A simple and effective method to preventthe Radial artery occlusion after intervention

防止桡动脉术后闭塞简单有效的方法

A simple and effective method to preventthe Radial artery occlusion after intervention

防止桡动脉术后闭塞简单有效的方法

田 军Tian Jun,MD,FCIT

田 军Tian Jun,MD,FCIT

Effect of RAO

•The patient maybe feel gloomy although The patient maybe feel gloomy although without ischemic of hand becausewithout ischemic of hand because•The pThe pulsateulsate of RA of RA disappeardisappear so that it is so that it is difficult to palpate the pulse for Chinese tdifficult to palpate the pulse for Chinese traditional medicineraditional medicine

Incidence of RAO• The incidence is 4% or 5% in the foreign repor

ts 1.Spaulding C, Lefevre T, Funck F, et al. Left radial approach for coro

nary angiography: results of a prospective study. Cathet Cardiovasc Diagn, 1996; 39: 365-70.

2.Nagai S, Abe S, Sato T, et al. Ultrasonic assessment of vascular complication in coronary angiography and angioplasty after transradial approach. Am J Cardial, 1999,83:180-186.

• The incidence is about 10% in China 吕树铮等 .主编 .冠脉介入诊治技巧及器械选择 .北京 :人民卫生出版社 , 2003:240-241

Foreboding of RAO

• Pulsating of radial artery became weaker than before puncture and of ulnar artery became stronger

• The ache at the forearm muscle was reduced while the ulnar artery was blocked.

The causes of RAO• The artery endothelium was injured by puncture• The injured artery was pressed for homeostasis• The diameter of sheath≥the diameter of artery• The blood was Incomplete heparinization

How to prevent? Our thinking

The bloodstream of the brachial artery dividesinto two branches: radial artery and ulnar artery

Our thinkingThe bloodstream of the RA reduced even stopped whilethe RA was pressed, It maybe kept on after loosening. The bloodstream of ulnar artery compensatory increased

The bloodstream of the RA reduced

S=59.9 cm/sD=1.39 cm/sMN=11.5 cm/s

The bloodstream of UA increased

S=81.2 cm/sD=13.1 cm/sMN=20.4 cm/s

To block persistingly the ulnar artery, so that the bloodstream of the brachial artery could enter almostwhole into the radial artery to distend and wash theartery being faced with imminent occlusion

Our thinking

Blocking UA to increasethe bloodstream of RA

S=117 cm/sD=6.97 cm/sMN=27.2 cm/s

Method

• The sheath was removed immediately postprocedure and the puncture site was enswathed with pressure ；

• The pressure was released suitably in 2 hours after the procedure and the enswathement was loosened in 4 hours; • About one hour after loosening the enswathement th

e ulnar artery of all patients whose pulsating of RA became weak was blocked persistingly with finger

Patients selection

• From June 2001 to March 2006 • Out of 2658 patients who underwent a TRCI,

one hundred eighty-six (7%) whose pulsating of radial artery became weak .

• 117 of male ， 69 of female

The results

• The average time of pressing ulnar artery was 4.1±1.18h (2.5-6.5h).

• There were only 2 patients (1.1%) whose radial artery was occluded. so the efficacious rate of our method is 98.9% and the incidence of RAO is 0.075% in this group patients.

①Tthe location of pressing for blocking ulnar artery was not correct and

②The time of pressing was not enough long for comeback of the radial artery.

The causes of failurefor 2 patients were:

Thanks your attention