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.

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 Accuracy of Peak Systolic Velocity of Radial Artery as Predictor of Maturation of Radiocephalic Arteriovenous Fistula in Cipto Mangunkusumo Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 30-33
Author(s):  
Dedy Pratama ◽  
Richard Yehuda Limen ◽  
Akhmadu Muradi
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Peak Systolic Velocity ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Cross Sectional Design ◽  
Stage Renal Disease ◽  
End Stage ◽  
Relationship Of

Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p <0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p <0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p <0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 42 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard. Conclusion: Preoperative PSV >40 cm/s and intraoperative PSV >42 cm/s had a good predictor value for radiocephalic FAV maturation. Keywords: peak systolic velocity, maturation, arteriovenous fistula, radial artery

scholarly journals Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe

2021 ◽  
Author(s):  
Thibaut Jacques ◽  
Charlotte Brienne ◽  
Simon Henry ◽  
Hortense Baffet ◽  
Géraldine Giraudet ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gold Standard ◽  
Ultrasound Guidance ◽  
Ultrasound Guided ◽  
Major Complications ◽  
Incision Size ◽  
Contraceptive Implant ◽  
The Mean ◽  
Contraceptive Implants ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to assess the feasibility, performance, and complications of a non-surgical, minimally-invasive procedure of deep contraceptive implant removal under continuous ultrasound guidance. Methods The ultrasound-guided procedure consisted of local anesthesia using lidocaine chlorhydrate 1% (10 mg/mL) with a 21-G needle, followed by hydrodissection using NaCl 0.9% (9 mg/mL) and implant extraction using a Hartmann grasping microforceps. The parameters studied were the implant localization, success and complication rates, pain throughout the intervention, volumes of lidocaïne and NaCl used, duration of the procedure, and size of the incision. Between November 2019 and January 2021, 45 patients were referred to the musculoskeletal radiology department for ultrasound-guided removal of a deep contraceptive implant and were all retrospectively included. Results All implants were successfully removed en bloc (100%). The mean incision size was 2.7 ± 0.5 mm. The mean duration of the extraction procedure was 7.7 ± 6.3 min. There were no major complications (infection, nerve, or vessel damage). As a minor complication, 21 patients (46.7%) reported a benign superficial skin ecchymosis at the puncture site, spontaneously regressing in less than 1 week. The procedure was very well-tolerated, with low pain rating throughout (1.0 ± 1.5/10 during implant extraction). Conclusions Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, effective, and safe. In the present cohort, all implants were successfully removed, whatever the location, with short procedural time, small incision size, low pain levels, and no significant complications. This procedure could become a gold standard in this indication. Key Points • Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location (even close to neurovascular structures), with only a small skin incision (2.7 ± 0.5 mm). • The procedure was safe, quick, without any major complications, and very well tolerated in terms of pain. • This minimally invasive ultrasound-guided procedure could become the future gold standard for the removal of deep contraceptive implants, as an alternative to surgical extraction, even for implants in difficult locations such as subfascial ones or those close to neurovascular structures.

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.

Distal Transradial “Snuffbox” Approach

2021 ◽  
pp. 23-30
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H. Chen ◽  
Pascal M. Jabbour ◽  
Eric C. Peterson
Keyword(s):  
Radial Artery ◽  
Lower Risk ◽  
Patient Positioning ◽  
Diagnostic Procedures ◽  
Interventional Cardiology ◽  
Neutral Position ◽  
Radial Approach ◽  
Radial Access ◽  
Frequent Use ◽  
Distal Location

The distal radial or “snuffbox” approach is a modification of the traditional radial approach that uses a more distal location of the radial artery for puncture. The radial artery at this location is beyond the palmer arch thus puncturing has a theoretically lower risk of hand or thumb ischemia. In addition, the hand is positioned in the neutral position so it is more comfortable for the patient. Finally, the compression times are shorter so the patient can be discharged earlier after diagnostic procedures. This was originally an interventional cardiology innovation because of the frequent use of left radial access in interventional cardiology, but the approach has benefits for right radial access in neurointervention as well. The patient positioning and technical nuances of the snuffbox approach are reviewed.

Placental Transfer of Vitamin K1 and Its Implications in Fetal Hemostasis

1988 ◽  
Vol 60 (01) ◽  
pp. 039-043 ◽  
Author(s):  
L Mandelbrot ◽  
M Guillaumont ◽  
M Leclercq ◽  
J J Lefrère ◽  
D Gozin ◽  
...  
Keyword(s):  
Vitamin K ◽  
High Performance ◽  
Ultrasound Guidance ◽  
Placental Transfer ◽  
Vitamin K1 ◽  
Vitamin K Deficiency ◽  
Prothrombin Activity ◽  
Oral Supplementation ◽  
K Deficiency ◽  
The Mean

SummaryVitamin K status was evaluated using coagulation studies and/ or vitamin IQ assays in a total of 53 normal fetuses and 47 neonates. Second trimester fetal blood samples were obtained for prenatal diagnosis under ultrasound guidance. Endogenous vitamin K1 concentrations (determined by high performance liquid chromatography) were substantially lower than maternal levels. The mean maternal-fetal gradient was 14-fold at mid trimester and 18-fold at birth. Despite low vitamin K levels, descarboxy prothrombin, detected by a staphylocoagulase assay, was elevated in only a single fetus and a single neonate.After maternal oral supplementation with vitamin K1, cord vitamin K1 levels were boosted 30-fold at mid trimester and 60 fold at term, demonstrating placental transfer. However, these levels were substantially lower than corresponding supplemented maternal levels. Despite elevated vitamin K1 concentrations, supplemented fetuses and neonates showed no increase in total or coagulant prothrombin activity. These results suggest that the low prothrombin levels found during intrauterine life are not due to vitamin K deficiency.

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

2020 ◽  
Vol 3 (2) ◽  
pp. 147-150
Author(s):  
Kaczynski RE ◽  
Asaad Y ◽  
Valentin-Capeles N ◽  
Battista J
Keyword(s):  
Arteriovenous Fistula ◽  
Complete Loss ◽  
Dialysis Access ◽  
Loss Of Function ◽  
Access Site ◽  
Surgical Ligation ◽  
Arteriovenous Access ◽  
Vascular Steal ◽  
Steal Syndrome

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

scholarly journals Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

2021 ◽  
Author(s):  
Navarat Vatcharayothin ◽  
Pornthep Kasemsiri ◽  
Sanguansak Thanaviratananich ◽  
Cattleya Thongrong
Keyword(s):  
Confidence Interval ◽  
Maxillary Sinus ◽  
Inferior Turbinate ◽  
Radial Access ◽  
Sinus Wall ◽  
Nasal Floor ◽  
Significant Difference ◽  
Anterolateral Wall ◽  
The Mean ◽  
Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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