rate of radial artery cannulation. Methods Ninety-two women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed ultrasound-guided cannulation were identified and randomized into the median nerve block group and control group. Median nerve block was performed under the guidance of ultrasound in the middle forearm and 5 ml of 0.5% lidocaine was injected. Subcutaneous local block was administered in the control group. The ultrasound-guided radial artery cannulation was performed ten minutes after blocking. Baseline measurements (T1) were performed after 10 minutes of rest. All variables were measured again at 10 (T2) and 30 (T3) minutes after median nerve block or local block. The primary outcome was the success rate of radial artery cannulation within 10 minutes after blocking. The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter and cross-sectional area were recorded before (T1), 10 minutes (T2) after, and 30 minutes (T3) after block. Results A total of 92 pregnant women were identified and completed the follow-up. As compared to control group, the first-attempt success rate of radial artery cannulation was significantly higher (95.7% vs78.3%, p = 0.027) and procedure time to success was significantly shorter (118 ± 19 s vs 172 ± 66 s, p < 0.001) in median nerve group. Median nerve group also had a significantly less overall number of attempts (p = 0.024). Compared with control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in median nerve group (p < 0.001), as well as percentage change of radial artery diameter and CSA. No difference was observed in the overall complication at chosen radial artery, which including vasospasm (21.7% vs 28.3%; p = 0.470) and hematoma (4.3% vs 8.7%; p = 0.677). Conclusions Ultrasound-guided median nerve block can increase the first-attempt success rate of chosen radial artery cannulation in women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed radial artery cannulation, and especially for those anesthesiologists with less experienced in radial artery cannulation. Trial registration ChiCTR2100052862; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 06/11/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01793-4.
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Affiliation(s)
- Xin Men
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Qian Wang
- Department of Anesthesiology, The Affiliated ZheJiang Hospital, School of Medicine, Zhejiang University, Hangzhou, 315014, China
| | - Wen-Shen Hu
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Yun Chai
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Ting-Ting Ni
- Department of Anesthesiology, Ningbo NO.7 Hospital, Ningbo, 320000, China
| | - Hong-Ye Sho
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China.
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China.
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20
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Claessen B, Beerkens F, Henriques JP. Vasoactive and Antiarrhythmic Drugs During PCI. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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21
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Gautam NK, Griffin E, Hubbard R, Pawelek O, Edmonds K, Rydalch E, Zhang X, Sharma S, Hoffmann C. Intraarterial papaverine for relief of catheter-induced peripheral arterial vasospasm during pediatric cardiac surgery: A randomized double-blind controlled trial. Paediatr Anaesth 2022; 32:764-771. [PMID: 35304932 DOI: 10.1111/pan.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maintaining the patency of peripheral arterial lines in pediatric patients during surgery can be challenging due to multiple factors, and catheter-related arterial vasospasm is a potentially modifiable cause. Papaverine, a potent vasodilator, improves arterial line patency when used as a continuous infusion in the pediatric intensive care setting, but this method is not convenient during surgery. AIM Extrapolating from the benefit seen in the intensive care unit, the authors hypothesize that a small-volume intraarterial bolus of papaverine immediately after arterial line placement will reduce vasospasm-related arterial line malfunction. METHODS This was a prospective, randomized, double-blind study. Patients less than 17 years of age undergoing cardiac surgery were enrolled. Patients were randomized into the heparin or papaverine groups. Immediately after arterial line insertion, an intraarterial bolus of heparin (2 units/ml, 1 ml) or papaverine (0.12 mg/ml, 1 ml) was administered (T1, Figure 1). An optimal waveform was defined as the ease of aspirating a standardized blood sample within 30 s, absence of cavitation when sampling, absence of color change at the catheter site during injection, and presence of a dicrotic notch. The primary outcome evaluated was the presence of an optimal arterial waveform at 5 min after the first randomized dose (T1 + 5 min). The secondary outcomes were the presence of optimal arterial waveform an hour after the first dose and the ability of papaverine to rescue suboptimal waveforms. RESULTS A total of 100 patients were enrolled in the study. Twelve patients were excluded from the analysis. Complete datasets after randomization were available in 88 patients (heparin group, n = 46; papaverine group, n = 42). At baseline, groups were similar for age, weight, arterial vessel size, and arterial line patency. At T1 + 5 min, an improvement in the waveform characteristics was observed in the papaverine group (heparin,39% [8/46] vs. papaverine, 64% [27/42]; p = .02; odds ratio, 2.8; 95% CI, 1.2 to 6.6, Figure 3, Table 2). At the end of 1 h, both groups showed continued improvement in arterial line patency. After the second dose, a higher number of patients in the heparin group had suboptimal waveforms and were treated with papaverine (heparin,37% [17/46] vs. papaverine,17% [7/42], p = .05). Patients in the heparin group treated with papaverine showed significant improvement in patency (13/17 vs. 3/7, p = .01). No serious adverse events were reported. CONCLUSIONS In pediatric patients, papaverine injection immediately after peripheral arterial catheter placement was associated with relief of vasospasm and improved initial arterial line patency. Further, papaverine can be used as a rescue to improve and maintain arterial line patency.
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Affiliation(s)
- Nischal K Gautam
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Evelyn Griffin
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Richard Hubbard
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Olga Pawelek
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Kayla Edmonds
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Eric Rydalch
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Xu Zhang
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | | | - Cassandra Hoffmann
- Department of Anesthesiology, McGovern Medical School, UT Health Houston, Houston, Texas, USA
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22
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Munir U, Khan R, Nazeer N, Akhter J, Hassan AU, Hanif B. Frequency and Predictors of Radial Artery Occlusion in Patients Undergoing Percutaneous Coronary Intervention. Cureus 2022; 14:e25505. [PMID: 35800796 PMCID: PMC9243215 DOI: 10.7759/cureus.25505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background and objective Transradial access (TRA) has become the preferred route for percutaneous coronary interventions (PCI), and this site is often a chink in the armor for staged PCI. In this study, we aimed to evaluate the incidence and predictors of radial artery occlusion (RAO) after TRA. Methods We conducted a retrospective study involving 1,307 patients who underwent PCI at the Tabba Heart Institute (THI) in Karachi, Pakistan from August 2018 to June 2019. TR band was used for hemostasis after PCI. Results The primary outcome of our study was RAO, which was observed in 11.3% of the study subjects. On multivariate analysis, female gender [odds ratio (OR): 1.79, 95% CI: 1.21-2.64], cardiovascular instability (OR: 2.5, 95% CI: 1.22-5.11), dyslipidemia (OR: 0.61, 95% CI: 0.4-0.92), and a higher number of diseased vessels were found to be predictors of RAO (p=0.004). Conclusion RAO is often an asymptomatic complication of TRA. To ensure radial artery patency, a carefully thought-out management plan and follow-up must be devised for high-risk patients.
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23
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Weinberg JH, Sweid A, Asada A, Schaefer J, Ruiz R, Kang K, Gooch MR, Herial NA, Tjoumakaris S, Zarzour H, Rosenwasser RH, Jabbour P. Access Site Complications and Management of the Transradial Approach for Neurointerventions. Neurosurgery 2022; 91:339-346. [DOI: 10.1227/neu.0000000000002022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
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Kyriakopoulos V, Xanthopoulos A, Papamichalis M, Skoularigkis S, Tzavara C, Papadakis E, Patsilinakos S, Triposkiadis F, Skoularigis J. Patent hemostasis of radial artery: Comparison of two methods. World J Cardiol 2021; 13:574-584. [PMID: 34754402 PMCID: PMC8554357 DOI: 10.4330/wjc.v13.i10.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radial artery obstruction is the most common complication of coronary angiography performed via transradial access. Patent hemostasis can significantly reduce the risk of radial artery occlusion. Previous studies utilized sophisticated methods to evaluate radial artery patency. Simplified and easily applicable methods for successful patent hemostasis are currently lacking.
AIM To determine which method (pulse oximeter vs the traditional radial artery palpation) is better to achieve patent hemostasis.
METHODS This prospective, single center study included 299 consecutive patients who underwent coronary angiography or percutaneous coronary intervention between November 2017 and July 2019. Patients less than 18 years old, with a history of radial artery disease, or no palpable artery pulse were excluded from the study. Patients were randomly assigned to two groups. In the first group, radial artery flow was assessed by palpation of the artery during hemostasis (traditional method). In the second group, radial artery patency was estimated with the use of a pulse oximeter. Two different compression devices were used for hemostasis (air chamber and pressure valve). The primary study endpoint was the achievement of successful patent hemostasis.
RESULTS The two groups (pulse oximeter vs artery palpation) had no significant differences in age, sex, body mass index, risk factors, or comorbidities except for supraventricular arrhythmias. The percentage of patients with successful patent hemostasis was significantly higher in the pulse oximeter group (82.2% vs 68.1%, P = 0.005). A lower percentage of patients with spasm was recorded in the pulse oximeter group (9.9% vs 19.0%, P = 0.024). The incidence of local complications, edema, bleeding, hematoma, vagotonia, or pain did not differ between the two groups. In the multivariate analysis, the use of a pulse oximeter (OR: 2.35, 95%CI: 1.34-4.13, P = 0.003) and advanced age (OR: 1.04, 95%CI: 1.01-1.07, P = 0.006), were independently associated with an increased probability of successful patent hemostasis. The type of hemostatic device did not affect patent hemostasis (P = 0.450).
CONCLUSION Patent hemostasis with the use of pulse oximeter is a simple, efficient, and safe method that is worthy of further investigation. Larger randomized studies are required to consider its clinical implications.
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Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | | | | | - Chara Tzavara
- Department of Health, Medical School, University of Athens, Athens 11527, Greece
| | - Emmanouil Papadakis
- Department of Cardiology, Konstantopoulio General Hospital, Athens 14233, Greece
| | | | | | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
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25
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Manzoor MU, Almulhim IA, Alrashed AA, Alturki AY, Alghabban FA, Al-Qahtani SM. Common ground, different path: Ulnar artery access for interventional neurovascular procedures. Interv Neuroradiol 2021; 28:463-468. [PMID: 34515561 PMCID: PMC9326858 DOI: 10.1177/15910199211040280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recently, radial artery access has gained popularity for interventional neurovascular procedures due to patient comfort and fewer complications. However, there are instances where the radial artery approach is not feasible. In such cases, trans-ulnar artery access (TUA) can offer an alternate route. There is limited data regarding neuro-interventional procedures performed via this approach. This study aims to evaluate the feasibility and safety of trans-ulnar approach for a wide range of interventional neurovascular procedures. MATERIALS AND METHODS The data for all patients who underwent ulnar artery access for diagnostic or interventional neuroradiology procedures was retrospectively collected between September 2020 and March 2021. Patient demographics, procedural details, procedure success, and complications were recorded. RESULTS During the study period, 23 patients underwent 24 trans-ulnar approach procedures. The mean age of patients was 50.1 ± 14.2 years. Fourteen diagnostic cerebral angiograms and ten interventional procedures were performed. All procedures were successfully completed via trans-ulnar approach without a switch to alternate access. No major access site complication was observed. CONCLUSION Ulnar artery access is a safe and feasible option for neurovascular procedures. It can be effectively utilized for diagnostic cerebral angiography and a wide range of interventional procedures.
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Affiliation(s)
- Muhammad U Manzoor
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim A Almulhim
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah A Alrashed
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Y Alturki
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia.,Department of Neurosurgery, National Neuroscience Institute, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fatimah A Alghabban
- Department of Neurosurgery, 48172King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia
| | - Sultan M Al-Qahtani
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
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26
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Sweid A, Weinberg JH, Khanna O, Das S, Kim J, Curtis D, Hammoud B, El Naamani K, Abbas R, Majmundar S, Sajja KC, Chalouhi N, Saiegh FA, Mouchtouris N, Atallah E, Gooch MR, Herial NA, Tjoumakaris S, Romo V, Rosenwasser RH, Jabbour P. Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls. Neurosurgery 2021; 88:E510-E522. [PMID: 33862629 DOI: 10.1093/neuros/nyab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The radial approach has been gaining more widespread use by neurointerventionalists fueled by data from the cardiology literature showing better safety and overall reduced morbidity. OBJECTIVE To present our institution's experience with the radial approach for neuroendovascular interventions in 614 consecutive patients who underwent a cumulative of 760 procedures. METHODS A retrospective analysis was performed and identified neuroendovascular procedures performed via the upper extremity vasculature access site. RESULTS Amongst 760 procedures, 34.2% (260) were therapeutic, and 65.7% (500) were nontherapeutic angiograms. Access sites were 71.5% (544) via a conventional radial artery, 27.8% (211) via a distal radial artery, 0.5% (4) via an ulnar artery, and 0.1% (1) via the brachial artery. Most of the procedures (96.9%) were performed via the right-sided (737), 2.9% (22) via the left-sided, and 0.1% (1) via a bilateral approach. Major access site complications occurred at a rate of 0.9% (7). The rate of transfemoral conversion was 4.7% (36). There was a statistically higher incidence of transfemoral conversion when repeat procedures were performed using the same access site. Also, there was no significant difference between nontherapeutic procedures performed using the right and left radial access, and conventional versus distal radial access. Procedural metrics improved after completion of 14 procedures, indicating a learning curve that should be surpassed by operators to reach optimal outcomes. CONCLUSION Radial artery catheterization is a safe and effective means of carrying out a wide range of neuroendovascular procedures associated with excellent clinical outcomes and an overall low rate of periprocedural complications.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Somnath Das
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julie Kim
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Darcy Curtis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Batoul Hammoud
- Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Shyam Majmundar
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kalyan C Sajja
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Victor Romo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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27
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Nishida H, Fukuhara H, Nawano T, Kanno H, Yagi M, Yamagishi A, Sakurai T, Naito S, Kato T, Kudo K, Ichikawa K, Tsuchiya N. Adjuvant heparinization before manipulation of artery reduces early failure in primary arteriovenous fistula for end-stage renal disease patients. Clin Exp Nephrol 2021; 25:1346-1353. [PMID: 34215926 DOI: 10.1007/s10157-021-02109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arteriovenous fistula (AVF) is the most preferred vascular access for hemodialysis patients, and early failure of AVF is one of the most avoidable complications of this procedure. We retrospectively evaluated whether adjuvant systemic heparinization just before arterial manipulation could reduce early failure of primary AVF. METHODS Three hundred and fifty-six patients with end-stage renal failure who underwent primary AVF surgery from April 2009 to September 2020 were enrolled in this study. The patients were divided into two groups based on whether they received adjuvant heparinization or not. Patient backgrounds, frequency of early AVF failure, and bleeding events were compared between the two groups. Multivariate Cox regression analysis identified risk factors for early AVF failure. RESULTS Early failure of AVF was observed in only 2 of 157 patients (1.2%) in the adjuvant group, and the incident was significantly lower than observed in the non-adjuvant group, i.e., 17 of 199 patients (8.5%) (p = 0.002). Bleeding events were not significantly different between the two groups. Seven of 157 patients (4.5%) in the adjuvant group and 7 of 199 patients (3.5%) in the non-adjuvant group experienced bleeding events (p = 0.785). Female sex, use of steroids, hypoalbuminemia, venous stenosis in pre-surgical evaluation, arterial spasm in the perioperative period, new-onset venous stenosis after AVF anastomosis, technical failure of surgery, no early cannulation after surgery, and non-adjuvant heparinization were related to early AVF failure in the multivariate regression analysis. CONCLUSION Adjuvant systemic heparinization therapy just before arterial manipulation reduced early failure of primary AVF without increasing bleeding events.
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Affiliation(s)
- Hayato Nishida
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan.
| | - Hiroki Fukuhara
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Takaaki Nawano
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Hidenori Kanno
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Mayu Yagi
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Atsushi Yamagishi
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Toshihiko Sakurai
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Sei Naito
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Tomoyuki Kato
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Kosuke Kudo
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Kazunobu Ichikawa
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, Japan
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Cho SA, Jang YE, Ji SH, Kim EH, Lee JH, Kim HS, Kim JT. Ultrasound-guided arterial catheterization. Anesth Pain Med (Seoul) 2021; 16:119-132. [PMID: 33866769 PMCID: PMC8107253 DOI: 10.17085/apm.21012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Ultrasonography facilitates arterial catheterization compared to traditional palpation techniques, especially in small arteries. For successful catheterization without complications, practitioners should be familiar with the anatomic characteristics of the artery and ultrasound-guided techniques. There are two approaches for ultrasound-guided arterial catheterization: the short-axis view out-of-plane approach and the long-axis view in-plane approach. There are several modified techniques and tips to facilitate ultrasound-guided arterial catheterization. This review deals with the anatomy relevant to arterial catheterization, several methods to improve success rates, and decrease complications associated with arterial catheterization.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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29
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Contemporary Use of Radial to Peripheral Access for Management of Peripheral Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Jung Oh E, Jin Min J, Su Kim C, Yun Hwang J, Gook J, Lee J. Evaluation of the factors related to difficult ultrasound-guided radial artery catheterization in small children: A prospective observational study. Acta Anaesthesiol Scand 2021; 65:203-212. [PMID: 32929724 DOI: 10.1111/aas.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although ultrasound guidance has significantly improved the success rate of radial artery catheterization, the failure rate in children is still high. For the further improvement of success rate, we prospectively evaluated the factors that make ultrasound-guided radial artery catheterization difficult in children under two years old. METHODS From October 2018 to September 2019, patients who required radial artery catheterization for surgery were enrolled. After collecting the anatomical characteristics of the radial artery using ultrasound at the puncture site, ultrasound-guided radial artery catheterization was performed by one experienced anaesthesiologist. The primary outcome was to identify the factors related to the first attempt failure. The factors associated with the total duration of the procedure until success were also evaluated. RESULTS A total of 183 children were included in the analysis. A radial artery cross-sectional area of ≤1 mm2 (odds ratio [OR] = 5.26; 95% confidence interval [CI], 2.48-11.18; P < .0001) and the presence of an anomalous radial artery branch (OR = 3.37; 95% CI, 1.43-7.95; P = .005) were independent predictors of first-attempt failure during ultrasound-guided radial artery catheterization. The total procedure time was also negatively associated with the small cross-sectional area (P < .001). CONCLUSIONS A cross-sectional area of ≤ 1 mm2 and the presence of an anomalous branch of radial artery significantly increased the difficulty of ultrasound-guided radial artery catheterization in children under two years old. In patients of these ages, pre-procedural ultrasound scanning to find an optimal site for catheterization may increase the first-attempt success rate although further studies are needed to verify our results. TRIAL REGISTRATION Clinical Research Information Service (https://crits.nih.go.kr, October 6, 2018 [KCT0003239]; Principle investigator: Jong-Hwan Lee).
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Affiliation(s)
- Eun Jung Oh
- Department of Anesthesiology and Pain Medicine Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Ji Yun Hwang
- Department of Anesthesiology and Pain Medicine Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Joonhee Gook
- Department of Anesthesiology and Pain Medicine Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Jong‐Hwan Lee
- Department of Anesthesiology and Pain Medicine Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
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Early experience with a novel 088 long sheath in transradial neurointerventions. Clin Neurol Neurosurg 2021; 202:106510. [PMID: 33529966 DOI: 10.1016/j.clineuro.2021.106510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transradial access (TRA) for neuroendovascular procedures has several clear benefits compared to transfemoral access. In this study, we report our initial experience with neuroendovascular procedures performed via transradial access using the novel Ballast 088 long sheath. METHODS We conducted a retrospective analysis and identified 91 consecutive patients who underwent neuroendovascular procedures via TRA using the Ballast 088 long sheath. Data collection was performed on indication for procedure, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, failure of radial access and conversion to transfemoral access, periprocedural complications, and procedural outcomes. RESULTS Amongst 91 patients, the average age was 65.5 years ± 14.2 with 45 (49.5 %) female patients. 25 (27.5 %) patients underwent aneurysm treatment, 2 (2.2 %) AVM/AVF embolization, 28 (30.8 %) intracranial or extracranial stenting, 31 (34.1 %) stroke treatment, and 5 (5.5 %) underwent diagnostic angiogram. The mean number of target vessels catheterized was 1.07 ± 0.25, the mean procedure duration (minutes) was 96.5 ± 57.2, mean fluoroscopy time (minutes) was 21.9 ± 14.2, mean contrast dose (ml) was 112.7 ± 66.7, and mean radiation exposure (Gycm2) was 54.82 ± 41.37. The success rate of target vessel catheterization was 100 %. There were no complications resulting in long term sequelae. Access complications occurred in 1 (1.1 %) patients. Transfemoral conversion was required in 3 (3.3 %) patients. CONCLUSIONS The Ballast 088 long sheath is safe and effective for TRA in neuroendovascular procedures with a low rate of complications and conversion.
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32
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mikailiMirak S, Talasaz AH, Jenab Y, Vatanara A, Amini M, Jalali A, Gheymati A. Novel combined topical gel of lidocaine-verapamil-nitroglycerin can dilate the radial artery and reduce radial pain during trans-radial angioplasty. IJC HEART & VASCULATURE 2021; 32:100689. [PMID: 33392383 PMCID: PMC7773593 DOI: 10.1016/j.ijcha.2020.100689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
Introduction Radial approach for coronary angioplasty is accepted by many specialists in medical centers around the world. The use of radial access is associated with fewer vascular complications and the same success rate in comparison with traditional femoral access. Radial artery spasm is one of the main concerns in this method. The small size of the radial artery and high density of alpha-1 adrenergic receptors in this artery can accelerate the spasm. The objects of this study were to evaluate whether the combined topical gel of lidocaine–verapamil–nitroglycerin could dilate the radial artery and reduce patient pain and sympathetic response during radial puncture. Methods Patients undergoing elective trans-radial angioplasty were randomized to either placebo or therapeutic gel group in single-center, double-blind study. Placebo or therapeutic gel applied 1 cm proximal to the radial styloid process. Radial artery size was measured by ultrasound. Radial pain was reported by the visual analog scale (VAS) and the sympathetic response was assessed by changes in systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR). The incidence of spasm was defined by the radial artery spasm score. Results 60 patients (30 patients in each group) participated in this study. A significant increase in the size of the radial artery was observed in the group receiving therapeutic gel compared to the placebo group (mean diameter, mm: 2.95 ± 0.48 vs. 2.54 ± 0.43, p = 0.001; area, cm2: 0.07 vs. 0.05, p = 0.001). During radial puncture, the radial pain intensity was significantly decreased in patients receiving therapeutic gel (4 (1–5) vs. 2 (1–2), p = 0.003). Radial artery spasm didn’t happen in any group. Conclusion Based on our results, Pre-procedural administration of combined topical gel of verapamil-nitroglycerin-lidocaine significantly increases the size of the radial artery and effectively reduces the radial pain during radial puncture in patients undergoing trans-radial angioplasty.
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Affiliation(s)
- Sevda mikailiMirak
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita H Talasaz
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Vatanara
- Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Amini
- Department of Medicinal Chemistry, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Gheymati
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Barranco Pons R, Rodriguez Caamaño I, de Dios Lascuevas M. Radial Access for Neurointerventions. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Transradial access (TRA) has become the standard approach for cardiac intervention, with a large body of evidence demonstrating a lower incidence of vascular complications, better patient experience and cost reduction. There has been increasing interest in using TRA both for diagnostic neuroangiography and for interventional neurovascular procedures. This aim of this article is to discuss the advantages and limitations of TRA for neurointerventions. General technical details, such as pre-procedure recommendations, prevention of spasm and occlusion, haemostasis protocols and distal TRA puncture, are also described, along with the specific technical details of TRA for aneurysm embolisation, stroke thrombectomy and other neurovascular interventions. TRA provides additional tools to the neurointerventionist and – with appropriate training – the whole spectrum of intervention procedures can be achieved using this approach.
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Affiliation(s)
- Roger Barranco Pons
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Rodriguez Caamaño
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Bellamoli M, Venturi G, Pighi M, Pacchioni A. Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions. Minerva Cardiol Angiol 2020; 69:557-578. [PMID: 33146480 DOI: 10.23736/s2724-5683.20.05391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention (PCI) has been widely adopted in the last decades since its first description in the late 40s. The transradial approach has been associated with favorable outcomes as compared with transfemoral access (TFA) in several registries and randomized clinical trials, mainly due to the lower incidence of access-site bleedings, vascular complications and improved patient comfort. This review aimed to summarize the body of evidence supporting the use of TRA, to discuss clinical implications, possible technical limitations and future directions, such as the implementation of TRA as the primary access for complex procedures and structural interventions.
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Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pacchioni
- Department of Cardiology, Civil Hospital, Mirano, Venice, Italy -
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35
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Zalocar LAD, Doroszuk G, Goland J. Transradial approach and its variations for neurointerventional procedures: Literature review. Surg Neurol Int 2020; 11:248. [PMID: 32905334 PMCID: PMC7468190 DOI: 10.25259/sni_366_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. Methods: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. Results: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. Conclusion: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.
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Affiliation(s)
| | - Gustavo Doroszuk
- Neurointervention Section, Hospital El Cruce Néstor Kirchner, Florencio Varela
| | - Javier Goland
- Neurointervention Section, Hospital El Cruce Néstor Kirchner, Florencio Varela.,Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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36
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Abstract
BACKGROUND In percutaneous coronary interventions, use of the radial artery may be limited by vascular anatomy or vascular complications, such as radial artery spasm, dissection or perforation. The balloon-assisted tracking (BAT) technique is a novel and innovative method to successfully perform transradial procedures in patients with difficult vascular anatomy, severe tortuosity or radial artery spasm. In addition, the BAT technique can serve as a bail-out technique when vascular complications such as artery dissection or perforation occur. OBJECTIVE We analysed data of all percutaneous coronary intervention patients in whom the BAT technique was undertaken in daily practice and report acute and long-term outcomes. RESULTS A total of 62 patients were included and, in most patients, the BAT technique was performed for radial spasm. Most patients were administered benzodiazepines or nitrates before the BAT technique was performed. The primary end point, defined as successful passage of the catheter through the artery of the arm using the BAT technique, was 98%. 11% of patients developed a complication within 24 h (haematoma, prolonged pain or visible vascular damage at the end of procedure); all completely recovered at follow-up. No complications occurred during long-term follow-up. CONCLUSION BAT is a low-risk and easy-to-use technique that increases the success rate of radial artery access and may prevent vascular complications.
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Abstract
Trans-radial approach (TRA) has been used in cardiac and peripheral interventional radiology practices for decades, because of safety and patient comfort. There is interest in TRA in the cerebrovascular field, with potential to replicate benefits over trans-femoral approach. TRA is technically more challenging and has a learning curve, which hinders its use as the first-line approach; however, as more neuro-interventionalists embrace TRA, techniques are being optimized simultaneously for supra-aortic vessel catheterization. This article describes advantages, patient selection, conventional and distal radial access, and detailed techniques of trans-radial catheterization for diagnostic angiography, as well as cerebrovascular interventions and its current limitations.
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Affiliation(s)
- Pratit Patel
- Department of Neurosurgery, Rutgers University, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, 80 Jesse Hill Jr Drive SE, Box 036, Atlanta, GA 30303, USA; Department of Neurosurgery, Emory University School of Medicine, Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, 80 Jesse Hill Jr Drive SE, Box 036, Atlanta, GA 30303, USA; Department of Radiology, Emory University School of Medicine, Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, 80 Jesse Hill Jr Drive SE, Box 036, Atlanta, GA 30303, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, 80 Jesse Hill Jr Drive SE, Box 036, Atlanta, GA 30303, USA; Department of Neurosurgery, Emory University School of Medicine, Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, 80 Jesse Hill Jr Drive SE, Box 036, Atlanta, GA 30303, USA; Department of Radiology, Emory University School of Medicine, Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, 80 Jesse Hill Jr Drive SE, Box 036, Atlanta, GA 30303, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, Rutgers University, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
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Abstract
Background
Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation.
Methods
This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 μg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm.
Results
A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, –25.2%; 95% CI, –39.6 to –10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P < 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%).
Conclusions
Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Khan MZ, Patel K, Franklin S, Faruqi A, Ahmad W, Saeed J. Radial artery spasm: reviews and updates. Ir J Med Sci 2020; 189:1253-1258. [PMID: 32185750 DOI: 10.1007/s11845-020-02203-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/10/2020] [Indexed: 11/25/2022]
Abstract
Elective and emergent coronary interventions via transradial access (TRA) are been used increasingly as they carry a reduced risk of complications. Percutaneous coronary intervention via TRA may lead to radial artery spasms (RAS) that may result in prolonged procedure time, cross-over of access site, and other complications. This review article discusses the recent definitions, incidences, pathophysiology, predictive score calculator, efficacy, the safety of the radial cocktails, and treatment of the RAS.
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Affiliation(s)
- Muhammad Zubair Khan
- Department of Internal Medicine, St Mary Medical Center, 1201 Langhorne-Newtown Rd, Langhorne, PA, 19047, USA.
| | - Krunalkumar Patel
- Department of Internal Medicine, St Mary Medical Center, 1201 Langhorne-Newtown Rd, Langhorne, PA, 19047, USA
| | - Sona Franklin
- Department of Internal Medicine, St Mary Medical Center, 1201 Langhorne-Newtown Rd, Langhorne, PA, 19047, USA
| | - Aradh Faruqi
- Department of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Waqar Ahmad
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Jamaluddin Saeed
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Raelson C, Ahmed B. Prevention and Management of Radial Access Complications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-0808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Williams T, Condon J, Davies A, Brown J, Matheson L, Warner T, Savage L, Boyle A, Collins N, Inder K. Nursing-led ultrasound to aid in trans-radial access in cardiac catheterisation: a feasibility study. J Res Nurs 2020; 25:159-172. [PMID: 34394621 DOI: 10.1177/1744987119900374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Trans-radial access is increasingly common for cardiac catheterisation. Benefits include reduced bleeding complications, length of hospital stay and costs. Aims To determine the feasibility of implementing a nurse-led ultrasound programme to measure radial artery diameter before and after cardiac catheterisation; to determine radial artery occlusion (RAO) rates, risk factors for RAO and predictors of radial artery (RA) diameter. Method A prospective observational cohort study design for 100 consecutive patients undergoing cardiac catheterisation, using RA access. Pre- and post-procedural RA diameter were measured using ultrasound, by specialist nurses trained to do so. Logistic regression analyses were performed to determine risk factors for RAO and predictors of RA diameter with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results There were no adverse events, supporting the feasibility of nurse led ultrasound programmes. A 4% (n = 4) rate of occlusion was observed. Haemostasis device application time of greater than 190 min was a predictor of RAO (OR 3.12, 95% CI 0.31-31). Male gender and height were predictors for a RA diameter of >2.2 mm. Conclusions Nurses can lead the assessment of RA occlusion using ultrasound to enhance planning and care, including monitoring compression times to reduce RAO.
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Affiliation(s)
- Trent Williams
- Clinical Nurse Consultant, Department of Cardiology, John Hunter Hospital, Australia
| | - Jeremy Condon
- Registered Nurse, Department of Cardiology, John Hunter Hospital, Australia
| | - Allan Davies
- Interventional Fellow, Cardiology, John Hunter Hospital, Australia
| | - Jennifer Brown
- Registered Nurse, Cardiology, John Hunter Hospital, Australia
| | | | | | - Lindsay Savage
- Clinical Nurse Consultant, Cardiology, John Hunter Hospital, Australia
| | - Andrew Boyle
- Professor of Cardiovascular Medicine, Director of Priority Clinical Centre for Cardiovascular health, Department of Cardiology, John Hunter Hospital, Australia
| | - Nicholas Collins
- Associate Professor, Director, Cardiac Catheterisation Lab, John Hunter Hospital, Australia
| | - Kerry Inder
- Associate Professor of Nursing: Deputy Head of School-Research, School of Nursing and Midwifery, University of Newcastle, Australia
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Aoun J, Hattar L, Dgayli K, Wong G, Bhat T. Update on complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther 2020; 17:741-751. [PMID: 31608731 DOI: 10.1080/14779072.2019.1675510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Transradial artery access (TRA) was introduced in 1989 and has been universally used as an alternative approach to the traditional transfemoral access (TFA). Complications of TRA include asymptomatic and less likely symptomatic radial artery occlusion, nonocclusive radial artery injury, radial artery spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, granuloma formation, access-site bleeding, nerve damage, complex regional pain syndrome along with other rare complications.Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 1 May 2019). Authors reviewed all articles related to transradial artery catheterization, its complications, as well as novel techniques for their management. The article provides insight on the incidence, risk factors, and prevention of such complications along with a description of usual and newer techniques to decrease morbidity.Expert opinion: With increasing experience, TRA complication rate is decreasing and new very uncommon complications are being described. A 'radial first' approach should be implemented in all catheterization laboratories and a physician's familiarity with minor and major complications is a must. Distal radial artery access through the snuff box might be the preferred site of accessing the radial artery and further studies will be needed to prove its superiority to the current access site.
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Affiliation(s)
- Joe Aoun
- Division of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, USA
| | - Laith Hattar
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Khabib Dgayli
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Gordon Wong
- Department of Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Tariq Bhat
- Division of Cardiology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Abstract
Transradial access (TRA) is favored over transfemoral access for performing coronary angiography and percutaneous coronary intervention due to the reduced risk for vascular and bleeding complications and the documented survival benefit in ST-segment–elevation myocardial infarction patients who undergo primary percutaneous coronary intervention. TRA complications can be categorized as intra- or postprocedural and further categorized as related to bleeding or nonbleeding issues. Major intra- and postprocedural complications such as radial artery perforation and compartment syndrome are rare following TRA. Their occurrence, however, can be associated with morbid consequences, including requirement for surgical intervention if not identified and treated promptly. Nonbleeding complications such as radial artery spasm and radial artery occlusion are typically less morbid but occur much more frequently. Strategies to prevent TRA complications are essential and include the use of contemporary access techniques that limit arterial injury. This document summarizes contemporary techniques to prevent, identify, and manage TRA complications.
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Affiliation(s)
- Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Malcolm R. Bell
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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van der Heijden DJ, van Leeuwen MA, Ritt MJ, Dapper MM, Boer K, Teerenstra S, van Royen N. Hand Sensibility after Transradial Arterial Access: An Observational Study in Patients with and without Radial Artery Occlusion. J Vasc Interv Radiol 2019; 30:1832-1839. [DOI: 10.1016/j.jvir.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022] Open
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Jang YE, Kim EH, Lee JH, Kim HS, Kim JT. Guidewire-assisted vs. direct radial arterial cannulation in neonates and infants. Eur J Anaesthesiol 2019; 36:738-744. [DOI: 10.1097/eja.0000000000001064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A novel predictor of radial spasm: arterial stiffness. Blood Press Monit 2019; 23:253-259. [PMID: 29985200 DOI: 10.1097/mbp.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study, we aimed to assess the relationship between radial artery spasm (RAS) and arterial stiffness (AS) measured by the oscillometric method. MATERIALS AND METHODS A total of 123 consecutive patients scheduled for elective coronary angiography in a single default radial center were enrolled for the study. AS [namely, augmentation pressure; augmentation index (AIx); and pulse wave velocity] was assessed using a validated oscillometric device (Mobil-O-Graph NG 24 h PWA). Central arterial pressures were also recorded. In the cath lab, the number of puncture attempts, total procedural time (TPT), and largest catheter size were noted. If greater than two catheters were required to complete imaging, it was additionally specified. RAS was considered to exist if two or more of predefined clinical features were present. RESULTS RAS was observed in 20 (16.3%) patients. Patients were divided into two distinct groups in terms of the occurence of RAS. In the RAS(+) group, the proportion of hypertensive individuals was significantly higher, whereas there were fewer smokers. With respect to operational data, TPT (24.3±9.8 vs. 29.3±9.1 mins; P=0.038) and procedures carried out with more than one puncture attempts were significantly higher in the RAS(+) group. Among all oscillometric parameters, augmentation pressure, AIx, and PR were found to be higher in the RAS(+) group. According to multivariate analysis, TPT (P=0.029) and AIx (odds ratio: 1.044, 95% confidence interval=0.977-1.117; P=0.009) were found to be independent predictors of RAS. CONCLUSION Along with conventional risk factors, AS assessment, as a practical, noninvasive method, may help to predict RAS in angiographic procedures.
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Abstract
RATIONALE Transradial access (TRA) is common for cardiac catheterization, but radial artery spasm (RAS) is suggested to be highlighted. Severe radical artery spasm could be solved by a relative novel approach called "sheathless technique," using a Tiger diagnostic catheter. PATIENT CONCERNS A 73-year-old woman presented to our institution with a recurrent feeling of discomfort in her chest. Her electrocardiogram showed ST segment depression. Her medical history indicated arterial hypertension, diabetes, and chronic renal failure. She was on hemodialysis for 5 years for the management of renal problems. Five stents were implanted from femoral access in another hospital via 2 percutaneous coronary interventions. The patient agreed to angiography this time and wanted a more comfortable solution. DIAGNOSIS Recurrent exertional angina was confirmed based on the chief complaint, electrocardiogram, and history. INTERVENTIONS After a successful radial artery puncture, a 6F arterial sheath pipe and a 5F Tiger diagnostic ductus could only advance slightly because of the RAS. Glonoin and verapamil functioned with the help of the radial sheath, and systemic nitroglycerin was applied later but had a negative outcome. Warm covers were positioned on the antebrachium, but no relief was reported.The "homemade sheathless technique" was applied. The 5F tube was held, and the 6F sheath was withdrawn. A blade was used to damage the sheath in reverse, and the excess sheath tube was removed. OUTCOMES The diagnostic catheter was successfully advanced to the ascending aorta, enabling left main and right coronary engagement and angiography. No significant coronary lesion was observed. The patient was discharged 3 days after angiography. Moreover, no complications were observed. A follow-up for 1 month after discharge also showed no complications. LESSONS Severe RAS causing failure of TRA is frequent in the transradial catheterization procedure. The sheathless technique may be useful in relieving spasm when other measures fail.
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Affiliation(s)
- Zaiyong Zhang
- Department of Cardiology, Panyu Central Hospital
- Cardiovascular Institute of Panyu District
- School of Life Sciences, South China Normal University, Guangzhou, China
| | - Qiang Xie
- Department of Cardiology, Panyu Central Hospital
- Cardiovascular Institute of Panyu District
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Feng X, Zhang X, Dai J, Bin J. Efficacy and safety of a 260-cm Amplatz Super Stiff guidewire during transradial percutaneous coronary intervention. Medicine (Baltimore) 2018; 97:e12568. [PMID: 30334943 PMCID: PMC6211875 DOI: 10.1097/md.0000000000012568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although transradial percutaneous coronary intervention (TR-PCI) is widely used in clinical practice, guidewire-related complications are an important cause of transradial approach failure. We investigated the prognostic value of the 260-cm Amplatz Super Stiff guidewire for reducing the complication rate during TR-PCI. METHODS Five hundred patients with positive Allen's test results were divided into 3 groups according to the type of angiography guidewire: group A, 150-cm Emerald guidewire standard J-tip (n = 160); group B, 150-cm Radifocus guidewire M (n = 176); and group C, exchangeable 260-cm Amplatz Super Stiff guidewire after placement of a 150-cm Radifocus guidewire M (n = 164). RESULTS Group C had the highest success rate (P = .008) and the lowest incidence of operative complications such as radial artery spasms and hematomas (P = .030 and P = .036, respectively). In addition, the groups differed significantly in terms of fluoroscopy and catheter placement times (P = .02. and P < .001, respectively); group C had the shortest times for these occurrences. CONCLUSIONS The exchangeable 260-cm Amplatz Super Stiff guidewire markedly decreased the incidence of guidewire-related complications, reduced fluoroscopy times, and increased the procedural success rate. Therefore, this tool can be considered a safe, effective, and feasible exchangeable guidewire for TR-PCI.
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Affiliation(s)
- Xuguang Feng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
- Affiliated Hospital of Inner Mongolia Medical University, Huhhot
| | - Xiaoyun Zhang
- Affiliated Hospital of Inner Mongolia Medical University, Huhhot
| | - Jun Dai
- Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
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Regional to the Rescue! Axillary Brachial Plexus Nerve Block Facilitates Removal of Entrapped Transradial Catheter Placed for Cardiac Catheterization. Reg Anesth Pain Med 2018; 42:475-477. [PMID: 28277420 DOI: 10.1097/aap.0000000000000595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to describe the first reported use of an axillary brachial plexus block to treat the entrapment of a transradial artery catheter due to vasospasm. CASE REPORT A 42-year-old man undergoing transradial arterial cardiac catheterization suffered arterial vasospasm causing the catheter to become entrapped and refractory to conservative (warm compresses) and standard pharmacologic interventions (intracatheter verapamil, intravenous infusions of nitroglycerin and nicardipine, and subcutaneous lidocaine and topical nitroglycerin). Anesthesia was consulted, and attempts at catheter removal under monitored anesthesia and general anesthesia failed. Finally, in order to avoid surgical intervention, an ultrasound-guided axillary brachial plexus block with mepivacaine was performed, resulting in easy removal of the catheter. CONCLUSIONS Axillary brachial plexus nerve blocks are an effective, efficient, and safe intervention with a wide range of indications. This case report demonstrates that an axillary nerve block can be used to treat the entrapment of a transradial artery catheter due to vasospasm.
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Xanthopoulou I, Stavrou K, Davlouros P, Tsigkas G, Koufou E, Almpanis G, Koutouzis M, Tsiafoutis I, Perperis A, Moulias A, Koutsogiannis N, Hahalis G. Randomised comparison of JUDkins vs. tiGEr catheter in coronary angiography via the right radial artery: the JUDGE study. EUROINTERVENTION 2018; 13:1950-1958. [PMID: 29061547 DOI: 10.4244/eij-d-17-00699] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the performance of the Tiger-II with Judkins 3.5L/4R catheters in coronary angiography (CAG) via the transradial approach (TRA). METHODS AND RESULTS Consecutive patients undergoing non-urgent CAG via the right TRA were randomised to either the Tiger-II (Terumo) or Judkins (3.5L/4R; Medtronic) 5 Fr catheters; 320 patients in each group were randomised. Catheter or access site change was required in 57 (17.8%) vs. 68 (21.3%) patients allocated to the Tiger-II and Judkins group, respectively (p=0.3). The study's primary endpoint of contrast volume (ml) used until completion of CAG was lower for Tiger-II vs. Judkins group: 66.8 (54.0-82.0) vs. 73.4 (60.0-94.1), p<0.001. Angiography, fluoroscopy time (min) and severe spasm rate were also significantly lower for Tiger-II vs. Judkins group: 5.52 (4.17-7.32) vs. 6.85 (5.15-9.63), p<0.00, 2.01 (1.32-3.13) vs. 2.24 (1.50-3.50), p=0.01 and 6 (2.8%) vs. 39 (12.2%), p<0.001, respectively. The Tiger-II catheter obtained better opacification grade for the right coronary artery (RCA): 4.0 (4.0-4.0) vs. 4.0 (3.0-4.0), p=0.02, but slightly compromised opacification of the left anterior descending (LAD) and left circumflex (LCX) arteries compared with the Judkins group: 3.75 (3.0-4.0) vs. 4.0 (3.5-4.0), p<0.001, and 3.78 (3.6-4.0) vs. 4.0 (3.6-4.0), p<0.001, respectively. CONCLUSIONS The Tiger-II was found superior to the Judkins 3.5L/4R regarding contrast volume use, procedural and fluoroscopy time, spasm rate and RCA imaging, and inferior regarding LAD and LCX imaging.
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