IMAGEN 1
Desde la introducción de la Angiografía coronaria Radial por Campeau en 1989, el uso del acceso radial cada día va incrementado su uso por su seguridad, las ventajas que le ofrece a los pacientes y Operadores, la mayor ventaja es la reducción de complicaciones como sangrados mayores y la completa movilización post procedimiento.
Descripción Anatómica:
La tabaquera anatómica es un espacio hueco en el lado radial de la muñeca cuando se extiende el pulgar; está limitado por el tendón del extensor largo del pulgar hacia atrás y de los tendones del extensor corto del pulgar y del abductor largo anterior. La arteria radial cruza el piso que está formado por el escafoides y los huesos del trapecio. El acceso de la arteria radial distal de la fosa radial fue descrito por primera vez por Babunashvili et al para abrir las arterias radiales ipsilaterales ocluidas de forma retrógrada.1
Método y Procedimiento:
La parte superior izquierda se coloca cómodamente sobre un cojín en el lado izquierdo del paciente. La mano izquierda está doblada hacia la ingle derecha del paciente.
Después de la desinfección, el paciente está cubierto con un campo estéril que contiene cuatro orificios (dos radiales, dos femorales). El orificio femoral izquierdo se coloca sobre el lado dorsal de la mano izquierda del paciente.
El operador toma una posición cerca de la cabeza del paciente para la inyección subcutánea de 3-5 cc de xilocaína que llena la fosa radial.
Para llevar la arteria a la superficie de la fosa, se le pide al paciente que tome su pulgar debajo de los otros cuatro dedos, con la mano ligeramente abducida.
La arteria se punciona, preferiblemente con una aguja abierta de calibre 21 (G), bajo un ángulo de 30-45 grados y de lateral a medial. La aguja se dirige al punto de pulso más fuerte, proximal en tabaquera anatómica.
No se recomienda una punción por transfixión, ya que la aguja tocará el periostio del escafoides o los huesos del trapecio, lo que puede ser doloroso.
Después de una punción exitosa, se inserta una guía metalica flexible, blando y en forma de J de 0.21 ". Para evitar daños en la punta del introductor y la funda, que podrían dañar la arteria, se realiza una pequeña incisión en la piel, seguidamente se introduce el Introductor radial de 6 Fr.
Después de la administración de un cóctel espasmolítico que contiene 200 mcg de nitroglicerina y 5 mg de verapamilo y de una dosis de heparina ajustada al peso, el operador puede tomar una posición al nivel de las rodillas del paciente para manipular la guía metalica 0,35 " y subir los catéteres y los dispositivos intracoronarios. Si se encuentra resistencia con la guía a nivel del codo flexionado, se cruzará un guía hidrofílica.
CONTROL Y HEMOSTASIA
Conclusiones:
El acceso de la arteria radial distal izquierda para la angiografía coronaria y la angioplastia, en pacientes con acceso radial izquierdo preferido, es factible y seguro. Esta nueva técnica merece una exploración seria porque brinda ventajas a los pacientes y los operadores; sin embargo la buena selección del paciente con una anatomía bien desarrollada, asegura el éxito del procedimiento, debemos seguir realizando esté tipo de procedimiento para mayores aplicaciones.References
- Orazio Valsecchi MD. Early Clinical Experience With Right and Left Distal Transradial Access in the Anatomical Snuffbox in 52 Consecutive Patients. The Journal of InvasIve CardIology® 2018;30.
- Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention 2017;13:851–7.
Todas las imágenes fueron tomas con el consentimiento firmado y registrado del paciente, las fotos fueron tomas con equipo Samsumg J7
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CORAZÓN Y DEPORTE (PARTE I)
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Thanks..
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Muy buen Post !
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Muchas Gracias
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You got a 85.71% upvote from @bdvoter courtesy of @alfonzoasdrubal!
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Sneaky Ninja Attack! You have just been defended with a 2.91% upvote!
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Buenos dias dr excelente post me ayudo demasiado para la tarea ajajajaj(soy estudiante de medicina de la Unerg.) Lo invito a unirse a esta comunidad que apoya demasiado esta clase de contenido.
https://discord.gg/ezSQWH
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Muchas gracias por la invitacion
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¡Excelente!
Post votado por el proyecto
Gracias a la curación manual de los Lunes y Martes.
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