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Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement
Lucas Rovira1, Gerardo Aguilar1, Alberto Cuñat2
1Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain.
Insights
Long radial artery catheters (LRC) significantly reduce radial artery blood flow compared to short radial artery catheters (SRC) but do not chronically affect other upper limb arteries. No ischemic events were observed despite some radial artery occlusions.
Area of Science:
- Vascular Surgery
- Hemodynamics
- Critical Care Medicine
Background:
- Assessing upper limb arterial blood flow after prolonged catheterization is crucial for patient safety.
- Comparing long radial artery catheters (LRC) with standard short radial artery catheters (SRC) and no catheter (NOCATH) provides insight into potential complications.
Purpose of the Study:
- To evaluate chronic blood flow changes in upper limb arteries following prolonged catheterization with LRC versus SRC.
- To compare these changes against a no-catheter control group.
Main Methods:
- Prospective observational study involving 20 ICU patients with LRC or SRC inserted for over 48 hours.
- Doppler ultrasound assessment of arterial flow in both upper limbs more than 45 days post-catheter removal.
- Comparison of blood flow in arms with LRC (FlowLRC), SRC (FlowSRC), and no catheter (FlowNOCATH).
Main Results:
- No significant differences in ulnar, brachial, or subclavian artery flow between LRC and SRC groups.
- Significant reduction in radial artery mean flow observed with LRC compared to SRC (2.2 vs. 8.5 cc/min).
- Radial artery flow reduction with LRC (74%) showed a tendency towards increased ulnar flow, suggesting a compensatory mechanism. No ischemic events occurred despite 18% radial artery occlusion in the LRC group.
Conclusions:
- Long radial artery catheters (LRC) do not cause chronic significant changes in brachial or subclavian artery blood flow.
- LRC use leads to a significant reduction in radial artery flow and a tendency for increased ulnar flow.
- Compared to SRC, LRC's primary impact is significantly lower radial artery flow; other arterial flow changes do not significantly differ.
Background:
The purpose of the study was to assess blood flow in the upper limb arteries after prolonged catheterization with long radial artery catheters (LRC) which reach the subclavian artery compared to catheterization with standard short radial artery catheters (SRC) and a group of upper limb flow without any catheter placement (NOCATH), with both SRC and NOCATH as control groups.
Methods:
Prospective observational study with 20 patients admitted to ICU (40 upper limbs) with LRC and/or SRC inserted >48 h for hemodynamic monitoring. More than 45 days after catheter withdrawal, patients underwent a Doppler ultrasound study of both upper limbs. Arterial flows of arms with LRC (FlowLRC) were compared with arterial flows of arms with SRC (FlowSRC) and those without any catheter (FlowNOCATH).
Results:
Flow in the ulnar, brachial, and subclavian arteries did not show any significant difference between the two types of catheters. The only significant difference was in the radial arteries, showing a lower mean flow in the arms with LRC than in the arms with SRC (2.2 vs. 8.5 cc/min; p = 0.041). Flow reduction in the radial artery (74%) in the arms with LRC compared to the SRC arms showed a tendency to increase ulnar flow as a compensatory mechanism. None of the patients with LRC included in our study had any ischemic events, in spite of observing complete flow occlusion in three radial arteries (18%) from the Doppler study.
Conclusions:
In this sample, the use of PiCCO long radial catheters reaching the subclavian artery did not produce chronic significant changes in brachial or subclavian flows. However, LRC produces a significant reduction in radial flow and a tendency to increase ulnar flow. When comparing these blood flow changes with those produced by SRC use, only the radial flow reduction was significantly lower, whereas the other arterial flow changes did not significantly differ.
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