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Radial artery access is commonly performed for coronary angiography and invasive hemodynamic monitoring. Despite limitations in diagnostic accuracy, the modified Allen test (manual occlusion of radial and ulnar arteries followed by release of the latter and assessment of palmar blush) is used routinely to evaluate the collateral circulation to the hand and, therefore, to determine patient eligibility for radial artery access. We sought to evaluate whether a smartphone application may provide a superior alternative to the modified Allen test. We compared the modified Allen test with a smartphone heart rate–monitoring application (photoplethysmography readings detected using a smartphone camera lens placed on the patient’s index finger) in patients undergoing a planned cardiac catheterization. Test order was randomly assigned in a 1:1 fashion. All patients then underwent conventional plethysmography of the index finger, followed by Doppler ultrasonography of the radial and ulnar arteries (the diagnostic standard). The primary outcome was diagnostic accuracy of the heart rate–monitoring application. Among 438 patients who were included in the study, we found that the heart rate–monitoring application had a superior diagnostic accuracy compared with the modified Allen test (91.8% v. 81.7%, p = 0.002), attributable to its greater specificity (93.0% v. 82.8%, p = 0.001). We also found that this application had greater diagnostic accuracy for assessment of radial or ulnar artery patency in the ipsilateral and contralateral wrist (94.0% v. 84.0%, p < 0.001). A smartphone application used at the bedside was diagnostically superior to traditional physical examination for confirming ulnar patency before radial artery access. This study highlights the potential for smartphone-based diagnostics to aid in clinical decision-making at the patient’s bedside. Trial registration: Clinicaltrials.gov, no. NCT02519491.

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group (p<0.001). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group (p<0.001). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

Application of exposure to 50/60 Hz magnetic fields (MFs) has been conducted in the treatment of muscle pain and fatigue mainly in Japan. However, whether MFs could increase blood flow leading to muscle fatigue recovery has not been sufficiently tested. We investigated the acute effects of a 50 Hz sinusoidal MF at B max 180 mT on hemodynamics, electrocardiogram, and vascular endothelial function in healthy young men. Three types of regional exposures to a 50 Hz MF, i.e., forearm, upper arm, or neck exposure to MF were performed. Participants who received three types of real MF exposures had significantly increased ulnar arterial blood flow velocity compared to the sham exposures. Furthermore, after muscle loading exercise, MF exposure recovered hemoglobin oxygenation index values faster and higher than sham exposure from the loading condition. Moreover, participants who received real MF exposure in the neck region had significantly increased parasympathetic high-frequency activity relative to the sham exposure. The MF exposure in the upper arm region significantly increased the brachial artery flow-mediated dilation compared to the sham exposure. Computer simulations of induced in situ electric fields indicated that the order-of-magnitude estimates of the peak values were 100–500 mV/m, depending on the exposure conditions. This study provides the first evidence that a 50 Hz MF can activate parasympathetic activity and thereby lead to increase vasodilation and blood flow via a nitric oxide-dependent mechanism. Trial registration: UMIN Clinical Trial Registry (CTR) UMIN000038834 . The authors confirm that all ongoing and related trials for this drug/intervention are registered.

Background There is a lack of reports in the literature regarding changes in radial artery blood flow after decannulation. The objective of this study was to investigate changes in radial and ulnar artery blood flow after radial artery decannulation using Doppler ultrasound and to explore the factors that influence radial artery blood flow recovery. Methods In current observational study, we used colour Doppler ultrasound to measure the cross-sectional area of the radial (S R ) and ulnar artery (S U ) and peak systolic velocity of the radial (PSV R ) and ulnar artery (PSV U ) for both hands at four time points in patients with radial artery cannulation: pre-cannulation (T0), 30 min after decannulation (T1), 24 h after decannulation (T2), and 7 days after decannulation (T3). Repeated measures analysis of variance and logistic regression analysis were performed to analyse the data. Results Overall, 120 patients were included in the present study. We obtained the following results on the side ipsilateral to the cannulation: compared with T0, the ratio of PSV U /PSV R increased significantly at T1 and T2 ( p  < 0.01); compared with T1, the ratio of PSV U /PSV R decreased significantly at T2 and T3 ( p  < 0.01); compared with T2, the ratio of PSV U /PSV R decreased significantly at T3 (p < 0.01). Female sex (OR, 2.76; 95% CI, 1.01–7.57; p  = 0.048) and local hematoma (OR 3.04 [1.12–8.25]; p  = 0.029) were factors that were significantly associated with the recovery of radial artery blood flow 7 days after decannulation. Conclusions There was a compensatory increase in blood flow in the ulnar artery after ipsilateral radial artery decannulation. Female sex and local hematoma formation are factors that may affect the recovery of radial artery blood flow 7 days after catheter removal.

The superficial ulnar artery (SUA) is a rare anatomical variant that usually arises either in the axilla or the arm and runs a superficial course in the forearm, enters the hand, and participates in the formation of superficial palmar arch. During the routine dissection of cadavers in the department of anatomy, whilst preparing the specimen for medical students, an unusual bilateral branch of the axillary artery was found in one of the cadavers: a rare variant of the artery known as SUA, which originates from the 2nd part of the axillary arteries of both sides. The SUA is a known anatomical variant, but the bilateral high origin from the 2nd part of the axillary artery is extremely unusual. Its occurrence is of great clinical importance to the surgical and radiological departments.

The biometry and the histology of coronary, radial, ulnar, epigastric and internal thoracic arteries were studied in order to investigate the cause of their occlusions in coronary bypass grafts and to improve the results of these bypass grafts. These various arteries were removed from 40 anatomical specimens (27 males and 13 females). We found a correlation between the internal calibers of the ulnar and coronary arteries in males. Intimal changes and the presence of atheromatous plaque were observed in coronary, radial and ulnar arteries, but never in the internal thoracic artery. Like coronary arteries and their branches, radial, ulnar and epigastric arteries are muscular arteries and ageing results in thickening of the intima, which becomes fibrotic with migration of myocytes from the media and duplication of the internal elastic lamina. The media becomes fibrous, hypertrophic or atrophic. In contrast, the internal thoracic artery is an elastic artery, like the aorta. Ageing is characterized by loss, over a variable extent, of one or several elastic laminae of the media and more marked intimal thickening. Although anatomically, the caliber of radial, ulnar, and epigastric arteries remains adapted to that of coronary arteries, the long-term patency of radial, ulnar and epigastric arteries used as grafts is related to their histological characteristics.

Background We investigated the previously undescribed phenomenon of ulnar artery occlusion on clenching to make a fist, following the presentation of a patient to our unit with idiopathic ulnar-sided hand pain. This led us to study this unusual finding in a cohort of asymptomatic patients. Methods Ninety-one radial and ulnar arteries were studied in 23 volunteers by color duplex ultrasonography. The subjects were all asymptomatic, their ages ranged from 18 to 78 years, and included 10 males and 13 females. Results Twenty-two percent of ulnar arteries occluded on clenching a fist, resulting in the hand relying on in-flow solely from the radial artery. All arteries opened up following fist release allowing anterograde flow. Furthermore, 11% of superficial palmar branches of radial arteries occluded on fist-making. The pattern of flow on making a fist showed an initial burst of reverse flow followed by reduced or occluded flow and subsequently an increase in antegrade flow after release of the fist. No subject could occlude both radial and ulnar arteries simultaneously. Conclusions We discuss these findings in view of the potential clinical implications in terms of Raynaud’s phenomenon, scleroderma, and importantly, the potential for false-positive findings of pathological ulnar artery occlusion on ultrasonography.

The degree of digit and ulnar reflex vasoconstriction is a useful measure of hand sympathetic function. Reflex vasoconstriction is generally expressed as the percentage of reflex reduction in blood flow compared to resting flow. Sympathetic traffic to and from the hand can be altered by environmental testing factors, and lead to a reduction in reflex vasoconstriction. In this study we tested the effect of pronation and supination on inspiratory gasp induced digit skin and ulnar artery vasoconstrictor reflex responses. In 11 healthy subjects (range 21-65 yrs, mean 39 yrs, 8 females, 3 males) the mean second digit vasoconstriction in supination was 55 (SD 19)/44 (SD 20), for pronation 55 (SD19)/48 (SD19); for the fourth digit, in supination 63 (SD18)/59 (SD 21), in pronation 64 (SD15)/69 (SD13) (right and left). Mean ulnar vasoconstriction in supination was 81 (SD 11)/88 (SD11), for pronation 81 (SD10)/86 (SD12) (right and left). For all vascular regions, reflex vasoconstriction was not significantly different between pronation and supination. All subjects felt the pronation position more comfortable and an added benefit of this position was significantly shorter testing time.

The aim of this prospective study was to assess whether the removal of the radial artery (RA) caused any alteration in the function or power of hand on postoperative 15th day. The study group included 25 patients with objective or subjective complaints on postoperative 15th day regarding harvest site following coronary bypass surgery by using RA. Patients were examined for bilateral forearm function (soft touch and pin-prick neural sensation, handgrip power). The ulnar artery and palmar arcus Doppler measurements such as peak systolic and end-diastolic velocity, and radius of the arteries have been measured both at rest and following handgrip test. The operated arm was evaluated and compared with the opposite arm. Wilcoxon test was used to compare continuous variables. Among 18 patients complained a loss of sense in the RA excised arm, the sensory defects were documented in 5. Among 7 patients presented with a feel of strength loss, handgrip power revealed a nonsignificant decrease of strength in the harvested arm. After squeezing test, ipsilateral ulnar artery peak systolic velocity increased from 86+/- 15 to 105+/- 15 cm/sec (<0.001), end-diastolic flow velocity from 28+/- 5 to 36+/- 8 cm/sec (<0.001) without any change in the ulnar artery radius. In contrast, no significant change in the flow velocity and the diameter of palmar arcus was noted before and after squeezing test. The comparison of the ulnar artery radius and blood flow velocity parameters in the RA excised arm to those of contralateral one after exercise test demonstrated no difference. With an assumption of appropriate selection, removal of RA does not change the forearm blood supply and functions with little sensory disturbances in the early postoperative period.

Limited literature exists on the vascular reactivity of the radial and ulnar arteries in hypertensive patients following radial artery cannulation. This study assessed the vascular reactivity of the radial and ulnar arteries by comparing Doppler images and laser speckle contrast imaging (LSCI) obtained from both normotensive and hypertensive patients after radial artery cannulation under general anesthesia. This study recruited 99 normotensive and 99 hypertensive patients who required arterial cannulation under general anesthesia. In the course of research, to evaluate the impact of hypertension on arterial reactivity, we employed duplex Doppler ultrasonography to measure the inner diameter (ID), resistance index (RI) and mean volume flow (MVF) of both arteries at five different time points. We equally performed perfusion of thumb and little finger by laser speckle contrast imaging. After radial artery cannulation, the hypertensive group showed less increase in radial ID and less decrease in RI compared to the normotensive group. The MVF increase was also less pronounced in hypertensive patients, while both groups demonstrated equivalent ulnar ID changes, and the normotensive group exhibited a more significant decrease in RI and a greater MVF increase. Thumb perfusion decreased post-cannulation in both groups, with the hypertensive group showing a less robust recovery. Little finger perfusion increased after artery cannulation in both groups, but the hypertensive group's increase was lower. The incidence of vasospasm in the hypertensive group is higher than that in the normotensive group. The radial and ulnar arteries in hypertensive patients may lack a compensatory response to radial artery cannulation during general anesthesia. •This study is the first to use laser speckle contrast imaging to evaluate finger perfusion after radialartery cannulation.•This study suggests hypertensive patients may not fully compensate for radial artery cannulation, unlike normotensive ones.•Hypertensive patients are prone to vasospasm with radial artery cannulation; caution is advised.