The ulnar artery: a site suitable for arterial cannulation in pediatric patients. Pediatric ulnar and radial artery sizes

Background Recently, radial artery access has gained popularity for interventional neurovascular procedures due to patient comfort and fewer complications. However, there are instances where the radial artery approach is not feasible. In such cases, trans-ulnar artery access (TUA) can offer an alternate route. There is limited data regarding neuro-interventional procedures performed via this approach. This study aims to evaluate the feasibility and safety of trans-ulnar approach for a wide range of interventional neurovascular procedures. Materials and methods The data for all patients who underwent ulnar artery access for diagnostic or interventional neuroradiology procedures was retrospectively collected between September 2020 and March 2021. Patient demographics, procedural details, procedure success, and complications were recorded. Results During the study period, 23 patients underwent 24 trans-ulnar approach procedures. The mean age of patients was 50.1 ± 14.2 years. Fourteen diagnostic cerebral angiograms and ten interventional procedures were performed. All procedures were successfully completed via trans-ulnar approach without a switch to alternate access. No major access site complication was observed. Conclusion Ulnar artery access is a safe and feasible option for neurovascular procedures. It can be effectively utilized for diagnostic cerebral angiography and a wide range of interventional procedures.

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Remodeling of ipsilateral ulnar artery after radial artery harvesting for coronary artery bypass graft

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2020-0432 ◽

2021 ◽

Vol 99 (2) ◽

pp. 231-236

Author(s):

Melchior L. Lima ◽

Héber S.M. Silva ◽

Lourival N. Lougon ◽

Fanilda S. Barros ◽

Walter J. Gomes

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Radial Artery ◽

Ultrasound Examination ◽

Color Doppler ◽

Artery Bypass ◽

Ulnar Artery ◽

Intima Media Thickness ◽

Diabetic Patients ◽

Media Thickness

There are controversies in the literature on the blood supply to the forearm after surgical removal of the radial artery in coronary artery bypass grafting (CABG). The objective was to investigate the arterial remodeling of the ulnar artery after the removal of the radial artery in myocardial revascularization by means of ultrasound examination with color Doppler in the pre- and post-operative periods. This paper describes an observational prospective study of the remodeling of the left brachial and ulnar arteries (donor arm) in 103 right-handed non-consecutive adult patients undergoing CABG with removal of the ipsilateral radial artery using the color Doppler ultrasound examination. In the ulnar artery, a significant increase (P < 0.05) was seen in the following measurements: lumen diameter by 13%, lumen area by 26%, peak systolic flow by 40%, and average flow by 46%. Intima-media thickness measured in the ulnar artery did not show a statistically significant difference (P = 0.22), except in diabetic patients (P = 0.007). We conclude that the ulnar artery undergoes positive physiological remodeling, adapting to the new requirements of chronic increase in flow after the ipsilateral removal of the radial artery to serve as a graft in CABG. There was no evidence of increased intima-media thickness, except in diabetic patients.

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Necrosis of the Forearm Following Radial Artery Catheterization in a Patient with Reye's Syndrome

PEDIATRICS ◽

10.1542/peds.65.1.141 ◽

1980 ◽

Vol 65 (1) ◽

pp. 141-143

Author(s):

Thom Mayer ◽

Michael E. Matlak ◽

Joel A. Thompson

Keyword(s):

Radial Artery ◽

Pediatric Patients ◽

Male Infant ◽

Serum Glucose ◽

Reye's Syndrome ◽

Partial Loss ◽

Local Hospital ◽

Radial Artery Catheterization ◽

Excellent Health ◽

History Of

The use of indwelling arterial catheters has become increasingly widespread in pediatric patients in recent years. As experience has expanded so has awareness of the complications that their use may entail. We report a case of a 9-month-old patient with Reye's syndrome who suffered diffuse microvascular compromise, which resulted in partial loss of an extremity following radial artery catheterization. CASE REPORT A 9-month-old male infant, previously in excellent health, was seen with a three-day history of rhinorrhea and cough, a one-day history of vomiting, and a 12-hour history of lethargy. When seen at a local hospital he had status left-sided focal seizures and a serum glucose of 17 mg/100 ml.

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A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

Journal of Interventional Cardiology ◽

10.1155/2020/7928961 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Dmitrii V. Ognerubov ◽

Alexander Sedaghat ◽

Sergey I. Provatorov ◽

Andrey S. Tereshchenko ◽

Olivier F. Bertrand ◽

...

Keyword(s):

Coronary Angiography ◽

Randomized Trial ◽

Hospital Discharge ◽

Radial Artery ◽

Ulnar Artery ◽

Artery Occlusion ◽

Puncture Site ◽

Coronary Procedures ◽

Baseline Characteristics ◽

Radial Artery Occlusion

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

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P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study

European Heart Journal ◽

10.1093/eurheartj/ehz746.1113 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Ognerubov ◽

A Tereshchenko ◽

E Merkulov ◽

S Provatorov ◽

G Arutyunyan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Angiography ◽

Radial Artery ◽

Stable Coronary Artery Disease ◽

Ulnar Artery ◽

Coronary Intervention ◽

Artery Occlusion ◽

Careful Examination ◽

Radial Access ◽

Short Time

Abstract Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions. Aim To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access. Materials and methods During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO. Results The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P<0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01). Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 <0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 <0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01 Conclusion Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.

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Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa314 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Mahmoud Tolba ◽

Martin Maresch ◽

Dhafer Kamal

Keyword(s):

Arteriovenous Fistula ◽

Radial Artery ◽

Hemodialysis Patient ◽

Ulnar Artery ◽

Complete Relief ◽

Retrograde Flow ◽

Palmar Arch ◽

Artery Ligation ◽

Steal Syndrome ◽

Distal Radial Artery

Abstract We present a case of dialysis associated steal syndrome in a hemodialysis patient with left radiocephalic arteriovenous fistula that caused him severe rest pain. Angiography showed retrograde flow from the ulnar artery to the distal radial artery through a hypertrophied palmar arch. The problem was solved by surgical ligation of the distal radial artery leading to complete relief of patient symptoms without any notable complications.

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Digital ulcers secondary to radial artery thrombosis following arterial cannulation in systemic sclerosis

Rheumatology ◽

10.1093/rheumatology/kez544 ◽

2019 ◽

Vol 59 (5) ◽

pp. 987-987

Author(s):

Miriam Cox ◽

Kar-Ping Kuet ◽

Michael Hughes

Keyword(s):

Systemic Sclerosis ◽

Radial Artery ◽

Digital Ulcers ◽

Arterial Cannulation ◽

Artery Thrombosis

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Variations in the branching pattern of brachial, ulnar and radial arteries

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401552 ◽

2015 ◽

Vol 04 (02) ◽

pp. 107-109

Author(s):

Ashwini Mutalik ◽

Chandrashekhar Hanji ◽

Sanjeev I Kolagi ◽

GB Rairam

Keyword(s):

Clinical Significance ◽

Radial Artery ◽

Undergraduate Students ◽

Brachial Artery ◽

Ulnar Artery ◽

Vascular Anomalies ◽

Branching Pattern ◽

Medical College ◽

Collateral Arteries ◽

Interosseous Artery

AbstractDuring routine dissection of a cadaver alloted to the undergraduate students in the department of anatomy in SN Medical College, Bagalkot, the authors found multiple variations in the branching pattern of brachial, ulnar and radial arteries. There was high division of brachial artery into ulnar and radial arteries. The profunda brachii originated from brachial artery as usual while superior and inferior ulnar collateral arteries originated from ulnar artery. The radial artery gave origin to common interosseous artery which further divided into anterior and posterior interosseous arteries. All the three arteries i.e. brachial, ulnar and radial were considered as superficial arteries as they were superficial throughout the course. These observations of vascular anomalies are of clinical significance to vascular and plastic surgeons.

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