OBJECTIVETo explore a new method in estimating extent and degree of arterial injury in upper limbs sustaining high tension electric burns.

METHODSEighteen patients (twenty-four upper limbs) with high tension electricity injury were admitted from December 1998 to September 2002, The damaged limbs consisted of four parts: wrist wound part, 5 cm, 10 cm, 15 cm parts around wrist wound, where the radial and ulnar arteries were detected using B ultrasound and color WP Doppler examination. The changes of endangium, vessel diameter, thickness of the vessel wall and volume of blood flow were recorded respectively. The parameters of normal radial and ulnar arteries were also determined as normal control.

RESULTSB ultrasound and color WP Doppler examination showed that the endangium in radial and ulnar arteries become coarse, edema or exfoliation. The vessel wall was thicker than that of the normal control and the thickness was heterogeneity. The vessel wall could be necrosis in severe patient and the vessel cavity was stricture or beaded. Thrombosis or occlusion could occur at the site of severe injury area in vessel. The decrease in volume of blood flow was observed. The condition of the radial and ulnar arteries become well apart from 10 - 15 cm of wrist wound.

CONCLUSIONSThe ultrasonography can be used to detect the changes in endangium, diameter, thickness of the vessel wall, blood flow volume in injury blood vessel caused by electric burn injury. It is helpful in judging the degree and extent of injury vessel and could be a safe, non-invasive diagnostic method and is worth popularizing.

Adolescent ; Adult ; Burns, Electric ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging ; injuries ; Ulnar Artery ; diagnostic imaging ; injuries ; Ultrasonography ; Wrist Injuries ; diagnostic imaging

OBJECTIVETo compare the difference between digital subtraction angiography (DSA) and type B ultrasonography in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.

METHODSNineteen patients with high voltage electrical injury of upper limbs were enrolled in the study as burn group, and another 12 healthy volunteers as controls. The endovascular membrane, vascular wall thickness, intra-vascular blood flow and endovascular thrombosis formation of ulnar and radial arteries at wound site and in regions 5, 10 and 15 cm proximal to the wounds were examined by DSA and type B ultrasonography and compared with imagings of healthy volunteers as control. The injury degree of the ulnar and radial arteries was examined during operation for evaluation to corroborate with DSA and ultrasonography findings. Necrotic and/or thrombotic vessels were excised and sent for pathomorphological examination.

RESULTSBy DSA images abnormal signs as thrombosis, vascular lumen stenosis and blood flow deceleration were found in 14 ulnar and 11 radial arteries, and the signs were more pronounced in ulnar arteries. By type B ultrasonography, abnormal signs as roughing of tunica intima, swelling or exfoliation, thickening of vascular wall, lumen stenosis, decreased blood flow, even necrosis of vascular wall and thrombosis were identified in 19 ulnar and 16 radial arteries in burn group (P < 0.05 approximately 0.01). The blood flow in ulnar artery 5 cm to the approximal part of the wound edge was obvious lower than that of the control (31.60 +/- 13.90 ml/min vs 47.70 +/- 9.60 ml/min, P < 0.05).

CONCLUSIONType B ultrasonography and DSA could be helpful in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.

Adult ; Angiography, Digital Subtraction ; methods ; Burns, Electric ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging ; injuries ; Ulnar Artery ; diagnostic imaging ; injuries ; Ultrasonography, Doppler, Color ; methods

Arterial cannulation can be used to monitor blood pressure in real time and facilitate frequent arterial blood gas analysis.It is one of the commonly used clinical techniques in anesthesia,emergency,and intensive care units.Studies have demonstrated that ultrasound guidance can increase the success rate of arterial cannulation and reduce the incidence of related complications.In recent years,ultrasound guidance technology has developed rapidly and is increasingly used in clinical practice.This article reviews the latest advances in the application of ultrasound guidance in radial artery cannulation.
Blood Pressure ; Catheterization, Peripheral/methods* ; Radial Artery/diagnostic imaging* ; Ultrasonography ; Ultrasonography, Interventional/methods*

Aged ; Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; Female ; Femoral Artery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radial Artery

BACKGROUNDTransradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention.

METHODSTwo hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar (TUA) or transradial approach (TRA). Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events (MACE) as secondary end point was recorded till 30 days follow-up.

RESULTSSuccessful puncture was achieved in 98.3% (118/120) of patients in the TUA group, and in 100% (120/120) of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively (P = 0.949). No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients.

CONCLUSIONSThe transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.

Aged ; Coronary Angiography ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging ; Treatment Outcome ; Ulnar Artery ; diagnostic imaging ; Ultrasonography

BACKGROUNDThe transradial approach is regarded as a useful vascular site for coronary procedures. The aim of this study was to test whether 4Fr catheters assisted by ACIST variable rate injector system can produce comparable angiographic quality and reduce the risk of radial artery injury compared to hand manifold 6 Fr catheters.

METHODSA total of 1816 patients were studied consecutively, among whom 856 patients received coronary angiography by 4 Fr catheters (4Fr group) and 960 patients by 6 Fr catheters (6Fr group). Angiographic and procedural characteristics were observed and recorded. The luminal inner radial arterial diameter before and after the procedure were collected.

RESULTSThe baseline clinical characteristics were similar in both groups. There were no significant differences in procedure time, radiation dose and quality scores in both groups (P > 0.05), but more contrast media was delivered in the 6Fr group (P < 0.001). The mean radial arterial diameter six months after the procedure in the 6Fr group reduced significantly compared to that measured one day prior to the procedure (P < 0.001).

CONCLUSIONSCoronary angiography using the 4Fr catheters with Acist power injection system can achieve an acceptable diagnostic quality while at the same time minimizing radial artery injury and contrast media consumption.

Aged ; Cardiac Catheterization ; instrumentation ; Coronary Angiography ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging ; Ultrasonography

OBJECTIVETo probe the efficacy and feasibility of the transradial approach for diagnostic coronary angiography with 5F universal catheter.

METHODSTransradial coronary angiography was performed in 3094 consecutive patients, 2396 men and 698 women, aged 30 - 81 years, mean age (56.1 +/- 9.8) years, from July 2000 to April 2004. Patients were divided into 5F improved Terumo catheter group (improved Terumo group, n = 985), 5F universal Terumo catheter group (Terumo group, n = 1024) and 5F universal Medtronic catheter group (Medtronic group, n = 1085). The procedure success rate, duration of operation and fluoroscopy between groups were compared.

RESULTSThe procedure success rate was 98.4% in improved Terumo group, 98.0% in Terumo group, and 96.0 % in Medtronic group, respectively. The success rate was higher in improved Terumo group than in Medtronic group (P < 0.05). The average duration of operation and fluoroscopy in improved Terumo group was (17.9 +/- 5.8) min and (4.8 +/- 1.8) min, in Terumo group was (18.2 +/- 5.5) min and (5.0 +/- 1.7) min, but (21.1 +/- 7.2) min and (5.2 +/- 1.9) min in Medtronic group. There were significant differences among group (P < 0.05).

CONCLUSIONS(1) Transradial coronary angiography with small diameter universal catheter is safe and easy to perform with a higher success rate and allow earlier patient ambulation, and should be strongly encouraged and recommended. (2) Option of angiographic catheter plays a key role in the safety, efficacy and quality of transradial coronary angiography. Seemingly, the improved Terumo group was excellent and shoud be popularized.

Adult ; Aged ; Aged, 80 and over ; Cardiac Catheterization ; methods ; Coronary Angiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging

BACKGROUNDTransradial coronary intervention (TRI) introduces injury to the radial artery (RA) which will affect repeat transradial coronary procedure and the quality as a bypass conduit. We sought to compare the early radial injury after TRI between first-TRI and repeat-TRI by ultrasound biomicroscopy (UBM).

METHODSA total of 1116 patients who underwent the transradial coronary procedures were enrolled. The patients depending on whether for the first time to accept transradial coronary procedure were divided into first-TRI group and repeat-TRI group. The RA was examined by UBM before and one day after the procedure.

RESULTSCompared with first-TRI group, the mean RA diameter of repeat-TRI one day after the procedure decreased significantly (P < 0.05). In first-TRI group, the mean RA diameter was (2.32 ± 0.53) and (1.93 ± 0.57) mm before procedure and one day after the procedure respectively (P < 0.05). In repeat-TRI group, the mean RA diameter was (2.37 ± 0.51) and (1.79 ± 0.54) mm before procedure and one day after the procedure, respectively (P < 0.01). Compared with first-TRI group, the mean RA diameter was reduced significantly in repeat-TRI group one day after the procedure (P < 0.05). The early radial injuries and intimal thickening were compared between first-TRI and repeat-TRI. The mean intima-media thickness of RA was (0.24 ± 0.13) mm and (0.59 ± 0.28) mm before procedure and one day after the procedure in first-TRI group. The mean intima-media thickness of RA was (0.29 ± 0.16) mm and (0.68 ± 0.32) mm before procedure and one day after the procedure in repeat-TRI group. Compared with first-TRI group, the mean intimal thickening was increased significantly in repeat-TRI group one day after the procedure (P < 0.05). Intimal dissection, stenosis and occlusion were all significantly greater in repeat-TRI RAs (P < 0.05). Linear regression analysis revealed that diameter, repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening.

CONCLUSIONSRA early injuries were greater in repeat-TRI patients than in first-TRI patients. We first use high-resolution UBM imaging to demonstrate the rate of radial injury and revealed that diameter, repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Carotid Intima-Media Thickness ; Female ; Humans ; Male ; Microscopy, Acoustic ; methods ; Middle Aged ; Radial Artery ; diagnostic imaging ; injuries