Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 74-82 ◽  
Author(s):  
Matteo Tebaldi ◽  
Simone Biscaglia ◽  
Carlo Tumscitz ◽  
Annamaria Del Franco ◽  
Francesco Gallo ◽  
...  
Keyword(s):  
Radial Artery ◽  
Primary Outcome ◽  
Study Groups ◽  
Adjunctive Treatment ◽  
Access Site ◽  
Double Blind ◽  
Access Site Complication ◽  
Heparin Administration ◽  
Coronary Procedures ◽  
Sheath Insertion

Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery oc­clusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

Access-site complications of the transradial approach: Rare but still there.

2020 ◽  
Vol 16 ◽  
Author(s):  
Stelina Alkagiet ◽  
Dimitrios Petroglou ◽  
Dimitrios N. Nikas ◽  
Theofilos M. Kolettis
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Access Site ◽  
Transradial Approach ◽  
Financial Benefits ◽  
Eversion Endarterectomy ◽  
Life Threatening ◽  
Sheath Insertion ◽  
Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

scholarly journals Anomalous Medial Branch of Radial Artery: A Rare Variant

2016 ◽  
Vol 59 (3) ◽  
pp. 100-103 ◽  
Author(s):  
Surbhi Wadhwa ◽  
Vandana Tomar
Keyword(s):  
Radial Artery ◽  
Anatomical Variations ◽  
Medial Branch ◽  
Normal Pattern ◽  
Access Site ◽  
Capillary Vessel ◽  
Radial Forearm ◽  
Coronary Procedures ◽  
Technical Failures ◽  
Flexor Carpi Radialis Muscle

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.

Access Through the Anatomical Snuffbox for Neuroendovascular Procedures: A Single Institution Series

2020 ◽  
Vol 19 (5) ◽  
pp. 495-501 ◽  
Author(s):  
Joshua H Weinberg ◽  
Ahmad Sweid ◽  
Omaditya Khanna ◽  
Nikolaos Mouchtouris ◽  
Ashlee Asada ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Radial Artery ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Safe Alternative ◽  
Access Site Complication ◽  
Size Number ◽  
Therapeutic Procedures ◽  
The Mean ◽  
Transradial Catheterization

Abstract BACKGROUND Distal transradial catheterization in the anatomic snuffbox is an alternate route of access that has started to gain consideration for neuroendovascular procedures. OBJECTIVE To assess the feasibility and outcomes and present our institution's experience in performing neuroendovascular procedures via distal transradial access (dTRA). METHODS We conducted a retrospective analysis and identified 120 patients who underwent consecutive neuroendovascular procedures via dTRA in the anatomic snuffbox. Data collection was performed on indication for procedure, sheath size, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success. RESULTS Of 120 patients with an average age of 54.7 yr ± 14.7, 73 (60.8%) underwent diagnostic angiograms, 38 (31.7%) underwent follow-up angiograms, and 9 (7.5%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.5 ± 0.1 per procedure, the mean procedure time was 68.3 min ± 43.4, the mean fluoroscopy time was 10.8 min ± 7.6, the mean contrast dose was 70.6 mL ± 39.1, and the mean radiation exposure was 27 672.2 mGycm2 ± 42 728.4. Successfully completed therapeutic procedures included aneurysm 1 (0.8%), arteriovenous malformation (AVM)/arteriovenous fistula/carotid cavernous fistula 7 (5.8%), and 1 (0.8%) other treatment. Three patients (2.5%) required adjunct transfemoral endovenous access for AVM embolization. Two minor complications (1.67%) were a local wrist hematoma and a radial artery vasospasm without any sequelae. CONCLUSION Distal radial artery catheterization in the anatomic snuffbox is a safe and effective access site to perform neuroendovascular procedures. Complications and conversion rate are low making it a safe alternative.

scholarly journals Low Dose Perioperative Intravenous Tranexamic Acid in Patients Undergoing Total Knee Arthroplasty: A Double-Blind Randomized Placebo Controlled Clinical Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mahdi Motififard ◽  
Mohammad Ali Tahririan ◽  
Mehdi Saneie ◽  
Sajad Badiei ◽  
Amin Nemati
Keyword(s):  
Tranexamic Acid ◽  
Primary Outcome ◽  
Low Dose ◽  
Study Groups ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Significant Difference ◽  
Duration Of Hospitalization ◽  
Slow Infusion ◽  
The Difference

Background and Objectives. The null hypothesis of this study was that TA has no effect on postsurgical bleeding in patients undergoing TKA. Methods. This study was a double-blind randomized trial. In the first group (T) patients received 500 mg of intravenous Tranexamic acid (TA) twice (once preoperatively and once 3 hours postoperatively) and in the second group (P) they received slow infusion of normal saline as placebo. The primary outcome of the study was the level of Hb 48 hours after surgery. Results. Hb levels 48 hours after surgery as the primary outcome were 10.92±0.97 and 10.23±0.98 (g/dL) in groups T and P, respectively, and the difference was statistically significant (P=0.001). Statistically significant differences were also observed in Hb levels 6 and 24 hours after surgery, the drain output 48 hours after surgery, and the number of units of packed cells transfused between study groups (P<0.05). There was no significant difference in duration of hospitalization between the study groups (P = n.s.). Conclusions. The low dose perioperative intravenous TA significantly reduces blood loss, requirement for blood transfusion, and drain output in patients undergoing TKA. However, duration of hospitalization did not change significantly.

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Ruzsa ◽  
N Sandor ◽  
J Toth ◽  
M Deak ◽  
B Zafirovska ◽  
...  
Keyword(s):  
Radial Artery ◽  
Subclavian Artery ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Access Site Complication ◽  
Radial Access ◽  
Angiographic Data ◽  
Procedural Complications ◽  
Radial Artery Occlusion

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&lt;0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

Outcome off Primary Coronary Angioplasty by Radial Route: Study on 100 Cases

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr. Dilip Ratnani ◽  
Dr. Rekha Ratnani
Keyword(s):  
Hospital Stay ◽  
Radial Artery ◽  
Bleeding Complications ◽  
Access Site ◽  
Transfemoral Approach ◽  
Artery Cannulation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Radial Access ◽  
Coronary Procedures

Recently radial artery is being used as a vascular access route for coronary procedures. Primary angioplasty with transfemoral procedure is associated with high access site bleeding complications due to use of potent antiplatelets and anticoagulants therefore radial access should be preferred if the operators are experienced and familiar with the technique. Methods: Total 100 pa‡…tients were included in the study in which procedure was performed by the trans radial route. All routine laboratory investigations were performed. Support of a temporary pacemaker was kept ready. All patients were prepared according to the Cardiac Catheterization Laboratory Standards. Radial artery cannulation was performed. Results: 100 patients were included in the study selected for radial route. Mean age of the patients who underwent primary CAI was 59±8.4. The most affected artery in the as shown angiography was Left anterior descending (58%) followed by Right coronary artery (41%). Least affected artery was left main (6%) and Ramus intermedius (6%). Mean of diseased vessels was 1.34 ± 1.25. Crossover from radial to femoral route was done on 5 patients of which 2 patients were having radial artery anomaly and in 3 patients arterial puncture was not successful. Mean hospital stay of the patients after procedure was 6.8 ± 2.1. Conclusion: transradial approach for coronary procedures is a safe technique and gives similar clinical results to transfemoral access. Complications at the radial access site are negligible. Length of hospital stay, time to mobilisation and cost all are reduced in the transfemoral approach.

Transradial intraoperative cerebral angiography: a multicenter case series and technical report

2019 ◽  
Vol 12 (2) ◽  
pp. 170-175
Author(s):  
Joshua W Osbun ◽  
Bhuvic Patel ◽  
Michael R Levitt ◽  
Alexander T Yahanda ◽  
Amar Shah ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Carotid Arteries ◽  
Case Series ◽  
Patient Positioning ◽  
Interventional Cardiology ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Access Site Complication

BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

Radial artery pseudoaneurysms after transradial cardiac catheterisation

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 229-232 ◽  
Author(s):  
Jehangir N. Din ◽  
Aengus Murphy ◽  
Karen Chu ◽  
Patty Forman ◽  
Richard D. Mildenberger ◽  
...  
Keyword(s):  
Clinical Features ◽  
Radial Artery ◽  
Femoral Artery ◽  
Surgical Repair ◽  
High Volume ◽  
Cardiac Catheterisation ◽  
Access Site ◽  
Artery Pseudoaneurysm ◽  
Diagnostic Angiography ◽  
Coronary Procedures

Abstract. Background: Although uncommon, radial artery access site complications are likely to become more frequent with the increased adoption of transradial cardiac catheterisation. There is a lack of data regarding the incidence and clinical features of radial artery pseudoaneuryms. We aimed to describe the incidence, clinical features and management of radial artery pseudoaneurysms in a high-volume transradial cardiac catheterisation centre. Patients and methods: We performed a search of the Vancouver Island Health Authority medical imaging database from 1st Jan 2008 to April 2012 looking for all radial and femoral artery pseudoaneuryms occurring after cardiac catheterisation. Hospital charts were reviewed to determine patient and procedural characteristics as well as management and outcome. Results: There were a total of 14,968 coronary procedures performed over the four year search period, of which 13,216 (88 %) were trans-radial. The incidence of radial artery pseudoaneurysm after cardiac catheterisation was 0.08 %, and did not differ between transradial diagnostic angiography and PCI (0.07 % vs 0.08 %; P = 0.90). In contrast, the incidence of femoral artery pseudoaneurysm was higher, at 1.4 % (P < 0.0001). Patients with radial pseudoaneurysms were generally elderly, with a median age of 77 years, and there were no gender differences. Only one patient had received a glycoprotein IIb / IIIa inhibitor, whilst two received warfarin post-procedure. The majority of cases (80 %) were treated with surgical repair. Conclusions: We have demonstrated that radial artery pseudoaneuryms are a rare but important complication of transradial cardiac catheterisation, with patients generally requiring surgical repair. Most patients were elderly, but surprisingly only a minority were anti-coagulated with warfarin.

scholarly journals Coronary angiography through ipsilateral ulnar approach in a patient with small-diameter radial artery

2013 ◽  
Vol 66 (5-6) ◽  
pp. 245-249
Author(s):  
Zoran Stajic ◽  
Zdravko Mijailovic
Keyword(s):  
Coronary Angiography ◽  
Radial Artery ◽  
Small Diameter ◽  
Ulnar Artery ◽  
Effective Alternative ◽  
Alternative Approach ◽  
Coronary Procedures ◽  
Sheath Insertion ◽  
The Right

Introduction. Coronary procedures cannot be completed in 5-15% of cases through initially used radial artery approach due to frequent radial artery anomalies and vasospasm. In these cases, the ulnar artery approach could be the safe and effective alternative wrist approach. Case report. A 60-year-old patient with stable angina pectoris, hypertension, dyslipidaemia and positive endurance test was admitted to our hospital for coronary angiography. Due to the backbone pains which also made prolonged lying in bed very uncomfortable and painful, we opted for the wrist approach (standard radial approach) after both modified Allen?s tests had been performed, which gave the positive result. After sheath insertion into the right radial artery and unsuccessful advancement of the guidewire and the catheter, we performed the right forearm angiography, which revealed that the right radial artery had a small diameter and the right ulnar artery was the dominant one. Afterwards, the right ulnar artery was cannulated successfully and the coronary angiography was performed through this approach. Both sheaths were removed simultaneously immediately after the procedure and hemostasis was secured by the compression with two Terumo- bands over the puncture sites without any complications. The pulses of both arteries were checked regularly over the next 24 hours and they remained normal. A day after the procedure, the control Doppler-ultrasound check-up was performed and it confirmed the normal flow in both cannulated arteries. One-month follow-up was uneventful, and the patient did not experience any ischemic symptoms of the hand. Conclusion. This case is the proof that the ipsilateral ulnar approach can be a safe and effective alternative approach in patients with positive Allen?s test after the failure of initial radial attempt in cases where femoral approach should be avoided or the wrist approach should be maintained.

scholarly journals Efficacy and safety of adjunctive lacosamide in the treatment of primary generalised tonic-clonic seizures: a double-blind, randomised, placebo-controlled trial

2020 ◽  
Vol 91 (10) ◽  
pp. 1067-1075 ◽  
Author(s):  
David G Vossler ◽  
Susanne Knake ◽  
Terence J O'Brien ◽  
Masako Watanabe ◽  
Melissa Brock ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Adjunctive Treatment ◽  
Efficacy And Safety ◽  
Phase 3 ◽  
Double Blind ◽  
Kaplan Meier ◽  
History Of ◽  
Clonic Seizures

ObjectiveTo evaluate efficacy and safety of lacosamide (up to 12 mg/kg/day or 400 mg/day) as adjunctive treatment for uncontrolled primary generalised tonic-clonic seizures (PGTCS) in patients (≥4 years) with idiopathic generalised epilepsy (IGE).MethodsPhase 3, double-blind, randomised, placebo-controlled trial (SP0982; NCT02408523) in patients with IGE and PGTCS taking 1–3 concomitant antiepileptic drugs. Primary outcome was time to second PGTCS during 24-week treatment.Results242 patients were randomised and received ≥1 dose of trial medication (lacosamide/placebo: n=121/n=121). Patients (mean age: 27.7 years; 58.7% female) had a history of generalised-onset seizures (tonic-clonic 99.6%; myoclonic 38.8%; absence 37.2%). Median treatment duration with lacosamide/placebo was 143/65 days. Risk of developing a second PGTCS during 24-week treatment was significantly lower with lacosamide than placebo (Kaplan-Meier survival estimates 55.27%/33.37%; HR 0.540, 95% CI 0.377 to 0.774; p<0.001; n=118/n=121). Median time to second PGTCS could not be estimated for lacosamide (>50% of patients did not experience a second PGTCS) and was 77.0 days for placebo. Kaplan-Meier estimated freedom from PGTCS at end of the 24-week treatment period (day 166) for lacosamide/placebo was 31.3%/17.2% (difference 14.1%; p=0.011). More patients on lacosamide than placebo had ≥50% (68.1%/46.3%) or ≥75% (57.1%/36.4%) reduction from baseline in PGTCS frequency/28 days, or observed freedom from PGTCS during treatment (27.5%/13.2%) (n=119/n=121). 96/121 (79.3%) patients on lacosamide had treatment-emergent adverse events (placebo 79/121 (65.3%)), most commonly dizziness (23.1%), somnolence (16.5%), headache (14.0%). No patients died during the trial.ConclusionsLacosamide was efficacious and generally safe as adjunctive treatment for uncontrolled PGTCS in patients with IGE.

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