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The Disaster of Trans-Radial Intervention Operator: Radial Artery Occlusion and Hand Ischemia.

The Disaster of Trans-Radial Intervention Operator: Radial Artery Occlusion and Hand Ischemia.


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  • 1. The Disaster of TRI Operator:Radial Artery Occlusion and Hand IschemiaShenyang Northern Hospital Wang shouli
  • 2. Duplication of brachial artery (3%)
  • 3. Anomalies of Brachial ArteryIsolatedpersistence High origin High origin Duplicityof the of the of the of themedian artery ulnar artery Radial artery brachial artery R IMU R I U R I U R I U I = common intercosseous artery; M = median artery; R = radial artery; U = Ulnar artery
  • 4. New Procedure – New Complication Amorphous material Possibly polymer Surrounded by chronic Inflammatory cells 30 / 1063 ,2.8% Kozak et al. CCI 2003
  • 5. rates of RAOlocal complications of angiography:1!3%; Angiotheraphy:1!5% (Heintzen MP, Herz. 1998;23:4)RAO:5% (Saito S, et al. Catheter Cardiovasc Interv. 1999 ;46:37 )RAO:5/220,2.2% (Jang-Young Kim,et al.Yonsei Medical J.2005;46:503)8F 14.3%;7F 6.52%;6F 0.43% (Kikuchi, et al.Jpn J Iinterv Cardiol 2000,15:343)
  • 6. Radial Artery Flow During Conventional Hemostasis and Radial Artery Occlusion at Follow-up(7-days) Preserved flow Absent flow P at follow-up at follow-up value (n=246) (n=29)Absent flow before sheath 120(49%) 15(54%) 0.41removalAbsent flow after placing 155(63%) 19(66%) 0.49hemostatic bandagesAbsent flow before removing 132(54%) 26(90%) 0.0001hemostatic bandages(2 hr)Absent flow after hemostatic 34(13%) 15(54%) 0.0001bandages Marcelo Sanmartin,et al. Catheterization and Cardiovascular Interventions 70:185(2007)
  • 7. Radial artery flow was absent in 174 cases (174/275,62%) immediately after entry-site compressionAfter 2 hr of conventional hemostasis, radial artery flow was absent in 162 cases (58%) before bandage removalAt 7-day follow-up, 12 patients (4.4%) had absent pulsations and radial artery flow was absent in 29 cases (10.5%) Marcelo Sanmartin,et al. Catheterization and Cardiovascular Interventions 70:185(2007)
  • 8. &# 30/563 ()*+,-./ 012345+%# 16/563$#"# ()*+,-./ 012345+ Stella PR, et al. Cathet Cardiovasc Diagn. 1997;40:156
  • 9. The clinical symptoms of RAO pain cold sensitivity weaknesstissue death with ulceration and/or necrosis
  • 10. Risk Factors of RAO
  • 11. Naoyuki Yokoyama, et al. Catheter Cardiovasc Interv. 2000 ;49:357
  • 12. Patients with an occluded radial artery at follow-up had significantly smaller arterial diameters at baseline (2.23 60.4 mm vs. 2.4060.5 mm;P=0.032) and more frequently had absent flow during hemostasis (90% vs. 54%, P <0.001) Marcelo Sanmartin,et al. Catheterization and Cardiovascular Interventions 70:185(2007)
  • 13. Stepwise logistic regression analysis revealed that absent flow before compressive bandages removal was the only independent predictor of radial artery occlusion at follow-up (OR 5 6.7; IC 95%: 1.95-22.9; P 5 0.002). Marcelo Sanmartin,et al. Catheterization and Cardiovascular Interventions 70:185(2007)
  • 14. Incidence and risk factors of acute RAO followingtransradial percutaneous coronary intervention Acute RA0 occulted in 68 patients(68/7215,0.94 7). more female and DM patients The dosage of heparine used in the operational procedure in RAO group were significantly less than normal group(3723 IU6556 IU VS 7603 IU61533 IU8P<0.01) The post--procedure duration of high--pressure compression hemostais were longer in RA0 patients than normal patients(103.8 min 6 23.3 min VS 87.7 min631.2min8P= 0.02) Zhou YJ,et al.Natl Med J China, June 12,2007;87:1531
  • 15. Logistic regression analyses showedthat the dosage of heparine used in theprocedure9the category and size ofsheath and the post—procedurecompression time were independentrisk factors for RA0 Zhou YJ,et al.Natl Med J China, June 12,2007;87:1531
  • 16. Treatment andPrevention of RAO
  • 17. RAO surgical treatment David S. Ruch,et al. J Hand Surg 2000;25A:282
  • 18. David S. Ruch,et al. J Hand Surg 2000;25A:282
  • 19. Pre-operation Post- operationDavid S. Ruch,et al. J Hand Surg 2000;25A:282
  • 20. Pre-operation Post- operationDavid S. Ruch,et al. J Hand Surg 2000;25A:282
  • 21. The incidence of RAO can be minimizedby appropriate anticoagulation, propersheath selection, and avoidingprolonged durarion of high-pressurecompression hemostasis following theprocedure Zhou YJ,et al.Natl Med J China, June 12,2007;87:1531
  • 22. Thanks