Left Radial Artery Research Articles

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a relatively rare but important cause of acute coronary syndrome. The diagnosis is often made at autopsy. Risk factors include the peripartum period, oral contraceptive use, and atherosclerotic disease. SCAD must be considered every time a healthy young patient presents with an onset of acute myocardial ischemic syndrome. A timely diagnosis and intervention are mandatory as SCAD can cause sudden death. We describe two cases of SCAD, both treated successfully with emergency coronary artery bypass grafting using left internal mammary and radial arteries in the first case and the left internal mammary artery only for the second case.

Epidural anaesthesia for caesarian section in a parturient with a single ventricle

Epidural anaesthesia for caesarian section in a parturient with a single ventricle

Massive Intraoperative Thrombus of the Aortic Arch and Proximal Descending Aorta

A 49-year-old male patient presented with a paravalvular leakage 18 years after aortic valve replacement. The patient received a mechanical valve and was weaned uneventfully from cardiopulmonary bypass. After a drop in the pressure curve of the left radial artery an additional line was placed in the proximal ascending aorta showing normal systemic pressure. Transesophageal echocardiography showed a massive circular thrombosis of the distal aortic arch. The patient received a covered stent to expand the residual aortic lumen and left the hospital in good health.

A Rare Axillary Artery Aneurysm with Limb-Threatening Ischemia

Introduction Isolated subclavian or axillary artery aneurysms are extremely rare, accounting for less than 3% of peripheral aneurysms. These aneurysms can be caused by a secondary infection such as syphilis, trauma, Ehler – Danlos syndrome, poststenotic dilation from thoracic outlet obstruction, arthrosclerosis, or congenital reasons. They are at risk for rupture, distal embolism, and thrombosis. These complications can cause limb loss and or death. Case Report An 80-year-old woman presented to the emergency room with a cold left upper extremity. The patient had a history of atrial fibrillation, congestive heart failure, and hypertension. A presumptive diagnosis of peripheral emboli was made because of the patient's atrial fibrillation and recent myocardial infarction. She was taken to the operating room for a thrombectomy of the left brachial, radial, and ulnar arteries. At that time, a pulsatile mass was noted on the patient's shoulder, and an ultrasound was ordered. The ultrasound revealed a left axillary artery aneurysm measuring 3.62 cm anteroposteriorly x 3.72 cm transverse. There was nonocclusive thrombus within the lumen of the aneurysm. There was diminished, monophasic flow in the axillary and brachial arteries. Postoperatively the patient was placed on intravenous heparin. She was taken back to the operating room where a 7-mm Dacron graft was placed between the left axillary and brachial artery with exclusion of the axillary artery aneurysm. On postoperative duplex the bypass graft was patent. The patient did not suffer any long-term complications as the result of ischemia. Conclusion Although upper-extremity aneurysms are rare, and little is known about the natural history, there are multiple documented limb-threatening and or life-threatening complications. It is essential that they be treated in a timely manner as to avoid limb-threatening complications. An ultrasound can provide a noninvasive method of detecting a subclavian-axillary aneurysm. It can be used to screen patients when there is a suspicion of an aneurysm and determine the presence of concomitant thoracic or abdominal aneurysm.

Metallic Mercury Embolism to the Hand

Severe pain developed in the left hand of a 46-year-old woman after open heart surgery was performed to repair an atrial septal defect. It was initially thought that this pain was due to a thrombosis associated with a pressure-monitoring device in her left radial artery. Physical examination showed erythematous lesions, cyanosis, and ischemia of her left hand (Panel A). Radiographic findings revealed radiopaque particles (Panel B, black and white arrows) that were consistent with the presence of mercury in the soft tissues of her hand. The particles most likely came from the manometer used with the arterial line (a common . . .

The Feasibility of Bypass Graft Angiography by Right Radial Access

Background and ObjectivesLeft transradial coronary angiography may result in damage of both radial arteries in patients who experienced right radial access. In some patients, the left radial artery has been used as a graft. We investigated whether graft angiography using right radial access is feasible in patients with bypass surgery to preserve the left radial artery as a future graft.Subjects and MethodsA total of 109 consecutive patients with bypass surgery who had undergone right radial access underwent graft angiography via the same access.ResultsSixteen (15%) patients were excluded because of the presence of a severely tortuous right subclavian artery. Bypass graft angiography via right radial or brachial access was completed successfully in 90 (97%) out of 93 patients. In 3 (3%) of patients, femoral access was needed to complete the angiography. Saphenous vein grafts were cannulated selectively in 150 (90%) of 167 grafts with satisfactory image quality and not found even on the aortogram in the other 17 (10%) grafts. Ninety-two (89%) out of 103 left mammary grafts were cannulated selectively or semi-selectively using a modified Simmons catheter, resulting in satisfactory image quality. The other 11 (11%) grafts were visualized non-selectively using a Judkins Left catheter, and resulting in acceptable image quality in 10 (91%) grafts. There were no procedure-related complications.ConclusionGraft angiography via right radial access can be performed reliably in most patients that lack severe subclavian tortuosity.

Coil Embolization of an Unruptured Intracranial Aneurysm Associated With Behcet's Disease -Case Report-

A 36-year-old male patient with Behcet's disease consulted our hospital for treatment of an unruptured intracranial aneurysm. He was neurologically intact. He had undergone surgery for an aneurysm of the superior mesenteric artery 2 years ago and had been followed up because of the aneurysm of the left radial artery for 1 year. He had been receiving steroid treatment for 4 years. Three-dimensional computed tomography angiography identified an aneurysm of the left intracranial internal carotid artery. The lesion was treated by coil embolization. He was discharged without complications. Intracranial aneurysm formation is extremely rare in patients with Behcet's disease. The presence of extracranial aneurysms indicates screening for intracranial aneurysms. The present case shows that coil embolization can be used to treat unruptured intracranial aneurysm in patients with Behcet's disease.

Our medical treatment protocol for symptomatic distal ulnar artery occlusion

Arterial occlusive disease of the upper extremity is a rare entity.In this study ,we report our medical treatment protocol for symptomatic distal ulnar artery occlusion. INTRODUCTION The vascular patterns of the palmar arches and their interconnecting branches present a complex and challenging area. Improvements in microsurgical techniques have made a better understanding of vascular patterns and vessel diameters more important (1). CASE PRESENTATION Our case was a 72-year-old male. He was suffering from pain in the left hand and discoloration and coldness of the tips of 3, 4 and 5 digits for one month. Physical examination revealed no ulceration of this non-dominant hand (Figures 1&2). Only the left ulnar arterial pulse was detectable with sonic Doppler device and the remaining pulses were easily palpable. Clinical examination shows a positive Allen test for ulnar artery occlusion. Figure 1 Figure 1 Our medical treatment protocol for symptomatic distal ulnar artery occlusion 2 of 4 Figure 2 Figure 2 His past medical history was significant for Type 2 Diabetes Mellitus for 8 years that was regulated with oral antidiabetic agents. He also was an ex-smoker who quit smoking 10 years ago. Selective left upper extremity DSA revealed patent left subclavianaxillarybrachialand radial arteries (Figures 3&4). Figure 3 Figure 3 Figure 4 Figure 4 Ulnar artery was occluded at distal segment. Moreover, palmar arch was invisible and metacarpal arteries were occluded at multiple levels (Figures 5&6). Figure 5 Figure 5 Our medical treatment protocol for symptomatic distal ulnar artery occlusion 3 of 4 Figure 6 Figure 6 Taking these findings into account, our medical treatment strategy was as follows: Figure 7 He completed the late period after the onset of therapy with this ambulatory treatment protocol. His complaints of pain and discoloration completely faded away. His sensorimotor neurological status is normal. DISCUSSION Arterial occlusive disease of the upper extremity is most often due to posttraumatic occlusion of the ulnar artery. An embolic source of the ischemia should be considered most strongly when sudden ischemia or vasospasm is associated with atrial fibrillation or follows a myocardial infarction. Connective tissue disorders and several arteridities are infrequent causes of upper-extremity occlusive disease (2). Because damage to either the radial or the ulnar artery in the form of laceration or thrombosis can occur with no or minimal symptoms due to adequate collateral circulation, the prevalence of asymptomatic occlusions is unknown (3). Increased sympathetic tone from reflex vasospasm in the face of otherwise adequate collateral vessels may decrease perfusion sufficiently to cause ischemic symptoms and signs(3,4). Isolated ulnar artery occlusion is seldom the cause of digital tip necrosis (3). Only 5% of normal subjects had ulnar artery dominance in all digits(5). Arteriography still remains the reference standard for the evaluation of vascular insufficiency (3). Arteriography can be useful in the identification of upper extremity emboli and their source, and should include studies of the aortic arch, proximal subclavian artery, and digital arteries (6).

Thrombus Aspiration Complicated by Systemic Embolization in Patients With Acute Myocardial Infarction

Percutaneous coronary intervention (PCI) is the preferred treatment modality for patients with acute coronary syndrome, but the "no-reflow" phenomenon, primarily caused by distal embolism, has hampered the effectiveness of PCI as regards reperfusion of the myocardium. Thrombus aspiration is sometimes used to reduce the incidence of distal embolism, but potentially the procedure may be complicated by upstream thrombus migration and systemic embolism. Two cases of systemic embolism during thrombus aspiration are presented. One patient had embolism of the cerebral artery and the other embolism of the left radial artery. It is suggested that a large-lumen guiding catheter with a deep-seated position and gentle injection of contrast medium should be used for thrombus aspiration.

The feasibility of left radial artery approach for coronary angiography

Objective To study the feasibility of the left radial approach for coronary angiography. Methods 195 patients diagnosed with coronary atherosclerotic heart disease were randomly divided for coronary angiography(CAG) into a left radial artery approach group(98 cases) and a right radial artery approach group(97 cases) from Jan 2006 to Dec 2006. Selective coronary angiographies were performed with 5F TIG catheters. The time of puncturing, duration under X-ray fluoroscopy and of the operation, successful rates of puncturing and coronary angiography were recorded. Results There was no difference in the time of puncturing(2.25 ± 1.58 min vs 2.19 ± 1.62 min), duration under X-ray fluoroscopy(3.12 ± 1.53 min vs 3.21 ± 1.49 min) and the duration of the operation(12.87 ± 2.52 min vs 12.98 ± 2.85 min), nor in the success rates of puncturing(95.91% vs 95.87%) and coronary angiography(94.90% vs 94.85%). Conclusion Coronary angiography can be accomplished via the left radial artery approach, indicating that this is a worthwhile clinical approach.

Relation of Preoperative Radial Artery Flow-Mediated Dilatation to Nitric Oxide Bioavailability in Radial Artery Grafts Used in Off-Pump Coronary Artery Bypass Grafting

The radial artery is prone to vasospasm after coronary bypass surgery, and endothelial dysfunction is likely to be a key factor. We investigated whether endothelial dysfunction in radial artery conduits is present, and can be identified, preoperatively using a simple noninvasive ultrasound test of radial artery endothelial response, flow-mediated dilatation (FMD). The study population consisted of 126 patients scheduled for coronary artery bypass grafting. The afternoon before operation, patients had noninvasive ultrasound assessment of endothelial function in the left radial artery by FMD, which measures change in arterial size after an increase in flow-an endothelial-dependent response. Surplus graft segments were obtained at operation and nitric oxide bioavailability within the vessels determined from ex vivo responses to acetylcholine. Preoperative FMD in the radial artery was associated with vasorelaxations to acetylcholine in radial artery grafts (p<0.001 for both dose-response curves and maximum relaxations), although there was weak borderline association between FMD and vasorelaxations of saphenous vein grafts (p=0.07 for dose-response curves and p<0.05 for maximum relaxations). In multivariate analysis including cardiac risk factors, FMD was a predictor of vasorelaxations of radial artery grafts (beta=0.020, SE=0.009, p=0.030), independent of classic risk factors for atherosclerosis. In conclusion, there is significant interindividual variation in the endothelial function of vessels used for coronary artery bypass surgery, particularly the radial artery. These differences are present and can be identified preoperatively by FMD.

Acute Presentation in Adult in Bland‐White‐Garland Syndrome: Double‐Conduit, Two‐Coronary Repair

Adult presentation with myocardial infarction in anomalous origin of the left main coronary artery from the pulmonary artery is rare. We describe the different coronary flow physiology in the adult form. A double-conduit repair with a separate feeder vessel to each limb of the left coronary circulation may be necessary to balance the myocardial demand and supply in large systemic collateral coronary beds. The report describes the use of the left internal mammary and radial artery for repair.

Congenital thenar hypoplasia with absent radial artery – A case report

Cavanagh syndrome is a rare, isolated congenital thenar hypoplasia with characteristic clinical, radiological and electrophysiological features. It has never been reported to occur in association with absent radial artery. We report the case of a boy with left sided congenital thenar hypoplasia fulfilling the characteristic clinical, radiological and electrophysiological features of Cavanagh syndrome, associated with congenital absence of left radial artery. We also discuss the possible underlying aetiopathology of Cavanagh syndrome.

Quality control after total arterial revascularisation: multislice computer tomography cannot replace coronary angiography

Coronary angiography is regarded as the gold standard in evaluating graft patency, Multi-slice CT (MSCT) which enable rapid imaging of cardiac structures, including coronary arteries may be a less invasive technique. Therefore in our institution a prospective pilot study was performed combining these procedures. Starting from July 2004 a study was done with 13 patients. They received TAR using composite left internal thoracic artery (LITA) and left radial artery (RA) as T-graft. Intra-operative angiography was performed in these patients to confirm graft patency. Follow-up control (9-21 months) was performed with exercise Ergometry and 64 slides MSCT. Mean procedure time for intra-operative angiography was 13.7 +/- 7.3 min and mean fluoroscopy time was 6.2 +/- 4.6 min. In one patient, RA-marginal artery side to side anastomoses was stenosed and had to be revised. And in another, there was a kinking of the LITA and was corrected. At follow-up, exercise ergometry showed no signs of angina or ECG-changes in all patients. MSCT showed occluded radial artery grafts in two patients. In two other patients interpretation was difficult due to resolution reasons. In all patients the LITA graft was patent. The intra-operative graft angiography can be performed in patients undergoing TAR easily. MSCT can be used for post-operative less-invasive angiography with limitations in patients with small graft/coronary diameters and arrhythmias. However, this study shows that an interdisciplinary cooperation is a new possibility toward quality control during and after TAR.

Blood Pressure Is the Main Determinant of the Reflection Wave in Patients with Type 2 Diabetes

Augmentation index (AI), the ratio of augmented pressure by the reflection pressure wave to the pulse pressure (PP), is an index of arterial stiffness and central blood pressure (BP). Although type 2 diabetes mellitus (DM) is a major risk factor for atherosclerosis, there is controversy with respect to how DM affects AI. In the present study, we investigated possible determinants of AI in 194 type 2 DM patients (mean age 67+/-9 years). AI was measured in the left radial artery using an automated tonometric method. In a simple correlation analysis, AI showed a positive association with age, and a negative association with body height, body weight, waist circumference, heart rate (HR), plasma glucose, and HbA1c. Women had significantly higher AI than men. Stepwise regression analysis revealed that mean BP (MBP) (beta=0.260, p<0.001), HR (beta=-0.550, p<0.001) and body height (beta=-0.217, p<0.001) were independent determinants of radial AI. Similarly, the second peak of systolic BP (SBP2), an index of central aortic systolic BP (SBP), showed a positive association with age, BMI, waist circumference, MBP and AI, and a negative association with body height. In a separate analysis performed in diabetic patients with treated hypertension (n=123), again, only MBP, HR and body height were significant determinants of radial AI. There was no difference in radial AI and SBP2 among the classes of antihypertensive drugs used. These findings indicate that tight BP control would be effective in reducing the reflection wave and aortic BP, which could independently relate to cardiovascular disease in type 2 diabetic patients.

Arterial and end-tidal carbon dioxide pressure differences during laparoscopic colorectal surgery

Arterial and end-tidal carbon dioxide pressure differences during laparoscopic colorectal surgery

Perioperative management of late metastasis of pheochromocytoma in clavicle

Perioperative management of late metastasis of pheochromocytoma in clavicle

Patients and complication with off-pump vs. on-pump cardiac surgery a single surgeon experience

Off-pump operations (OPCAB) are growingly used for patients with coronary artery disease (CAD) and may be associated with improved outcomes when compared with coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC), especially in patients with comorbidities. The aim of this study is to compare the intra- and postoperative results of OPCAB complete arterial myocardial revascularization with standard on-pump CABG under respect of comorbidities. We report about the implementing of the off-pump technique in our institution from November 2004 to May 2006. Sixty-two patients with CABG in off-pump technique were compared to a control group of 129 patients with CABG using ECC. The off-pump technique was mostly used in patients with vascular and pulmonary diseases. All operations were performed by the same surgeon. All off-pumps were performed using both internal thoracic arteries (ITA) or left ITA and radial artery (RA) in T-graft technique, while in the on-pump group only the LITA and saphenous vein were used. The conversion rate from OPCAB to conventional CABG was 3.2% (two patients). Peripheral vascular disease (PVD) and chronic obstructive pulmonary disease (COPD) were significant more often in the off-pump group. Other preoperative risk factors were comparable between the groups. Operation time was significantly longer in the off-pump group. Postoperative symptomatic transient psychotic syndromes were more often in the on-pump group. Outcome was similar, despite significant longer operation time in off-pump group. Off-pump coronary artery surgery can be performed in patients with comorbidities with similar outcome compared to on-pump surgery.

Rare Presentation of Subclavian Artery Isolation in a Neonate With a Family History of Aortic Arch Anomalies

Isolation of the left subclavian artery is a rare aortic arch anomaly in which the artery originates from the pulmonary artery through a ductus arteriosus rather than the aorta. In neonates it is usually diagnosed incidentally with other aortic or cardiac anomalies and can be associated with chromosomal deletions. We describe an extremely rare presentation whereby subclavian artery isolation was presented with left arm ischemia in a 6-day-old child. There were also a concurrent right aortic arch, ventricular septal defect, persistent left superior vena cava, and both radial and ulnar artery hypoplasia. A family history of aortic arch anomalies with no known chromosomal aberration was also present, whereby all the male family members on the maternal side had undergone aorto-cardiac surgery as neonates. Diagnosis and surgical management are discussed.

MDCT evaluation of the right gastroepiploic artery prior to coronary artery bypass surgery

A 69-year-old female with long standing history of diabetes mellitus was admitted to our hospital because of exertional chest pain. She had undergone repetitive percutaneous transluminal coronary angioplasty for all three coronary arteries. Since coronary angiography revealed significant stenoses in all three coronary arteries, coronary artery bypass surgery was scheduled. Ultrasonography revealed that the left radial artery was calcified and that the thoracic and abdominal aorta were markedly calcified. For evaluation of the right gastroepiploic artery (RGEA), multi-detector row computed tomography (MDCT) angiography was performed using a 16-slice scanner (LightSpeed 16, GE Systems, USA). Five milligrams of sodium bicarbonate tartaric acid dissolved by 10 ml of water was administered in order to expand the stomach and to extend the RGEA 5 min prior to the MDCT scan. The contrast medium (80 ml, Iopamiron 370, Nihon Schering, Osaka, Japan) was injected intravenously at 3.5 ml/s. The slice thickness was 0.625 mm, pitch was 0.3:1, rotation time was 0.5 s and temporal resolution was 125 ms. Cross-sectional