Advantages and disadvantages in radial and femoral arterial access
Ever D. Grech in Practical Interventional Cardiology, 2017
The radial artery (RA) arises at the bifurcation of the brachial artery in the cubital fossa. It runs distally along the radial side of the forearm and joins the ulnar artery through the palmar arch, creating the dual circulation system in the hand. The anatomical features of RA confer advantages in terms of vascular access, compared to FA. Its small diameter (1.8–2.5 mm)9 combined with its superficial location and the presence of a bone plane allow better haemostatic control after percutaneous coronary intervention (PCI) (Table 24.1). Together with the absence of nearby neurovascular structures, these characteristics explain the marked reduction of access site complications.10–12 In contrast, its smaller calibre (one/sixth of the femoral)9 means that the radial access can hardly accommodate devices larger than 6 Fr. This may become a limitation when performing PCI (especially in complex lesions such as left main, bifurcation, chronic total occlusion [CTO]). Furthermore, itstortuous path, the relative frequency of radial spasm (it is a muscular artery) and the presence of unfavourable angles with the ascending aorta and aortic arch, especially in elderly patients with type 3 arch pattern, make this access more challenging for the operators. It is worth noting that these conditions increase patient discomfort as well as the risk of complications.
Phalloplasty
James Barrett in Transsexual and Other Disorders of Gender Identity, 2017
If a free flap phalloplasty is chosen the feeding vessels must be confirmed to be intact, usually by a vascular Doppler ultrasound examination. If the flap is from a distal limb, then the remaining artery must be shown adequately to perfuse the distal hand or foot on its own. A typical clinical test is the Allen test for the upper limb. Both the radial and ulnar arteries are occluded by digital compression at the wrist. The patient makes a fist a few times till the hand goes white as the veins empty. The compression on the ulnar artery (assuming a radial artery flap is planned) is released while still occluding the radial artery. The hand should pink up within a few seconds. This confirms that the ulnar artery is adequate to supply the hand. Patients who have had fractures of the distal limbs must all have a vascular Doppler ultrasound examination anyway, to check both the arteries and the veins. Extensive scarring from suicide attempts on the forearm may preclude the use of a forearm flap, particularly if the cuts were very deep or involved any vessels.
Upper Limb
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
In the region of the elbow, the brachial artery divides into the radial artery and the ulnar artery (Figure 4.4). Because the two latter arteries are mainly anterior arteries and the branches of the deep brachial artery are connected distally to recurrent arterial branches at the elbow region, another “trick” is required to provide blood supply to the posterior forearm compartment. Therefore, the ulnar artery gives rise to a branch—the common interosseous artery—that divides into the anterior interosseous artery and the posterior interosseous artery (Plate 4.9b). In Section 4.2.1.2, we explained in detail the configuration of the posterior and anterior interos-seous neurovascular structures, and provided an easy way for students to remember that it is the ulnar artery that thus gives rise to the posterior and anterior interosseous arteries (Box 4.7).
The pulseless radial artery in transradial catheterization: challenges and solutions
Published in Expert Review of Cardiovascular Therapy, 2019
Analkumar Parikh, Ian C Gilchrist
The right tool for the job is typically the best advice for many trades, and cardiac catheterization is not exempt. Initially, catheters for cardiac procedures were too large for most vessels andcardiologist were left with the brachial and femoral access points during the early decades of invasive cardiology. With improving access techniques, the dominant access site settled into the femoral region, and the brachial access became analmost forgotten secondary access point. As technology improved catheters and devices, equipment started to become usable at sizes that now permitted the use of smaller diameter vessels. The smaller arteries included the radial artery and its neighbor the ulnar artery along with analogous arteries in the foot.
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.
Technique of percutaneous closure of an endovascular arteriovenous fistula created for dialysis access
Published in Baylor University Medical Center Proceedings, 2023
Stephen E. Hohmann, Erin Cha
Surgical AVFs are classically created in the easier to approach radial or brachial artery, but the common ulnar artery is difficult to approach surgically.10 eAVFs are frequently commonly created between the common ulnar artery (segment between the brachial bifurcation and prior to the takeoff of the interosseus and proper ulnar artery) and medial ulnar vein5 secondary to the larger size of both the common ulnar arteries and veins in this area. This endovascular advantage in access to the ulnar artery during eAVF creation translates similarly for the patient in this case report when considering approaches to occlusion of eAVFs.
Related Knowledge Centers
- Vein
- Forearm
- Blood
- Blood Vessel
- Elbow
- Brachial Artery
- Radial Artery
- Wrist
- Ulnar Veins
- Cubital Fossa