Mean Radial Artery Diameter Research Articles

Flow-mediated dilatation facilitates transradial coronary angiography: a comparative study.

Radial artery (RA) spasm is demonstrated to be one of the most common complications of transradial approach (TRA). We hypothesised that radial flow-mediated dilation (FMD) can be used as a preprocedural method to assess the likelihood of arterial spasm. The patients were divided into 2 groups: those with and without flow-mediated RA dilatation. A blood pressure cuff was placed on the upper part of the antecubital region of the patients in the FMD group and inflated for 10 min, allowing the pressure to rise to 30 mm Hg above the systolic blood pressure. RA diameters of the patients in both groups were measured via quantitive coronary angiography method before transradial coronary angiography. A total of 165 patients were included in the study, of whom 64 (38.8%) were women. The median age of the patients was 56 years (48-63). The mean RA diameter was significantly larger in the FMD group (3.44 ±0.48 vs. 2.96 ±0.46 mm, p < 0.001), and the number of punctures required for successful transradial cannulation was found to be significantly higher in the group without FMD (1.55 ±0.7 vs. 1.20 ±0.64; p < 0.001). Linear regression analysis revealed diabetes and FMD as independent predictors of RA diameter. In the diabetic subgroup, RA diameter remained larger in the FMD group (3.00 ±0.35 vs. 2.78 ±0.26, p = 0.036). Radial puncture attempts were significantly higher in the control group compared to the FMD group (1.55 ±0.7 vs. 1.20 ±0.64; p < 0.001). In our study, we demonstrated that FMD created by pressure application significantly increased RA diameter and reduced puncture attempt during TRA.

THE RELATIONSHIP BETWEEN INFLAMMATION MARKERS AND MAGNESIUM/PHOSPHATE RATIO WITH ENDOTEL FUNCTION IN PERIPHERAL ARTERY DISEASE

Objective: In our study, it was aimed to evaluate the relationship between neutrophil/lymphocyte, monocyte/high-density lipoprotein and magnesium/phosphate ratios with endothelial functions in patients with peripheral artery disease. Methods: Sixty patients followed up with peripheral arterial disease were included in this study. Endothelial functions of the patients were evaluated by flow-mediated vasodilation test. Pearson correlation analysis was used to evaluate the relationship between magnesium/phosphate, neutrophil/lymphocyte, monocyte/high-density lipoprotein ratios with percent change in flow-mediated vasodilation. Results: 48.3% of the participants are male and 51.7% are female. The mean age of the patients were 66.85±11.08 years. The mean radial artery basal diameter was 0.24±0.02 cm in the flow-mediated vasodilatation test and after the test the mean radial artery diameter was 0.27±0.02 cm(p&lt;0.001). In the flow-mediated dilatation test predicting endothelial functions, the percentage change in arterial diameter was positively correlated with the Magnesium/phosphate ratio (r=-0.326, p=0.011), and negatively correlated with the Neutrophil/lymphocyte ratio and monocyte/high-density lipoprotein ratio (respectively r= -0.411, p=0.001; r=-0.530, p=0.001). Conclusion: Magnesium/phosphate ratio, neutrophil/lymphocyte ratio and monocyte/high-density lipoprotein ratio can be used to predict endothelial dysfunction in patients with peripheral artery disease.

Distal radial artery (snuffbox) access for carotid artery stenting - Technical pearls and procedural set-up.

To report use of distal radial artery (dRA) access for carotid artery stenting (CAS) and to discuss procedural setup and technical considerations for a successful intervention. A retrospective review of our prospective neurointerventional database of CAS was conducted between May 2019 and March 2020. All CAS cases via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data was collected. 22 CAS procedures in 20 patients via dRA were identified. Patients' mean age was 69.4 years (range 53-87 years). 3 patients were female. Mean radial artery diameter was 2.1 mm (range 1.6-2.8 mm). dRA access was achieved in all cases. Conversion to femoral access was required in 2 cases (9.1%) due to persistent radial artery vasospasm resulting in patient discomfort despite multiple additional doses of intraarterial vasodilators and added intravenous sedation as well as tortuous vessel anatomy and limited support of the catheters in a type 3 aortic arch for left CAS. Our preliminary experience with dRA access for CAS suggests this approach to be feasible and safe for patients. Technical considerations are important and preprocedural planning is necessary for a successful intervention. Catheter systems and devices specifically designed for radial access are needed to enable more interventionalists to safely perform neurointerventional procedures via wrist access.

Anatomical features of the radial artery in the Xinjiang population in China and its impact on the transradial coronary intervention procedure.

The anatomical features of the radial artery (RA) influence the transradial coronary intervention. The aim of this study is to discuss the anatomical features of the RA in the Xinjiang population and to guide interventionists in decreasing complications and improving success rates. We enrolled 1731 patients in this study. All relevant basic information was recorded in detail, and the RA diameter was examined. Patients were divided into a RA variation group and a RA non-variation group; univariate and multivariate factor analyses were performed to evaluate the relevant factors for RA diameter and the predictive value of the variable factors in RA variations. The mean RA diameter for all patients was 3.01 ± 0.14 mm. The multi-factorial analysis showed that height, gender, and occupation are significantly associated with RA diameter (p < 0.05). The incidence of RA variation was 4.97% (86/1731). Multi-factorial analysis showed that: gender (OR 2.72, 95% CI 1.469-5.037, p < 0.01), occupation (OR 2.228, 95% CI 1.0.000-0.012, p < 0.001) and RA inner diameter (OR 0.002, 95% CI 0.000-0.012, p < 0.001) are significantly associated with the incidence of RA variation. The mean RA diameter in the Xinjiang population was 3.01 ± 0.14 mm, height, gender, occupation are associated with RA diameter, gender, farmer, RA diameter are associated with RA variation. These factors can guide the interventionists to choose the appropriate equipment before the operation then can increase the efficiency of operation and prevent from the complications.

Incidence and predictors of radial artery occlusion after transradial coronary catheterization

BackgroundRadial artery occlusion (RAO) is considered the most common and devastating complication of transradial approach (TRA). It has been described as the “Achilles’ heel” of the transradial technique. Our aim was to assess the incidence and predictors of radial artery occlusion after transradial coronary catheterization.ResultsThis was a prospective study enrolling 164 patients undergoing percutaneous coronary interventions (PCI) via the transradial approach (TRA) using 6-F catheters. Doppler ultrasonography assessment of the radial artery (RA) was conducted on day 1 and 6 months following the procedure. The studied group included 104 male (63.4%) and 60 female (36.6%) patients with a mean age of 57.7 ± 8.8 years and a mean RA diameter of 2.8 ± 0.5 mm. On day 1, Doppler examination revealed RAO in 54 patients (32.9%). After 6 months, RAO was detected in 49 patients (29.9%). Interestingly, only 1 new case (0.9%) of RAO was noted, and 6 patients (11.1%) had regained their RA patency. On multivariate analysis, female gender, age, manual compression, and RA diameter emerged as independent predictors of RAO. Using TR band for hemostasis for only 2 h was recognized as a potent independent predictor of RA patency on day 1 and 6 months after the procedure (n = 2, 3.7% in the RAO group, vs. n = 23, 20.9% in the non-RAO group, p = 0.004).ConclusionRAO, although clinically a silent issue, has been the main complication following TRA. In patients with high predictors of RAO, careful management and close follow-up are required to ensure radial artery long-term patency.

Complications Following Transradial Cerebral Angiography : An Ultrasound Follow-Up Study.

ObjectiveThe feasibility and usefulness of transradial catheterization for coronary and neuro-intervention are well known. However, the anatomical change in the catheterized radial artery (RA) is not well understood. Herein, we present the results of ultrasonographic observation of the RA after routine transradial cerebral angiography (TRCA). MethodsPatients who underwent routine TRCA with pre- and post-procedure Doppler ultrasonography (DUS) of the catheterized RA were enrolled. We then recorded and retrospectively reviewed the diameter and any complicated features of the RA observed on DUS, and the factors associated with the diameter and complications were analyzed. ResultsA total of 223 TRCAs across 181 patients were enrolled in the current study. The mean RA diameter was 2.48 mm and was positively correlated with male gender (p<0.001) and hypertension (p<0.002). The median change in diameter after TRCA was less than 0.1 mm (range, -1.3 to 1.2 mm) and 90% of changes were between -0.8 and +0.7 mm. Across 228 procedures, there were 12 cases (5.3%) of intimal hyperplasia and 22 cases (9.6%) of asymptomatic local vascular complications found on DUS. Patients with abnormal findings on the first procedure had a smaller pre-procedural RA diameter than that of patients without findings (2.26 vs. 2.53 mm, p=0.0028). There was no significant difference in the incidence of abnormal findings for the first versus subsequent procedures (p=0.68). ConclusionDUS identified the pre- and post-procedural diameter and local complications of RA. Routine TRCA seems to be acceptable with regard to identifying local complications and changes in RA diameter.

19. Radial artery ultrasound predicts the success of transradial coronary angiography

Smaller radial artery diameter, CSA, and perimeter is associated with higher vascular access complications during coronary angiography. The transradial approach has become the preferred vascular access during conventional coronary angiography (CCA). A small mean radial artery diameter (RAD), however, may lead to higher rates of vascular access complications (VAC). To date, there are no data regarding the effect of the radial artery cross-sectional area (CSA) and perimeter. We evaluated the impact of preprocedure radial artery diameters, the CSA, and the perimeter on vascular complications. We conducted a single-center prospective analysis of 513 patients who underwent CCA. Radial artery ultrasonography was performed before and after CCA to measure the RAD, CSA, and perimeter.The average RAD, CSA, and perimeter were 2.60 ± 0.48 mm, 6.2 ± 3.0 mm 2 , and 8.9 ± 1.7 mm, respectively. The same measurements were significantly larger in men than in women: 2.8 ± 0.5 vs. 2.4 ± 0.4 mm ( P ± 3.4 vs. 5.3 ± 1.5 mm ( P ± 1.7 vs. 8.2 ± 1.5 mm (P ± 0.5 vs. 2.70 ± 0.54 mm ( P = 0.0001), 4.9 ± 2.1 vs. 6.4 ± 3 mm 2 ( P = 0.001), and 7.6 ± 2.1 vs. 9.2 ± 1.6 mm ( P = 0.0001), respectively. Univariate logistic regression showed that radial ultrasonographic parameters can independently predict VACs as follows: odds ratio (OR) 1.2, 95% CI 1.12–1.28 ( P P P

RADIAL ARTERY ULTRASOUND PREDICTS THE SUCCESS OF TRANSRADIAL CORONARY ANGIOGRAPHY

The transradial approach has become the preferred vascular access during conventional coronary angiography (CCA). A small mean radial artery diameter (RAD), however, may lead to higher rates of vascular access complications (VAC). To date, there are no data regarding the effect of the radial artery

Fogarty® catheter dilatation of veins smaller than 2.5 mm after completion of the anastomosis during arteriovenous fistula creation

Introduction. Risk of failure after surgical creation of the AVF was linked to the diameter and flow dynamics of the vessel that is to be quantified by preoperative ultrasound mapping. We aimed to report our results using a different technique consisting of Fogarty® catheter dilatation of the cephalic vein after completion of the anastomosis. Material and methods. A total of 23 patients, aged between 35 to 70 years, with a cephalic vein diameter of ≤ 2.5 mm received a dilatation technique for arteriovenous creation. Patients having reoperations, aneurysmatic or thrombosed veins and multiple risk factors were not considered eligible and access failure within 60 days was defined as early fistula failure. Results. Mean cephalic vein diameter was 2.03 ± 0.28 mm and mean radial artery diameter was 2.33 ± 0.16 mm. At 15th day visit, 21 of 23 patients (91.3%) had patent arteriovenous fistula. Mean time of follow-up was 7.2 ± 1.67 months and was complete in 20 of 21 patients with a patent fistula. Overall patency was 18/23 (78.2%) in patients with survived AVFs. Conclusion. Fogarty® catheter dilatation of the cephalic vein after completion of the anastomosis during arteriovenous fistula creation is effective and safe in patients with small calibrated veins.

34. Radial artery ultrasound preceding transradial coronary angiography

Background and purpose Transradial approaches (TRA) became the preferred vascular access during conventional coronary angiography (CCA). In fact a smaller mean radial artery diameter (RAD) may lead to higher rates of vascular access complications (VAC); however, there are no data regarding the effect of radial cross sectional area (CSA) and perimeter. We therefore evaluated the impact of preprocedure radial artery diameter, CSA and perimeter on vascular complications. Methods We conducted a single-center prospective analysis of 207 patients underwent CCA. A radial artery ultrasound performed pre and post CCA to measure RAD, CSA, and perimeter. Results The average RAD, CSA and perimeter were (2.7 ± 0.55mm), (6.3 ± 1.9mm 2 ), (9.2 ± 1.7mm) respectively. The same measurements were significantly larger in men than in women (2.8 ± 0.5 vs. 2.3 ± 0.4mm [ P P P = 0.001], respectively). Fourteen patients (6.8%) had VACs. The RAD, CSA and perimeter were significantly smaller in procedures with VACs than in procedure with no complications (2.1±0.5 vs. 2.7±0.5 [ P = 0.014], 4.6±1.4 vs. 9.4±1.6 [ P = 0.014], and 7.2±1.8 vs. 9.4±1.6 [ P = 0.022], respectively). Univariate logistic regression showed that radial ultrasonic parameters can independently predict VACs as follows: RAD (Odds ratio (OR)=1.4. 95% CI 1.08–1.68, p =007) for RAD, (OR=2. 26. 95% CI 1.11–4.58, p =0. 24) For CSA and (OR=2.86. 95% CI 1.3–6, p =0. 006) for perimeter. Summary ultrasonic study of the radial artery before CCA can provide important information regarding the vascular access. We found that a smaller radial diameter, CSA and perimeter are associated with higher rates of VACs.

El Bileğinden Yapılan Radiosefalik Arteriovenöz Fistüllerin Başarısızlık ve Açıklık Sürelerinin Diyabetik ve Diyabetik Olmayan Grupta Karşılaştırılması

Objective: The radiocephalic arteriovenous fistula (avf) at the wrist is the first choice for hemodialysis access. Several authors have reported diabetes mellitus (DM) as an independent risk factor on primary failure and patency of the fistula, also reports stating that DM is only a clinically comorbid factor. We aimed to investigate the effect of DM on primary failure and patency rates of distal radiocephalic avf. Material and Methods: 87 patients (43 diabetic and 44 non diabetic) who underwent distal radiocephalic avf operations between May 2011-January 2013 were reviewed retrospectively. Demographic findings and data about radial artery and cephalic vein were documented. Primary failure and 6 months primary patency of the fistula were also calculated retrospectively. Results: The mean cephalic vein diameters were similar but the mean radial artery diameter (2.34±0.26 mm versus 2.63±0.38 mm, p=0.0002) and the mean radial artery flow (25.05±11.8 ml/min versus 28.9±11.3 ml/min. p=0.0277) of the diabetic group were significantly lower. There were no significant differences on primary failure and primary patency rate for 6 months. Conclusion: Even though the mean radial artery diameter and flow were lower in diabetic group, there are no significant differences at primary failure and patency rates. By so we conclude that DM is not an independent risk factor on primary failure or patency rate of the fistula but may be a comorbid factor. Radiocephalic arteriovenous fistula at the wrist remains our first choice for both diabetic and non-diabetic patients.

Size of distal radial and distal ulnar arteries in adults of southern Rajasthan and their implications for percutaneous coronary interventions

Aims and objectivesTransradial interventions are gaining popularity in recent years. However the radial artery being small, there is a limitation in using interventional devices through this route. We have measured radial and ulnar arteries size in adult patients at our tertiary care cardiology center in southern Rajasthan. MethodAdult patients >30 years, who came for Echocardiography at a tertiary care center were included. Radial and ulnar arteries inner diameters were measured 2–3 cm above the Styloid process in both forearms with the Ultrasonography. Patient information about weight, height, diabetes and hypertension were collected. Body mass index and Body surface area were calculated. ResultsWe studied 204 patients, which includes 60.8% males. Mean diameter was 2.325 ± 0.4 mm mm for radial arteries and 2.358 ± 0.39 mm for ulnar arteries (p = 0.24). Hypertensive and male patients had larger mean radial artery diameter than non hypertensive (2.383 mm v/s 2.272 mm, p = 0.006) and female patients (2.37 mm v/s 2.26 mm, p = 0.008) respectively. Diabetic patients (2.305 mm) had nonsignificantly smaller radial arteries diameters than nondiabetics (2.329 mm, p = 0.6). We calculated correlations between radial arteries diameters and Body surface area, Body mass index, height and weight of patients, none of these correlations were statistically significant (r = 0.30, r = 0.28, r = 0.07, r = 0.031 respectively). ConclusionMean radial artery diameter (2.325 ± 0.4 mm) in the study was slightly smaller than ulnar artery (2.358 ± 0.39 mm). Males and hypertensives had a larger mean radial artery diameter than females and non hypertensives. Radial artery inner diameter measurement by Ultrasonography may be more helpful than Allen's test for ideal selection of cases.

Assessment of early radial artery injury after transradial coronary intervention by high-resolution ultrasound

BackgroundAlthough transradial coronary intervention (TRI) has been developed to minimize the bleeding and to improve the quality of life, radial artery injury is a problem. The present study was undertaken to compare the early radial artery injury after TRI between first-TRI and repeat-TRI by high-resolution ultrasound. Methods and resultsA total of 328 patients who are undergoing coronary angiogram through transradial route were included. We compared the radial artery findings between first-TRI patients (n = 268) and repeat-TRI patients (n = 60). The Radial Artery (RA) was examined by ultrasound before and one day after the procedure. ResultsIn first-TRI group, the mean RA diameter was 2.2 ± 0.35, 1.7 ± 0.37 mm before procedure and one day after the procedure p < 0.05. In repeat-TRI group, the mean RA diameter was 2.1 ± 0.6, 1.6 ± 0.36 mm before procedure and one day after the procedure respectively p < 0.05. The mean IMT of RA was 0.31 ± 0.1 mm and 0.40 ± 0.15 mm before procedure and one day after the procedure in first-TRI group. The mean intima-media thickness of RA was 0.35 ± 0.20 mm and 0.48 ± 0.17 mm before procedure and one day after the procedure in repeat-TRI group. Multivariate linear regression analysis showed that diameter repeated TRI Procedure were independent predictors of Intima media thickness (IMT). ConclusionThe lumen diameters were smaller in repeat-TRI patients than in first-TRI patients due to intima-medial thickening, in the radial artery. Care should be taken when the radial artery is used as a conduit in coronary artery bypass graft surgery, particularly in patients who have undergone TRI.

ASSESSMENT OF EARLY RADIAL INJURY AFTER TRANSRADIAL CORONARY INTERVENTION BY HIGH-RESOLUTION ULTRASOUND BIOMICROSCOPY

ObjectivesThe radial artery has become an alternative vascular access site for percutaneous coronary procedures. Transradial coronary intervention (TRI) introduces injury to the radial artery (RA) which will affect repeat transradial...

Feasibility of Transradial Coronary Intervention Using a Sheathless Guiding Catheter in Patients With Small Radial Artery

Background and ObjectivesTransradial coronary angiography and intervention are increasing in frequency due to lower major vascular access site complications and the potential for early mobilization. However, the small size of the radial artery (RA) is a major limitation of this technique. A sheathless guiding catheter (GC) has recently been introduced that has a 1-2 French smaller diameter compared with the corresponding introducer sheath. This catheter also has a hydrophilic coating along its entire length. We evaluated the feasibility of using a sheathless GC in patients who have small radial arteries.Subjects and MethodsThe procedural results were evaluated in patients with small radial arteries (diameter <2.3 mm) who underwent transradial coronary intervention using a sheathless GC.ResultsA total of 25 (male: 9) patients with 29 lesions were enrolled. The mean RA diameter was 1.81±0.26 mm. 44% of the patients had stable angina and 50.0% had acute coronary syndrome. The procedural success rate was 93.1%. Two patients (6.9%) had chronic total occlusive lesions that could not be crossed with a guide-wire despite good guiding support. An intravascular ultrasound could be used for all of the treated lesions. Multi-vessel intervention was performed in 29.2% of the patients. Two bifurcated lesions were treated with a kissing balloon technique, and one with a modified T-stenting technique. No catheter related complications were reported.ConclusionThe use of a sheathless GC is feasible in patients with small radial arteries without catheter related complications.

Effects of median nerve block on radial artery diameter and peak velocity

Peripheral artery cannulation is a common procedure but can sometimes be difficult. Our goal was to determine if a median nerve block would increase the diameter and flow of the radial artery. Radial artery diameter and peak velocity was measured using a SonoSite Ultrasound System. Using ultrasound guidance, a median nerve block was performed with lidocaine. Subsequent measurements of the radial artery and peak velocity were again made at 5 minutes post-block and 10 minutes post-block. Mean radial artery diameter measured vertically was 0.23 ± 0.06 cm pre-block, 0.23 ± 0.05 cm at 5 minutes post-block, and 0.23 ± 0.05 cm 10 minutes post-block. Mean radial artery diameter measured horizontally was 0.26 ± 0.05 cm pre-block, 0.27 ± 0.06 cm at 5 minutes post-block, and 0.27 ± 0.08 cm 10 minutes post-block. Peak velocities were 11.3 ± 6.9 cm/s pre-block, increased to 15.0 ± 6.9 cm/s 5 minutes post-block (P = 0.005), and finally increased to 17.7 ± 7.8 cm/s 10 minutes post-block (P = 0.01). This study set out to measure the effects of median nerve blockade on the radial artery. We found a significant increase in peak velocities post-median nerve blockade.

Dialysis Fistulae Patency and Preoperative Diameter Ultrasound Measurements

This study was designed to investigate the possibility of defining a vascular diameter with a practical cut-off point, which predicts a successful patency for radiocephalic arteriovenous fistulae in dialysis patients. This is a retrospective analysis of prospectively gathered data. Consecutive patients (n=148) with chronic renal failure, needing vascular access for haemodialysis, were included if they underwent duplex ultrasound examination to evaluate preoperatively the vascular status and diameters for radiocephalic arteriovenous fistulae (RCAVF) construction. The associations between the diameter of the radial artery and cephalic vein and primary failure at six weeks, primary and secondary patency at one year were investigated. There was no significant association between either radial artery diameter or dilated cephalic vein diameter and primary failure. There was an association between radial artery diameter and primary patency (Overall P=0.042). Males had a significantly larger mean radial artery diameter than females (P=0.005). Gender did not influence primary patency. We recommend using radial artery diameters of > or = 2.1 mm and < or = 2.5 mm for RCAVF construction, this diameter category having the highest patency at 1 year. A single cut-off guideline cannot be recommended.

Comparison of hemodynamic changes associated with two different polytetraflouroethylene arteriovenous fistulae in hemodialysis patients

The aim of this prospective study was to identify hemodynamic factors associated with two different types of polytetrafluroethylene (PTFE) AV grafts. The study was conducted on 46 hemodialysis patients over a 3-year period. The subjects were randomly assigned to one of two study groups: Group 1 patients ( n = 24) underwent a brachiocephalic loop PTFE fistula; Group 2 patients ( n = 22), a brachioaxillary PTFE fistula. Preoperatively, we recorded each individual's subclavian catheter history, hemodialysis frequency, and serum levels of parathormone (PTH), calcium (Ca)–phosphorus (P) product, homocysteine, protein C, and protein S. Doppler ultrasonography was used to evaluate vascular hemodynamic changes in the proximal and distal portions of the AV fistula at 48 hours and 1 week postoperatively. Group 1 showed a significantly greater number of ipsilateral subclavian catheter interventions prior to AV graft surgery than Group 2 (14 versus 7, respectively; P = .05; chi-square). The mean peak systolic velocity in the brachial artery in Group 1 was significantly higher than that in Group 2 at 1-week postoperatively ( P = .04, paired t-test). The mean radial artery diameter in Group 1 was greater than that of Group 2 at 1 week postoperatively ( P = .05, Student t-test). At 48 hours postoperatively the observed change in cephalic vein diameter in Group 1 was significantly greater than the change in axillary vein diameter in Group 2 ( P = .08, paired t-test). Preoperatively, the mean serum protein C and protein S levels in Group 1 were higher than those in Group 2 ( P = .03 and P = .04, respectively; Mann-Whitney U test). The total numbers of dialysis sessions per week in each group were significantly different ( P = .001, chi-square). Six Group 1 patients exhibited graft thrombosis at 48 hours after AV graft surgery. None of the patients in Group 2 exhibited thrombosis at 48 hours or 1 week postoperatively. The results indicate that patients with brachiocephalic PTFE AV grafts show more significant changes in the cephalic vein and brachial artery than patients with brachioaxillary PTFE AV grafts. The findings also suggest that more ipsilateral subclavian catheter interventions and a higher weekly frequency of hemodialysis prior to AV graft surgery are risk factors for early thrombosis of PTFE AV grafts.

Coronary rotational atherectomy via transradial approach: a study using radial artery intravascular ultrasound.

The use of coronary rotational atherectomy via radial artery (RA) has been limited because of the large diameter of guiding catheters. We studied the feasibility of this approach by sizing the RA by intravascular ultrasound (IVUS) and using 7 Fr (2.31 mm) guiding catheters. Seventeen transradial percutaneous transluminal coronary rotational atherectomy (PTCRA) procedures were performed in 16 patients, mean age 62 +/- 12 years, for a total of 19 vessels treated. The mean RA diameter was 2.9 +/- 0.36 mm and the mean reference diameter of the treated coronary vessels was 2.7 +/- 0.45 mm. The mean coronary percent stenosis was 74% +/- 10%, the mean minimum lumen diameter was 0.76 +/- 0.35 mm, and the mean lesion length was 16 +/- 19 mm. Ten vessels were treated with rotational atherectomy alone, or with adjunctive high pressure balloon angioplasty, achieving an acute lumen gain of 0.8 +/- 0.4 mm (P = 0. 001). Nine arteries had stent implantation in addition to rotational atherectomy, resulting in an acute lumen gain of 2.4 +/- 0.5 mm (P = 0.001). The success rate was 94%. There were no vascular complications. Two patients had a non-Q myocardial infarction. In conclusion, transradial PTCRA when used in conjunction with IVUS of the RA is a safe and feasible procedure in selected cases. This may be an alternative approach of revascularization technique especially for patients with limited vascular access and for those who require early ambulation or early discharge from the hospital.