T Ransradial Peripheral Vascular Intervention Using Fowler’s Position and Terumo R2P System for Patients With Heart Failure

BackgroundPositioning a patient on the catheterization table is important for proper cardiac or respiratory function during peripheral vascular interventions (PVIs). Fowler’s position, where the patient’s head is a 45-degree angle, is more effective in reducing venous blood volume returning to the heart from the periphery compared to the supine position. The Terumo R2P® system has been developed for transradial PVI.Case presentationTwo patients with heart failure (HF) underwent lower-extremity PVI in Fowler’s position to prevent worsening HF. Because their head position was opposite the C-arm of the X-ray machine, the left radial artery was selected as the access site. The Terumo R2P® system was used for transradial PVI. We successfully treated superficial artery diseases with long shaft balloons and rapid-exchange Terumo R2P® Misago® stents. ConclusionsAlthough lower-extremity PVI using Fowler’s position and the Terumo R2P® system has several limitations, including device availability and technical complexity, it may be effective for particular patients who have higher risk of worsening HF in the supine position.

A LITERATURE STUDY TO UNDERSTAND PHYSIOLOGY OF PRE VENEPUNCTURE-POSITION OF LEGS W.S.R TO SUSHRUT SAMHITA

Position of a patient in surgical procedures, clinical examinations is an important assisting factor. Position of patient in minor and major surgical procedures is mentioned in ayurveda as well as modern surgery. One of such position is mentioned in Sushrut samhita sharirsthan chapter 8 and shloka number 8. This reference is about siraa utthaan before siravedh / venepuncture / bloodletting procedure. Before this procedure a position is given to patient by doctor. This study is about review of physiological changes in venous blood flow due to position of legs, use of bandhan [like tourniquet], location of bandhan from venepuncture site and effect of these techniques on veins and venous blood volume. Vein should be prominent and full of blood [sira utthaan] i.e., expected before bloodletting treatments/procedures. Keywords: sira vedh, veins in legs, venous blood volume in legs, sira utthaan, bloodletting in legs

Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound

Cerebral venous drainage in humans is thought to be ensured mainly via the internal jugular veins (IJVs). However, anatomic, angiographic, and ultrasound studies suggest that the vertebral venous system serves as an important alternative drainage route. We assessed venous blood volume flow in vertebral veins (VVs) and IJVs of 12 healthy volunteers using duplex ultrasound. Measurements were performed at rest and during a transient bilateral IJV and a circular neck compression. Total venous blood volume flow at rest was 766 ± 226 ml/min (IJVs: 720 ± 232, VVs: 47 ± 33 ml/min). During bilateral IJV compression, VV flow increased to 128 ± 64 ml/min. Circular neck compression, causing an additional deep cervical vein obstruction, led to a further rise in VV volume flow (186 ± 70 ml/min). As the observed flow increase did not compensate for IJV flow cessation, other parts of the vertebral venous system, like the intraspinal epidural veins and the deep cervical veins, have to be considered as additional alternative drainage pathways.