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Richards D, Levin KH. Other median neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:89-101. [PMID: 38697748 DOI: 10.1016/b978-0-323-90108-6.00011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Median mononeuropathy is common, with carpal tunnel syndrome the most frequently encountered acquired mononeuropathy in clinical practice. However, other disorders of the median nerve and many known anatomical variants can lead to misdiagnosis and unexpected surgical complications if their presence is not correctly identified. A number of inherited and acquired disorders can affect the median nerve proximal to the wrist, alone or accompanied by other affected peripheral nerves. Recognizing other disorders that can masquerade as median mononeuropathies can avoid misdiagnosis and misguided management. This chapter explores median nerve anatomical variants, disorders, and lesions, emphasizing the need for careful examination and electrodiagnostic study in the localization of median neuropathy.
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Affiliation(s)
- Danielle Richards
- Neuromuscular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Kerry H Levin
- Neuromuscular Center, Cleveland Clinic, Cleveland, OH, United States.
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2
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Hou Q, Zhou B, He J, Chen X, Zuo Y. Complications and related risk factors of transradial access cannulation for hemodynamic monitoring in general surgery: a prospective observational study. BMC Anesthesiol 2023; 23:228. [PMID: 37391714 PMCID: PMC10311751 DOI: 10.1186/s12871-023-02168-z] [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: 02/17/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To examine the short-term complications of arterial cannulation for intraoperative monitoring and their related risk factors. METHODS We included adult inpatients (≥ 18 years old) who underwent an initial transradial access (TRA) cannulation and were scheduled for general surgery between April 8 and November 30, 2020. We used 20G arterial puncture needles for puncturing and manual compression for hemostasis. Demographic, clinical, surgical, anesthetic, and laboratory data were extracted from electronic medical records. Vascular, neurologic, and infectious complications of TRA cannulation were recorded and analyzed. Logistic regression analyses were used to identify risk factors related to TRA cannulation for intraoperative monitoring. RESULTS Among 509 included patients, 174 developed TRA cannulation-related complications. Puncture site bleeding/hematoma and median nerve injury were observed in 158 (31.0%) and 16 (3.1%) patients, respectively. No patient developed cannula-related infections. Logistic regression analysis revealed increased odds of puncture site bleeding/hematoma in women (odds ratio 4.49, 95% CI 2.73-7.36; P < 0.001) and patients who received intraoperative red blood cell (RBC) suspension transfusion ≥ 4U (odds ratio 5.26, 95% CI 1.41-19.57; P = 0.01). No risk factors for nerve injury were identified. CONCLUSION Bleeding/hematoma were a common complication of TRA cannulation for intraoperative hemodynamic monitoring during general surgery. Median nerve injury may be an under recognized complication. Female sex and extensive intraoperative RBC transfusion are associated with an increased risk of bleeding/hematoma; however, the risk factors for nerve injury remain unclear. TRIAL REGISTRATION The study protocol was registered at https://www.chictr.org.cn (ChiCTR1900025140).
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Affiliation(s)
- Qin Hou
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
| | - Bin Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
| | - Juanjuan He
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
- Department of Anesthesiology, Jiangsu Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, Jiangsu Province 210028 P.R. China
| | - Xueying Chen
- Department of Anesthesiology, Chengdu Shang Jin Nan Fu Hospital, Chengdu, Sichuan Province, 611730 P.R. China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
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3
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Hohmann SE, Cha E. Technique of percutaneous closure of an endovascular arteriovenous fistula created for dialysis access. Proc AMIA Symp 2023; 36:403-405. [PMID: 37091778 PMCID: PMC10120556 DOI: 10.1080/08998280.2023.2167188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Endovascular arteriovenous fistulas (eAVFs) are a new and less invasive type of creation for dialysis access. The anastomosis for eAVFs often occurs between the ipsilateral proximal radial artery and vein or proximal ulnar artery and vein. As eAVF creations are in locations that are not traditionally used for surgical AVF creations, the question of how to approach reversal of these fistulas arises. Here we present a case of closure of an ulnar artery to ulnar vein eAVF.
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Affiliation(s)
- Stephen E. Hohmann
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, Texas
| | - Erin Cha
- Texas A&M School of Medicine, Dallas, Texas
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4
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Aru RG, Miller JC, Clark AH, Hubbuch J, Hughes TG, Bounds MC, Minion DJ, Tyagi SC. Lateral Axillary Exposure for Antegrade Access during Endovascular Repair of Complex Abdominal Aortic and Thoracoabdominal Aneurysms. Ann Vasc Surg 2021; 74:176-181. [PMID: 33549793 DOI: 10.1016/j.avsg.2020.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND During endovascular treatment of pararenal aortic aneurysms (PAA) and thoracoabdominal aortic aneurysms (TAAA), our antegrade vascular access of choice is a lateral axillary exposure (LAE). We directly access the axillary artery with multiple sheaths followed by primary closure of the axillary artery at case completion. The aim of this study is to describe our technique and to report our results with this approach. METHODS This study is a single-institution, retrospective review of 53 patients who were treated with parallel grafts for endovascular repair of PAA and TAAA from 2006 to 2018. The aortic repairs requiring LAE included: 9 cases of endo-leaks from prior endovascular repair, 20 TAAAs, and 24 PAAs. The axillary artery was exposed with a vertical axillary skin incision followed by retraction of the lateral border of the pectoralis major to expose the axillary artery distal to the pectoralis minor. A 5-French (F) through 12F sheaths were used to directly access the axillary artery for delivery of endovascular devices. RESULTS Two hundred and sixty reno-visceral stents were delivered through 125 axillary sheaths in an antegrade fashion to 114 arteries without intraoperative complications or technical failures. Two postoperative complications included an access-site hematoma managed conservatively (1.9%) and a left brachial vein thrombosis treated with anticoagulation (1.9%). There were no cases of cerebrovascular or peripheral neurologic events, upper extremity ischemia, or reoperation related to LAE. CONCLUSIONS LAE is a valid approach for upper extremity access during the endovascular repair of complex aortic aneurysms requiring simultaneous delivery of multiple reno-visceral devices. It does not require the use of a prosthetic conduit. There were no neurologic events or upper extremity ischemia in our series.
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Affiliation(s)
- Roberto G Aru
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY.
| | - Jeremy C Miller
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Abigail H Clark
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Jacob Hubbuch
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Travis G Hughes
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Michael C Bounds
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - David J Minion
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Sam C Tyagi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
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5
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Gunawardena T, Godakandage M, Cassim R, Wijeyaratne M. An unusual cause for median nerve palsy after brachial catheterization: Report of two cases. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_81_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Watts MM. Percutaneous Endovascular Aneurysm Repair: Current Status and Future Trends. Semin Intervent Radiol 2020; 37:339-345. [PMID: 33041479 PMCID: PMC7540639 DOI: 10.1055/s-0040-1714728] [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: 12/17/2022]
Abstract
Endovascular aneurysm repair (EVAR) is a common, safe, and effective method of treating abdominal aortic aneurysms. Traditionally treated via surgical cutdown over the common femoral arteries, many recent studies demonstrate percutaneous access techniques to avoid the surgical cutdown. Developing familiarity with these percutaneous techniques, including risks, complications, adjuncts, and alternative accesses, can help improve the outcomes and availability of EVAR. As these techniques become increasingly common, it is not unlikely that they can be practiced safely in select patients in an outpatient setting.
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Affiliation(s)
- Micah M. Watts
- Vascular Institute of Atlantic Medical Imaging, Galloway, New Jersey
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7
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Kuo F, Park J, Chow K, Chen A, Walsworth MK. Avoiding peripheral nerve injury in arterial interventions. ACTA ACUST UNITED AC 2020; 25:380-391. [PMID: 31310240 DOI: 10.5152/dir.2019.18296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury.
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Affiliation(s)
- Frank Kuo
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Park
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kira Chow
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Alice Chen
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew K Walsworth
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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8
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Lam UP, Lopes Lao EP, Lam KC, Evora M, Wu NQ. Trans-brachial artery access for coronary artery procedures is feasible and safe: data from a single-center in Macau. Chin Med J (Engl) 2019; 132:1478-1481. [PMID: 31205107 PMCID: PMC6629324 DOI: 10.1097/cm9.0000000000000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- U Po Lam
- Department of Cardiology, Centro Hospital Conde de Sao Januario, Macau, China
| | | | - Kan Chit Lam
- University of Michigan, Ann Arbor, Michigan 48104, USA
| | - Mario Evora
- Department of Cardiology, Centro Hospital Conde de Sao Januario, Macau, China
| | - Na-Qiong Wu
- Department of Cardiology, Center of Endocrinology & Cardiometabolism, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing 100037, China
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9
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Stefanou MI, Schubert V, Ruschil C, Winter N, Schuhmann MU, Ziemann U, Grimm A. Median nerve dissection after brachial artery catheterization revealed by high-resolution ultrasound. Clin Neurophysiol 2019; 130:1081-1082. [PMID: 31077909 DOI: 10.1016/j.clinph.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/20/2019] [Accepted: 04/07/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Maria-Ioanna Stefanou
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.
| | - Victoria Schubert
- Department of Neurology & Epileptology, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Christoph Ruschil
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Natalie Winter
- Department of Neurology & Epileptology, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | | | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany; Department of Neurology & Epileptology, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
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10
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Simon EM, Summers SM. Vascular Access Complications: An Emergency Medicine Approach. Emerg Med Clin North Am 2017; 35:771-788. [PMID: 28987428 DOI: 10.1016/j.emc.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Millions of central venous and arterial catheters are placed across the United States annually as mechanisms of obtaining advanced hemodynamic monitoring and facilitating acute resuscitation. Although presumably life saving or sustaining in many circumstances, current literature identifies the preprocedural and postprocedural complications of infection, thrombosis, embolism, and iatrogenic injury as resulting in patient morbidity and mortality. Today, through the application of aseptic technique, performance of operator training, and the utilization of ultrasound, emergency physicians may limit vascular access complications and improve patient outcomes.
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Affiliation(s)
- Erica Marie Simon
- Emergency Department, San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, SAMMC, MCHE-EMR, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-6200, USA.
| | - Shane Matthew Summers
- Emergency Department, San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, SAMMC, MCHE-EMR, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-6200, USA
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11
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Tong Z, Gu Y, Guo L, Guo J, Gao X, Li J, Wang Z, Zhang J. An Analysis of Complications of Brachial and Axillary Artery Punctures. Am Surg 2016; 82:1250-1256. [PMID: 28234193 DOI: 10.1177/000313481608201235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To examine the complications of brachial and axillary artery punctures and the precautionary measures taken to lower their incidences. Retrospective analysis of 266 cases of brachial and axillary artery punctures was performed for angiography or angioplasty between January 2009 and December 2013 at the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University. Complications and their causes were assessed. Among all brachial artery punctures (n = 140), there were complications in 3.6 per cent of cases, including local hematoma in 1.4 per cent, pseudoaneurysm in 0.7 per cent, acute arterial thrombosis in 0.7 per cent, and median nerve injury in 0.7 per cent. Among all axillary artery punctures (n = 126), there were complications in 10.3 per cent of cases, including local hematoma in 4.8 per cent, pseudoaneurysm in 0.8 per cent, acute arterial thrombosis in 0.8 per cent, acute venous thrombosis in 0.8 per cent, and nerve injury in 3.2 per cent. The incidence of complications was significantly lower in brachial axillary artery puncture compared with axillary artery puncture (P < 0.05). The main factors associated with complications might be patient's vascular condition, perioperative medication, anatomical features of the artery, puncture site, successful rate of first-attempt puncture, and bandage strength. Incidence of complications of brachial and axillary artery punctures could be lowered by strengthening the choice of indications, improving the perioperative managements, being fully aware of the anatomical characteristics of the brachial and axillary arteries, and applying the standardized techniques of puncture and compression hemostasis.
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Affiliation(s)
- Zhu Tong
- Department of Vascular Surgery, XuanWu Hospital, and Institute of Vascular Surgery, Capital Medical University, Beijing, China
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12
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Abstract
The median nerve serves a crucial role in extrinsic and intrinsic motor and sensory function to the radial half of the hand. High median nerve injuries, defined as injuries proximal to the anterior interosseous nerve origin, therefore typically result in significant functional loss prompting aggressive surgical management. Even with appropriate recognition and contemporary nerve reconstruction, however, motor and sensory recovery may be inadequate. With isolated persistent high median nerve palsies, a variety of available tendon transfers can improve key motor functions and salvage acceptable use of the hand.
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Affiliation(s)
- Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E Broad Street, Richmond, VA 23298, USA.
| | - Obinna Ugwu-Oju
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E Broad Street, Richmond, VA 23298, USA
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13
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Gillick JL, Cooper JB, Babu S, Das K, Murali R. Successful Treatment of Complex Regional Pain Syndrome with Pseudoaneurysm Excision and Median Nerve Neurolysis. World Neurosurg 2016; 92:582.e5-582.e8. [PMID: 27318309 DOI: 10.1016/j.wneu.2016.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy, is a pain syndrome characterized by severe pain, altered autonomic and motor function, and trophic changes. CRPS is usually associated with soft tissue injury or trauma. It has also been described as a rare complication of arterial access for angiography secondary to pseudoaneurysm formation. CASE DESCRIPTION A 73-year-old woman underwent catheterization of the left brachial artery for angiography of the celiac artery. The following day, the patient noticed numbness and severe pain in the median nerve distribution of the left upper extremity. Over the next 6 months, the patient developed CRPS in the left hand with pain and signs of autonomic dysfunction. Further work-up revealed the formation of a left brachial artery pseudoaneurysm with impingement on the median nerve. She underwent excision of the pseudoaneurysm with decompression and neurolysis of the left median nerve. Approximately 6 weeks after surgery, the patient had noticed significant improvement in autonomic symptoms. CONCLUSIONS This case involves a unique presentation of CRPS caused by brachial artery angiography and pseudoaneurysm formation. In addition, the case demonstrates the efficacy of pseudoaneurysm excision and median nerve neurolysis in the treatment of CRPS as a rare complication of arterial angiography.
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Affiliation(s)
- John L Gillick
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
| | - Jared B Cooper
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Sateesh Babu
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Kaushik Das
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Raj Murali
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
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14
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Morimoto D, Isu T, Kim K, Sugawara A, Isobe M, Morita A. Proximal Entrapment Neuropathy of the Median Nerve above the Elbow-Case Report. J NIPPON MED SCH 2016; 82:287-9. [PMID: 26823032 DOI: 10.1272/jnms.82.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report an extremely rare case of proximal entrapment neuropathy of the median nerve above the elbow in a 44-year-old man who presented with paresthesia with median nerve distribution. Tinel's sign was located in the upper arm medial to the biceps and 5 cm proximal to the elbow. The patient underwent microsurgery under local anesthesia. The fascia covering the brachial- and the biceps brachii muscle entrapped median nerve. After operation, he reported symptom improvement. Lesions above the elbow should be considered as possible causative factors of entrapment neuropathy of the median nerve.
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15
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Nasr B, Albert B, David CH, Khalifa A, El Aridi L, Badra A, Braesco J, Gouny P. Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access. Ann Vasc Surg 2016; 33:45-54. [PMID: 26802290 DOI: 10.1016/j.avsg.2015.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The femoral access is the approach of reference for iliac angioplasty. In the current context of an early ambulation and a minimization of in-hospital stay period, the brachial access seems to be an appropriate approach, especially that long and small diameter equipments are available. Furthermore, it is extremely useful in case of inappropriate or unavailable femoral access. The aim of this study was to evaluate the complication risk factors of the brachial approach in the treatment of iliac stenosis. METHODS Between January 2012 and December 2013, we performed 281 iliac transluminal angioplasties of which 57 (20%) consecutive left brachial artery accesses were performed in 54 patients. The choice of brachial access was justified in 68% of the cases by an unavailable femoral access, in 29% of the cases by the presence of bilateral iliac lesions, and in 3% of the cases after failure of retrograde femoral approach. RESULTS The patients were of a male majority (81%) with a mean age of 66 ± 9 years. The procedure was performed under local anesthesia in 65% of the cases. No upper limb ischemia or nervous complications had been reported. No cerebrovascular stroke has been identified. One patient presented with dysarthria associated with disorientation without the presence of cerebrovascular ischemia on the computed tomography scan and on the magnetic resonance imaging. There were 3 major hematomas at the brachial access site, which required reoperation; these 3 patients were on dialysis. There was no statistically significant relationship between a complication occurrence and the diameter or length of the introducer. The mean in-hospital stay period was 2 days. The procedure was considered successful in 91% of the cases. We reported 5 cases of failure: 4 of which was due to a difficulty in crossing the lesion and 1 due to a very short material. The only significant risk factor of failure was the thrombosis of the iliac axis (odds ratio 23.3, 95% confidence interval 2.5-264.6, P = 0.003). CONCLUSIONS The femoral access remains the recommended approach for the treatment of iliac occlusive lesions. However, brachial artery access seems to provide a safe and secure alternative approach for patients when femoral artery access is unavailable. It allows a rapid ambulation and an ambulatory care.
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Affiliation(s)
- Bahaa Nasr
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
| | | | | | - Ahmed Khalifa
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Layal El Aridi
- CHU de Brest, Centre Regional de Pharmacovigilance, Brest, France
| | - Ali Badra
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Jacques Braesco
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Pierre Gouny
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
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16
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Lazaro RP. Complex regional pain syndrome and acute carpal tunnel syndrome following radial artery cannulation: a neurological perspective and review of the literature. Medicine (Baltimore) 2015; 94:e422. [PMID: 25621693 PMCID: PMC4602652 DOI: 10.1097/md.0000000000000422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 01/16/2023] Open
Abstract
Complex regional pain syndrome (CRPS) associated with acute carpal tunnel syndrome (aCTS) developed in a 38-year-old right-handed man following radial artery cannulation (RAC) during the course of lumbar spine surgery. Inciting events and risk factors that might have led to these complications included: multiple arterial punctures and subsequent hematoma formation, radial artery spasm compounded by aggressive hemostasis, anatomical changes in the wrists related to repetitive manual activities in the workplace, and possible protracted hyperextension of the wrists during perioperative and operative procedure. Although CRPS is considered a rare complication of RAC, the condition is disabling and debilitating, especially when associated with aCTS.
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Affiliation(s)
- Reynaldo P Lazaro
- From the Neurology and Electroneuromyography Clinic, Oneonta, New York, USA
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17
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Abstract
Arterial or central venous vascular access is the cornerstone of invasive cardiac diagnosis, monitoring, and therapeutics. Although procedural safety has significantly improved with protocols perfected over decades of use, their prevalence renders even the uncommon neurologic complication clinically relevant. Serious peripheral nerve complications result from direct or indirect nerve injuries in the setting of a hematoma or compartment syndrome. Functional outcome is dependent upon prompt diagnosis and early treatment, so proceduralists should be aware of the relevant anatomy and early signs of nerve injury. Ischemic stroke is the most common central nervous system complication of diagnostic and therapeutic cardiac catheterization, and is presumed to be due to embolization of atherosclerotic plaque or thrombus dislodged during guiding catheter manipulation, platelet-fibrin thrombus that forms on the catheters, or air that appears during catheter flushing. Acute neurologic deterioration after thrombolysis for acute myocardial infarction should be presumed to be an intracranial hemorrhage until proven otherwise. The ideal angiography suite of the future is patientcentric and multipurpose, coordinating diagnostic and therapeutic strategies for multivascular disease, allowing for multispecialty collaboration, and, in the event of a neurologic complication of a cardiac procedure, facilitating the various treating physicians to converge efficiently upon the patient.
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18
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Abstract
The flexor digitorum profundus tendons are markedly interconnected, making them less able to move independently than the tendons of the flexor digitorum superficialis. This difference is often attributed to the common muscle belly of the profundus, but also, more importantly, to cross-connections between the tendons of the profundus. The effect of this quadriga phenomenon is important in several clinical situations, including testing for strength, assessing movement of the tendons, and when deciding which exercises to teach the patient after a tendon injury. The anatomy and biomechanics of this phenomenon are reviewed in this article to help explain why certain conditions occur, and to improve the diagnosis and treatment of some conditions in rehabilitation medicine.
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Affiliation(s)
- T A R Schreuders
- Erasmus MC University Hospital, Department of Rehabilitation Medicine & Physical Therapy, Rotterdam, The Netherlands.
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Ikeda K, Osamura N. MEDIAN NERVE PALSY: A COMPLICATION OF BRACHIAL ARTERY CARDIAC CATHETERIZATION. ACTA ACUST UNITED AC 2011; 16:343-5. [DOI: 10.1142/s0218810411005667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 03/12/2011] [Accepted: 03/18/2011] [Indexed: 11/18/2022]
Abstract
The patient, an 83-year-old male with ischemic cardiac disease, was examined using a periodical left brachial artery cardiac catheterization. Six hours after the examination, complete median nerve palsy appeared. Four months later, the median nerve was explored and found to be compressed by a hematoma in the brachial artery. The location of the hematoma was at 6 cm proximal to the puncturing point, because the catheter may have penetrated the brachial artery from the lumen. The median nerve was released and the hematoma removed. One year after surgery, the median nerve palsy had disappeared.
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Affiliation(s)
- Kazuo Ikeda
- Department of Orthopaedic Surgery, Kanazawa Medical Center, Ishikawa 920-8560, Japan
| | - Naoki Osamura
- Department of Orthopaedic Surgery, Kanazawa Medical Center, Ishikawa 920-8560, Japan
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20
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Yi-Loong Woon C, Yi-Liang Lee J. Brachial Venous Pseudoaneurysm with High Median Nerve Palsy Following Cardiac Catheterization: A Case Report. JBJS Case Connect 2011; 1:e11. [PMID: 29252227 DOI: 10.2106/jbjs.cc.k.00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Colin Yi-Loong Woon
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169608.
| | - Jonathan Yi-Liang Lee
- Dr. Jonathan Lee Hand, Wrist and Upper Limb Surgery, #12-08, Mount Elizabeth Medical Center, Singapore 228510
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21
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Abstract
The potential to reduce cardiovascular morbidity through dietary modification remains an area of intense clinical and scientific interest. Any putatively beneficial intervention should be tested within a randomised controlled trial which records appropriate endpoints, ideally incident CVD and death. However, the large sample sizes required for these endpoints and associated high costs mean that the majority of dietary intervention research is conducted over short periods among either healthy volunteers or those at only slightly increased risk, with investigators using a diverse range of surrogate measures to estimate arterial health in these studies. The present review identifies commonly employed techniques, discusses the relative merits of each and highlights emerging approaches.
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22
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Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, Frasier D, Gulati R, Skelding K, Bertrand O, Patel T. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv 2011; 78:823-39. [PMID: 21544927 DOI: 10.1002/ccd.23052] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/13/2011] [Indexed: 01/21/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/standards
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/methods
- Cardiac Catheterization/standards
- Cardiovascular Diseases/diagnostic imaging
- Cardiovascular Diseases/therapy
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/methods
- Catheterization, Peripheral/standards
- Clinical Competence
- Coronary Angiography/adverse effects
- Coronary Angiography/methods
- Coronary Angiography/standards
- Credentialing
- Endovascular Procedures/adverse effects
- Endovascular Procedures/methods
- Endovascular Procedures/standards
- Humans
- Patient Selection
- Radial Artery
- Risk Assessment
- Risk Factors
- Societies, Medical
- Treatment Outcome
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Affiliation(s)
- Ronald P Caputo
- St. Joseph's Hospital, S.U.N.Y. Upstate Medical School, Syracuse, New York 13203, USA.
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23
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Tran DD, Andersen CA. Axillary sheath hematomas causing neurologic complications following arterial access. Ann Vasc Surg 2011; 25:697.e5-8. [PMID: 21514101 DOI: 10.1016/j.avsg.2010.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/26/2010] [Indexed: 11/17/2022]
Abstract
Iatrogenic brachial plexus injuries secondary to expanding hematomas and pseudoaneurysms have been described in limited nature in previously published data. We present the case of a 55-year-old woman who developed neurologic deficits because of a compressive hematoma after axillary arteriography. She underwent emergent exploration of her left arm with decompression of the axillary sheath and brachial artery repair with complete recovery. We describe the presentation, relevant anatomy, and importance of this condition and stress the need for early recognition and surgical intervention to prevent permanent neurologic deficits.
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Affiliation(s)
- Daniel D Tran
- Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
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24
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Plaza Martínez Á, Carrera Díaz S, Alonso Álvarez M, Escudero J, Vaquero Puerta C, Cairols Castellote M, Riambau V, Lojo Rocamonde I, Gutiérrez Alonso V. Tratamiento endovascular de la patología obstructiva aortoiliaca. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Affiliation(s)
- John Zhang
- Department of Anatomy & Structural Biology, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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26
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The brachial artery: a critical access for endovascular procedures. J Vasc Surg 2008; 49:378-85; discussion 385. [PMID: 19028057 DOI: 10.1016/j.jvs.2008.09.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/11/2008] [Accepted: 09/11/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The brachial artery is often used for coronary angiography. However, data on brachial access for aortic and peripheral interventions are limited. This study evaluated our experience with brachial artery catheterization for diagnostic arteriography and endovascular interventions. METHODS Between August 2004 and August 2005, 2026 endovascular procedures were performed. Of these, 323 cases (16%) in 289 patients required brachial artery access, forming the basis for this study. Patients who underwent multiple interventions, but with a single access (ie, thrombolysis), were considered a single case. Demographic and clinical data were recorded in a database and analyzed using logistic regression analyses with generalized estimating equations and the Fisher exact test for nominal variables. RESULTS The mean age of all patients was 66.4 years, with 57% men. Brachial access was used for diagnostic purposes in 27% and for interventions including angioplasty, stenting, and thrombolysis in 73%. The use of brachial access was considered obligatory in 40%, adjunctive in 19% (ie, endovascular repair of abdominal aortic and thoracic aortic aneurysms) and preferential to femoral access in 41%. In 91% of patients, the brachial arteries were accessed percutaneously, and 9% underwent surgical cutdown for access. In patients whose brachial artery was approached percutaneously, access was achieved in all but one (99.6% technical success rate). Hemostasis after catheterization was achieved by manual compression in 89%. Operative mortality rate was 6.2% and not related to brachial artery access. Brachial access site-related complications occurred in 21 patients (6.5%). Thirteen of these 21 patients (62%) required a surgical correction, mostly for brachial artery thrombosis or pseudoaneurysm. Patients with complications were more commonly women (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.68-13.26; P = .003) and had a long interventional sheath (OR, 6.7; 95% CI, 1.53-29.07; P = .012). The risk of a brachial artery complication was not associated with thrombolysis, procedure type, vascular territory treated, or the use of heparin. No upper extremity limb or finger loss occurred. CONCLUSIONS Brachial artery access is necessary for complex endovascular procedures and can be achieved in most patients safely. Postprocedural vigilance is warranted because most patients with complications will require operative correction.
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27
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Haddad F, Zeeni C, El Rassi I, Yazigi A, Madi-Jebara S, Hayeck G, Jebara V, Yazbeck P. Can Femoral Artery Pressure Monitoring Be Used Routinely in Cardiac Surgery? J Cardiothorac Vasc Anesth 2008; 22:418-22. [DOI: 10.1053/j.jvca.2007.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Indexed: 11/11/2022]
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28
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Lo TSN, Buch AN, Hall IR, Hildick-Smith DJ, Nolan J. Percutaneous Left and Right Heart Catheterization in Fully Anticoagulated Patients Utilizing the Radial Artery and Forearm Vein: A Two-Center Experience. J Interv Cardiol 2006; 19:258-63. [PMID: 16724969 DOI: 10.1111/j.1540-8183.2006.00139.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stopping oral anticoagulants prior to cardiac catheterization is associated with an increased risk of thromboembolism. Performing the procedures via the femoral artery and vein without interruption of anticoagulation is associated with a high rate of major access site complications. The transradial technique for left heart catheterization is safe in fully anticoagulated patients but few data are available on the percutaneous right and left heart catheterization utilizing a combination of the radial artery and antecubital vein in this group of patients. METHODS We report our experience in 28 consecutive patients that underwent left and right heart catheterizations via this percutaneous arm approach without interruption of anticoagulation. These were compared to 31 consecutive non-anticoagulated patients that underwent the procedure via a conventional femoral artery and vein approach. RESULTS Arterial and venous accesses were achieved and complete angiographic and hemodynamic data obtained in all patients. There were no access site complications in the anticoagulated patients despite an International normalized ratio (INR) of 2.5 +/- 0.5. Procedural duration was longer in the anticoagulated group of patients, but fluoroscopy time and patient radiation dose were similar in both groups. CONCLUSION Our experience suggests that left and right heart catheterization can be safely performed in most fully anticoagulated patients using this technique with a low bleeding and thromboembolic risk and no increase in radiation exposure.
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Affiliation(s)
- Ted S N Lo
- Cardiothoracic Centre, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
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29
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Brillet PY, Vayssairat M, Tassart M, Deux JF, Bazot M, Allaire E, Boudghene F. Gadolinium-enhanced MR Angiography as First-Line Preoperative Imaging in High-Risk Patients with Lower Limb Ischemia. J Vasc Interv Radiol 2003; 14:1139-45. [PMID: 14514805 DOI: 10.1097/01.rvi.0000086533.86489.de] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the clinical relevance of gadolinium-enhanced MR angiography (Gd-MRA) as the first-line angiographic examination for planning lower limb revascularization in patients at high risk of complications after contrast arteriography (CA). METHOD Forty-five consecutive patients at high risk of post-CA complications because of chronic renal insufficiency, diabetes mellitus, advanced age, or the need for brachial artery catheterization or graft puncture had Gd-MRA as first-line angiography before a surgical or endovascular procedure for lower limb ischemia. RESULTS After Gd-MRA, 59 procedures were performed, including 38 surgical reconstructions, 17 endovascular procedures, and four amputations. Complementary CA was only required in seven patients for whom a below-knee bypass was planned. Cumulative patency rates at 1 and 24 months were, respectively, 91% and 91% for suprainguinal bypasses, 100% and 92% for infrainguinal above-knee bypasses, 80% and 57% for below-knee bypasses, and 92% and 76% for iliofemoral angioplasties. After 24 months of follow-up, limb salvage, amputation, and mortality rates were, respectively, 86%, 3.5%, and 7% for stage II ischemia and 48%, 11%, and 30% for stages III and IV. CONCLUSION Gd-MRA can be proposed for first-line preoperative imaging in the management of lower limb ischemia for patients at high risk and permits the selective use of CA as a second-line examination if a below-knee bypass is required.
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Affiliation(s)
- Pierre Y Brillet
- Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75970 Paris, France
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30
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Hildick-Smith DJR, Walsh JT, Lowe MD, Petch MC. Coronary angiography in the fully anticoagulated patient: the transradial route is successful and safe. Catheter Cardiovasc Interv 2003; 58:8-10. [PMID: 12508189 DOI: 10.1002/ccd.10374] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The radial approach to coronary angiography is intuitively attractive for fully anticoagulated patients (INR > 2) but no data exist concerning efficacy or safety of this procedure. The consensus view is that the femoral approach is contraindicated in fully anticoagulated patients, and though some operators undertake femoral catheterization in such patients and use closure devices, there are no data to suggest that it is safe to do so. At our institution, the radial approach for coronary angiography is reserved for patients in whom there is a relative contraindication to the femoral route. We have undertaken over 600 radial coronary angiograms in such patients since 1996, 66 of whom underwent transradial catheterization specifically because of anticoagulation status (INR > 2). Thirty-eight patients (58%) were male, average age 67 +/- 11 years. All 66 patients had an INR > 2 but < 4.5. The approach was left radial in 26 (39%), right radial in the remainder; sheath size was 4 Fr in 4 (6%), 5 Fr in 13 (20%), and 6 Fr in 49 (74%). Seven operators in total were involved, though two operators undertook the majority of cases (47; 71%). Success rate was 97%, with no failure of access, and only one minor postprocedural hemorrhage. Failures were due to radial artery atherosclerosis (1) and subclavian tortuosity (1). The radial approach to coronary angiography is safe and to be recommended in the fully anticoagulated patient.
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31
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Hildick-Smith DJR, Walsh JT, Lowe MD, Shapiro LM, Petch MC. Transradial coronary angiography in patients with contraindications to the femoral approach: An analysis of 500 cases. Catheter Cardiovasc Interv 2003; 61:60-6. [PMID: 14696161 DOI: 10.1002/ccd.10708] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The transradial approach to coronary angiography is considered by some to be a route of choice, by others to be a route that should be used only where there are relative contraindications to the femoral approach. We present the largest series to date of patients in whom transradial coronary angiography was undertaken specifically because of contraindications to the femoral approach. Since 1995, patients at this cardiothoracic center have been considered for a transradial approach to coronary angiography if there were relative contraindications to the femoral route. Data from 500 patients was prospectively collected. Patients were aged 66 +/- 9 years; 72% were male. Indications for the radial approach included peripheral vascular disease (305), therapeutic anticoagulation (77), musculoskeletal (59), and morbid obesity (32). Sixty-eight patients (14%) required a radial procedure following a failed femoral approach. Access was right radial 291 (58%), left radial 209 (42%). Eighteen operators were involved, but two operators undertook 355 (71%) of the cases. Catheter gauge was 6 Fr (n = 243; 49%), 5 Fr (219; 43%), and 4 Fr (29; 6%). The procedure was successful in 463 cases [92.6%; 88.2% for nonmajority vs. 94.4% (P < 0.05) for the two majority operators]. Success in males (93.6%) significantly exceeded that in females (90.1%; P < 0.05). In-catheter-laboratory duration was 45 +/- 17 min; fluoroscopy time, 7.5 +/- 6 min; radiation dose, 40 +/- 23 CGy. The procedure was without incident in 408 cases (82%). There were procedural difficulties in 18% of cases, including radial artery spasm (12%) and vasovagal response (5%). The incidence was higher with 6 Fr catheters (23%) than with 5/4 Fr (15%; P < 0.05). Major procedural complications occurred in three cases: brachial artery dissection in one and cardiac arrest in two. Postprocedure major vascular complications numbered three: claudicant pain on handgrip in one, ischemic index finger (with subsequent terminal phalanx amputation due to osteomyelitis) in one, and ischemic hand for 4 hr in one. Patients with contraindications to the femoral approach form a high-risk group. In these patients, transradial cardiac catheterization can be performed successfully and with a low risk of major complications. Minor adverse features remain frequent, occurring in one in five cases, though difficulties are minimized both with increasing operator experience and smaller sheath diameter.
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Hildick-Smith DJR, Khan ZI, Shapiro LM, Petch MC. Occasional-operator percutaneous brachial coronary angiography: first, do no arm. Catheter Cardiovasc Interv 2002; 57:161-5; discussion 166. [PMID: 12357512 DOI: 10.1002/ccd.10329] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The percutaneous brachial approach to coronary angiography is perceived, rightly or wrongly, to be the easiest of the arm approaches. Predominantly femoral operators may therefore be encouraged to use the percutaneous brachial approach as an occasional procedure. We decided to investigate prospectively whether this was a reasonable strategy by examining outcome in patients who underwent percutaneous brachial cardiac catheterization by occasional brachial operators. Between October 1997 and 2000, 55 patients underwent percutaneous brachial coronary angiography (0.6% of coronary angiographies), aged 66 +/- 10 years, of whom 40 (73%) were male. Chief indications for a brachial approach were peripheral vascular disease in 35 (64%), failed femoral approach in 10 (18%), and orthopnoea in 5 (9%). The procedure was completed successfully in 46 patients (84%). Reasons for failure were failure of access (two), brachial artery spasm (one), inability to negotiate brachial/subclavian tortuosity (two), dissection of the brachial artery (two), and inability to intubate a vein graft (two). Six patients required catheterization from an alternative site (brachial arteriotomy in two, percutaneous transradial in two, femoral in two), with success in all. There were complications of varying severity in 20 patients (36%). Major complications were false aneurysm requiring surgical repair (one), large brachial hematoma requiring surgical exploration and arterial repair (one), and hematoma with clinical median nerve dysfunction for one month. Minor complications included need for repeat coronary angiography via alternative approach (six), weakness of radial pulse < 24 hr (two), brachial artery dissection without clinical sequelae (two), brachial artery spasm terminating procedure (one), and wound oozing (three). Percutaneous brachial coronary angiography is a hazardous procedure when undertaken by occasional brachial operators. Complications are unacceptably frequent. As with all practical procedures, complication rates are likely to be inversely proportional to operator volumes. Patients requiring an arm approach should be referred to operators with high-volume brachial or radial experience.
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33
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Ristic S, Strauch RJ, Rosenwasser MP. The assessment and treatment of nerve dysfunction after trauma around the elbow. Clin Orthop Relat Res 2000:138-53. [PMID: 10660708 DOI: 10.1097/00003086-200001000-00013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nerve dysfunction after trauma around the elbow can lead to significant long-term pain and functional deficit. Fortunately, most of these injuries are neurapraxias that will recover spontaneously after conservative treatment. The necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. Often surgical exploration exacerbates rather than alleviates the presenting nerve problem. Distal humeral shaft fractures, elbow dislocations, Monteggia fracture-dislocations, supracondylar fractures in children, and proximal forearm trauma all have been associated with various types of nerve injuries with a variable degree of recovery. The early recognition of nerve dysfunction combined with appropriate treatment measures is the key to successful outcome.
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Affiliation(s)
- S Ristic
- New York-Presbyterian Orthopaedic Hospital, NY 10032, USA
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