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50-year-old woman, was brought to the hospital on September 17, 1973, along with her severed right forearm which had been completely amputated by machine approximately 30 minutes prior to admission.Replantation was performed by bone fixation, arterial and vein anastomosis, nerve suture, tendon and muscle suture and skin covering.On the 14th postoperative day, reconstructed radial artery occured rupture. Ruptured radial artery was restored with autovein-graft immediately.But on the postoperative 21th day, the patient had died with acute hepatitis.Histological finding of the ruptured arterial wall showed infected change.

The rupture of a saccular aneurysm during a direct attack can led to a disastrous result unless deep hypotension has been induced before the dissection. If the mean pressure recorded through a microcatheter introduced into the radial artery is at 30 mm Hg level or below the rupture remains circumscribed and the operative field can be dried easily with adjustable suction wherever the situation of the rupture may be. This technique was used in 52 cases with the operative microscope which enables, a clear vision of the lesion and of its vicinity. The mortality was 2, or 3.8%, in spite of 34 operative ruptures.

Seven cases of necrosis of the skin proximal to the site of radial-artery cannulation are described, a frequency of about 3%. Histological, anatomical, and radiological investigations suggested that the arterial blood-supply closely proximal to the usual site for radial-artery cannulation makes this site unsuitable for such a purpose. Application of a modified technique has avoided this complication in a further fifty consecutive cannulations.

In an asymptomatic 38 year old man, an abnormal mediastinal density was due to kinking of the aortic arch. A delay in the systolic peak of the femoral pulse compared to that of the radial pulse aided in making the correct diagnosis. Indirect pulse tracings taken simultaneously from the femoral and the right radial arteries revealed that the delayed femoral pulse was due to a longer systolic build-up time in the femoral artery than in the radial artery. The onset of the up-stroke was simultaneous in both arteries as in normal persons. An aortogram demonstrated narrowing of the aortic lumen at the site of the kink. Direct intraaortic pressure measurements revealed identical peak systolic pressures in the aortic arch and in the descending aorta distal to the kink.

Venous blood from the dorsal surface of the hot hand of 23 conscious patients was analyzed by micromethods. The pH, Pco2, Po2 and derived oxygen saturation were compared with those of blood taken from the radial artery; significant differences were found. Arterialized venous blood may be regarded as arterial blood with a venous admixture which in this series averaged about 11 per cent of the total flow through the hand. For clinical measurements of Pco2 and pH, arterialized venous blood may provide an adequate estimate. It appears to be of little use as a measure of arterial Po2 or oxygen saturation.

'tr3 increasing number of articles in the medical literature on cerebrovascular isease and its t rea tment reflects the interest of neurosurgeons and vascular surgeons in this problem.2.3.5, s-~ 0 I t is apparent , however, from the methods of ~rteriography described, tha t an entirely satisfactory method of visualizing the cerebrovascular circulation and origin of the cerebral vessels has not as yet been evolved. Demonstrat ion of the entire vascular tree is as important in the pat ient in whom a bleeding aneurysm is suspected, as in one with evidence of cerebrovascular insufficiency. The method tha t we wish to present has proved to be useful and is not complicated. I t has the advantage of giving the maximum amount of informatior, with a minimal number of needle punctures. Figs. 1 and ~ are representative of the roentgenograms tha t are obtained by this method of catheterization. From April 15, 1960, until June ~7, 1961, 103 patients were studied. There was a failure to introduce the catheter in 5 additional patients. In ~ of these 5 cases we subsequently visualized the carotid systems by direct percutaneous injection of t typaque. A brief review of previous methods tried reveals tha t many of the modifications were described after the excellent article by Fisher 6 appeared. Prior to this article, attempts at ar ter iography were directed primarily toward the intracranial circulation. However, after his article, most investigators modified their technique to demonstrate the common carotid ar tery at its bifurcation. At the present t ime most examiners feel that the vessels contributing to the cerebral circulation should be demonstrated from the aorta outward, and a t tempts are now being made a t what may be described as " total cerebral angiography." In 1947, Radner 1I described a method of catheterizing the vertebral ar tery via the radial artery, but this method was never generally accepted. In 1953, Seldinger 12 described a method of aor tography via the femoral artery. His method of passing the catheter over a springsteel guide wire was quickly accepted and adapted to the particular vessel in which the investigator was interested. Sheehan et al. TM used Seldinger's technique to pass a catheter through the brachial ar tery into the innominate ar tery on the right and subclavian ar tery on the left. They were able to obtain excellent visualization by this method. Kuhn 7 and Gurdjian TM have advocated brachial arteriography, but do not use

The upstroke time ratio is based on the relationship in duration and contour of the central and peripheral artery pressure curves. Although differing in contour, the normal central and peripheral arterial pulses show a constant relationship in the duration of their upstroke slopes. This relationship is altered by aortic valve and left ventricular outflow abnormality. The upstroke time ratio measures this difference and can, therefore, be used to differentiate between aortic and subaortic valvular stenosis. It is expressed as Radial artery corrected upstroke time Central aorta corrected upstroke time All studies were made during diagnostic cardiac catheterizations. Patients with involvment of any valve other than the aortic were not included in this study. The upstroke time ratio results were as follows: 12 normal subjects, 0.50 to 0.70; 12 with rheumatic aortic valvular stenosis, 0.80 to 0.87; 5 with congenital (bicuspid) valvular stenosis, 0.68 to 0.77; 4 with aortic subvalvular ring, 0.54 to 0.63; and 3 with idiopathic hypertrophy of left ventricular outflow tract, 1.0 to 1.2. The upstroke time ratio is useful in differentiating between aortic and subaortic stenosis and in diagnosing idiopathic hypertrophy with a subaortic fibrous stenosis. Other differential hemodynamic findings are mentioned.

One hundred and five percutaneous radial-artery cunnulations were prospectively studied in 100 patients. The patients were examined daily for complications, utilizing physical examination and Doppler flow measurements. Forty of the 105 cannulations (38 per cent) resulted in radialartery thrombosis.

Fifty-one patients with renal failure underwent construction of arteriovenous fistulas at the University of Utah Medical Center and the Salt Lake Veterans Administration Hospital during the last three years and have been maintained on hemodialysis using these fistulas. Forty-three of the patients had arteriovenous fistulas at the wrist level (radial artery) with several failures, primarily from clotting. Eight patients had fistulas at the elbow level (brachial artery) and in two of these patients neurovascular complications developed which were confined to the forearm and hand in the extremity with the fistula. The neurovascular problems were characterized by pallor, paresthesias, pain, weakness, and muscle atrophy in the forearm and hand. These complications were reversed rapidly by surgical correction of the fistula which restored normal circulation to the extremity.

Digital flow, digital artery systolic pressure, resistance, pulse volume, pulse contour, and delay between right and left pulses were evaluated in the upper extremities of four patients with the subclavian steal syndrome. Studies were made preoperatively in all patients and following surgical reconstruction of the subclavian in three cases. Digital artery pressures were consistently lower on the side with the subclavian occlusion. Flow on the occluded side was equal to or higher than that in the opposite extremity except when a second, more distal occlusion was present. In each case there was a delay in the foot of the digital pulse on the occluded side and a more marked delay in the pulse peak. Distal to the occlusion the pulse amplitudes were decreased and the contours were abnormal. The amplitude of the digital pulse was markedly decreased with exercise of the affected extremity. The pulse delay and the disappearance of pulse in the radial artery during exercise previously described clinically has been confirmed by measurement.

Dynamic characteristics of the response of arterial O2 tension (Pao2) to supine submaximal leg exercise were studied in 7 physically active young men. Pao2 was recorded continuously in the radial artery at the wrist; work load was varied sinusoidally between the extremes of 250 and 1050 kpm/rnin with periods of 0.75, 1.5, 3.0, and 7.0 min. Time-averaging harmonic analysis showed a clear dominance of the fundamental component over the second and third harmonics in the Pao2 response, indicating approximately linear properties of the underlying system within the work-load region studied. The transfer function for PaO2, exhibiting the characteristics of a variable regulated within narrow limits in the steady-state condition, indicated that the basic response of PaO2 to a change in work load is a transient change in the opposite direction preceded by a pure time delay. Resonance occurred for work-load periods near 3.0 min (peak-to-peak deviations approaching 14 mm Hg). Referring Pao2 changes to blood entering the left heart, the estimated time delay before a change in work load resulted in a change in Pao2 amounted to 15 sec. The existence of a resonance is interpreted in terms of an unbalance between factors determining O2 uptake from, and supply to, the alveolar space.

Evans blue dye was injected at a constant rate into the right ventricle or pulmonary artery of 17 subjects in 21 experiments. The consequent arterial dilution patterns were recorded continuously by a cuvette oximeter connected to an indwelling needle in the radial artery. From these dilution patterns the amount and concentration of dye in the intravascular space between the injecting and sampling sites were determined when an equilibrium concentration was attained. From these dimensions the "central vascular volume" was calculated. The values for the central vascular volume thus derived showed agreement with those determined in near-simultaneous estimations by Hamilton's modification of Stewart's method. The values for the "lung blood volumes" by the Newman method in these subjects were systematically smaller than the values for the central vascular volume.

1. The pressure at the surface of a segment of forearm enclosed in a plethysmograph was abruptly raised from atmospheric level to +40 mm Hg, held at the new level for 4 sec, and abruptly dropped to atmospheric level. 2. Forearm circumference (Vf) equivalent to the volume of a small segment of forearm, was monitored with a mercury-in-rubber strain gauge. Pressure was measured in the cylinder (Pp) in veins exposed to external compression (Pv, e), and in the radial artery exposed to compression (Pra). 3. Forearm blood flow was measured by venous occlusion plethysmography before, and after, release of external compression. There was, on average, over the 3rd and 4th second after release of pressure, a 2·4-fold increase of inflow, as compared with resting level. 4. By the 15th second after release of compression, forearm blood flow had returned to its previous resting level. 5. The increase in blood flow after compression appears to be due to active reduction in vascular resistance, for refilling of the arteries and arterioles would be completed before the increased flow was recorded; venous backflow can be excluded, and the pressure difference for flow (arterial minus venous) is virtually unchanged.

Barr P.-O. Percutaneous puncture of the radial artery with a multipurpose Teflon catheter for indwelling use. A Teflon catheter assembly is described, which was designed for percutaneous insertion and indwelling use in the radial artery, and in other superficial blood vessels with calibers of a similar order of magnitude. The advantages of the instrument, which may also be used for percutaneous puncture of other superficial tissues and organs, are reported and discussed, especially with regard to the preferential choice of the radial artery for arterial punctures.

Three additional cases of traumatic aneurysm of the radial artery are reported. It is probable that many are undiagnosed or unreported as the total number recorded in the literature since 1914 is less than twenty. Diagnosis can be made when the typical sequence of events occurs and characteristic findings are present. It is twice as common in males. A history of trauma to the lower forearm is invariable. Thereafter, a soft, irregular mass approximately 2.5 cm. in its greatest dimension appears along the course of the radial artery. This mass empties on pressure and rapidly refills when pressure is released. An arteriogram is usually not utilized for diagnosis. The treatment of choice is resection with an end to end anastomosis; but because of the caliber of the artery and the defect remaining after excision of the aneurysm, ligation has been used in most patients and appears to be satisfactory.

Percutaneous coronary catheterization and revascularization are commonly performed all over the world. Among various access sites for coronary interventions, most cardiologists favour the femoral approach, while the procedure via the radial artery is only performed by a limited number of operators. In this study, we aimed to assess the procedural outcome of the trans-radial coronary angiography (CAG) among the patients in a tertiary care hospital in Bangladesh. This prospective observational study was carried out among 40 patients underwent trans-radial coronary angiography. The study was conducted for a period of one year. Indication of CAG including chronic stable angina, unstable angina, non ST elevated myocardial infarction (MI) and ST elevated MI were observed. Procedural attempt, success rate and outcome with or without complications were mentioned. Out of 40 patients, 70% were male and 30% were female (M: F=2.3:1). Among the patients undergoing trans-radial CAG, 50% had dyslipidemia and HTN, 55% had family history of IHD, 52.5% were smoker and 20% had DM. Most of the patients underwent trans-radial CAG due to unstable angina (52.5%) and this was followed by ST elevated MI (30%), non ST elevated MI (10%) and chronic stable angina (7.5%).The mean procedural time was 19.85±1.3 minutes. The fluoroscopy time was 9.60±.9 minutes. The mean hemostasis time was 9.00±7.0 minutes. All patients were ready for discharge within 24 hours. Only 7.5% patients experienced spasm of radial artery during CAG. No other complications were detected. Trans-radial approach is an attractive alternative to conventional trans-femoral approach, in suitable patients at the hand of experienced operator, with appropriate hardwire and should be ready to cross over, to the femoral approach when needed. Keywords: Trans-radial coronary angiography; trans-femoral approach. DOI: 10.3329/uhj.v5i2.4553 University Heart Journal Vol.5(2) July 2009 pp.52-55

A technique of aorta-to-coronary artery bypass grafting using the patient's radial artery is proposed with the aim of reducing the incidence of late pathological changes in the graft. Experience with 40 radial artery grafts in 30 human patients has shown excellent short-term results and has demonstrated the primary importance of mechanical dilation of the arterial graft before implantation to counteract its spasm. Even though several advantages favor use of the radial artery over the vein for grafting (arterial structure, elasticity, regularity of the lumen) and over the mammary artery (graft size and length, resistance of the arterial wall), the ultimate fate of the radial artery graft needs a longer follow-up to be determined with certainty.

In 1947, Radner introduced a method of opacification of the thoracic aorta and its branches by the introduction of a catheter along the radial artery and the injection of contrast medium through the catheter. The method proved a technically satisfactory one but suffered the disadvantage of the necessity of surgical exposure of the radial artery which subsequently had to be sacrificed after the procedure was complete. To avoid the need of surgical exposure, the Seldinger (1953) percutaneous technique has been adopted by several authors (Pygott and others) to introduce the catheter into the brachial artery and thence into the thoracic aorta. Pygott and Hutton (1959) catheterised the brachial artery percutaneously to demonstrate the vertebral artery, whilst sporadic reports have appeared on the use of this artery for other procedures. The method of percutaneous brachial artery catheterisation, however, has not achieved widespread use and this partly stems from the technical difficulties of percutaneous punct...

Blood pressures were recorded simultaneously from the aortic arch and radial artery using two manometric systems with identical static and dynamic sensitivities. Measurements were made in four normal young men at rest and upright exercise requiring 29, 49, 78, and 100% of maximal oxygen uptake. Average radial arterial pressure rose from 133/66 mm Hg at rest to 236/58 mm Hg at maximal exercise. At the same time, average aortic pressures were 112/68 and 154/70 mm Hg, respectively. From rest to maximal exercise, pulse pressures at central and peripheral sites increased by factors of 1.95 and 2.60, respectively. Inducing reactive hyperemia in the arm abolished peripheral amplification. This amplification also diminished with time during prolonged heavy exercise. Mean pressures were nearly identical at the two sites at any oxygen uptake; mean pressures rose from 87 to 104 mm Hg from mild to maximal exercise. We conclude that estimates of stress on aortic and cerebral vessel walls and central baroreceptors would be grossly overestimated by use of peripheral pulse pressures.

Three cases of hypertrophic subaortic stenosis are presented. The following clinical and hemodynamic characteristics are demonstrated: 1. 1. A diamond-shaped holosystolic murmur was present at the fifth left intercostal space, inside the cardiac apex; the aortic second sound was well heard. The murmur was less intense at the base and not transmitted well into the neck. 2. 2. There was synchronism of the rapid upstroke time and slope of the simultaneously recorded left ventricular and central aortic pressure curves. Also present was a parallelism of the radial artery upstroke time with that of the central aortic pressure curve. A prolonged ejection time was seen and a large secondary systolic wave, representing the subaortic muscular obstruction, was noted. 3. 3. It is our belief that the unusual central and peripheral arterial pulse contour in hypertrophic subaortic stenosis represents, by itself, a diagnostic feature of this disease if not complicated by other anomalies. 4. 4. The beats following premature ventricular contractions always exhibited lower arterial pulse pressure than did the normal beats. 5. 5. Angiocardiography showed a cone formation and marked diminution of the outflow tract lumen during systole, about 3 cm. below the valve, and normal contour of the valvular cusps. 6. 6. Of special interest is that two of the three patients had subacute bacterial endocarditis, responding to penicillin therapy. 7. 7. One patient died following attempted surgical correction of the hypertrophic subaortic stenosis.

Summary A means for evaluation of the palmar circulation using the Doppler ultrasonic velocity detector is described. The test was applied to a population of 70 normal volunteers (140 hands). Our investigation showed that between 4.8 and 12.8 patients per 1,000 can be expected to have acute ischemia of the hand after cannulation of the radial artery. An additional 25 to 50 patients per 1,000 would have to rely on poor collateral circulation for continued viability of the hand. Routine clinical use of this test in patients who may require cannulation of the radial artery is recommended.

In 1947, Radner (1) introduced a method of thoracic aortography and vertebral angiography by the insertion of a catheter in the radial artery and its placement in the thoracic aorta. This proved to be a successful procedure but required surgical exposure of the radial artery and later its sacrifice. Other investigators at the time could not duplicate the ease of the performance as described by Radner or the quality of his results. Vertebral angiography was performed by Lindgren (2), by placement of a catheter in the subclavian artery from a brachial artery puncture by the percutaneous method. Excellent films were reported by this means, with few complications. Pygott and Hutton (3) catheterized the brachial artery percutaneously to demonstrate the vertebral artery, using the modified Seldinger technic. This procedure, which was accepted by many, obviates the danger of intramural injection of the contrast medium, a technical complication of direct vertebral arteriography which can cause an occasional death...

A new method of arterial blood sampling from the radial artery using a 1 ml plastic syringe is reported. The results of Pao2, Paco2 and pH analyses of such samples are compared with those from analyses of conventional samples withdrawn into 10 ml glass syringes. It is concluded that the results of analyses of editorial samples by the new mehtod and fully accaptable for clinical use. The only complication experienced was the formation of a small haematoma in a few cases. ZUSAMMENFASSUNG Es wird uber eine neue Methode der Blutabnahme aus der Arteria radialis mit einer 1 ml-Plastik-spritze berichtet. Die Ergebnisse der Pao2-, Paco2-und pH-Bestimmungen aus solchen Blutproben wurden mit denen konventioneller Blutproben, die mittels 10 ml Glasspritzen gewonnen worden waren, verglichen. Dabei kamen wir zu dem Schluβ, daβ die Analysenresultate der mit der neuen Methode gewonnenen arteriellen Blutproben fur den klinischen Bedarf annehmbar sind. Die einzige festgestellte Komplikation war die Ausbildung kleiner amatome in einigen Follen.

One hundred fifty individuals of different ages without evidence of peripheral vascular impairment (100 normal persons and 50 patients with history of cerebral vascular disease) were examined with the Allen test; the radial and ulnar arteries were examined in both hands. A false-positive test could easily be obtained spontaneously or be provoked by intentional hyperextension of the hand more than 20° beyond the straight position. In the straight position of the hand, the time for appearance of rubor after opening of the hand exceeded 5 seconds in 34% of the normal persons. When a relaxed slight flexion at the wrist joint was used, the flush after opening the hand appeared at an average of 3 seconds for the ulnar artery and 2.75 for the radial artery. In 50 normal individuals examined with optimal technique described, no individual artery required more than 6 seconds for the flush to appear after opening of the hand. The authors recommend that the Allen test be performed with the patient's hand slightly flexed and relaxed.

The object of this study was to determine whether the resistance to compression of the arterial wall introduces an error of any importance in the clinical measurement of systolic blood pressure by methods employing circular compression of the arm.No previous studies are free from serious criticism on the ground of inaccuracy of the methods employed. Some direct on post-mortem vessels (v. Basch, Martin, Herringham and Womack), and some indirect (Oliver, Hill, Williamson, Russell). In consequence of the discordant results, opinion has been divided. Some hold the resistance to compression of the arterial wall to be negligible; others that it might be extreme. The present study has been carried on by a method giving graphic records of the pressure within the artery, the pressure in the external compressing medium, and of the changes in the outflow from the artery by a Hurthle membrane manometer. Ringer's solution was used in all the experiments. The point of first collapse of the artery, of complete obliterat...

A case of self-administrated injection of amphetamine sulphate solution into the radial artery is described. Treatment, which was initiated as soon as possible, consisted of sympathetic block and administration of vasodilators, heparin and antibiotics. With the increase in number of drug addicts this syndrome may be more frequently encountered.

COMPRESSION of the subclavian artery is well known as an essential aspect of the pathology of cervical rib, the scalenus syndrome and anomalies of the first thoracic rib. The demonstration of this compression, with or without resort to the so-called scalenus maneuver introduced by Adson and Coffey,1 should be considered a routine prerequisite for the diagnosis of symptomatic cervical rib or the scalenus syndrome.2 In this maneuver the arterial compression is usually appreciated through palpation of the radial artery at the wrist. By this means complete obliteration of the pulse is of course readily detectable, but partial obstructions are less . . .

Nous avons utilise un appareil d’une grande simplicite pour faire la compression d’une artere a la suite d’une ponction arterielle. Cet appareil permet de maintenir la compression pour un temps choisi et se degonfle automatiquement au bout de cet intervalle.

“If obstruction of the ulnar artery is suspected, the radial artery in each wrist is located by its pulsations; the examiner then places one thumb lightly over each radial artery and the index finger of each behind the patient's wrists and so each wrist is held lightly between the thumb and index fi

Percutaneous central arterial catheterizations were performed at the first radial-artery site in 492 (92 per cent) of 536 insertion attempts in patients in an intensive-care unit. The high success rate was attributed to placement by skilled nurse technicians and use of a simplified catheter device. The mean duration of catheterization was 3.4 days (range, one to 25 days). With use of a continuous flush system, only five catheters became nonfunctional. Hypotension, use of vasoconstrictive agents and prolonged catheterization were associated with complete arterial occlusion in three study patients who required thrombectomies. Partial occlusions, detected by Doppler ultrasonic flowmeter, occurred in 19.3 per cent. No local or systemic infections could be definitely related to arterial catheters. Results of 200 arterial catheter-tip cultures were positive in eight cases (4 per cent), but none of these were judged to be a primary source of clinical infection. (N Engl J Med 290:1227–1231, 1974)

Experiments are reported concerning an evaluation of sympathetic influences on heart rate and cardiac contractility in normal young adult humans during a stressful reaction time task. During the preparatory interval only vagal influences on heart rate change could be found which were related to concomitant somatic activity. In expectation of the shock and for a more sustained period thereafter, sympathetic influences became manifested on both heart rate and contractility which were independent of concomitant somatic activity. In a follow-up study, the relationship was evaluated between blood pressure, as measured directly from the radial artery, and both contractility and heart rate. Sympathetic influences on the heart were not found to be secondary to depressor effects, although appreciable phasic decreases in blood pressure were sometimes found to follow the onset of large increases in heart rate and contractility. The data suggest that sympathetic influences on the heart are normally very minimal but are evoked by intense stress when the organism attempts to cope with the stress.

Blood viscosity, hematocrit and plasma protein concentrations were determined simultneously in five different vessels of the systemic and pulmonary circulations, before and immediately after cardiopulmonary bypass and again after surgery. There was a reduction in all these measurements after bypass and a lesser reduction one day after operation. At any one stage, however, values in the pulmonary artery and pulmonary vein were not significantly different from those in the superior vena cava, radial artery and a peripheral vein.