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Wrist injuries are not uncommon in forensic routine and are usually found in the context of suicides or as a result of psychiatric illnesses, e.g., borderline disorders. Sharp objects (knives, broken glass, etc.) are usually used. In the case reported here, a paranoid-schizophrenic man not only injured himself with razor blades on both wrists, but he also inflicted extensive wrist bite injuries using his dental prosthesis. In addition to the severance of flexor tendons, venous vessels and the left radial artery were torn with subsequent blood loss. At the time of death, there was also acute exposure to methadone and opiates. Patients suffering from psychotic illnesses have an increased risk of committing spectacular or bizarre suicides., (© 2024. The Author(s).)

Background: The characterization of radial artery perforation (RAP) patterns using optical coherence tomography (OCT) has not been well established. This study aimed to identify the characteristic RAP patterns in patients diagnosed through post-procedural OCT examination., Methods: This retrospective study included 1936 consecutive patients who underwent radial artery (RA) OCT following OCT-guided transradial coronary intervention (TRI) from January 2016 to July 2022. Data regarding RAP characteristics were collected through OCT, including the perforation site as well as dimensions such as the length, width, and arc. Furthermore, RAP types were classified as small or large perforations, with a cut-off arc value of ≤90°., Results: RAP, as identified by RA angiography (RAA) during TRI and on post-procedural OCT, was found in 16 out of 1936 patients (0.83 %). RA OCT imaging showed that the median distance between the RA ostium and the perforation site, the perforation length, width, and arc were 30.6 (14.4-42.2) mm, 1.55 (1.03-1.92) mm, 0.74 (0.60-1.14) mm, and 42.5 (25.0-58.1) °, respectively. Small perforations (arc ≤90°) were observed in 14 out of the 16 (87.5 %) patients with RAP. Post-procedural RAA revealed that 15 out of the 16 (93.7 %) patients with RAP had sealed perforations, with the remaining patient requiring external compression., Conclusions: Our findings demonstrated that RAP is uncommon during TRI, with clearly defined characteristic patterns on OCT. Most RAPs are small and tend to spontaneous seal through catheter tamponade., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Idiopathic true aneurysm of the distal radial artery is a rare disease with only few reported cases. Most patients were treated surgically with proximal and distal arterial ligatures, while there are reports of only 7 cases where revascularization procedures were performed. We present a case of a 66-year-old man with a pulsatile mass in the right forearm at the location of the radial artery. Six months preceding the presentation, the patient had first noticed a pulsatile tumefaction which gradually increased in size, with a sudden increase during the last month. The patient worked as a waiter and was a non-smoker with no significant comorbidities. There was no history of trauma, recent infection, hospitalization, recurrent injury, or peripheral venous cannulation. After CDT diagnosis, we performed resection of aneurysm and reconstruction with cephalic autovenous graft. One month afterwards, at the follow-up visit, the patient denied having symptoms of hand ischemia and duplex ultrasound examination showed adequate patency of the radial artery. This paper presents a rare case of a true idiopathic radial artery aneurysm that was treated surgically by complete resection and interposition with a reverse cephalic vein autovenous graft. Detailed anamnesis and clinical examination are necessary for the appropriate surgical treatment of the disease., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

This study was performed to analyze the impact of transradial intervention (TRI), performed by long (25-cm) hydrophilic-coated radial introducer sheath (HRS), on radial artery (RA). Both acute damages and chronic intimal modifications, occurring in RA, were assessed using frequency domain-optical coherence tomography (FD-OCT). FD-OCT evaluation of RA was performed in 51 consecutive patients, undergoing TRI by long (25-cm) HRS. FD-OCT was performed from RA ostium to the puncture site. Acute damages such as intimal tears and medial dissections together with chronic intimal modifications, assessed as intimal hyperplasia indexes, were observed and compared between proximal and distal RA segments. Intimal tears were detected in 37 % of patients, especially located in proximal RA segment ( p = 0.09). Medial dissections were imaged in 9.8 % of patients with no significant difference between proximal and distal RA segments. Intimal hyperplasia indexes were higher in distal RA segment, with no significant association with a previous history of TRI. In the setting of TRI, performed by long HRS, intimal tears represented the main RA injury occurring in about one-third of patients, while medial dissections only occurred in a small proportion of patients. Distal RA segment was more prone to intimal thickening, although this phenomenon was not associated with repeated transradial procedures. [ABSTRACT FROM AUTHOR]

The transradial approach for cardiac catheterization, coronary angiography, and percutaneous intervention is associated with a lower risk of access site-related complications compared to the transfemoral approach. However, with increasing utilization of transradial access for not only coronary procedures but also peripheral vascular procedures, healthcare personnel are more likely to encounter radial access site complications, which can be associated with morbidity and mortality. There is significant heterogeneity in the reporting of incidence, manifestations, and management of radial access site complications, at least partly due to vague presentation and under-diagnosis. Therefore, physicians performing procedures via transradial access should be aware of possible complications and remain vigilant to prevent their occurrence. Intraprocedural complications of transradial access procedures, which include spasm, catheter kinking, and arterial dissection or perforation, may lead to patient discomfort, increased procedure time, and a higher rate of access site cross over. Post-procedural complications such as radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve injury could lead to patient discomfort and limb dysfunction. When radial access site complications occur, comprehensive evaluation and prompt treatment is necessary to reduce long-term consequences. In this report, we review the incidence, clinical factors, and management strategies for radial access site complications associated with cardiac catheterization., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To evaluate a new haemostasis method using an ultrasound probe to compress the radial artery and haemostasis under direct vision to replace traditional manual compression of the radial artery., Methods: According to a random number table, 240 patients with gastrointestinal tumours who had undergone arterial puncture were divided into Group A (120 cases) and Group B (120 cases). In Group A, patients were under the guidance of ultrasound to confirm the vascular port, determine the compression position of the ultrasound probe, observe the degree of vascular deformation, and press the radial artery puncture port with pressure to stop bleeding under direct vision. In Group B, traditional manual compression was used. All patients received 5 min of compression for haemostasis, and haemostasis conditions were recorded after compression and 24 hours postoperatively., Results: The incidence of bleeding, haematoma, and skin ecchymosis at the puncture site after 5 minutes of compression in Group A was lower than that in Group B ( P < 0.05). No significant difference was found between the two groups at 24 hours after the operation ( P > 0.05)., Conclusion: The method using an ultrasound probe to guide radial artery compression to haemostasis is better than traditional manual compression when applied for compression haemostasis after removing the radial artery catheter., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Xianwei Jin et al.)

Background: The study aimed to assess the effects of serum YKL-40 level on patency at the repair site in patients who underwent arterial repair at the level of the forearm., Methods: The study included 58 subjects, including 29 patients (aged 18-50 years) who had ulnar or radial artery injury secondary to cut injury to wrist between June 2015 and November 2019 and no comorbid disease and 29 age- and sex-matched healthy controls. The vascular patency was assessed using Doppler sonography in patients who underwent arterial repair at the level of the forearm. The patients were defined as flow failure if the blood flow was ≤50%, and sufficient flow if the blood flow was >50% of those in the synonymous artery on the intact extremity. The YKL-40 level differences in the patient and control groups were compared to those in the sufficient and insufficient flow groups., Results: The patients were stratified into 2 groups based on the presence of sufficient flow. The mean YKL level was 11.96 ± 8.87 in the sufficient flow groups, whereas it was 32.22 ± 15.43 in the insufficient flow groups (p= 0.038). Besides, it was found that each unit of increase in the YKL-40 level increased the likelihood of having flow failure by 1.128., Conclusion: Based on our results, it was observed that over-expression of the YKL-40 level has adverse effects on patency following arterial repair., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population., Methods: We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic., Results: Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01)., Conclusion: Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.

Purpose: Simultaneous lesions of both proper digital arteries of the thumb are common in hand trauma surgery. The purpose of this anatomical study was to determine if the dorsal arterial network could be sufficient to ensure the vascularization of the thumb skin sheath., Methods: We carried out a cadaveric study on 22 hands. The ulnar and radial proper digital arteries of the thumb were ligated at the base of the first phalanx. Red dye was injected into the radial artery and blue dye into the ulnar artery at the wrist level. Visual evaluation of skin staining and systematic photographs was done at 1, 3 and 10 min after injection of dyes., Results: Staining of the thumb sheath was obtained in 100% of the dissections and complete in 91.91% of cases. Staining originated from mixed radial and ulnar artery origins in 81.82% of cases. It was incomplete in 9.09% of cases with a missing on the dorsoradial edge of the proximal phalanx. In one dissection, the whole hand skin was only stained red, and in another dissection only stained blue., Conclusion: The dorsal vascular network ensures the substitution of the skin vascularization in more than 90% of cases when ligating the proper digital arteries of the thumb. A clinical impression of good skin vascularization after injury of both proper digital arteries might lead the surgeon not to perform systematic revascularization, but the risk of variable damages of adjacent tissues due to an interruption of one major arterial system requires a palmar arterial anastomosis whenever possible.

Aim of the Study: The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss., Methods: This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate., Results: The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma., Conclusion: Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: This study aimed to evaluate acute injuries of the radial artery (RA) using optical coherence tomography (OCT) in patients who underwent coronary intervention via the snuffbox approach., Methods: Forty-six patients, who underwent coronary intervention and assessment of the conventional RA using OCT via the snuffbox approach, were enrolled from two university hospitals between August 2018 and August 2019., Results: The mean age of the patients was 65.1 years. In this study population, 6-French (Fr) sheaths were used. The mean diameter of the conventional RA was 2.89 ± 0.33 mm, and the mean lumen area of the conventional RA was 6.68 ± 1.56 mm2. Acute injuries of the conventional RA, after the snuffbox approach, were observed in 5 (10.9%) patients. Intimal tear was observed in the RA in 1 (2.2%) case. Intraluminal thrombi, without vessel injuries, were detected in the RA in 4 (8.7%) cases. However, medial dissection was not observed in the OCT analysis., Conclusions: This retrospective OCT-based study showed that the diameter of the conventional RA was 2.89 mm and acute vessel injury of the conventional RA was rare in patients who underwent coronary intervention via the snuffbox approach.

The advantages of sheathless guiding catheters over the conventional approach using sheaths in percutaneous coronary intervention (PCI) regarding access-site complications, particularly ultrasound-diagnosed radial artery occlusion (RAO), remain unknown. The present study investigated the incidence of access-site complications of transradial primary PCI using sheathless guiding catheters in acute coronary syndrome (ACS). This prospective study evaluated access-site complications in 500 patients with ACS undergoing sheathless transradial primary PCI. Doppler ultrasound evaluation of the radial arteries was performed 2 and 30 days after the procedure. Sheathless guiding catheters (7.5-Fr) were used in 91.0% of the patients. The procedural success rate was 98.4%. Ultrasound-diagnosed RAO rates were 2.0% and 3.8% at 2- and 30-day follow-ups, respectively. Logistic regression analysis identified that the sheath-to-artery ratio (per 0.1) (odds ratio [OR] 5.71; 95% confidence interval [CI] 1.18-27.71; p = 0.001) was associated with more frequent RAO and that hypertension (OR 0.22; 95% CI 0.06-0.81; p = 0.023) was associated with less frequent RAO. Receiver operating characteristic curve analysis revealed that a sheath-to-artery ratio of 1.47 was the cutoff for 30-day post-procedural RAO (sensitivity 72%, specificity 81%). Sheathless transradial primary PCI for ACS was associated with a low incidence of access-site complications and a higher sheath-to-artery ratio cutoff for RAO than that expected from conventional PCI using sheaths based on historical data, demonstrating the access-site safety of sheathless guiding catheters and their benefit in PCI for ACS (University Hospital Medical Information Network-Clinical Trial Registry Number UMIN000019931).

Objective: To compare the outer diameter (OD) of conventional and radial sheaths from different manufacturers for sizes typically used in infant catheterization., Background: The smallest sheath size is recommended to minimize risk of arterial injury in infants. However, sheath size refers to its internal diameter (ID), but it is the larger OD that determines risk. The OD varies between manufacturers and is frequently not known to the end user., Methods: Three authors measured the OD of 3, 3.3, 4, 5, and 6 French (Fr) sheaths from different manufacturers using a Mitutoyo digital micrometer. Continuous variables are reported as mean ± SD. The midshaft and proximal-shaft sheath measurements were compared using an independent samples t test. Agreement between author measurements was tested using intra- and inter-rater reliability analysis. Manufacturer sheath OD measurements were obtained. Statistical significance was set at p < .05., Results: There was no difference in the measured sheath diameters at the midpoint and proximally (p < .05). The intra-rater and inter-rater reliability were excellent (Intraclass correlation coefficient 1.0). Among conventional sheaths the OD varied between manufacturers, Terumo sheaths had the smallest and Galt sheaths had the largest OD. Radial sheaths had the smallest OD (1 Fr smaller) when compared to similar sized conventional sheaths. For instance, the OD of 4 Fr radial sheath (1.610 ± 0.006 mm) is essentially the same as the OD of the conventional 3 Fr (1.644 ± 0.016 mm) and 3.3 Fr (1.635 ± 0.005 mm) sheaths., Conclusions: Our study shows variation in the OD of sheaths used in infant catheterization. The radial sheaths offer the smallest OD across sizes., (© 2020 Wiley Periodicals, Inc.)

Objectives: We sought to compare the procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography., Background: The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual- versus single-catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate., Methods: This is a study-level meta-analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm., Results: A total of 2,062 patients (978 randomly assigned to dual-catheter and 1,084 to single-catheter strategy) included in seven trials were available for the quantitative synthesis. A dual-catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [-0.69, 1.78]; p = .32), fluoroscopy time (-0.36 [-2.39, 1.67]; p = .68) and contrast volume (-0.93 [-3.79, 1.94]; p = .44) comparable to a single-catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual- versus single-catheter strategy., Conclusions: This meta-analysis provides evidence for a comparable procedural performance of either dual- or single-catheter strategy for transradial coronary angiography. The fewer crossovers with dual-catheter strategy occur at the expense of more frequent radial artery spasm., (© 2019 Wiley Periodicals, Inc.)

Case: Two otherwise healthy male patients presented with lacerations to the volar distal forearm. Both patients had capillary refill at the fingertips and intact Doppler signals of the palmar arch. Computed tomography angiography revealed cessation of flow in the major forearm arteries at the level of the lacerations, with distal reconstitution from the anterior interosseous artery in both cases and from a branch off the ulnar artery in 1 case. The patients underwent operative exploration, where complete transections of the radial and ulnar arteries were found and repaired., Conclusions: In patients without arterial disease, contributions from minor forearm arteries can be sufficient for hand perfusion in the setting of radial and ulnar artery transection.

Background: Remodeling of the radial artery (RA) after transradial percutaneous coronary intervention (TRI) is under studied., Objectives: To examine the impact of TRI on RA diameter and intimal-medial thickness (IMT) in men and women using 55 Mhz ultrahigh frequency duplex ultrasound (UHFDU)., Methods: We performed UHFDU at 24 h and 90 days after non-emergent TRI in 41 patients (25 men, 16 women). Changes in RA diameter, IMT and RA injury were compared by patient gender. Multivariate linear regression was used to determine the predictors of RA diameter and IMT., Results: Of the 41 patients, mean age was 66 ± 9.8. Baseline RA diameter was larger in men vs. women (3.1 ± 0.40 mm vs. 2.8 mm ± 0.36, p = 0.02), however there were similar reductions in 90-day diameter (-0.57 ± 0.32 mm vs. -0.64 ± 0.40 mm, respectively; p = 0.48). Baseline IMT was also similar in men and women (0.28 ± 0.04 vs. 0.27 ± 0.06 mm; p = 0.37) and there were 0.073 ± 0.11 mm (26%) and 0.05 ± 0.080 mm (19%) increases in IMT noted, respectively (p < 0.0001 vs. baseline, p = 0.48 for men vs. women). Although UHFDU occasionally detected limited access site intimal tears (12%) at 90 days, frank dissections (2.4%), pseudoaneurysms (2.4%) and total occlusions (4.9%) were infrequent. Female gender correlated with smaller RA diameter at follow-up and there were no predictors of IMT., Conclusions: Following TRI, there is a 20% reduction in RA diameter and a 20-25% increase in IMT. Only gender predicted RA diameter. As a simple, noninvasive method to accurately depict the RA healing response following TRI, UHFDU may inform future clinical investigation in this area., Competing Interests: Declaration of Competing Interest The authors report the following conflicts of interest: WB - Institutional grant/research support: Boston Scientific, Speakers bureau and Consultant: Abbott Medical, Medtronic, Boston Scientific, Education grant: Medtronic; MS- Speakers bureau: Medtronic; AT - Consultant and Speakers bureau: Abiomed, Inc.; TN – Speaker's bureau: Abbott, Medtronic, Education grant: Medtronic. SY:Consultant: Boston Scientific; Proctor: Edwards; Proctor: CSI , Proctor: Boston Scientific. All other authors have no conflicts., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: This study aims to assess the effects of the hematopoietic stem cells and endothelial progenitor cells in peripheral blood and monocyte cluster of differentiation (CD) 34, CD133 and CD309 expression levels on maturation at the repair site in patients who underwent forearm arterial repair., Patients and Methods: This prospective study included 30 patients (23 males, 7 females; mean age 28.9±1.8 years; range, 18 to 49 years) with a well-defined cut at the wrist due to a stabbing injury but no comorbid condition who presented to the emergency department of our hospital between November 2014 and November 2017. Vascular patency was assessed by Doppler sonography in patients who underwent forearm arterial repair via micro-vascular techniques. The relationships between patency and hematopoietic stem and endothelial progenitor cell markers such as CD34, CD133 and CD309 were assessed by flow cytometry., Results: The patients were divided into two groups according to presence of sufficient flow in the arteries repaired. The mean CD34 expression level was 72.09±3.00 in the group with maturation whereas it was 54.64±7.34 in the group without maturation, indicating a statistically significant difference (p<0.05). In addition, the likelihood of sufficient flow was increased by 1.075 per one unit increase in CD34 level. Resistive index values were significantly lower in the group with maturation and CD34 level was predictive for maturation of arterial repair., Conclusion: In the present study, the findings demonstrated that high CD34 expression level has favorable effects on maturation after arterial repair.

Background: Immediate changes in vascular mechanics during aortic cross-clamping remain widely unknown. By using a numerical model of the arterial network, vascular compliance and resistance can be estimated and the time constant of pressure waves can be calculated and compared with results from the classic arterial waveform analysis., Methods: Experimental data were registered from continuous invasive radial artery pressure measurements from 11 patients undergoing vascular surgery. A stable set of beats were chosen immediately before and after each clamping event. Through the arterial waveform analysis, the time constant was calculated for each individual beat and for a mean beat of each condition as to compare with numerical simulations. Overall proportional changes in resistance and compliance during clamping and unclamping were calculated using the numerical model., Results: Arterial waveform analysis of individual beats indicated a significant 10% median reduction in the time constant after clamping, and a significant 17% median increase in the time constant after unclamping. There was a positive correlation between waveform analysis and numerical values of the time constant, which was moderate (ρ = 0.51; P = 0.01486) during clamping and strong (ρ = 0.77; P ≤ 0.0001) during unclamping. After clamping, there was a significant 16% increase in the mean resistance and a significant 23% decrease in the mean compliance. After unclamping, there was a significant 19% decrease in the mean resistance and a significant 56% increase in the mean compliance., Conclusions: There are significant hemodynamic changes in vascular compliance and resistance during aortic clamping and unclamping. Numerical computer models can add information on the mechanisms of injury due to aortic clamping., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Transradial access (TRA) is favored over transfemoral access for performing coronary angiography and percutaneous coronary intervention due to the reduced risk for vascular and bleeding complications and the documented survival benefit in ST-segment-elevation myocardial infarction patients who undergo primary percutaneous coronary intervention. TRA complications can be categorized as intra- or postprocedural and further categorized as related to bleeding or nonbleeding issues. Major intra- and postprocedural complications such as radial artery perforation and compartment syndrome are rare following TRA. Their occurrence, however, can be associated with morbid consequences, including requirement for surgical intervention if not identified and treated promptly. Nonbleeding complications such as radial artery spasm and radial artery occlusion are typically less morbid but occur much more frequently. Strategies to prevent TRA complications are essential and include the use of contemporary access techniques that limit arterial injury. This document summarizes contemporary techniques to prevent, identify, and manage TRA complications.

Background: In percutaneous coronary interventions, use of the radial artery may be limited by vascular anatomy or vascular complications, such as radial artery spasm, dissection or perforation. The balloon-assisted tracking (BAT) technique is a novel and innovative method to successfully perform transradial procedures in patients with difficult vascular anatomy, severe tortuosity or radial artery spasm. In addition, the BAT technique can serve as a bail-out technique when vascular complications such as artery dissection or perforation occur., Objective: We analysed data of all percutaneous coronary intervention patients in whom the BAT technique was undertaken in daily practice and report acute and long-term outcomes., Results: A total of 62 patients were included and, in most patients, the BAT technique was performed for radial spasm. Most patients were administered benzodiazepines or nitrates before the BAT technique was performed. The primary end point, defined as successful passage of the catheter through the artery of the arm using the BAT technique, was 98%. 11% of patients developed a complication within 24 h (haematoma, prolonged pain or visible vascular damage at the end of procedure); all completely recovered at follow-up. No complications occurred during long-term follow-up., Conclusion: BAT is a low-risk and easy-to-use technique that increases the success rate of radial artery access and may prevent vascular complications.

Objectives: The aim of this study was to analyse the consequence of radial or femoral access during coronary interventions to radiation dose, fluorography time and a number of pseudoaneurysms following each type of intervention. Background: According to the results of many recent studies (RIVAL, RIFLE-STEACS, STEMI RADIAL), current guidelines favour radial over femoral access during coronary intervention for safety, especially in cases of acute coronary syndromes. However, several papers have referred to problems in the design of these studies and the management of antithrombotic therapy. The influence of access site on radiation dose and fluorography time is also still unclear. Methods: We retrospectively analysed 4522 patients who underwent coronary angiography in 2012 and 2016 in a single centre in the Czech Republic. We compared the access site with the average radiation dose and mean effective dose that each patient received in Gy/cm 2 or mSv, respectively. We also compared average fluorography time in minutes and the incidence of pseudoaneurysms. Results: The radiation dose was a body mass index (BMI)-dependent parameter since each five points of body mass index increased radiation dose approximately by 23%. Use of femoral access resulted in lower fluorography time in all subgroups ( p < .001) and decreased radiation dose in patients with coronary artery bypass grafts (CABGs) by 26% ( p  = .044). On the other hand, there has been 16 times lower frequency ( p < .001) of post-catheterisation pseudoaneurysms after radial access than after femoral access. Conclusions: Both the radiation dose and fluorography time were lower after femoral access compared to radial access in patients with CABGs. On the other hand, radial access led to significantly fewer periprocedural pseudoaneurysms. Radial access therefore should be considered as the preferred access site during coronary intervention in patients with a high risk of pseudoaneurysm development, and femoral access should be considered for patients with a high risk of contrast-induced nephropathy.

This case, which almost ended in a compartment syndrome, is an extremely uncommon complication of transradial catheterization, with a described incidence around 0.125%.

Purpose: The aim of this study was to evaluate the efficacy and safety of distal radial (DR) versus traditional radial (TR) approach during coronary angiography., Methods: Two hundred patients scheduled to undergo transradial coronary angiography were randomized between the two approaches. Primary endpoint of the study was switching to another access site due to inability of successful target artery cannulation. Secondary endpoints were time to cannulation, total procedure duration, number of attempts, number of skin punctures and duration of manual hemostasis. Secondary safety endpoints were the rate of moderate or severe spasm, arm hematoma EASY class III or more and radial artery occlusion at discharge. Quality of life endpoint was the patient's preference of cannulation method at 30 days., Results: The primary endpoint was met in 30 patients (30%) from the DR group and 2 patients (2%) from the TR group (p < 0.001). The time of cannulation was longer in the DR group compared to the TR group (269 ± 251 s vs 140 ± 161 s, p < 0.001), but this did not affect the total procedural duration (925 ± 896 s vs 831 ± 424 s, p = 0.494). The number of attempts and the number of skin punctures were more in the DR group compared to the TR group (6.8 ± 6.2 vs 3.4 ± 4.5, p < 0.001 and 2.4 ± 1.7 vs 1.6 ± 1.2, p < 0.001, respectively). However, DR treated patients had faster manual hemostasis time compared to TR treated patients (568 ± 462 s vs 841 ± 574 s, p = 0.002). There were no differences recorded in the safety endpoints of moderate or severe spasm, EASY grade III or more radial hematomas or the incidence of radial artery occlusion after the procedure. Patients' preference to the randomized puncture sites was the same (79% vs 85%, p = 0.358)., Conclusion: Distal radial approach is associated with lower successful cannulation rates and shorter manual hemostasis time compared to the traditional radial approach., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women), a randomized controlled trial comparing radial and femoral access in women undergoing cardiac catheterization or percutaneous coronary intervention (PCI), was terminated early for lower than expected event rates. Whether this was because of patient selection or better access site practice among trial patients is unknown., Methods and Results: SAFE-PCI was conducted within the National Cardiovascular Data Registry CathPCI registry. Using the National Cardiovascular Research Infrastructure Identification, PCI date, and age, patients enrolled in SAFE-PCI were compared with trial-eligible female CathPCI registry patients 1 year before, during, and 1 year after SAFE-PCI enrollment. Patient and procedure characteristics, predicted bleeding and mortality, and post-PCI bleeding were compared between groups. Enrolled SAFE-PCI patients and registry patients from the 3 time periods were linked to Centers for Medicare and Medicaid Services data to compare 30-day death and unplanned revascularization rates. At 54 SAFE-PCI sites, there were 496 SAFE-PCI trial patients with a PCI visit within the CathPCI registry. There were 24 958 registry patients from 1 year before and 1 year after SAFE-PCI enrollment and 15 904 trial-eligible registry patients during trial enrollment. Trial patients were younger, had lower predicted bleeding and mortality, and had lower rates of post-PCI bleeding within 72 hours compared with registry patients. Among 12 212 Centers for Medicare and Medicaid Services-linked patients, there were no significant differences in 30-day death and unplanned revascularization among the 4 groups., Conclusions: Lower predicted risk of bleeding and mortality among SAFE-PCI trial patients compared with registry patients suggests that lower-risk patients were selectively enrolled for the trial. These data demonstrate how registry-based randomized trials may offer methods for enrollment feedback to curb selection bias in recruitment., Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01406236.

Electrical burns are responsible for arterial and venous thrombosis, as well as weakening of the arteries. Immediate or delayed arterial occlusions, secondary to the aggression of the intima, or aneurysms, secondary to the aggression of the media, sometimes lead to artery ruptures without any warning signs. Such ruptures may trigger a hemorrhagic shock whose period of onset is variable and unpredictable. We are presenting here three cases treated in our department for electrical burns, whose complications were marked by hemorrhagic shock, secondary to late artery ruptures, sometimes occurring several months following the event. These case reports required performance of emergency hemostasis in order to control sudden bleeding, with first approach being placement of a tourniquet at the base of the limb and/or a compression point. Through these cases, we thought it is crucial to closely monitor for a few weeks all patients who were victims of electrical injury, even more so if it was associated with a compartment syndrome of one or more limbs and high rhabdomyolysis, which seem to be predictive factors of late artery ruptures in our case reports.

Objectives: We aimed to detect if pre-procedure vascular ultrasound scanning (VUS) of radial arteries (RAs) can increase the radial access success (RAS) rate and/or reduce the vascular access time (VAT), by guiding the choice of the proper access site for repeated trans-radial interventions (TRIs)., Background: Currently, repeated-TRIs are encountered more frequently in most of the cath. labs. However, structural changes of the RAs after TRA may hinder it is usage for repeated-TRI. VUS is the most accurate noninvasive test for assessing RAs, nonetheless, its role in the setting of repeated-TRIs has not been studied before., Material and Methods: We randomly assigned 300 patients undergoing repeated-TRI, to either planning the vascular access site based upon the result of VUS that was performed pre-procedural (group A, 150 patients) or to be left to the operator's discretion (group B, 150 patients)., Results: In group A (143/145 [98.6%]), RAS rate was only numerically higher than group B (143/150 [95.3%]), P = 0.08. There was a statistically significant differences between both groups in VAT [(1.25 ± 0.17 min), vs. (4.95 ± 0.87 min) for group A and B, respectively, P = 0.02] and in procedure duration [(37.2 ± 19.8 min) vs. (51.8 ± 18.6 min) for group A and B, respectively, P = 0.04]. RA spasm was more common in group B [18% (27/150)] than group A [2% (3/145)], P = 0.001., Conclusion: VUS of RAs prior to repeated-TRI is associated with significant reduction in VAT, procedure duration, RA spasm and a mild increase in the RAS rate., (© 2017 Wiley Periodicals, Inc.)

Background: Although the pulseless supracondylar humeral fracture (SHF) in children is well known in the bibliography, controversy still exists regarding the treatment strategy. The purpose of this study was: (a) to describe our policy with pulseless hands following SHF and (b) evaluate the functional outcome in a 1-year follow-up., Methods: During the years 2013 to 2018 in our department, 23 of 210 children with type III SHF presented with a pulseless hand (20 with a PPH and 3 with a cold, pulseless hand). Fracture reduction was attempted in all patients followed by reevaluation of the vascular clinical status (including a Doppler ultrasound)., Results: In PPH, a palpable radial pulse was present in all patients in less than 48 hours after surgery. Closed reduction was able to improve the vascular status in 1 patient with pale pulseless hand but surgical exploration of the brachial artery was performed in the other two patients. A palpable radial pulse was present 24 hours after surgery in these 3 patients. All patients had good/excellent outcomes at 1-year follow-up., Conclusion: With our study, we want to enhance the traditional dogma of "watchful waiting" in pink pulseless hands following SHF, and we believe that it should not be revisited. In pale pulseless hands following SHF, at least one attempt of reduction and fixation of the fracture is recommended. If the pulse does not return or the vascular status does not improve, immediate surgical exploration of the artery is strongly indicated., Level of Evidence: Case series prognostic study, level IV.

Pseudoaneurysms arise from a disruption of arterial wall continuity and are most commonly related to a penetrating trauma, an arterial wall inflammation or iatrogenic causes. They differ from real aneurysms due to a lack of one or more layers of the arterial wall. The frequency of peripheral artery pseudoaneurysms in the upper extremities is less than in the lower extremities and its most common cause is a gunshot or a stab wound. The risk of a rupture is higher than in true aneurysms due to a lack of wall layers, therefore requiring surgical treatment in most cases. Here we describe an unusual case of an 8-year-old girl who presented to the emergency department complaining of swelling and pain in her left distal forearm. One month before admission she experienced a penetrating trauma in the same area due to a self inflicted stab wound. After clinical and duplex ultrasonography evaluation the tumefaction proved to be a posttraumatic pseudoaneurysm of the left radial artery.

Objective: Randomized clinical trial protocol to evaluate the incidence of radial artery occlusion with two different arterial compression devices after transradial procedures., Methods: Barbeau's test will be performed in adults scheduled to undergo transradial interventional procedures. Those with A, B, or C plethysmographic patterns will be selected. At the end of the procedure, patients will be randomly assigned (1:1) to receive patent haemostasis with TR Band™ device or conventional haemostasis with an elastic adhesive bandage. The primary outcome is the incidence of radial artery occlusion. Secondary outcomes are Barbeau's test curve change, additional time to achieve haemostasis, incidence of bleeding at the puncture site, pain severity, development of arteriovenous fistula, radial pseudo aneurysm, any access-site complication requiring vascular surgery intervention and costs between the two devices., Discussion: The results of this trial should provide valuable additional information on the best approach for haemostasis after transradial percutaneous cardiovascular interventions.

Tibial plateau fractures form a wide spectrum of injuries presenting varying challenges to the trauma surgeon. The prognosis of this injury spectrum is largely dependent on the management of each particular configuration, and the literature is as a result littered with a number of management strategies with limited consensus. The aim of this review is to provide a concise guide to the trauma surgeon based on newer and classical peer-reviewed publications in international orthopaedic journals. A PubMed search was conducted to identify peer-reviewed publications within the last 10 years and expanded to identify classic papers pertaining to the Schatzker classification. The focus was on articles based on management techniques, controversies and recent developments. The management of specific injury patterns is based on the Schatzker classification which is a widely accepted traditional classification system. Whilst there is a general consensus on the ultimate goal of a stable anatomic reduction in this subset of fractures, there continues to be a number of controversies surrounding issues including pre-operative imaging, initial assessment and definitive management of specific injury patterns, some of which do not conform to the original Schatzker classification. The majority of fractures will require operative management, and with whatever management strategy employed, the main emphasis is on respecting the soft tissue envelope. There remains a paucity of prospective randomised controlled trials comparing the different available operative techniques.

Background: We planned a three arm randomized study to evaluate the safety and efficacy of a new blood stopper, Ankaferd blood stopper (ABS) along with short-time compression, compared to either short-time compression with conventional sterile gauzes (CSG) or with a TR band after transradial (TRA) procedures., Methods: The Ankaferd blood stopper as a new strategy to avoid early complications. After transradial procedures (ABS transradial) trial is designed in a prospective, randomized, placebo-controlled fashion and registered with http://clinicaltrials.gov (NCT02982733). Six hundred and thirty patients were randomized into three arms in a 1:1:1 fashion corresponding to three different strategies of patent hemostasis techniques after diagnostic or interventional catheterization., Results: One (0.49%) patient in the CSG group and one patient (0.48%) in the TR Band group developed RAO at the end of the hemostasis, compared with 0 (0%) in the ABS group. At 30 days follow-up none of the groups had any patients with RAO. As a secondary end-points the difference was not statistically significant regarding hematoma among the three groups (P = 0.70). Bleeding during deflation of the TR Band or removal of the elastic bandage occurred in 55 patients (26.96%) in the CSG group and in 56 (27.31%) patients in the TR Band group compared to 19 patients (9.40%) in the ABS group (P < 0.001)., Conclusion: Ankaferd blood stopper is a promising device for use in patent hemostasis, with no evidence on RAO at short-term or long term and with reduced risk of re-bleeding at the end of hemostasis., (© 2018 Wiley Periodicals, Inc.)

We report a case of a 64-year-old man who developed a painful pulsatile mass in the distal forearm after a bicycle fall with fracture of the wrist. Ultrasonography confirmed a 2.5-cm large pseudoaneurysm of the radial artery. The patient underwent surgical exploration. The pseudoaneurysm was resected and the defect in the arterial wall was reconstructed with an autologous saphenous vein patch. We suggest that the double arterial supply of the hand should be preserved whenever possible.

The aim of this study was to emphasize the importance of early surgical treatment of multicomponent soft tissue injuries of the wrist. A retrospective review was performed on 156 patients with multicomponent soft tissue injuries of the wrist who were treated between July 2007 and July 2015. All the patients included in the study were operated within the first 36hours of the injury and were hospitalized after the surgery based on the extent of their injury. The patients were evaluated in terms of age, gender, etiology, injured structures, total number of damaged structures, mean follow-up time, complications and reoperation. The results were evaluated based on tendon function, opposition, intrinsic muscles, deformities and sensation. According to these criteria, excellent results were obtained in 81.6% to 88.8% of the patients. Poor results were found in less than 4 percent of the patients. In conclusion, we believe that early surgical management of multicomponent soft tissue injuries of the wrist, a meticulous approach and regular physical therapy are required to achieve good functional outcomes., (Copyright © 2018 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the effect and clinical value of auricular point sticking for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture, including radial artery spasm (RAS) and coronary artery spasm (CAS)., Methods: A total of 480 patients were randomized into an observation group (224 cases) and a control group (256 cases). Percutaneous coronary intervention and usual care in perioperative period were used in the control group. Auricular point sticking was began to apply 12 h before percutaneous coronary intervention in the observation group at Jiaogan (AH 6a ), Shenmen (TF 4 ), Pizhixia (AT 4 ), Neifenmi (CO 18 ), Xin (CO 15 ), Shen (CO 10 ), Shenshangxian (TG 2p ), 1 min a time every point, once every 2 h, 12 h before and after operation. The incidences of vasospasm and vagus reflex during piercing process were compared, and the usage ratios of vasoactive agent were recorded, including glyceryl trinitrate, dopamine and atropine injections., Results: The incidence of angiospasm was 4.9% (11/224) in the observation group, which was lower than 13.3% (34/256) in the control group ( P <0.01). The incidence of vagal reflex of the observation group was 7.1% (16/224), which was lower than 19.5% (50/256) of the control group ( P <0.01). The usage ratios of glyceryl trinitrate, atropine and dopamine injections were 3.6% (8/224), 7.1% (16/224), 6.3% (14/224) respectively in the observation group, which were lower than 14.8% (38/256), 15.6% (40/256), 15.2% (39/256) in the control group (all P <0.01). ., Conclusion: Auricular point sticking achieves effect for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture.

Some studies have suggested that radial access (RA) for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared to femoral access (FA). The purpose of this study was to investigate the routine use of hemostatic devices and bleeding complications among RA, brachial access (BA), and FA. Between January 2015 and December 2015, 298 patients treated for PCI with RA were compared with 158 patients using BA and 206 patients using FA. The radial sheath was routinely removed with ADAPTY, the brachial sheath with BLEED SAFE, and the femoral sheath with Perclose ProGlide. In-hospital bleeding complications were investigated. Cardiogenic shock was most frequent in patients in the femoral group (RA 1.3%, BA 2.5%, FA 9.2%, p < 0.0001). The rate of major bleeding was highest in the femoral group (RA 1.0%, BA 2.5%, FA 5.3%, p = 0.01). Blood transfusion rates were highest in the femoral group (RA 0.7%, BA 1.3%, FA 4.4%, p = 0.01). Retroperitoneal bleeding was observed in 1.9% of patients in the femoral group. Patients in the brachial group had large hematomas (RA 0.7%, BA 4.4%, FA 1.5%, p = 0.01). Pseudoaneurysm formation needing intervention occurred most frequently in the brachial group (RA 0%, BA 1.3%, FA 0%, p = 0.04). In conclusion, compared to the brachial and femoral approaches, the radial approach appears to be the safest technique to avoid local vascular bleeding complications. The brachial approach has the highest risk of large hematoma and pseudoaneurysm formation among the three groups.

Background/objectives: Complex extremity trauma commonly involves both soft tissue and vascular injuries. Traditional two-stage surgical repair may delay rehabilitation and functional recovery, as well as increase the risk of infections. We report a single-stage reconstructive surgical method that repairs soft tissue defects and vascular injuries with flow-through free flaps to improve functional outcomes., Methods: Between March 2010 and December 2016 in our hospital, 5 patients with severe upper extremity trauma received single-stage reconstructive surgery, in which a flow-through anterolateral thigh free flap was applied to repair soft tissue defects and vascular injuries simultaneously. Cases of injured artery were reconstructed with the distal trunk of the descending branch of the lateral circumflex femoral artery. A segment of adjacent vein was used if there was a second artery injury. Patients were followed to evaluate their functional recoveries, and received computed tomography angiography examinations to assess peripheral circulation., Results: Two patients had post-operative thumb necrosis; one required amputation, and the other was healed after debridement and abdominal pedicle flap repair. The other 3 patients had no major complications (infection, necrosis) to the recipient or donor sites after surgery. All the patients had achieved satisfactory functional recovery by the end of the follow-up period. Computed tomography angiography showed adequate circulation in the peripheral vessels., Conclusions: The success of these cases shows that one-step reconstructive surgery with flow-through anterolateral thigh free flaps can be a safe and effective treatment option for patients with complex upper extremity trauma with soft tissue defects and vascular injuries., (Copyright © 2017. Published by Elsevier Ltd.)