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Acute Limb Ischaemia
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
You take the patient to theatre but you are not pleased with the on-table angiogram result. The ulnar artery still is showing filling defects despite multiple balloon trawls. The situation is much the same with the radial artery. What would you do now?“I would consider on-table thrombolysis. If that did not work I would consider a bypass onto the best forearm vessel.”
Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Arterial territories: An Allen test assists in deciding whether the radial or ulnar artery is responsible for the major artery supply to the hand. An Allen test (Figures 3.19 and 3.20) (Videos 3.10 and 3.11) manoeuvre is performed at the wrist level and repeated to look for the predominant blood supply. Usually, radial artery remains the predominant artery supply for the hand.
Invasive hemodynamic monitoring in obstetrics
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Luis D. Pacheco, Shannon Clark, Gary D. V. Hankins
The preparation for arterial line (A-line) placement begins with sterile preparation of the site, local anesthesia of the insertion site, and positioning of the patient’s wrist on a hand board in the dorsiflexed position (14). The radial artery is located 1 to 2 cm from the wrist, between the bony head of the distal radius and the flexor carpi radialis tendon. The two techniques for A-line placement (over-the-wire and over-the-needle) begin with palpation of the artery and location of the radial pulse followed by entry of the needle at a 30’–45’ angle. In the over-the-wire technique, the catheter is advanced through the artery until a flash of blood is noted. At this point, both the needle and the catheter are advanced 1 cm deeper in order to completely transect the artery. After this, the needle is removed and the catheter is lowered until it is almost parallel with the skin. The catheter is pulled gently until pulsatile blood is noted. At this point, the guidewire is introduced, and then the catheter is advanced into the artery through the guidewire. Finally, pressure should be placed proximal to the catheter and the wire removed. For the over-the-needle technique, the needle is advanced slowly through the skin until a flash of blood is seen. The needle is then lowered 10’–15’, and the catheter is advanced into the artery. The catheter is then secured in place.
Technique of percutaneous closure of an endovascular arteriovenous fistula created for dialysis access
Published in Baylor University Medical Center Proceedings, 2023
In the operating suite, we accessed the medial ulnar vein with a micropuncture 4 cm proximal to the wrist crease. A 6F sheath was then used for angiography, which showed a patent eAVF with significant collateral filling of deep veins consistent with his forearm swelling (Figure 1a). A second access was obtained in the radial artery just proximal to the wrist crease. Arterial injection to localize the area of the endovascular anastomosis was then performed. To evaluate the feasibility of endovascular occlusion, an angled glide catheter and wire was used to traverse the ulnar vein peripherally and centrally to the anastomosis. A 5 mm × 4 cm balloon was then inflated across the area, and we injected the artery, which showed no further filling of the eAVF (Figure 1b). The balloon was deflated and removed. A covered 5 mm × 5 cm Gore Viabahn stent was placed via the 6F sheath in the medial ulnar vein and deployed under fluoroscopic guidance. Postdeployment injection through the radial artery confirmed occlusion of the endovascular anastomosis (Figure 1c). Injection through the vein confirmed patency of the deep venous system after stent deployment.
Percutaneous balloon pericardiotomy: efficacy in a series of malignant and nonmalignant cases
Published in Scandinavian Cardiovascular Journal, 2022
Holger H. Sigusch, Wolff Geisler, Ralf Surber, Marc Schönweiß, Jens Gerth
Each patient gave his/her written informed consent to pericardiocentesis and pericardiotomy. Ethics approval has been granted by the ethics committee at the Saxon State Medical Association (Dresden, Germany, EK-BR-67/22-1). The procedures were performed via a subxiphoid approach under fluoroscopic guidance in the catherization laboratory. In all cases, an arterial line for pressure monitoring had been established via the radial artery. Under strictly sterile conditions, local anesthesia (15 − 20 ml 1% lidocaine) was performed and the pericardiocentesis needle was inserted directly beneath the costal margin slightly to the left of the midline. After making a 1 cm skin incision, the needle was advanced in a 30-degree-angle to the skin-avoiding the liver-pointing toward the left shoulder. Once reaching the pericardial space a 0.035″ guidewire was inserted. First, a small (4 or 5 French) sheath was inserted to verify the intrapericardial location of the wire and the sheath. This was done by analysis of hemoglobin concentration and oxygen saturation as well as injection of iodinated contrast. In some cases, agitated saline was injected via the small sheath and intrapericardial contrasting was confirmed by echocardiography. Then, in all cases a 7 French sheath was inserted. A 7 French pigtail catheter was inserted, and the pericardial fluid drained.
Strategies and pitfalls during minimally invasive total coronary artery revascularization via left anterior minithoracotomy: a promising future
Published in Acta Cardiologica, 2022
Mugisha Kyaruzi, Ergun Demirsoy
Preoperative computed tomography (CT) angiography should be performed in all patients to asses peripheral vessels for arterial cannulation and also determine the presence or extent of calcification in ascending aorta [4]. Presence of severe calcification in ascending aorta may increase risk of neurologic events during manipulation and cross clamping. In such cases strategy for revascularization may be changed to off pump surgery with ‘no touch’ of ascending aorta technique. We also recommend radial artery access for coronary angiography instead of femoral artery access in all patients. Puncture of peripheral vessels in lower extremity during diagnostic coronary angiography may increase risk of haematoma or pseudoaneurysym which may cause difficulties during peripheral cannulation for cardiopulmonary bypass (CPB).