Abstract 315: Feasibility of Arteriovenous Fistula Creation After Previous Radial Artery Harvesting for Aortocoronary Bypass

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Nicholas J Gargiulo
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Ulnar Artery ◽  
Aortocoronary Bypass ◽  
Palmar Arch ◽  
Sestamibi Scanning ◽  
Preoperative Work Up ◽  
Work Up ◽  
Forearm Muscle ◽  
Steal Syndrome

Background: Arteriovenous fistula (AVF) formation remains the procedure of choice in patients requring hemodialysis. The feasibility of AVF creation in the setting of prior radial artery harvesting after aortocoronary bypass remains unknown. This investigation elucidates which patients might be candidates for AVF creation despite prior radial artery harvesting. Methods: A retrospective review was performed on 2,100 patients undergoing hemodialysis access procedures from 2003 to 2010. Of these patients, 11 (0.5%) were identified as having prior radial artery harvesting for aortocoronary bypass. Pre/Post-operative vein mapping, arterial duplex, digital plethysmography, selective angiography, and sestamibi scanning was performed to evaluate the ulnary artery and palmar arch. Patients with evidence suggesting an intact ulnar artery circulation then underwent AVF creation. Results: All 11 patients had an adequate preoperative work up. Seven (64%) of the 11 patients had digital plethysmography suggesting an intact ulnar artery/palmar arch and underwent successful AVF creation. Three (27%) of the patients had a variety of findings precluding successful AVF creation. One (9%) patient with normal preoperative plethysmography developed a steal syndrome requiring revision of the arteriovenous fistula. Conclusions: Successful AVF creation is feasible in patients with prior radial artery harvesting for aortocoronary bypass. The use of preoperative digital plethysmography, selective ulnar artery/palmar arch arteriography and sestamibi scanning to evaluate forearm muscle perfusion may be used as adjuncts to guide a successful intervention.

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

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.

scholarly journals AN ANATOMICAL STUDY OF SUPERFICIAL PALMAR ARCH IN WESTERN RAJASTHAN POPULATION

2020 ◽  
pp. 1-2
Author(s):  
Leena Raichandani ◽  
Dinesh Kumar ◽  
Sushma Kushal Kataria
Keyword(s):  
Radial Artery ◽  
Anatomical Study ◽  
Ulnar Artery ◽  
Palmar Arch ◽  
Variable Contribution ◽  
Palmar Aponeurosis ◽  
Median Artery ◽  
Arteria Princeps Pollicis ◽  
Arteria Radialis Indicis ◽  
Distal Border

The supercial palmar arch is an anastomosis formed mainly by the Ulnar artery with variable contribution from branches of radial Artery. It passes medial to the hook of the hamate, then curves laterally to form an arch that is convex distally and level with a transverse line through the distal border of the fully extended pollicies base. About a third of the supercial palmar arches are formed by the ulnar artery alone; a further third are completed by the supercial palmar branch of the radial artery; and a third by the arteria radialis indicis, a branch of either arteria princeps pollicis or the median artery. The supercial palmar arch is covered by palmaris brevis and the palmar aponeurosis and it is supercial to exor digiti minimi, branches of the median nerve and the long exor tendons and lumbricals.

Snuff box radial artery access for arteriovenous fistula intervention

2019 ◽  
Vol 21 (2) ◽  
pp. 237-240
Author(s):  
Jeffrey Hull ◽  
Stephanie Workman ◽  
Jean Isabell Heath
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Ultrasound Guidance ◽  
Neutral Position ◽  
Extensor Pollicis Longus ◽  
Radial Access ◽  
Major Complications ◽  
The Mean ◽  
Steal Syndrome

Purpose: The aim of this article is to retrospectively compare snuff box radial artery access with direct fistula access for radiocephalic fistula intervention. Materials and Methods: Review of 68 consecutive radiocephalic interventions between April 2013 and April 2017 was performed. The snuff box radial access was performed under ultrasound guidance with the hand in a neutral position (thumb up). The snuff box radial artery was entered distal to the extensor pollicis longus, over the trapezium bone. Hand held pressure was applied for hemostasis. The procedure times, success, and complications of snuff box radial artery access procedures were reviewed. Results: Snuff box radial artery access was used in 25% (17/68) of radiocephalic fistula interventions. All access procedures were successful. Snuff box radial artery access was only used in cases involving the proximal fistula. Lesions treated from snuff box radial artery access approach included 19% (10/54) of fistula stenosis, 50% (1/2) thrombosis, 63% (5/8) immature fistulae, 100% (1/1) steal syndrome, and none of the (0/5) symptomatic outflow occlusions. The mean procedure times for snuff box radial artery access and direct fistula access were not significant at 29.1 ± 16.3 min (range = 10–81) and 26.8 ± 14.0 min (range = 5–70), respectively (p < 0.57). Minor hematoma occurred in 12% (2/17) snuff box radial artery access and 2% (1/51) direct fistula access. There were no major complications. Conclusion: Snuff box radial access was used successfully for radiocephalic fistula intervention with procedure times similar to direct fistula access without major complications.

Patterns of Arterial Arcades of the Superficial Palmar Arch: A Study In Embalmed Cadaver Palms

2021 ◽  
Vol 9 (3.3) ◽  
pp. 8097-8102
Author(s):  
Suman Udupi ◽  
◽  
Pushpa Gowda ◽  
Keyword(s):  
Radial Artery ◽  
Index Finger ◽  
Ulnar Artery ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Artery Cannulation ◽  
Complete Type ◽  
Cardio Vascular ◽  
Interesting Area

Background: The complex and variable pattern of the arterial arcades of the palm form an interesting area of study anatomically and surgically. In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Different patterns of the arterial arcades of the superficial palmar arch are normally encountered during routine anatomical dissections of the palm which needs to be emphasized and highlighted for a desired surgical out come during microvascular reconstructive surgeries of the palm and during radial artery cannulation. Context: With technological advancements in microsurgical procedures of the hand, fields of anatomical interest like the classification of arterial arcades of the palm, now becomes essential for operating vascular surgeons for a desired surgical outcome Purpose of the study: The present study was taken up to analyze and document varying patterns of the arterial arcades of the superficial palmar arch. Methods and Material: the study was conducted by dissecting 70 randomly obtained formalin fixed cadaver palms. Results: In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Out of the 70 hands, incomplete arches were found only in 8 hands with an incidence of 11.4%. Conclusion: Knowledge of arterial pattern of the hand is very important to vascular and reconstructive surgeons for effective treatment of injuries of the hand. Such a knowledge of the disposition of the arterial arcades of the palm also enables cardio-vascular surgeons to plan and modify surgical procedures such as radial artery harvesting, cannulation and in preventing the ischemia of hands in such procedures. KEY WORDS: Superficial palmar arch, Arterial arcades, Complete arch, Incomplete arch.

Endovascular management of critical hand ischemia by ‘palmar arch loop’ technique

Vascular ◽  
2020 ◽  
pp. 170853812096693
Author(s):  
Amit Singh ◽  
Neeraj Kumar ◽  
Ajitesh P Jain ◽  
Rakesh Verma ◽  
Vinay Krishna
Keyword(s):  
Radial Artery ◽  
Ulnar Artery ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Endovascular Management ◽  
Technical Success ◽  
Palmar Arch ◽  
Technical Success Rate ◽  
Hand Ischemia ◽  
Loop Technique

Introduction Critical hand ischemia with advancing gangrene of digits requires urgent intervention to salvage as much tissue as possible. The purpose of this study was to evaluate the efficacy of “palmar arch loop” technique for endovascular management of critical hand ischemia by establishing inline flow to the palmar arch via both radial artery and ulnar artery, in patients with failed antegrade recanalization. To the best of our knowledge, this is the first case series evaluating the efficacy of “palmar arch loop” technique, with retrograde percutaneous transluminal angioplasty of the involved radial artery and/or ulnar artery. Material and methods We retrospectively investigated 10 patients (60% female; mean age 42 ± 18 years; mean time of presentation post-acute event 24 ± 11 days) with critical hand ischemia undergoing endovascular intervention using “palmar arch loop” technique at a single center in northern India between April 2017 and March 2019. All patients were followed up at regular intervals (weekly for a month, fortnightly for 3 months, and then at 6 and 12 months) with clinical assessment and SpO2 measurement. Study end points were technical success rate, hand healing, and primary patency rate at one year. Results Causes for critical hand ischemia were iatrogenic injuries due to inadvertent intra-arterial injection in 50% ( n = 5) and thromboembolic events in 50% patients ( n = 5). Vessels involved were: both radial artery and ulnar artery along with the PA in 50%; radial artery and palmar arch in 30%; ulnar artery and palmar arch in 20%. All of them had total occlusion of the involved vessel (>2/3rd of total length) with occlusion/diffuse disease of palmar arch as well; 70% technical success rate was achieved ensuring inflow to palmar arch via both the arteries with improved flow distally to the common and proper digital arteries. Retrograde percutaneous transluminal angioplasty of radial artery in 50% ( n = 5) and ulnar artery in 20% ( n = 2) was done successfully by looping the guidewire across the palmar arch; 90% showed subjective improvement in pain with healing of the lesions and/or formation of clear line of demarcation with reversal of pregangrenous changes proximally. Out of the eight patients with gangrene of fingers, three underwent minor amputation of the gangrenous digits and five underwent auto-amputation of the gangrenous tissue with complete healing of the stump. Primary patency rate was 85.7% at one year. There was no access site-related complication or mortality in the follow-up period. Conclusions Endovascular management of critical hand ischemia by “palmar arch loop” technique is an efficient technique to deal with occluded forearm vessels, particularly when antegrade recanalization fails. This technique, with good technical success and patency rates, is potentially a unique tool in the endovascular armamentarium for salvaging hand.

Proximal Ulnar Artery Arteriovenous Fistula Inflow is an Uncommon but useful Vascular access Option

2017 ◽  
Vol 18 (6) ◽  
pp. 488-491 ◽  
Author(s):  
William C. Jennings ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Ulnar Artery ◽  
Allen’S Test ◽  
Brachial Vein ◽  
Anatomic Variants ◽  
Allen's Test ◽  
Doppler Evaluation

Introduction A proximal ulnar artery arteriovenous fistula (PUA-AVF) is a logical vascular access option when the distal ulnar artery is occluded or inadequate in addition to other specific vascular anatomic variants. This study reviews a series of patients where the proximal ulnar artery was used for AVF inflow in establishing a reliable autogenous access for these uncommon patients. Materials and methods All new patients referred for vascular access with a PUA-AVF created during an eight-year period were evaluated. In addition to physical and ultrasound examinations, all patients had an Allen's test performed augmented with Doppler evaluation of the palmer arch. Analysis placed these patients into three anatomic groups: 1) A dominant radial artery with distal ulnar artery occlusive disease; 2) No cephalic or basilic vein option with an isolated and intact brachial vein originating from the ulnar vein for later staged transposition; 3) A proximal radial artery ≤2 mm in diameter and a normal Doppler augmented Allen's test. Results PUA-AVFs were created in 32 new patients during an eight-year period. Primary and cumulative patency rates were 80% and 94% at 12 months and 55% and 81% at 36 months. Follow-up was 2-62 months (mean 14 months). No patients developed steal syndrome during the study period. Conclusions A PUA-AVF is a safe and reliable autogenous access. It is particularly important when the radial artery is the only or dominant arterial supply to the hand, in patients with small but patent radial arteries, and in selected individuals requiring a brachial vein transposition.

scholarly journals VARIATIONS OF THE SUPERFICIAL PALMAR ARCH: A CLINICO-ANATOMICAL CONSIDERATION

2020 ◽  
Vol 8 (4.2) ◽  
pp. 7817-7822
Author(s):  
Pooja Dawani ◽  
◽  
Anita Mahajan ◽  
Sabita Mishra ◽  
Neelam Vasudeva ◽  
...  
Keyword(s):  
Radial Artery ◽  
Blood Supply ◽  
Myocardial Revascularization ◽  
Ulnar Artery ◽  
Vital Role ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Human Cadavers ◽  
Median Artery ◽  
Digital Caliper

Introduction: The superficial palmar arch plays a vital role in the blood supply to the hand. The knowledge of variations in the pattern of superficial palmar arch and its branches, and caliber of these arteries, has become more important for surgeons in reconstructive hand surgeries and radial artery harvesting for myocardial revascularization. The aim of this study was to observe the variations and measure the diameter of contributing arteries of the arches. Materials and methods: In the present study, thirty hands from formalin fixed adult human cadavers were dissected. Normal pattern as well as variations in the arteries contributing to the arch, completeness of arch, and the branching pattern were observed and noted. With the help of a digital caliper, the diameters of ulnar and radial arteries and median artery were taken at the level of the wrist and statistical analysis of the results was done. Results: It was observed that in 96.7 % cases, the superficial palmar arch was complete where there was anastomosis between the arteries forming the arch. In 3.3% cases, the arch was incomplete. The complete arch was divided into radioulnar (36.7%), ulnar (56.7%) and medianoulnar (3.3%) types. The diameter of superficial palmar branch of radial artery was found to be significantly less than the diameter of ulnar artery. (p=0.003). Conclusion: The data obtained on variations and morphometry of superficial palmar arches will certainly be useful in planning and choosing appropriate and safe surgical procedures to prevent inadvertent outcome. KEY WORDS: Palmar arch, blood supply, Hand, radial artery, myocardial revascularization.

scholarly journals Dialysis Access-Associated Steal Syndrome with Percutaneous Endovascular Arteriovenous Fistula Creation.

2021 ◽  
Author(s):  
Rakesh Varma ◽  
Manuel Betancourt-Torres ◽  
Eric Bready ◽  
Alian Al-Balas
Keyword(s):  
Risk Factors ◽  
Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Ulnar Artery ◽  
Renal Dysplasia ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Vessel Occlusion ◽  
Flow Through ◽  
Steal Syndrome

Abstract Background: Dialysis access-associated steal syndrome is an infrequent complication after hemodialysis access creation. Clinical symptoms depend on the degree of steal. Mild symptoms include coldness, numbness and pain during dialysis. Severe steal can present with rest pain, cyanosis and ulcerations, and may require surgical ligation of the fistula. With recent advances in arteriovenous fistula creation, percutaneous endovascular arteriovenous fistula creation has demonstrated better maturation and patency rates with lower risk of wound healing and infection rates as compared to surgically created hemodialysis access. Percutaneous creation offers a minimally invasive alternative, though complications have been reported. The following presents the first described case of DASS following the use of percutaneous endovascular arteriovenous fistula creation, and discusses risk factors and management. Case Presentation: Our case is that of a 27-year-old male with end stage renal disease due to congenital renal dysplasia, who underwent left percutaneous arteriovenous fistula creation for initiation of dialysis. Two months after the procedure the patient complained of coldness, pain, tingling, and numbness in the left arm during dialysis, concerning for steal syndrome. The patient subsequently underwent brachial artery angiogram, which showed predominant flow through the fistula and minimal antegrade flow through the ulnar and interosseous arteries towards the hand, with a focal, severe stenosis in the distal ulnar artery. Angioplasty of the stenosis was performed, though steal symptoms continued. Conclusions: DASS, though rare, can be seen with percutaneous arteriovenous fistula creation. Identification of the risk factors prior to creation, especially in patients who are at higher risk of peripheral vascular disease, can help avoid this complication. Management is largely guided by clinical presentation. As long as there is adequate collateral supply to the extremity, single vessel occlusion is not a contraindication to percutaneous arteriovenous fistula creation with the use of WavelinQ technology. Careful patient selection with pre-creation angiogram may reduce the risk of symptomatic steal.

scholarly journals SIMULATION ANALYSIS OF BLOOD FLOW IN ARTERIES OF THE HUMAN ARM

2017 ◽  
Vol 29 (04) ◽  
pp. 1750031 ◽  
Author(s):  
Wu Quanyu ◽  
Liu Xiaojie ◽  
Pan Lingjiao ◽  
Tao Weige ◽  
Qian Chunqi
Keyword(s):  
Radial Artery ◽  
Human Body ◽  
Simulation Analysis ◽  
Fluid Model ◽  
Ulnar Artery ◽  
Basic Structure ◽  
Circulation System ◽  
Imaging Data ◽  
Palmar Arch ◽  
Left Hand

Arteries in the upper limb play important roles in the circulation system of the human body. In particular, the radial artery has received considerable attention in traditional Chinese medicine for thousands of years. Here, a 3D model for the arm arteries has been created uncomplicated, in a Chinese adult’s left hand, from the magnetic resonance imaging data, using professional modeling software to restore the basic structure of the arm artery in human body, before being imported to Ansys software for simulation. Blood model has been only simulated, and using the blood density of constant parameter and viscosity using the Carreau fluid model, and using viscous-laminar model of Fluent to obtain the velocity profile, static pressure and shear stress in the brachial, interosseous, ulnar, radial and palmar arch arteries. In particular, the brachial and bifurcations have the high pressure and velocity profiles. The simulation results obtained here are also validated by those published in the literature and proved the ulnar artery prevails over the radial artery as a blood supplier to the vessels in the wrist and hand.

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