Efficacy of patient-controlled hydromorphone analgesia in those undergoing uterine fibroid artery embolization via the right radial artery

Objective: To evaluate the efficacy and safety of patient-controlled analgesia(PCA) with hydromorphone as perioperative analgesia during uterine artery embolization(UAE) via the right radial artery.Patients and methods: A total of 33 patients with uterine fibroids, who underwent UAE at the authors’ hospital between June 2021 and March 2022, were selected. Hydromorphone(10 mg) was dispensed into a 100 ml PCA pump with normal saline. Pump administration was initiated 15 min before the start of the procedure, and the intraoperative dose was adjusted according to patient pain level. A numerical rating scale was used to evaluate pain immediately after embolization, 5 min after embolization, at the end of the procedure, and 6, 12, 24, 48, and 72 h after the procedure. Side effects were also observed.Results: Thirty-three patients underwent uterine artery embolization via the right radial artery. Patient pain was well controlled at all time points surveyed, and patients reported satisfaction with analgesia. The median length of hospital stay was 5 days. There were 7 cases of adverse reactions, but no serious side effects were observed.Conclusion: Patients reported positive experiences with arterial embolization of uterine fibroids via the right radial artery. Hydromorphone PCA effectively controlled pain. The PCA pump is easy to operate, has a low incidence of adverse reactions, and offers economic benefits at the patient and institutional levels.

Comparison of Clinical Value between Right Distal Radial Artery Access and Right Radial Artery Access in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention

Objective:To compare the feasibility and safety between right distal radial artery access and right radial artery access in patients undergoing coronary angiography(CAG)or percutaneous coronary intervention(PCI).Methods:On the basis of arterial access,113 patients who underwent CAG or PCI in Kunshan Hospital of Traditional Chinese Medicine between January and October 2018 were divided into two groups:a right distal radial artery group(52 patients)and a right radial artery group(61 patients).We collected general information,the number of puncture attempts,access times,postoperative compression time,and complications.Results:The general characteristics,rate of successful radial artery puncture,and rate of successful catheter placement in the two groups were not different.The right radial artery group had fewer puncture attempts(1.26±0.44 times vs.2.19±0.53 times,P=0.001)and a shorter access time(3.23±0.86 min vs.4.77±1.49 min,P=0.001)than the right distal radial artery group.However,the postoperative compression time in the right distal radial artery group was shorter(3.44±0.9 h vs.7.16±1.21 h,P=0.001).Two cases of bleeding,four cases of hematoma,and one case of artery occlusion in the right radial artery group and one case of hematoma in the right distal artery group occurred before discharge.The rate of total complications in the right distal radial artery group was lower than in the right radial artery group(1.93%vs.11.48%,P=0.048).Conclusion:CAG or PCI through the right distal radial artery is feasible and safe.

Radial artery access site complications during cardiac procedures,clinical implications and potential solutions: The role of nitric oxide

Percutaneous coronary intervention for the treatment of coronary artery disease is most commonly performed in the UK through the radial artery,as this is considered to be safer than the femoral approach.However,despite improvements in technology and techniques,complications can occur.The most common complication,arterial spasm,can cause intense pain and,in some cases,procedural failure.The incidence of spasm is dependent on several variables,including operator experience,artery size,and equipment used.An antispasmolytic cocktail can be applied to reduce spasm,which usually includes an exogenous nitric oxide(NO)donor(glyceryl trinitrate).NO is an endogenous local vasodilator and therefore is a potential target for anti-spasm intervention.However,systemic administration can result in unwanted side-effects,such as hypotension.A method that adopts local delivery of NO might be advantageous.This review article describes the mechanisms involved in radial artery spasm,discusses the advantages and disadvantages of current strategies to reduce spasm,and highlight the potential of NO-loaded nanoporous materials for use in this setting.

Randomized study comparing incidence of radial artery occlusion post-percutaneous coronary intervention between two conventional compression devices using a novel airinflation technique

AIM To compare post-percutaneous coronary intervention(PCI) radial artery occlusion(RAO) incidence between two conventional radial artery compression devices using a novel air-inflation technique.METHODS One hundred consecutive patients post-PCI were randomized 1:1 to Safeguard or TR band compression devices. Post-radial sheath removal, each compression device was inflated with additional 2 m L of air above index bleeding point during air-filled device application and gradually down-titrated accordingly. RAO was defined as absence of Doppler flow signal performed at 24 h and at 6 wk post-PCI. Patients with missing data were excluded. Statistical significance was defined as P < 0.05.RESULTS All patients had 6 F radial sheath inserted. No significant differences were observed between Safeguard Radial(n = 42) vs TR band(n = 42) in terms of age(63 ± 11 years vs 67 ± 11 years), clinical presentation(electives, n = 18 vs n = 16; acute coronary syndrome, n = 24 vs n = 26) and total procedural heparin(7778 ± 2704 IU vs 7825 ± 2450 IU). RAO incidence was not significantly different between groups at 24 h(2% vs 0%, P = 0.32) and 6 wk(0%, both).CONCLUSION Safeguard Radial and TR band did not demonstrate significant between-group differences in short-term RAO incidence. Lack of evidence of RAO in all postPCI patients at 6 wk follow-up, regardless of radial compression device indicate advantage of using the novel and pragmatic air-inflation technique. Further work is required to more accurately confirm these findings.

Discrepancy of blood pressure between the brachial artery and radial artery

BACKGROUND:In this study,we attempted to find the relations between blood pressure(BP)measured on the brachial artery(bBP) and BP assessed on the radial artery(rBP) in the right arm.METHODS:Three hundred and fifteen patients were enrolled in this study.Those who had peripheral vascular disease,wounds of arm skin or subcutaneous tissue infection were excluded.After a 15-minute equilibration and stabilization period after inducation of anesthesia,three bBP and rBP records were obtained sequentially using an oscillometric device with an adult cuff and infant cuff,respectively.Order for each BP was randomized.RESULTS:The bBP was significantly lower than the rBP(P<0.05).The difference between the two values varied from 13 to 18 mmHg in systolic BP(SBP),diastolic BP(DBP) and mean blood pressure(MAP) respectively.And the rBP was positively correlated with the bBP(r=0.872,0.754,0.765;P<0.001,<0.001,<0.001;SBP,DBP,MAP,respectively).CONCLUSION:The bBP value can be evaluated by the noninvasive measurements of rBP using an appropriate cuff in clinical practice.

Patent hemostasis of radial artery:Comparison of two methods

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.

Subclavian artery stenting via bilateral radial artery access:Four case reports

BACKGROUND Subclavian artery stenosis refers to the stenosis in the lumen caused by the presence of plaque or thrombus in the subclavian artery.It is a common problem in endovascular interventions.In fact,conventional subclavian artery stenting via the femoral artery approach is effective and safe.Nevertheless,because femoral artery puncture is not easy to stop bleeding,it requires longer femoral artery compression or more expensive hemostatic materials,such as staplers.Patients need to be catheterized and bedridden for a longer time,which may lead to many complications,such as pseudoaneurysm.CASE SUMMARY Herein,we reported a new interventional therapy of subclavian artery.From March 1,2020 to August 31,2021,we operated on four patients with subclavian artery stenting via bilateral radial artery access.CONCLUSION After reviewing four cases of successful placement of clavicular artery stents via bilateral radial arteries,we concluded that bilateral radial artery approach is feasible.Clavicular artery stenting is safe,effective,and timesaving.It is an excellent alternative to the traditional femoral artery procedure,with few complications and high comfort degree.

Pseudoaneurysm with Median Nerve Injury Caused by Right Radial Artery Puncture:A Case Report

Background:Pseudoaneurysm with median nerve injury is a serious complication of radial artery puncture.It is very important to summarize the prevention and treatment experience of this complication through case discussion.Case report:A 66-year-old woman was admitted to the hospital because of‘‘paroxysmal chest tightness and suffocation for 5 days.”Coronary angiography was performed.During insertion of the arterial sheath,the patient experienced severe pain in the right forearm,which radiated to the palm.The puncture sheath did not return blood after the sheath core was withdrawn.The sheath was removed and local compression was used to stop bleeding.There was no obvious bleeding at the puncture point,and the compression was removed 6 hours after the procedure.Local swelling and increased tension were seen in the right forearm.At the 1-week follow-up she exhibited swelling,high local tension,small blisters,and bluish-purple skin of the right forearm,with an acceptable right radial artery pulsation.She had severe pain in the affected limb,which radiated to the thumb,index fi nger,and middle fi nger.Case discussion:We discuss the causes of and treatment measures for pseudoaneurysm with median nerve injury caused by radial artery puncture.

The Effects of Different Type Vasodilator Agents on Radial Artery Blood Flow: A Placebo-Controlled Clinical Study

Background: The radial artery (RA) is being used as a second arterial conduit in coronary artery bypass grafting (CABG) patients. Vasospasm during the harvesting is the most common problem, yet. Our goal of this research is to evaluate the effects of different vasodilators on RA blood flow. Material and Method: In our 250 CABG patients who were included into the study, patients were divided into five groups which have the same number of the patients. Before the harvesting of the RA, Allen test and modified Allen test were performed. In group 1, sodium nitroprusside (SNP) was administered via central line. In group 2, nitrogliceryne was applied as a vasodilator agent. In group 3, diltiazem as a calcium channel blocker was used. In group 4, dobutamine was used with a dose of 3micro./kg/min. In the remaining patients, as a control group (CG), normal saline solution was used with the same protocol. RA length and radial artery flow, mean arterial blood pressure, central venous pressure, and heart rate were measured before and 10 minutes after drug administration. Results: No significant differences were found between the groups in respect to age, body surface area, cardiopulmonary bypass time, aortic cross clamp time. A multivariate general linear model was created and revealed the drug (specifically SNP and nitroglycerin) as a predictor to increase flow in the radial artery (p = 0.001 and p = 0.002), respectively. SNP has significantly decreased mean arterial pressure when we compared to nitroglycerin (p 0.05). Conclusions: Our study showed that SNP and nitroglycerin are very effective agents to provide the increasing of RA blood flow. However, statistical comparisons exhibited that intravenous SNP was a very effective vasodilating agent for RA than nitroglycerin.

Assesment of Radial Artery by Means of Doppler Ultrasonography and Soft Tissue Roentgenogram in End-Stage Renal Disease Patients

Background: Although the radial artery (RA) is mostly selected for the creating of arterio-venous fistula (AVF) in end-stage renal disease patients (ESRDP), it still represents a suitable site to simply assess systemic calcification. Our goal of this study was to research the RA before the arteriovenous fistula creation in ESRDP and evaluate the risk factor determinants. Material and Methods: The RA has been determined to estimate vascular calcification in 67 ESRDPs on dialysis by doppler ultrasonography (USG). If there was any pathologic conditions, direct examination of the forehand soft tissue roentgenograms as a simply method was made. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. RA calcification was scored from Grade 0 which was defined as no calcification to Grade 4 which was described as severe calcification from proximal to distal end of RA. Results: Doppler USG has shown that the major or minor RA calcification was detected in 11 patients (16.5%). In these patients, direct roentgenogram also demonstrated RA calcific disease. Total and LDL cholesterol levels, gender and smoking status have no influence on calcification scores. When the dialysis periods are concerned, there was no correlation with the RA calcification. Serum calcium and phosphate levels, rather than calcium-phosphate products, and age were correlated with high calcification scores. The highest prevalence of RA calcification was also found in diabetic group. Conclusion: Our data indicate that RA calcification is highly prevalent among ESRDP, with the highest prevalence among diabetics. The RA was used as an A-V fistual creation in ESRDPs, which may be risky since the calcification percentage is higher. Therefore, a simple roentgenographic survey may help to identify patients with severe calcified RA. Because our roengenographyc results were correlated with doppler USG, it can be used to determine RA calcific disease before the arteriovenous fistula creation.

Radial Artery and Saphenous Vein Grafts in Coronary Artery Bypass Surgery Comparison in Terms of Patient Symptoms

Background: The aim of this study is to compare radial artery with saphenous vein grafts which are widely used for coronary bypass, from views of patients’ satisfaction and postoperative findings. Methods: 42 isolated coronary bypass (CABG) patients performed during November 2012-April 2013 are included in the study. 30 days after the operation, in patients who had both RA and SV removal made responses to a questionnaire form which included 6 questions about symptoms of extremity. Results: After analyzing the responses and physical examination, there was no difference in terms of quality of life and usefulness of the extremity for daily use between two grafts. 2 patients (2%) have wound infection on the saphenous vein incision and additional surgical procedure was performed and a scar tissue has occurred. There was no statistically significance between uncomfortable symptoms and demographic data. Conclusion: Our study suggested that RA graft using showed a bit more comfortable and suitable effect against SV in our patients. We think that radial arterial grafts should be used more widely in coronary surgery with selected patients.

Applied anatomy of radial midforearm flap pedicled with intermuscular branch of radial artery

To provide anatomic basis for transposition of vascularized radial midforearm flap.Methods On 40 adult cadaveric upper limb specimens injected with red dye,the origin,course,branchs,diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed.Results Originating from radial artery,intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator,the main stem was (4.8±1.0)cm in length and (1.2±0.2)mm in diameter.After its periosteal branches were sent off to distribute over middle and inferior shaft of radius,its cutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm.Perforating point of the cutaneous branch was located (11.1±1.3)cm beneath lateral epicondyle of humerus,its diameter was about (0.6±0.1)mm.Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow,forearm or hand.7 refs.

Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention

Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up. Methods Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.Results The incidence of RAS was 7.8% （112/1427） in all the patients received transradial procedure. Univariate analysis indicates that young （P=0.038）, female （P=0.026）, small diameter of radial artery （P 〈0.001）, diabetes （P=0.026）, smoking （P=0.019）, moderate or severe pain during radial artery cannulation （P〈0.001）, unsuccessful access at first attempt （P=0.002）, big sheath （P=0.004）, number of catheters （〉3） （P=0.048）, rapid baseline heart rate （P=0.032） and long operation time （P=0.021） were associated with RAS. Logistic regression showed that female （OR=1.745, 95% CI： 1.148-3.846, P=0.024）, small radial artery diameter （OR=4.028, 95%CI： 1.264-12.196, P=0.008）, diabetes （OR= 2.148, 95%CI： 1.579-7.458, P=0.019） and unsuccessful access at first attempt （OR=1.468, 95%CI： 1.212-2.591, P=0.032） were independent predictors of RAS. Follow-up at （28±7） days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain （11.8% vs. 6.2%, P=0.043）. The occurrences of hematoma （7.3% vs. 5.6%, P=0.518） and radial artery occlusion （3.6% vs. 2.6%, P=0.534） were similar. Conclusions The incidence of RAS during transradial coronary procedure was 7.8%. Logistic regression analysis showed that female, small radial artery diameter, diabetes and unsuccessful access at first attempt were the independent predictors of RAS.

Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention

Background More and more percutaneous coronary intervention were done from radial artery approach. But the great limitation of radial artery approach and main failure cause of transradial coronary intervention is smaller size and more variations of a radial artery approach. The aim of the study is to explore the features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention. Methods A total of 1400 patients who underwent scheduled first time transradial coronary angiography between July 2007 and September 2010 were enrolled. Radial arteriography was performed in all patients to detect the anatomical variations of this vessel. All patients＇ radial and ulnar artery inner diameters were measured using a computer assisted quantification method. A detailed patient history was recorded. Multivariate Logistic regression analysis was performed to evaluate the predictive value of variables （including age, gender, ethnicity, height, weight, body mass index, smoking, diabetes, hypertension and dyslipidemia） in arterial tortuosities and variations of this vessel. Results In southern Chinese populations, there were no significant differences in the diameters of the forearm arteries： the mean radial artery inner diameter was （3.04±0.43） mm in ethnic Han Chinese and （3.05±0.42） mm in ethnic Zhuang Chinese, P 〉0.05）, the mean ulnar artery inner diameter was （3.03±0.38） mm in Han Chinese and （3.05±0.36） mm in Zhuang Chinese, P 〉0.05）. It was estimated that the inner diameter of the radial artery was not smaller than a 6F Cordis sheath in 86.1% of male patients and in 57.0% of female patients, and not smaller than a 7F Cordis sheath in 59.3% of male patients and 24.9% of female patients. The factors found to positively affect the size of the radial artery were sex （bj=0.309, P 〈0.01）, weight （bj=0.103, P 〈0.01 ）, and diabetes mellitus （bj=-0.088, P 〈0.01） was found to negatively affect radial artery size. Arterial tortuosities occurred in 12.1% of patients and arterial variations in 4.1%. The incidence of tortuosities and variations included radial artery tortuosity （3.6%）, high origin of radial artery （1.7%）, radial artery loop （0.6%）, double radial artery （0.1%）, brachial artery tortuosity （0.4%）, double brachial artery （0.1%）, subclavian artery tortuosity （5.4%）, small subclavian artery （0.4%）, right retro-esophageal subclavian artery （0.6%）, brachiocephalic trunk tortuosity （2.8%）, small brachiocephalic artery （0.1%）, and brachiocephalic artery anomaly （0.4%）. For people in Guangxi province, tortuosities of the subclavian artery and radial artery are the most common among the vascular tortuosities of the radial artery approach. The overall rate of transradial procedural success was 96.1%. Procedural failure was more common in patients with anomalous radial artery approach than in patients with normal radial artery approach （22.8% vs. 1.8%, P=0.000）. According to multivariate Logistic regression analysis, age （OR=2.695, 95% CI 2.232-3.253, P=0.000）, female gender （OR=5.127, 95% CI 3.000-8.762, P=0.000）, height （OR=0.612, 95% CI 0.465-0.807, P=0.000）, body mass index （OR=2.377, 95% CI 1.834-3.082, P=0.000）, hypertension （OR=1.668, 95% CI 1.132-2,458, P=0.010）, hyperlipidemia （OR=1.273, 95% CI 1.425-2.049, P=0.034） and smoking （OR=5.750, 95% CI 3.636-9.093, P=0.000）, were independently associated with arterial tortuosities of the radial artery approach. Female gender was independently associated with arterial variations of the radial artery approach （OR=3.613, 95% CI 3.208-7.826, P=0.000）. Conclusions The diameters of the radial and ulnar arteries between the Han people and the Zhuang people in southern Chinese populations are similar. In a transradial operation, the most southern Chinese populations, the use of a 6F sheath and guiding catheter is safe, and using a 7F sheath and guiding catheter is feasible in some selected patients. Radial arterial tortuosities and variations in southern Chinese populations are relatively common and are a significant cause of the failure of transradial coronary procedure. Old age, female gender, short stature, high body mass index,hypertension, hyperlipidemia and smoking, were independently associated with an increased risk of arterial tortuosity. In addition, female gender was an independent predictor of arterial variations.

Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

Background Total arterial revascularization （TAR） was widely utilized in coronary artery bypass grafting （CABG） as a result of its better long-term effect compared with vein grafts. Of the arterial conduits, radial artery （RA） gained popularity for its easy availability and reported long-term patency. Thus, the objective of this study was to investigate the effect of RA in TAR in CABG. Methods From January 2000 to December 2006, 85 patients （56 male and 29 female） at a mean age of 57.0 ± 5.2 years, underwent TAR in CABG. RA and left internal mammary artery （LIMA） with composite Y or T and sequential grafting techniques were used. Post-operative complications were recorded and follow-up was performed. Results Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected. A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA, with the mean number of distal anastomosis per patient of 2.81 ± 0.47. The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9, Y or T graft off RA in 9. The distal end was anastomsed to right coronary artery system in 92 to obtuse margina in 46, to diagonal in 19 and to ramous intermedius in 5. Nine sequential anastomoses were performed with RA. Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA. One （1.2%） patient died, 3 patients （3.5%） experienced acute renal failure and 2 （2.4%） developed stroke. All patients were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean follow-up of 36.5 ＋ 4.1 months （6-67 months）. Postoperatively at 6 month, mean left ventricular ejective fraction was increased to 0.49 ±0.09, compared with that of 0.43 ± 0.11 preoperatively （P=-0.027）. Postoperative mean New York Heart Association class was 2.5±0.5, compared with that of 3.0±0.4 preoperatively （P=-0.003）. Conclusions TAR with arterial conduits of which RA was mainly used was proved in this study to be effective and safe in CABG.

Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention

Background：The risk of radial artery occlusion （RAO） needs particular attention in transradial intervention （TRI）.Therefore,reducing vascular occlusion has an important clinical significance.The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.Methods：We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI.Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.Risk factors for RAO were evaluated using a multivariate model analysis.Results：Of the 606 patients,the RAO occurred in 56 patients.Compared with TRI at 2-5 cm away from the radius styloid process,the odds ratio （OR） for occlusion risk at 0 cm and 1 cm were 9.65 （P =0.033） and 8.90 （P =0.040）,respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 （OR =2.45,P =0.004）.Conclusion：Distal puncture sites （0-1 cm away from the radius styloid process） can lead to a higher rate of RAO.

Twelve years＇ experience and clinical results of using the radial artery for coronary revascularization

Background The radial artery （RA） is becoming a popular conduit for coronary artery bypass grafting （CABG）,yet data reporting the long-term results are rare.We reported our clinical,angiographic and intravascular ultrasound findings on 93 patients who had the RA used as part of the conduit for the CABG procedures during a 12-year period from June 2001 to June 2013.Methods A total of 118 radial artery conduits were harvested in 87 males and 6 females,age from 28 to 66 （mean 49.9） years.An ＂intra-operative Allen＇s test＂ was developed to safeguard blood supply to the arm and hand.A ＂double-clip ＆ scissors-cut＂ technique was carried out to minimize the thermal injury to the radial artery from the diathermy.The left radial artery was used in 67 patients,the right in one,and bilateral radial arteries in 25 patients.One hundred and twenty-two out of 272 distal anastomoses （44.9％） were constructed with radial arteries,with an average of 2.9 grafts per patient （range 2-6）.Results Follow-up angiography and intravascular ultrasound study at 3-139 postoperative months （mean 59 months） revealed a 93.1％ RA patency.String sign occurred in one patient in whom the RA was directed to a big right coronary artery with a stenosis of around 50％.The patency for the internal mammary artery was 96.4％.Conclusions The RA is an excellent conduit that broadens the options for total arterial CABG surgery.Good graft patency could be achieved through careful harvesting techniques and choice of proper target coronary vessels.

The Effect of Fascial Pedicled Island Flap of the First Metacarpal Radial Dorsal Artery Skin Branch Chain on the Repair of Thumb Tissue Defect

Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defects treated in our hospital from 2017.01 to 2019.01 as the research objects,and divide them into control group and observation group randomly,50 cases in each group.In the observation group,the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain is used for repair,and in the control group,the thumb tissue is repaired with abdominal flap.Compare the DASH scores and outcomes of two groups.Results After treatment,the DASH score in the observation group is significantly lower than that in the control group,which is statistically significant(P<0.05);The operation time and intraoperative blood loss of Observation Group is significantly lower than Control Group,which is statistically significant(P<0.05).Conclusion Repairing defected thumb with the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chaint has the advantages of simple operation and easy mastery,and has significant curative effect on patients.It is an effective way to repair partial thumb defect,and worth popularizing.

Clinical application of individualized total arterial coronary artery bypass grafting in coronary artery surgery

BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used.This study determined whether these favorable clinical results could be realized at the authors’institute.AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019.LIMA was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 patients.Perioperative complications were observed,short-term graft patency rate was followed-up,and quality of life was assessed.RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful.All of them were discharged without any complications or deaths.During the follow-up,it was found that patients’angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for RGEA.CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

BACKGROUND The traditional radial approach(RA)is recommended as the standard method for coronary angiography(CAG),while a distal RA(DRA)has been recently used for CAG.AIM To assess the efficacy and safety of the DRA vs RA during CAG.METHODS The following databases were searched through December 2020:MEDLINE,the Cochrane Central Register of Controlled Trials,EMBASE,the World Health Organization International Clinical Trials Platform Search Portal,and Clinical-Trials.gov.Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included.The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm(RAS)and radial artery occlusion(RAO).Study selection,data abstraction and quality assessment were independently performed using the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Three randomized control trials and 13 registered trials were identified.The two approaches showed similar successful cannulation rates[risk ratio(RR)0.90,95%confidence interval(CI):0.72-1.13].The DRA did not decrease RAS(RR 0.43,95%CI:0.08-2.49)and RAO(RR 0.48,95%CI:0.18-1.29).Patients with the DRA had a shorter hemostasis time in comparison to those with the RA(mean difference-6.64,95%CI:-10.37 to-2.90).The evidence of certainty was low.CONCLUSION For CAG,the DRA would be safer than the RA with comparable cannulation rates.Given the limited data,additional research,including studies with standard protocols,is necessary.