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Arterial blood gas sampling
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Although rare, one of the complications of radial arterial puncture is acute occlusion. If this occurs, and there is no collateral circulation from the ulnar artery, there is a danger of vascular compromise to the hand.
Complications of upper extremity bypass grafting for occlusive and aneurysmal disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
The ulnar artery can be exposed at the mid-forearm or at the wrist. For both exposures, the arm is prepped circumferentially for intraoperative manipulation and is positioned with shoulder abducted to 90 degrees and the hand in the supinated position. The ulnar artery in the proximal forearm crosses under the superficial flexor muscles, so exposure is easier in the mid-forearm. The incision is made along an imaginary line drawn from the medial epicondyle of the humerus to the pisiform in the wrist. However, it is useful to first identify the artery with ultrasound and mark the incision on the skin. The antebrachial fascia is divided, and the flexor carpi ulnaris and flexor digitorum superficialis are separated to expose the ulnar artery. The ulnar artery is flanked by paired veins and crossing veins must be ligated to fully expose the artery. In the middle third of the forearm, the ulnar nerve runs along the medial boarder of the ulnar artery and should be identified and avoided.
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
Incising the volar carpal ligament, the palmaris brevis muscle and the hypothenar fibrous tissue will decompress the ulnar nerve within Guyon's canal. The nerve need not be completely circumferentially dissected out as this may devascularize it. Distally, the interval between the pisohamate and pisometacarpal ligaments is explored for any masses, fibrous bands or fracture fragments. The superficial branch passes superficial to the fibrous arch of the hypothenar muscles. The ulnar artery must be examined at this point to ensure that it is free of aneurysm or thrombus – it should be smooth and not tortuous.
Arterial embolism in a patient with pulmonary embolism and patent foramen ovale
Published in Baylor University Medical Center Proceedings, 2019
Waiel Abusnina, Mohammed Megri, Basel Edris, Mehiar El-Hamdani
A complete blood count, complete comprehensive panel, and coagulation profile were unremarkable (Table 1). A peripheral arterial angiogram showed acute right axillary artery thrombosis, which was treated with an EverFlex self-expanding 8 × 40 mm stent to the right axillary artery, thrombectomy to the right brachial and axillary arteries, and tissue plasminogen activator infusion catheter for the ulnar artery thrombosis. She was started on clopidogrel and atorvastatin 80 mg. A chest radiograph did not show any process that could explain the acute episode. Transthoracic echocardiogram revealed an ejection fraction of 65%. The right ventricle was moderately dilated with reduced ejection fraction, the right ventricular systolic pressure was 39 to 42 mm Hg, an agitated saline study was positive with timing of bubbles consistent with intrapulmonary shunt, and no free-floating cardiac thrombi were detected. Computed tomography angiography showed a large saddle pulmonary embolus extending from the right and left main pulmonary arteries (Figure 1). Venous ultrasonography revealed a left-sided lower-limb deep venous thrombosis from the superficial femoral vein into the popliteal vein. The patient was started on a heparin drip and then bridged to apixaban. Factor V Leiden, Factor II, antithrombin III, Protein C and Protein S, anticardiolipin immunoglobulin G/immunoglobulin M, and anti-dsDNA antibodies were all negative (Table 1). However, the MTHF mutation was present and coexistent with hyperhomocysteine.
The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience
Published in Acta Cardiologica, 2021
Feyzullah Besli, Fatih Gungoren, Zulkif Tanriverdi, Mustafa Begenç Tascanov, Halil Fedai, Huseyin Akcali, Recep Demirbag
In all cases, a 6 F sheath (Terumo, Germany) was placed into the right (mostly) or left radial artery after local anaesthesia with xylocaine 2%. Modified Allen test with pulse oximetry was carried out to evaluate ulnar artery patency before the radial puncture. 50 IU/kg or 100 IU/kg UFH together with 500 micrograms nitroglycerine were administered directly by means of radial sheath immediately after sheath insertion. Cardiac catheterisation was performed with the Tiger 3.5 diagnostic catheters (Terumo Interventional Systems, USA) as first choice for right and left coronary artery or if necessary standard judkins catheters by experienced cardiologists. Puncture attempt numbers, arterial access time (from the giving subcutaneous lidocaine to arterial cannulation) and any complications were recorded. Angiograpy and floro duration were also recorded. After standard angiography, the sheath was removed and a compressive device was applied (TR-band, Terumo band, Terumo, Germany) for hemostasis. The inflated TR-band was partially deflated at 30 min and completely removed after 3 h. In case of persistent bleeding, the TR-band was inflated again and hemostasis was checked again after 1 h. Patients were discharged usually within 3–4 h after cardiac catheterisation. All patients were checked regarding pain, weakness, paraesthesia, local swelling, absent pulses and haematoma with physical examination before discharging. Each patient was re-evaluated with physical examination and Doppler ultrasonography at 10 days after cardiac catheterisation. After that, in cases with RAO, the ulnar artery patency was checked unconditionally and low molecular weight heparin was given for four weeks to prevent hand ischaemia.
Pacinian hyperplasia presenting with Raynaud’s phenomenon
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Brent B. Pickrell, Simon G. Talbot, Danielle C. Costigan, Christian E. Sampson
On physical exam, there were exquisitely tender ulcerations at the tips of the right index and middle fingers, and left middle finger (Figure 1(a,b)). Doppler examination revealed strong triphasic signals of both radial arteries at the wrist and very weak monophasic signals of the ulnar artery at the wrist. There were strong Doppler signals at the base of each digit. Given the patient’s recurrent symptomatology and fingertip ulcerations, along with his previous therapeutic response to proximal sympathectomies, a focused distal sympathectomy at the level of the common and proper digital arteries was recommended to address his ongoing digital ischemia.