Transradial-Transfistula Access for Cardiac Catheterization in Patients With Abandoned Hemodialysis Fistulas
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PROVIDER: S-EPMC9685352 | biostudies-literature | 2022 Nov
REPOSITORIES: biostudies-literature
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Project description:Transradial catheterization is associated with radial artery injury and vasomotor dysfunction and represents an accessible model of acute vascular injury in humans. We characterized vascular injury and functional recovery to understand the role of circulating endothelial progenitor cells in vascular repair. In 50 patients (aged 64±10 years, 70% male) undergoing transradial cardiac catheterization, radial artery injury was assessed by optical coherence tomography and examination of explanted vascular sheaths. Flow- and nitrate-mediated dilatation of the radial artery was assessed in both arms at baseline, at 24 hours, and at 1, 4, and 12 weeks. Circulating endothelial progenitor cell populations were quantified using flow cytometry. Late endothelial outgrowth colonies were isolated and examined in vitro. Optical coherence tomography identified macroscopic injury in 12 of 50 patients (24%), but endothelial cells (1.9±1.2×104 cells) were isolated from all arterial sheaths examined. Compared with the noncatheterized radial artery, flow-mediated vasodilatation was impaired in the catheterized artery at 24 hours (9.9±4.6% versus 4.1±3.1%, P<0.0001) and recovered by 12 weeks (8.1±4.9% versus 10.1±4.9%, P=0.09). Although the number of CD133+ cells increased 24 hours after catheterization (P=0.02), the numbers of CD34+ cells and endothelial outgrowth colonies were unchanged. Migration of endothelial cells derived from endothelial outgrowth colonies correlated with arterial function before catheterization but was not related to recovery of function following injury. Transradial cardiac catheterization causes endothelial denudation, vascular injury, and vasomotor dysfunction that recover over 12 weeks. Recovery of vascular function does not appear to be dependent on the mobilization or function of endothelial progenitor cells. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02147119.
| S-EPMC5721759 | biostudies-literature
Project description:The main objective of this review paper is to study the comparison between transradial and transfemoral approach in catheterization. Transradial and transfemoral are two main approaches which are used as a diagnostic and therapeutic purpose in catheterization. The transradial approach in interventional cardiology is safe, effective, and feasible as compared to the transfemoral approach. The aim of this study is to compare pros and cons of transradial vs. transfemoral approach in catheterization. We conducted this systematic review on the role of transradial vs. transfemoral catheterization. The articles included real human data on interventional approaches. Reviews on these strategies were conducted in PubMed, medical literature analysis and retrieval system online (MEDLINE), Cochrane, Medscape and National Institute of Health. To maintain a high standard of review, studies published in all non-famous journals were excluded. Data collected from the studies have suggested that transradial approach has less bleeding complications, cost effective, decreased hospital mortality rate, and less access site complications as compared to transfemoral approach. However, longer procedural duration and radiation exposure are still concerns regarding transradial approach. The findings of the present study show that transradial approach in catheterization is safe, effective, and feasible as compared to the transfemoral approach. However, duration and radiation exposure are higher in the transradial access. Several studies suggest that the modern approach overweight in benefits with the comparison to the classical approach.
| S-EPMC5493462 | biostudies-other
Project description:We are presenting rare, but life-threatening complication of diagnostic coronary catheterization. To overcome the problem requires operator's experience and appropriate actions. We want to share our experience to interventionalists to be aware and ready to recognize and overcome such complication.
| S-EPMC5538233 | biostudies-other
Project description:Radial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion (RAO) but might be associated with incomplete hemostasis.In total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20- and 60-minute clamp application groups, respectively (P=0.19). The incidence of grade 1 hematoma was higher in the 20-minute group (6.7% versus 2.5%, P=0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20- and 60-minute groups, respectively (P=0.36). Requirement for clamp retightening (36% versus 16%, P=0.01) was higher among patients who had RAO. Need for clamp retightening was the only independent predictor of RAO (P=0.04).Ultrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60-minute clamp duration is safe and provides good access site hemostasis with low RAO rates.URL: http://www.clinicaltrials.gov. Unique identifier: NCT02269722.
| S-EPMC5523781 | biostudies-other
Project description:ObjectivesThis study aimed to compare effects of different hand exercises on improving limb function in patients after transradial cardiac catheterization.MethodsThis single-center, randomized clinical trial was conducted from August 20, 2020, to July 20, 2021, at an academic medical center. A total of 102 participants were selected from a Class A tertiary hospital in Nanjing, China and randomized into three groups: finger exercise group (n = 34), acupoint massage group (n = 34), and handgrip exercise group (n = 34). Symptoms of edema and pain were defined as primary outcomes, while skin temperature and degree of bleeding as secondary outcomes, which were monitored and measured 1, 2, and 4 h, after the intervention.ResultsAmong the 99 participants who completed the process, the palm edema was gradually relieved in the handgrip exercise group at 2 h (H = 6.710, P = 0.035) and 4 h (H = 10.060, P < 0.001) following the intervention. The edema of fingers in the handgrip exercise group was obviously relieved at 2 h (H = 9.353, P < 0.01) and 4 h (H = 10.699, P < 0.001) following the intervention compared with the other two groups. In addition, the pain score at 4 h (H = 7.048, P = 0.029) was clearly decreased in the handgrip exercise group. However, there was no significant difference in the punctured limb's skin temperature (H = 0.922, P = 0.631) and the degree of bleeding (H = 0.123, P = 0.940) among the three groups.ConclusionsWe found that handgrip exercise is more effective in reducing the edema of the limbs than finger exercise and acupoint massage.
| S-EPMC10148249 | biostudies-literature
Project description:AimsTo evaluate safety and efficacy of distal right radial access (DRRA) compared to right radial access (RRA), for coronary procedures, in patients with smaller diameter radial arteries (SDRA) (radial artery diameter (RAD) < 2.1 mm).Methods and resultsThis is a retrospective analysis of safety and efficacy of DRRA Vs. RRA in patients undergoing coronary procedures at our cardiac catheterization laboratories over a 10- month period between September 2017 and June, 2018 (first 5 calendar months with RRA-first; next 5 calendar months with DRRA-first). All patients underwent pre-procedure ultrasound of arm arteries. All patients had RAD<2.1 mm (mean RAD 1.63 ± 0.27 mm; RAD≤1.6 mm in 73.5%). Baseline characteristics were similar between groups. Primary end-point of puncture success was significantly lower in DRRA vs RRA group [79.5% vs 98.5%, p < 0.0001]. Puncture success was also lower in the subgroup of patients with RAD <1.6 mm Vs. ≥ 1.6 mm in the DRRA group (p < 0.0001). The secondary end-point of puncture time was significantly higher (2.1 ± 1.4 min vs. 1.0 ± 0.45 min, p < 0.00001) in the DRRA Vs. RRA group. The occurrence of vascular access site complications (including access site hematomas), radial artery occlusion (RAO) and distal RAO at day 1 and day 30 were similar between RRA and DRRA groups.Non-vascular access-site complication was seen only in the DRRA group.ConclusionDRRA is a safe and effective access for coronary procedures; though technically challenging in patients with SDRA (RAD<2.1 mm; mean RAD 1.63 ± 0.27 mm), with lower puncture success and higher puncture time compared to RRA.
| S-EPMC7961259 | biostudies-literature
Project description:Arterial pseudoaneurysms can develop secondary to a vessel injury, for example, an arterial line installation. We present a case of an 18-year-old female with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome who developed left radial artery and right brachial artery pseudoaneurysms secondary to arterial line placement and repeated blood draws, respectively. The ultrasonographic features of pulsating mass in connection with an artery and the yin-yang sign, combined with the patient's history, allowed accurate diagnosis. She was referred to vascular surgery for definitive treatment.
| S-EPMC7446689 | biostudies-literature
Project description:To sythesize the available literature on hand dysfunction after transradial catheterization.We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized.Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction (6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included.Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel.
| S-EPMC5545145 | biostudies-other
Project description:We evaluated the safety and feasibility of ipsilateral radial and ulnar artery cannulation during the same catheterization procedure. Crossover from radial to femoral was done in 122 patients. Both ipsilateral radial and ulnar catheterization were performed in 16 patients without any complications, which was further supported by Doppler ultrasonography.
| S-EPMC8322797 | biostudies-literature
Project description:BackgroundCentral venous catheter (CVC) placement has been linked to systemic inflammation. This study was conducted to compare the successful maturation of arteriovenous fistulas (AVFs) and the preoperative white blood cell (WBC) profiles between patients with and without preexisting CVCs.Materials and methodsA retrospective cohort study was conducted with 550 patients who underwent first-time AVF creation. Patients were divided into three groups according to preexisting CVCs and CVC types as follows: tunneled CVC (n = 23), nontunneled CVC (n = 223), and no CVC (n = 304). These three groups were compared in terms of AVF maturation and preoperative WBC profiles.ResultsThe mean age of the patients was 61.1 ± 14.3 years. The AVF maturation rates of the tunneled CVC, nontunneled CVC and no CVC groups were 65.2%, 54.7% and 74.7%, respectively (p < 0.001). According to the uni- and multivariate analyses, only the nontunneled CVC group had a lower odds of AVF maturation compared to the no CVC group (adjusted odds ratio 0.43; 95% confidence interval 0.29-0.62). Patients with preexisting nontunneled CVC but not tunneled CVC also had significantly higher mean WBC and neutrophil counts but a lower percentage of lymphocytes than patients with no preexisting CVC.ConclusionPreexisting nontunneled CVC had a negative impact on the successful maturation of the newly created AVF. Patients in the nontunneled CVC group had the highest preoperative WBC and neutrophil counts but the lowest lymphocyte percentage compared to patients in the other two groups.
| S-EPMC6806382 | biostudies-literature