The Disaster of TRI Operator:Radial Artery Occlusion and       Hand IschemiaShenyang Northern Hospital      Wang shouli
Duplication of brachial artery (3%)
Anomalies of Brachial ArteryIsolatedpersistence       High origin       High origin       Duplicityof the            of th...
New Procedure – New   Complication           Amorphous material           Possibly polymer           Surrounded by chronic...
rates of RAOlocal complications of angiography:1!3%;  Angiotheraphy:1!5% (Heintzen MP, Herz. 1998;23:4)RAO:5% (Saito S, et...
Radial Artery Flow During Conventional Hemostasis    and Radial Artery Occlusion at Follow-up(7-days)                     ...
Radial artery flow was absent in 174 cases (174/275,62%) immediately after entry-site compressionAfter 2 hr of conventiona...
&#      30/563                                    ()*+,-./                                    012345+%#                   ...
The clinical symptoms of RAO                   pain              cold sensitivity                 weaknesstissue death wit...
Risk Factors of RAO
Naoyuki Yokoyama, et al. Catheter Cardiovasc Interv. 2000 ;49:357
Patients with an occluded radial artery at follow-up had significantly smaller arterial diameters at baseline (2.23 60.4 m...
Stepwise logistic regression analysis revealed that absent flow before compressive bandages removal was the only independe...
Incidence and risk factors of acute RAO followingtransradial percutaneous coronary intervention Acute RA0 occulted in 68 p...
Logistic regression analyses showedthat the dosage of heparine used in theprocedure9the category and size ofsheath and the...
Treatment andPrevention of RAO
RAO surgical treatment David S. Ruch,et al. J Hand Surg 2000;25A:282
David S. Ruch,et al. J Hand Surg 2000;25A:282
Pre-operation          Post-        operationDavid S. Ruch,et al. J Hand Surg 2000;25A:282
Pre-operation          Post-        operationDavid S. Ruch,et al. J Hand Surg 2000;25A:282
The incidence of RAO can be minimizedby appropriate anticoagulation, propersheath selection, and avoidingprolonged durario...
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The Disaster of Trans-Radial Intervention Operator: Radial Artery Occlusion and Hand Ischemia.

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  1. 1. The Disaster of TRI Operator:Radial Artery Occlusion and Hand IschemiaShenyang Northern Hospital Wang shouli
  2. 2. Duplication of brachial artery (3%)
  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. 4. New Procedure – New Complication Amorphous material Possibly polymer Surrounded by chronic Inflammatory cells 30 / 1063 ,2.8% Kozak et al. CCI 2003
  5. 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. 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. 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. 8. &# 30/563 ()*+,-./ 012345+%# 16/563$#"# ()*+,-./ 012345+ Stella PR, et al. Cathet Cardiovasc Diagn. 1997;40:156
  9. 9. The clinical symptoms of RAO pain cold sensitivity weaknesstissue death with ulceration and/or necrosis
  10. 10. Risk Factors of RAO
  11. 11. Naoyuki Yokoyama, et al. Catheter Cardiovasc Interv. 2000 ;49:357
  12. 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. 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. 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. 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. 16. Treatment andPrevention of RAO
  17. 17. RAO surgical treatment David S. Ruch,et al. J Hand Surg 2000;25A:282
  18. 18. David S. Ruch,et al. J Hand Surg 2000;25A:282
  19. 19. Pre-operation Post- operationDavid S. Ruch,et al. J Hand Surg 2000;25A:282
  20. 20. Pre-operation Post- operationDavid S. Ruch,et al. J Hand Surg 2000;25A:282
  21. 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. 22. Thanks

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