Abstract: Objective To compare the effects of nitroglycerine (NTG)， Verapamil(VP), papaverine(PA) and the mixed solution of Verapamil and nitroglycerine (VG) on relaxing function of human radial arteries. Methods The radial arteries of thirty patients were used during the operation of coronary artery bypass grafting (CABG). A short segment (1.0-1.5cm) of radial arteris were taken from the distal end of radial arteries of each patient and were cut into vascular rings, which were mounted in the organ bath chamber and then subject to a series of tests for vascular smooth muscle viability and endothelial integrity. The effects of five storage solutions on the relaxing function were evaluated by “OrganBath” technique. The five solutions included: (1) Ringer’ s solution (control group); (2) VP solution (VP group); (3) NTG solution (NTG group); (4) PA solution (PA group); (5) VG solution (VG group). First, challenged with phenylephrine (10-5mol/L), vasorelaxant effect of these drugs (effect onset and efficacy) was observed at different time point and resting tension was recorded. Second, after 30min preincubation with either verapamil, papaverine, phenoxybenzamine or VG mixture, potassium chloride (final concentration of 60mmol/L) was added in the organ bath chamber and then vasoconstriction was observed subsequently. Finally, after 30min pretreatment of different antispasmodic agent in the same way as described above, the vascular rings were mounted in organ bath chamber and challenged with phenylephrine(10-5mol/L). Vascular spasticity and vosospasm duration were observed at different time point which might provide guidance for optimal timing of clinical application. Results The radial arteries in VG, VP, NTG and PA solutions were relaxed in 11 min after vasospasm and there was no difference between them (Pgt;0.05). But during the initial three minutes，the relaxation effect of VG and NTG was significantly better than other two groups. Relaxation curve showed that the ability of vasodilatation of VG, NTG, VP and PA decreased in order. In the experiment about antivasospasm pretreatment of radial arteries, there was no difference between VG and VP group (Pgt;0.05 ), whose effects were better than NTG and PA group(Plt;0.05 ). After cold storage for 24h, VG and VP still could prevent vasospasm. But NTG and PA hardly had any function and there was no difference compared with the control group (Pgt;0.05 ). Conclusion Although in the final all these drugs could prevent and relieve vasospasm of radial arteries in the different level, it appeared that a combination of verapamil and nitroglycenn is more fit for treating radial artery during CABG operation than other drugs.
With the development of interventional therapy technology, trans radial access (TRA) has gradually become the main approach of interventional therapy. Compared with trans femoral access (TFA), TRA has obvious advantages, which can shorten the time of lying in bed and reduce the incidence of complications. However, the radial artery is thinner than the femoral artery, the incidence of spasm is high, and the success rate of puncture is low, so the technical level of operation is required to be high. Nowadays, TRA has been gradually applied to lung cancer, aortic disease, hepatocellular carcinoma, spleen disease, renal artery disease, and other peripheral vascular diseases. With the confirmation of the safety and feasibility of TRA in interventional therapy in different fields, the popularization of TRA in different interventional fields will be supported.
Trans-radial access (TRA) has been a common approach to percutaneous coronary intervention (PCI). Comparing with trans-femoral access (TFA), TRA is used as an alternative approach for PCI with less local complications, higher comfort level, and better outcome. In recent years, TRA has been paid more and more attention in peripheral vascular interventions. We reviewed recent developments in peripheral vascular intervention using TRA, with detail summary of the effectiveness, safety, limits, and future developments of it, aiming to improve the understanding and performance of TRA in interventionalists to benefit patients.
【摘要】 目的 评估经桡静脉途径介入治疗冠状动脉病变的临床效果及安全性。 方法 将2003年7月-2009年7月接受治疗的174例冠状动脉病变患者随机分为对照组及观察组，对照组采用经典股动脉途径行冠脉介入治疗，观察组采用桡动脉途径介入治疗。观察两组患者穿刺时间、手术时间、穿刺成功率、手术成功率、并发症发生率。 结果 两组穿刺时间、手术时间、手术成功率差异无统计学意义，观察组并发症发生率少于对照组，穿刺成功率低于对照组。 结论 经桡动脉途径介入治疗冠状动脉病变能够减少手术后并发症的发生，临床疗效确切。【Abstract】 Objective To explore the clinical effect of intervention treatment through radial arteries on coranaria disease and its safety. Methods A total of 174 patients with coranaria disease from July 2003 to July 2009 were randomly divided into a control group and an observed group. The patients underwent the intervention treatment through femoral arteries in control group and through radial arteries in observed group. The duration and achievement rate of paracentesis and operation, and the incidence rate of complications were observed and the results in the two groups were compared. Results There were no differences in the duration and achievement rate of paracentesis and operation, and the achievement rate of operation between the control and observed groups. Compared with the control group, the incidence rate of complications and achievement rate of paracentesis were lower in observed group. Conclusion Intervention treatment through radial arteries on coranaria disease could reduce the post-operative complications with reliable therapeutic effect.
ObjectiveTo systematically review the efficacy and safety of primary percutaneous coronary intervention (PCI) via radial access versus via femoral access for patients with acute ST-segment elevation myocardial infarction (STEMI). MethodsRandomized controlled trials (RCTs) about the clinical efficacy and safety of radial access for PCI in patients with acute STEMI were searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 6, 2014), CNKI, VIP, and WanFang Data from 2000 to November 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of included studies were completed by two reviewers independently. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of fourteen RCTs involving 5 212 patients were enrolled. The results indicated that:a) radial access was associated with decreased risks of mortality (OR=0.54, 95%CI 0.40 to 0.74, P=0.000 1); decreased incidences of major bleeding (OR=0.50, 95%CI 0.34 to 0.74, P=0.000 8), major adverse cardiac events (MACE) (OR=0.65, 95%CI 0.50 to 0.83, P=0.000 6), and puncture site complications (OR=0.35, 95%CI 0.25 to 0.49, P < 0.000 01); and decreased hospital duration (MD=-2.14, 95%CI-3.97 to-0.31, P=0.002). b) However, the two groups were alike in the success rate of operation, exposure time of X ray, risk of stroke, and the rate of CABG. PCI via radial access took more operation time than that via femoral access, and PCI via radial access had a higher incidence of changing puncture access. ConclusionFor acute STEMI patients undergoing PCI, radial access could significantly reduce mortality, and incidences of major bleeding, MACE and puncture site complications. Therefore, under the conditions of strict indication control and increased operation skills, PCI via radial access is effective and safe in the treatment of acute STEMI. Due to limited quality and quantity of the included studies, more large-scale, multi-centre, high quality RCTs are needed to verify the above conclusion.
ObjectiveTo explore the clinical application of the flap supported by perforating branch of the radial artery superior wrist catena-form blood vessel in repairing hand and wrist wound. MethodsBetween March 2010 and March 2013, 24 cases of severe wounds in wrist were repaired with the flap supported by perforating branch of forearm radial artery and catena-form blood vessel. There were 15 males and 9 females, aged 19-54 years (mean, 37 years). In 22 patients with trauma, there were 9 cases of machine injury, 5 cases of traffic accident injury, 5 cases of crash injury of heavy objects, 1 case of sharp instrument injury, and 2 cases of electrical injury, with a mean disease duration of 11 days (range, 2-20 days). In 2 patients with tumor excision wound, there were 1 case of right forearm liposarcoma and 1 case of left forearm squamous-cell carcinoma, with the disease duration of 7 days and 3 months, respectively. All cases complicated by bone and tendon exposure. The size of defect was 4.5 cm×4.0 cm to 10.0 cm×7.5 cm, and the size of the flap was 6.0 cm×4.0 cm to 20.0 cm×8.5 cm. The donor site was directly sutured or repaired by skin graft. ResultsPartial flap necrosis occurred in 1 case, and was cured after dressing change; the other flaps survived, and primary healing of incision was obtained. The patients were followed up 6-36 months (mean, 20 months). The flap featured good color and texture, and also recovered protective sensation at 6 months after operation, with a mean two-point discrimination of 12 mm (range, 11-14 mm). No ulcers of the flap was observed. At last follow-up, according to Hand Surgery Society of Chinese Medical Association for functional evaluation of upper limb, the function was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case. ConclusionThe flap supported by perforating branch of forearm radial artery and catena-form blood vessel can be used to repair wound in wrist, which has no injury to the radial artery, and it also could be used for the patients with ulnar and radial artery injuries. Thus it is an ideal method to repair wound in the wrist because the operation is simple, and the flap has good appearance and texture.
Abstract: Though the use of the radial artery (RA) as a coronary artery bypass graft has been accepted world widely in myocardial revascularization, there has been no uniformity regarding harvest techniques, assessment of the adequacy of hand collateral circulation, antispasm rotocols, selection of target vessels, and the site of proximal anastomosis. It is widely believed and practiced that the RA should be harvested as a pedicle graft and preferably be used to bypass critically stenosed (gt;70% stenosis) coronary arteries. It is used either as a free graft with proximal anastomosis to the ascending aorta or as a composite arterial graft along with the left or right internal thoracic artery. The patency of RA grafts depends on the severity of the target coronary artery stenosis and target artery location rather than its use as an aortocoronary conduit or composite graft. Though lacking of evidences, most surgeons use antispasm therapy for RA conduits. There are advantages in using RA as an alternative for right internal mammary artery in total artery coronary revascularization.
ObjectiveTo explore the outcomes achieved by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) Y-composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease. MethodsFrom January 2009 through May 2015, 56 patients (36 males and 20 females) with multiple vessel disease underwent MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts without cardiopulmonary bypass in our hospital. MIDCAB was performed through a left anterior minithoracotomy. Thirty four patients used LIMA-RA grafts, and twenty two patients used LIMA-SV grafts. ResultsAll patients success-fully underwent MIDCAB with LIMA-SV or LIMA-RA Y-composite grafts. No patient required to convert to sternotomy during the surgery. Revascularization was performed for 2 target vessels in 12 patients, 3 target vessels in 41 patients and 4 target vessels in 3 patients. Mean postoperative ventilation time was 27.14±31.35 h. Mean ICU time was 3.16±2.53 d, and mean postoperative inhosptial time was 11.89±3.91 d. Thirty-day mortality was 1.79% (1/56). At a follow-up of 1 to 77 months, no patients received revascularization. The overall survival at 2 years postoperatively was 94.4%±5.4% in the LIMA-RA group and 86.8%±9.2% in the LIMA-SV group (P=0.299). The patency rate of LIMA was 100.0%. The overall patency rate of RA or SV grafts at 2 years postoperatively was 90.3%±5.3% or 86.7%±6.3% with no statistical difference (P=0.265). ConclusionMIDCAB with LIMA-RA or LIMA-SV Y-composite grafts is a safe and an effective procedure with favorable early and mid-term outcomes for patients with multiple vessel disease. LIMA-SV composite graft can be used as an alternative graft for patient whose RA is not possible or advisable.