Comparison of Safety and Efficiency between Tiger-2 Catheter with Right Radial Artery Access and Judkins Catheter with Left Radial Artery Access

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.

The importance of a lifeboat-median artery forearm flap in Goldenhar Syndrome

We present a case of a 32-year-old male with left-sided Goldenhar Syndrome and delta phalanx of the thumb, who was offered free tissue transfer from the forearm to address an intra-oral soft tissue deficiency. Despite the presence of appropriately developed right radial artery, used in previous facial reconstruction, the left radial artery occurred to be hypoplastic. He ultimately underwent free flap transfer based on the anomalous persistent left median artery. We suggest that in face of an unusual hand anatomy, flexible flap creation techniques that allow a lifeboat strategy of adjusting flap design should be considered preoperatively. Level of evidence: Level V, therapeutic study.

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.

Peripheral embolism as first and only clinical symptom of a true aneurysmal degeneration of the radial artery after ligation of a radiocephalic fistula

True aneurysmal degeneration of the inflow artery after arteriovenous fistula ligation is extremely rare. Pain is the most common symptom and surgical treatment by an autologous venous bypass is considered as the treatment of choice with good long-term results. We present a patient with peripheral embolism as first and only symptom leading to the diagnosis of a true aneurysmal degeneration of the entire left radial artery. It was discovered 5 years after the ligation of his radiocephalic fistula. As illustrated by this case, a conservative treatment by antiplatelet and anticoagulation therapy should be considered a satisfying alternative to the standard bypass surgery in patients with anatomical variations (e.g. an incomplete arterial palmar arch) since the latter include a higher risk of postoperative ischemic complications.

Anesthetic Management of A Giant Abdominal Aneurysm Monitored with The Flo-TracTM/Vigileo System

Background: The Flo-TracTM/Vigileo system (Edwards Lifesciences, Irvine, CA, USA) can be used to estimate cardiac output and stroke volume variation for giant abdominal aortic aneurysm (AAA). Case Presentation: A 60-year-old male patient presented with a thrombosed abdominal aortic aneurysm approximately 8.8 x 8.4 cm in size. The patient was scheduled to undergo open repair. The left radial artery was punctured to monitor direct arterial pressure, stroke volume, cardiac output, and SVV. A Flo-TracTM sensor (Edwards Lifesciences, Irvine, CA, USA) was connected to the arterial monitor system. The aneurysm was opened and longitudinally incised. A total of 600 ml of blood in the aneurysm was drained, and mural thrombi were removed. The graft was proximally anastomosed to the pararenal abdominal aorta. The distal potion of the graft was anastomosed to the iliac bifurcation. The clamping time was 62 min. The CO and SVV measured by the Flo-TracTM sensor were 4.2 L/min and 8%, respectively. Conclusions: We report a case of giant AAA where intravascular volume control was obtained by CO and SVV, which were monitored by a Flo-TracTM/Vigileo system.

Recreational cannabis use causing non-ischaemic cardiomyopathy and cardioembolism in a young adult

Cannabis is one of the most common illicit drugs and has been implicated with various complications which include stroke, acute myocardial infarction, arrhythmia and limb arteritis. We are reporting a case of a young man, who is a recreational cannabis smoker along with tobacco, who developed exertional progressive breathlessness for the last 4 months, mild cough for 2 months and acute left-sided hemiparesis along with ipsilateral facial palsy for 1 day that was attributed to an acute right middle cerebral artery territory infarct. There was also gangrene in his left forearm as a result of left radial artery thrombosis. Non-ischaemic-dilated cardiomyopathy was found in contrast-enhanced cardiac MRI and he was managed in the line of decompensated heart failure; the right-hand gangrene was later amputated in the subsequent follow-ups. Hence, cannabis can lead to cardiomyopathy and resulting cardioembolism. The mainstay of management remains supportive and avoidance of the offending agent. Social education is the need of the hour.

Rare case of radial artery pseudoaneurysm protruding through skin after a single arterial puncture for blood-gas analysis

The pseudoaneurysm of the radial artery is an infrequent complication mainly after iatrogenic procedures, with an increased incidence over the last years. The aim of the current study was to present a rare case of a radial artery pseudoaneurysm that projected through the skin after a single arterial puncture for blood-gas analysis. A 79-year-old man, with a history of atrial fibrillation and coronary heart disease on anticoagulants, was admitted to the cardiological intermediate care unit, with pulmonary oedema due to heart failure deregulation. On the next day, his left radial artery was punctured for blood-gas analysis. No other catheterization of the vessel was executed in the following days. Six days later a pulsatile, palpable mass on the skin surface, over the site of puncture, was recognized. Subsequently a Doppler ultrasound that was performed, confirmed the diagnosis of pseudoaneurysm. The pseudoaneurysm was surgically removed under general anesthesia. The patient was hospitalized for four days for trauma monitoring and intravenous antibiotics and afterwards he was discharged from the Hospital. Three months postoperatively, no sign of recurrence was observed. The pseudoaneurysm of the radial artery is an uncommon complication that might occur even after simple iatrogenic procedures, like after a direct arterial puncture for blood-gas analysis. Therefore, specialists should always be aware of this complication in similar cases.

Long Radial Sheath for Angiography of Femoral Artery Large Sheath Access Site with Vascular Closure Devices

Radial access combined with hemodynamic support has the limitation of not allowing adequate angiography or delivery of peripheral balloons for managing the femoral access site after removal of the large femoral sheath. We present a case series with use of a novel long 6 French guiding sheath via left radial artery access for angiography of the femoral access site after removal of a large sheath for left ventricular assist device with vascular closure devices.

Transradial Access: A Comprehensive Review

Transradial access (TRA) via the left radial artery is an alternative to traditional transfemoral access for catheter-based procedures that is becoming increasingly more relevant in all types of arterial vascular interventions. First investigated in the realm of cardiology, TRA has been proven to provide many benefits (such as lower complication rates, lower cost, and improved patient comfort during and after the procedure) when compared with traditional femoral access while maintaining efficacy. This article provides an in-depth summary of the technical aspects of radial access while incorporating more recent data to explain patient preference for TRA, and the ways that TRA can improve peri-procedure workflow and compensation. It also describes potential complications, such as radial artery spasm, difficult anatomic variants and radial artery occlusion, and then gives techniques for mitigating and treating these complications. The article explains why TRA has become an important option for vascular and interventional radiology physicians, and why it is likely that this will continue to grow in relevance.