Radial artery

Digital necrosis. An 18-year-old woman, with a history of severe anorexia nervosa of 5 years duration, who acknowledged regular use of tobacco and cannabis, was hospitalized for necrosis of the left index and thumb that had occurred shortly after left radial artery puncture for blood gas analysis. Acrocyanosis of the four limbs had been present since the onset of anorexia nervosa. Arteriography of the upper limbs showed major spasm of the left radial and cubital arteries and thromboses in the left interdigital arteries of the left index and thumb. The distal portions of the arteries were then on the left and on the right. The necrotic lesions healed after intravenous administration of ilomedine and interruption of tobacco and cannabis. Acrocyanosis of the four limbs persisted . 

B. Devulder. Digital necrosis in a patient with anorexia nervosa. Association of vasculopathy and radial artery injury Presse Med 2000 29(34) 1850-1852. 

In severe occlusive disease of the subclavian artery (SCA) blood supply of the arm is mainly provided by reversed flow through the vertebral artery (VA) arising behind the obstruction. The so-called subclavian-steal syndrome consists of ischemic symptoms in the arm, especially after exercise, such as pain or numbness or coolness (Reivich et al. 1961). Consequently a diminished or delayed pulse in the radial artery or decreased blood pressure on the side of SCA stenosis can be palpated. Rarely neurological symptoms such as spells of dizziness may be brought about by exercise ofthe arm. Even more rare are ischemic brainstem strokes in subclavian-steal syndrome (Bornstein and Norris 1986). 

Cicinelli, E., Cignarelli, M., Sabatelli, S., Romano, F., Schonauer, L. M., Padovano, R., and Einer-Jensen, N. (1998), Plasma concentrations of progesterone are higher in the uterine artery than in the radial artery after vaginal administration of micronized progesterone in an oil-based solution to postmenopausal women, Fertil. Steril., 69, 471—473. 

Blood flow to the two kidneys is approximately 22-25% of the cardiac output. The kidneys are supplied by the renal artery which enters the kidneys through the hilum and then branches progressively to form the interlobar arteries, arcuate arteries, interlobular arteries (also called radial arteries), and afferent arterioles, which lead to the glomerular capillaries. The distal ends of each glomerulus coalesce to form the efferent arteriole, which leads to a secondary capillary network, the peritubular capillaries which surround the renal tubules. The cortex receives approximately 90% of the blood flow compared to the medulla or papillae so blood-borne toxic molecules reaching the kidneys have a more toxic effect on the cortex, as compared to the medulla or renal papillae. The interstitial space is occupied by the fenestrated peritubular capillaries and a small number of fibroblast-like cells. Increase in thickness of interstitial space in pathological conditions is due to edema, proliferation of fibrous tissue, or infiltration of inflammatory cells (Guyton and Hall, 2006). 

Failla, M, Giannattasio, C., Piperno, A., Vergani, A., Grappiolo, A., Gentile, G., Meles, E., Mancia, G. Radial artery wall alterations in genetic hemochromatosis before and after iron depletion therapy. Hepatology 2000 32 569-573... 

Figure 40, A slash to the wrist cuts the radial artery and will kill an enemy laithin two minutes.

Arterial puncture requires considerable skiE and is usuaEy performed only by physicians or speciaEy trained technicians or nurses. The preferred sites of arterial puncture are, in order, the (1) radial artery at the wrist, (2) brachial artery in the elbow, and (3) femoral artery in the groin. Because leakage of blood from the femoral artery tends to be greater, especially in the elderly, sites in the arm are most often used. The proper technique for arterial puncture is described in NCCLS Standard Hll-A3. ... 

Several additional factors can result in erroneous BP measurements. Pseudohypertension is a falsely elevated BP measurement that is seen in elderly patients with a rigid, calcified brachial artery. In these patients, the true arterial BP when measured directly intraarterially (the most accurate measurement of BP) is much lower than that measured using the indirect cuff method. The Osier s maneuver can be used to test for pseudohypertension. In this maneuver, the BP cuff is inflated above peak SBP. If the radial artery remains palpable, the patient has a positive Osier s maneuver (rigid artery), which indicates pseudohypertension. 

FIGURE 45-1. The predominant types of vascular access for chronic dialysis patients are (A) the arteriovenous fistula and (B) the synthetic arteriovenous forearm graft. The first primary arteriovenous fistula is usually created by the surgical anastomosis of the cephalic vein with the radial artery. The flow of blood from the higher-pressure arterial system results in hypertrophy of the vein. The most common AV graft is between the brachial artery and the basilic or... 

Now, suppose the lABG team has successfully shown that the system can be manufactured and it works both in bench studies and in animal models. The sensor set is deemed ready to be taken to the relatively unknown territory of the radial artery of a sick patient. The radial artery has been used for pressure measurement but only an intact blood column to the central arteries is needed for pressure measurement and there is not necessarily substantial blood flow. Blood sampling is often performed as a passive activity that allows a syringe to fill by the action of the pressure. lABGs require reasonable flow to bring sample to the sensors. Cold, peripheral vasoconstriction, hypotension, and mechanical... 

The three sensing fibers are bonded together over their last 6 cm and then chemically sterilized, and are designed to reside within a standard 20-gauge (1-mm) radial artery catheter. The probe is thin enough to allow easy blood withdrawal and undistorted propagation of the arterial pressure signal to a pressure transducer. The PIM is clamped at the bedside and connected to the monitor located elsewhere. 

Figure 18-13. Radial artery catheter before and after insertion of the optical sensor. From [65].

Reversed segments of autologous saphenous vein can be used as appropriate conduits. Particularly in coronary revascularization, the internal mammary arteries and the radial arteries have widely been used [3]. However, autologous vessels may be insufficient for multiple or repeated bypasses and/or saphenous veins may have varicose degenerative alterations. Therefore, allograft arteries and veins as well as synthetic tubes have been developed, but they proved to be less satisfactory as conduits [4, 5] particularly, synthetic grafts with an internal diameter of 6 mm or less are prone to thrombus induction and occlusion [6]. 

For intra-arterial administration, dilute 10 mL of 10% calcium gluconate with 50 mL of D5W and infuse over 4 hours either through the brachial or radial artery catheter. The patient should be monitored closely over the next 4-6 hours and if pain recurs a second infusion should be given. Some authors have reported 48-72 hours of continuous infusion. 

In a limited and preliminary study it was reported that no blood pressure alteration was seen when a small dose of glyceryl trinitrate (amount not specified) was given as a dermal patch while subjects were taking 50 mg of sildenafil. In addition, the beneficial effects of the glyceryl trinitrate on the radial artery pressure waveform were approximately doubled, and persisted for up to 8 hours. ... 

Systemic pressure monitoring with a small catheter in the radial artery (18-20 gauge) is usually performed for at least 12 h after the procedure and, in particular cases, we assess central venous pressure if a venous introducer is available. 

Cameron J, Trivedi S, Stafford G, et al. Five-year angiographic patency of radial artery bypass grafts. Circulation 2004 110(Suppl. II) II23-6. 

Desai ND, Cohen EA, Naylor CD, et al. A randomized comparison of radial-artery and saphenous vein coronary bypass grafts. NEngl J Med 2004 351 2302-9. 

Fig. 14 Confocal micrographs of radial artery cells seeded onto samples of PVA-C control, PVA-C soaked in fibronectin (FN), PVA-C-FN (FN-functiraialized PVA-C) prepared without CDI, and PVA-C-FN prepared with CDI. Cytoskeleton (red) was labeled with anti-smooth muscle a-actin-Cy3-conjugated Ig02a primary. Cell nuclei (blue) were labeled with Hoechst 33342. Scale bars 50 pm. For further experimental details, refta- to [110]. Reprinted from [110] with permission. Copyright (2011) Elsevier...

Feijoo-Cano C Giant true aneurysm of the radial artery following ligation of an arteriovenous fistula for haemodialysis. Neffologia 2012 32 404M06. 

Arterial inflow stenoses represent atherosclerotic lesions proximal to the anastomosis, and their clinical picture is usually characterized by delayed AVF maturation. These lesions usually involving the radial artery are best treated with PTA [10]. 

---