젊은 성인에 있어서 수조 속에서 초음파로 측정한 요골 동맥의 깊이 및 단면적과 손목 뒤굽힘각도는 어떤 관계가 있는가

강인구,정원준,문경민 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.3

Purpose: Radial artery access has been promoted for anesthesia, critical care, and cardiac catheterization. Our aim was to establish the ideal wrist position for radial artery cannulation; thus we performed ultrasound examinations of the radial artery to analyze the effect of the angle of wrist extension on radial artery dimensions. Methods: Measurements were performed in 30 healthy volunteers. The radial artery diameter and the depth from the skin to the radial artery were measured using an ultrasound technique. Radial artery dimensions were measured at wrist joint angles of 0, 15, 30, 45, and 60 degrees. Results: The average age was 26.7±4.7 years. The mean height and weight were 171.0±6.9 cm and 68.3±15.1 kg,respectively. The mean width and height of the radial artery was 2.61±0.54 mm and 2.21±0.42 mm, respectively. The depth from the skin to the radial artery was 4.67±1.74 mm at a wrist joint angle of 0 degrees. A strong and direct association was found between body mass index with diameters (width and height length) and depth from the skin to the radial artery at wrist angles of 0 degrees. Repeated measure ANOVA revealed that the depth was affected by the wrist joint angle. Our volunteers were associated with shallower depth as increasing in the wrist joint angle statistical significantly (p=0.001). At wrist angles of 30 and 60degrees, the depth was shallower than 0 degrees (p=0.027,p=0.004). Conclusion: Our results indicate that in healthy subjects the depth of the radial artery is shallow when the wrist joint is extended up. A wrist extension at 30 and 60 degrees for healthy subjects results in a decrease in the depth of the radial artery.

경요골동맥 관상동맥 조영술을 시행하는 환자에서 요골동맥 사행성의 빈도 및 예측인자

박민아 ( Min Ah Park ),박태호 ( Tae Ho Park ),최재혁 ( Jae Hyuk Choi ),박선이 ( Sun Yi Park ),이수이 ( Su Ee Lee ),임태형 ( Tae Hyung Lim ),유정남 ( Jung Nam Yoo ),차광수 ( Kwang Soo Cha ),김무현 ( Moo Hyun Kim ),김영대 ( Young Da 대한내과학회 2006 대한내과학회지 Vol.71 No.4

Background: It is well known that the presence of a tortuous radial artery, in patients undergoing transradial coronary angiography (CAG), may cause undesirable results such as access failure and arterial dissection. Thus, our aim was to investigate the prevalence and predictors of the presence of a tortuous radial artery in patients undergoing transradial CAG. Methods: We prospectively investigated the tortuosity of the radial artery in 158 consecutive patients. The tortuosity of the radial artery was determined by radial angiography. A tortuous radial artery was defined as one with a maximal angulation of more than 45 degrees. To determine the predictors of a tortuous artery, we examined clinical and intra- procedural characteristics. Results: A right radial angiography was easily performed in 154 patients (97.5%) without any complications. A tortuous radial artery was identified in 34 patients (22%). On the univariate analysis, advanced age, female gender, short stature, underweight, hypertension, and absence of progression of the mini-guide wire were significantly associated with the presence of a tortuous radial artery. Significant independent predictors of a tortuous radial artery by multivariate analysis were: advanced age, absence of progression of the mini-guide wire and hypertension. Conclusions: These data showed that the presence of a tortuous radial artery could be predicted by advanced age, absence of progression of the mini-guide wire and a history of hypertension. Thus, identification of a tortuous radial artery prior to coronary angiography may be helpful for a safe transradial CAG in patients at high risk for a tortuous radial artery.(Korean J Med 71:381-387, 2006)

요골동맥을 이용한 관상동맥 조영술시 고용량 Nicorandil의 요골동맥 확장 및 임상적 효과

조용찬,김원,김종태,정안덕,조상철,강원유,황선호,김완 대한심장학회 2008 Korean Circulation Journal Vol.38 No.4

Background and Objectives: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. Subjects and Methods: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 μg mixed with verapamil 100 μg) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. Results: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6±11.4/10.4±7.7 mmHg in the Nicorandil group and 12.8±9.8/3.8±5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63±0.25 mm vs. 0.48±0.19 mm, respectively, p=0.013). Conclusion: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution. Background and Objectives: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. Subjects and Methods: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 μg mixed with verapamil 100 μg) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. Results: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6±11.4/10.4±7.7 mmHg in the Nicorandil group and 12.8±9.8/3.8±5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63±0.25 mm vs. 0.48±0.19 mm, respectively, p=0.013). Conclusion: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution.

동일 요골동맥을 이용한 반복 시술 시 요골동맥의 크기 변화 및 시술 결과

유병수,이승환,윤정한,이봉기,고지연,김승년,이명옥,황성오,최경훈 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.12

손목 결절종제거술시 경험한 요골동맥 기형의 치험례

김철한,송우진 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.1

Purpose: An intimate knowledge of the arterial anatomy of the upper extremity and its variations is indispensable to the hand surgeon. We report a patient with anomalous radial artery, superficial course of two radial arteries, encountered during the excision of volar wrist ganglion. Methods: The patient was a 53 - year - old man who showed a painful mass on the left volar wrist for 1 year. Under general anesthesia, a curved incision was made around the mass. With the skin flaps retracted, the dome of the cyst was identified. Particular care was taken to identify and protect the radial artery, which was intimately attached to the wall of the ganglion. Two radial arteries completely encircled the ganglion. The pedicle was traced to the volar joint capsule, radiocarpal ligament. The joint was open and the capsular attachments were excised. Results: The patient made an uneventful recovery. There were two arterial pulsations at the volar side of the wrist joint. Compressing this site revealed that the major arterial contributor to blood supply in the hand was the ulnar artery. At angioCT, an anomaly of the radial artery was found with a duplication. The pathway of this aberrant artery was superficial to the original radial artery. It changed its course subcutaneously at the level of the tendon of the brachioradialis muscle, and crossing the wrist lateral to the original radial artery and ending in the deep palmar arch. Conclusion: Authors experienced a case of bifurcating radial artery encountered during the excision of ganglion on the volar of the wrist. Because these duplicated radial arteries make strong contributions to the thumb and index finger as well as to the deep palmar arch, when they are present there may be probably less blood supply to the hand from the ulnar artery. If the radial artery is palpated superficially on the brachioradialis muscle, it is important to remember the kind of anomaly.

Proximal bifurcation of the superficial palmar branch of the radial artery and anomalous superficial course of the distal radial artery: a case report

Young-Soo Choi,유희진 대한수부외과학회 2022 대한수부외과학회지 Vol.27 No.4

Variations of the radial artery are rare, but clinically significant for surgeons when raising a radial forearm free flap. A 68-year-old man presented with an anomaly of the radial artery, which had a proximal bifurcation of the superficial palmar branch and an anomalous superficial course of the distal radial artery, mimicking duplication of the radial artery. A bifurcation of the main vessel was detected approximately 7 cm proximal to the wrist crease. Anastomosis was performed by using the superficial palmar branch of the radial artery. After anastomosis, the anomalously bifurcated deep palmar branch of the radial artery was transected 1 cm distal to the bifurcation. Although variations, such as unusual bifurcations of the radial artery, are extremely rare, surgeons should be aware of possible variations to ensure safe flap harvesting.

The Feasibility of Bypass Graft Angiography by Right Radial Access

이재훈,김민지,차광수,최재혁,이상엽,남영희,박종성,정석환,금동성,박태호,김무현,김영대 대한심장학회 2009 Korean Circulation Journal Vol.39 No.8

in patients who experienced right radial access. In some patients, the left radial artery has been used as a graft. We investigated whether graft angiography using right radial access is feasible in patients with bypass surgery to preserve the left radial artery as a future graft. Subjects and Methods: A total of 109 consecutive patients with bypass surgery who had undergone right radial access underwent graft angiography via the same access. Results: Sixteen (15%) patients were excluded because of the presence of a severely tortuous right subclavian artery. Bypass graft angiography via right radial or brachial access was completed successfully in 90 (97%) out of 93 patients. In 3 (3%) of patients, femoral access was needed to complete the angiography. Saphenous vein grafts were cannulated selectively in 150 (90%) of 167 grafts with satisfactory image quality and not found even on the aortogram in the other 17 (10%) grafts. Ninety-two (89%) out of 103 left mammary grafts were cannulated selectively or semi-selectively using a modified Simmons catheter, resulting in satisfactory image quality. The other 11 (11%) grafts were visualized non-selectively using a Judkins Left catheter, and resulting in acceptable image quality in 10 (91%) grafts. There were no procedure-related complications. Conclusion: Graft angiography via right radial access can be performed reliably in most patients that lack severe subclavian tortuosity. in patients who experienced right radial access. In some patients, the left radial artery has been used as a graft. We investigated whether graft angiography using right radial access is feasible in patients with bypass surgery to preserve the left radial artery as a future graft. Subjects and Methods: A total of 109 consecutive patients with bypass surgery who had undergone right radial access underwent graft angiography via the same access. Results: Sixteen (15%) patients were excluded because of the presence of a severely tortuous right subclavian artery. Bypass graft angiography via right radial or brachial access was completed successfully in 90 (97%) out of 93 patients. In 3 (3%) of patients, femoral access was needed to complete the angiography. Saphenous vein grafts were cannulated selectively in 150 (90%) of 167 grafts with satisfactory image quality and not found even on the aortogram in the other 17 (10%) grafts. Ninety-two (89%) out of 103 left mammary grafts were cannulated selectively or semi-selectively using a modified Simmons catheter, resulting in satisfactory image quality. The other 11 (11%) grafts were visualized non-selectively using a Judkins Left catheter, and resulting in acceptable image quality in 10 (91%) grafts. There were no procedure-related complications. Conclusion: Graft angiography via right radial access can be performed reliably in most patients that lack severe subclavian tortuosity.

속가슴동맥 편 및 속가슴동맥-노동맥 복합이식편의 자유혈류

최종범,고광표,이미경,류대웅,이삼윤 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.10

Background: The Y-composite graft of internal thoracic artery and radial artery is commonly used in coronary bypass surgery. The aim of this study is to look for a way to raise the free flow of the internal thoracic graft and to see flow dynamics of the Y-graft. Material and Method: In 15 patients undergoing coronary bypass surgery, free flow of the in-situ internal thoracic artery graft was measured using two different papaverine application methods; extraluminal papaverine spray in 7 patients and intraluminal papaverine injection in 8. In 18 other patients for whom the Y-graft was used, total free flow and flow changes from the two ends were measured. Result: The free flow of the in-situ internal thoracic artery graft almost doubled with internal papaverine injection than with external papaverine spray (47.7±9.6 mL/min vs. 100.8±26.3 mL/min, p<0.001). Total flow of the Y-composite graft was significantly more than either flow of the internal thoracic artery end or radial artery graft end (173.3±45.3 mL/min vs. 121.1±34.3 mL/min or 117.5±42.8 mL/min). When both ends of the Y-composite graft were opened, free flows from the two ends were similar (85.4±27.8 mL/min vs. 87.9±42.4 mL/min, p=0.772). The flow of one end of the Y-composite graft was increased significantly by clamping of the other-end than when both ends were opened. Conclusion: Intraluminal papaverine injection is very effective in raising free flow of the internal thoracic artery graft, and the free flow of the Y-composite graft of in-situ internal thoracic artery and free radial artery graft is more than that of the in-situ internal thoracic artery graft. The flow of one end flow of the Y-graft may be altered by the flow change of the other end. 배경 및 목적: 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 관상동맥우회 술에 많이 이용된다. 이 연구의 목적은 속가슴동맥 편의 혈류를 증가시킬 수 있는 방법을 찾고 Y-복합이식편의 혈류역학을 알고자 함이다. 대상 및 방법: 관상동맥우회 술을 받은 15예에서 속가슴동맥 편을 두 가지 방법으로 처치하여 속가슴동맥 혈류량을 측정하였다. 7예에서는 혈관 외부에만 파파베린 액을 처치하였고 8예에서는 혈관 내로 파파베린 액을 주입하였다. 다른 18예에서는 속가슴동맥 편과 유리 노동맥 편으로 Y-복합이식편을 만들어 사용하였고 그 자유 혈류량과 두 분지의 혈류 변화를 조사하였다. 결과: 속가슴동맥 편의 혈관 내로 파파베린을 주사한 경우는 혈관외부에 파파베린을 처치한 경우보다 약 2배의 자유혈류량을 얻을 수 있었다(47.7 9.6 mL/min와 100.8 26.3 mL/min, p<0.001). Y-복합이식편의 양측을 다 연 상태에서 총 자유혈류량은 속가슴동맥 측만을 열었을 때나 노동맥 측만을 열었을 경우보다 훨씬 많았다(173.3 45.3 mL/min와 121.1 34.3 mL/min 혹은 117.5 42.8 mL/min, 각각 p<0.001). Y-복합이식편의 양 분지를 다 연 경우 양측의 혈류량은 차이가 없었다(85.4 27.8 mL/min와 87.9 42.4 mL/min, p=0.772). Y-복합이식편에서 한 측의 혈류량은 다른 측을 열 때보다 막을 때 훨씬 많았다. 결론: 속가슴동맥 편의 혈관 내에 파파베린 액을 주입하는 방법은 자유혈류량을 올릴 수 있는 매우 효과적인 방법이다. 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 속가슴동맥의 단독 이식편보다 더 많은 자유혈류량을 보이며, Y-복합이식편의 한 측의 혈류량은 다른 측의 혈류량의 변화에 따라 변할 수 있다.

요골동맥을 이용한 관동맥 조영술의 유용성

윤정한,이승환,이한요,김장영,김일회,최윤종,이형준,이명옥,김승년,황성오,홍인수,최경훈 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.10

원인불명의 습관성 유산 환자에서 말초혈액 자연살해세포의 증가가 임신초기 자궁혈류의 변화에 미치는 영향

구화선 ( Hwa Seon Koo ),이현정 ( Hyun Jeong Yi ),이민영 ( Min Young Lee ),안현숙 ( Hyun Suk Ahn ),최민혜 ( Min Hye Choi ),성나영 ( Na Young Sung ),황유임 ( Yu Im Hwang ),송인옥 ( In Ok Song ),궁미경 ( Mi Kyoung Koong ),강인수 ( In 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.7

Objective: To evaluate whether increased peripheral blood inflammatory immune cell can induce decrease of uterine blood flow in patients with unexplained recurrent spontaneous abortion (RSA). Methods: This study designed prospectively 33 pregnant women between 5 to 7 gestational weeks with a history of unexplained RSA included in this study. 47 normal pregnant women between 5 to 7 gestational weeks without history of infertility and/or RSA included as a control. Peripheral blood natural killer (pbNK) (CD3-/56+) fractions among peripheral blood monocyte (PBMC) were checked by flow cytometry. Uterine color-pulsed Doppler trans-vaginal ultrasound for evaluation of uterine radial artery RI was checked. Uterine radial artery resistance index (RI) compared between study and control group. After then, uterine radial artery RI was compared between high pbNK cell fraction above 12.1% among PBMC and normal pbNK cells fraction below 12.1%, Correlation between pbNK cell fraction to uterine radial artery RI was also evaluated, Results: Uterine radial artery RI in early pregnancy was significantly higher in patients with RSA than that of normal control (0.60 ± 0.14 vs. 0.54 ± 0.12, P = 0.039). Especially, the mean value of uterine radial artery RI in RSA patients with elevated pbNK cells was significantly increased than that of normal control (0.62 ± 0.13 vs. 0.54 ± 0.12, P=0.029). Otherwise, pbNK cell fractions among PBMC displayed strong positive correlation to uterine radial artery RI (Pearson`s correlation coefficient P=0.001, r = 0.667). Conclusion: Increased pbNK cells can evoke decreased uterine blood flow by their pro-inflammatory action on micro vascular structure such as uterine radial artery. This can be a one causative mechanism of inducing spontaneous abortion by increased NK cells. But, larger scaled study is needed for clarify our results.