• Archives of Plastic Surgery
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• v.47 no.5
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• pp.435-443
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• 2020

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.551-556
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• 2005

Background: Complete arterial off-pump coronary artery bypass grafting (OPCAB) by sequential anastomoses with one or two arterial grafts provides favorable outcomes. However, problems of insufficient graft length, hypopefusion, kinking of graft, and unfavorable course of graft may be encountered. To solve these problems, we have used different technique with multiple arterial Y composite graft to allow end-to-side rather than sequential anastomoses and evaluated the results of this method. Material and Method: Between February 2003 and October 2004, If patients underwent total arterial OPCAB using multiple arterial V composite grafts with left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA). We divided RA into multiple segments by number of distal target site after measuring of individual proper length and constructed arterial composite graft. One of segments was sutured end-to-side to LIMA and other segment was sutured end-to-side to the previously constructed radial graft. Postoperative graft patency was evaluated in 6f patients by multi-slice computed tomegraphy. Result: An average of $2.5\pm0.6$ arteries and $3.7pm0.7$ distal anastomoses per patient were done. There was no perioperative myocardial infarction, clinical hypoperfusion syndromes, and operative mortality. Postoperative mean CK-MB level was $17.4pm29.7\;IU/L.$Overall graft patency was $99.1\%\;(214/216)(LIMA:\;100\%,\;RA:\;98.4\%,\;RIMA:\;100\%).$ Conclusion: This technique allows total arterial OPCAB without technical problems and provides excellent early clinical results and graft patency. We believe that this technique is more convenient in the obtuse marginal area compared to sequential technique, and helpful in patients who require complex arterial grafting.

• Korea-Australia Rheology Journal
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• v.18 no.2
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• pp.51-65
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• 2006

Of concern in the present theoretical investigation is the study of blood flow and convection-dominated diffusion processes in a model bifurcated artery under stenotic conditions. The geometry of the bifurcated arterial segment having constrictions in both the parent and its daughter arterial lumen frequently appearing in the diseased arteries causing malfunction of the cardiovascular system, is constructed mathematically with the introduction of suitable curvatures at the lateral junction and the flow divider. The streaming blood contained in the bifurcated artery is treated to be Newtonian. The flow dynamical analysis applies the two-dimensional unsteady incompressible nonlinear Wavier-Stokes equations for Newtonian fluid while the mass transport phenomenon is governed by the convection diffusion equation. The motion of the arterial wall and its effect on local fluid mechanics is, however, not ruled out from the present model. The main objective of this study is to demonstrate the effects of constricted flow characteristics and the wall motion on the wall shear stress, the concentration profile and on the mass transfer. The ultimate numerical solutions of the coupled flow and diffusion processes following a radial coordinate transformation are based on an appropriate finite difference technique which attain appreciable stability in both the flow phenomena and the convection-dominated diffusion processes.

• Journal of Chest Surgery
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• v.32 no.10
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• pp.897-902
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• 1999

Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. Maternal and method: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). Result: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well. Conclusion: Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results. acceptable results.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.384-387
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• 2009

Radial artery aneurysm is an extremely rare disease and this is usually caused by iatrogenic trauma such as arterial cannulation. Most traumatic aneurysms in the extremities are false aneurysms and most cases have occurred at the level of the wrist. Very few true aneurysms of the radial artery have been reported, with most of them being iatrogenic. A right handed 38-year-old female had a true aneurysm of the distal radial artery in the thenar groove of the palm. The patient had a history of excessive handclapping and the injury was suggestive of repetitive occupational injury due to scissoring. She underwent surgical treatment for the aneurysm of the radial artery in the thenar groove of the palm of her hand.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.466-469
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• 1985

The patient was 17 years old female who complained of coldness of right arm and occasional dizziness, since 4 months prior to admission. On physical examination, the right radial, brachial and common carotid arterial pulses were not palpable. Aortography revealed narrowing of innominate and right common carotid arteries, and complete obstruction of right subclavian artery. The right axillary artery was faintly visualized on the delayed film. Axillo-axillar bypass was done using Gore-Tex graft of 8 mm I.D.. By bilateral subclavicular incision, both side axillary arteries was exposed. End to side anastomosis was made between graft and right axillary artery and the graft was brought out to the left side, subcutaneously, over the sternum, and the anastomosis was made between graft and left axillary artery. Postoperatively, both radial pulses were equally palpable. On follow-up visiting, there were no subjective symptoms and blood pressure in both arms was equal.

• Archives of Pharmacal Research
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• v.3 no.1
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• pp.13-16
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• 1980

The model of an isolated organ system has been constructed to simulated the behavior of drug in the circulatory system of an acting organ or site. The model is developed on the following assumptions : The drug in the microcirculatory system cannot permeate the capilary walls. The capilary bed is modeled as a simple ideal plug flow system with and without radial concentration gradient. The mathematical model is developed from basic considerations of drug distribution with hemodynamical and pharmacokinetical meanings. It is considered that a nonmetabolic drug substance is injected into the arterial inflow site of an isolated organ at a constant rate. The concentration of the drug in the outflow site is mathematically expressed as a function of time.

• International Journal of Vascular Biomedical Engineering
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• v.1 no.1
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• pp.41-47
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• 2003

The patency rates of small diameter vascular grafts are disappointing because of the formation of thrombus and intimal hyperplasia. Among the various factors influencing the success of graft surgery, the compliance and the size of a graft are believed to be the most important physical properties of a vascular graft. Mismatch of compliance and size between an artery and a graft alters anastomotic flow characteristics, which may affect the formation of intimal hyperplasia. Among the hemodynamic factors influencing the development of intimal hyperplasia, the wall shear stress is suspected as the most important one. The wall shear stress distributions are experimentally measured near the end-to-end anastomosis models in order to clarify the effects of compliance and diameter mismatch on the hemodynamics near the anastomosis. The effects of radial wall motion, diameter mismatch and impedance phase angle on the wall shear rate distributions near the anastomosis are considered. Compliance mismatch generates both different radial wall motion and instantaneous diameter mismatch between the arterial portion and the graft portion during a flow cycle. Mismatch in diameter seems to be affecting the wall shear rate distribution more significantly compared to radial wall motion. The impedance phase angle also affects the wall shear rate distribution.

• Journal of Sensor Science and Technology
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• v.26 no.4
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• pp.239-244
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• 2017

Noninvasive, cuffless, and continuous blood pressure (BP) monitoring is essential to prevent and control hypertension. A well-known existing method for this measurement is pulse transit time (PTT), which has been investigated by many researchers as a promising approach. However, the fundamental principle of the PTT method is based on the time interval taken by a pulse wave to propagate between the proximal and distal arterial sites. Consequently, this method needs an independent system with two devices placed at two different sites, which is a problem. Even though some studies attempted to synchronize the system, it is bulky and inconvenient by contemporary standards. To find a more sensitive method to be used in a BP measurement device, this study used radial electrical bioimpedance (REB) as a potential indicator for BP determination. Only one impedance plethysmography channel at the wrist is performed for demonstrating a ubiquitous BP wearable device. The experiment was evaluated on eight healthy subjects with the ambulatory BP monitor on the upper arm as a reference. The results demonstrated the potential of the proposed method by the correlation of estimated systolic (SBP) and diastolic (DBP) BP against the reference at $0.84{\pm}0.05$ and $0.83{\pm}0.05$, respectively. REB also tracked the DBP well with a root-mean-squared-error of $7.5{\pm}1.35mmHg$.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.275-281
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• 1997

The radial artery as a graft for myocardial revascularization was introduced by Carpentier in the early 1970s. Mid-term results were unfortunately discoura ing, and the clinical experience with this graft was interrupted. At the end of the 1980s, these authors reproposed the same arterial conduit with more satisfying results, because of improved technique and pharmacological management of the graft. Between October 1994 and July 1995, 36 patients underwent myocardial revascularization with a radial artery graft in Seiong General Hospital. Left internal mammary artery was concomitantly used as a pedicled Vift in 34 patients. Fifteen patients (42%) had a complete arterial waft revascularization. A total of 12) distal anastomoses were performed (average 3.4 per patient), including 36 left internal mammary artery wafts (two sequential in 2 patients), and 23 saphenous vein grafts. The remaining 64 distal anastomoses were perFormed with radial artery grafts (mean 1.8 per patient). The radial arteries were anastomosed to the circumflex (n=38), diagonal (n= 18), right coronary(n=G), and left anterior descending coronary artery(n=2). The percent ge of radial artery graft anastomoses (64) to the total anastomoses(123) was 52%. The radial artery was used as a single graft in 10 patients, as a sequential graft in 25 patients, and two grafts in 1 patient. Twenty patients underwent associated procedures coronary endarterectomy (14), coronary artery patch angioplasty (4), mitral valve repair (1), and repair of ventricular septal rupture (1). One patient died of low cardiac output syndrome and the others had no perioperative myocardial infarction. There are no ischemic and functional complications in the arm or hand aftcr removal of the radial artery. Only 1 patient required reexploration of the am, for the hematoma evacuation, and 2 patients complained transient thumb dysesthesia of the side of the havested arm. This dysesthesia improved within one month. Postoperative angiovaphic controls were obtained in 11 patients(31%) postoperative 79 to 210 days (mean 126 days). The patency rate were as follows : left internal mammary artery (100%), saphcnous vein (100%), and radial artery(95%). We concluded that the radial artery is useful alternative graft, but long term clinical and angiographic studies are required to derterminc whether wider application is warranted.