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Background: Coronary artery disease, involving stenoses of the coronary vasculature, is a major contributor to cardiovascular disease (CVD) morbidity and mortality in Australia. Cardiac catheterisation is a key strategy in the management and diagnosis of coronary artery disease. This procedure is rapidly evolving as new knowledge and technological advancements change practice. Such rapid evolution has created challenges in sustaining the evidence base to guide best practice. Current recommendations suggest the use of the radial artery to gain access for the procedure. Despite the current emphasis on radial artery access, the prevalence of radial artery spasm (RAS) poses a notable challenge with rates of up to 30% reported for transradial cardiac catheterisation procedures potentially affecting the success rates of the procedure and causing considerable discomfort for patients. Hence, understanding and mitigating RAS has become increasingly critical in optimising patient outcomes and procedural success. Aim: This Doctoral project sought to gain greater insight into the management of RAS in transradial cardiac catheterisation. This overarching aim was achieved through a series of distinct yet interrelated studies which sought to; review the current literature on pharmacotherapy to reduce the occurrence of RAS during transradial cardiac catheterisation. identify the predictors of RAS and the pharmacotherapy used for its prevention and management. map current practices and explore factors that influence clinical decision-making for transradial cardiac catheterisation. Methods: A creative approach was used consisting of three separate yet interrelated phases. Phase one included two systematic reviews of current evidence for the management of RAS. Phase two comprised a quantitative descriptive study to identify medications and practices implemented to reduce the occurrence of RAS. Finally, in phase three, a sequential mixed methods study was carried out, focusing on curre

The conventional fabrication process of prosthetic sockets is known for being labor-intensive and time-consuming. It takes the user to wait 2-5 weeks to receive the prosthetic socket. In addition, most of the conventional sockets have fixed volumes that do not consider the volume fluctuations that the user experience daily because of muscle activities and comorbid medical conditions. 3D printing has shown promising results in producing lower limb sockets; however, upper limb sockets are overlooked. The goal of this master thesis is to design and fabricate a volume-adjustable, affordable, 3D printable transradial, prosthetic socket. In this research, the V3D (Volume-adjustable, 3D printable) socket has been developed with a material cost of only €30. The socket provides a volume-adjustable closure system around the residual limb, easiness of donning and doffing without skin shearing, full elbow extension, high range of flexion, low weight, and breathability. The socket was designed to be able to withstand a load of 50N that can be applied axially or transversely at the tip of the socket without breakage. The designed socket was 3D printed using the Fused Deposition Modeling (FDM) printing technique, from tough Polylactic Acid (tough PLA). Mechanical and human assessments have been conducted to evaluate the strength, function, and comfort of the developed socket. Results have shown that the socket managed to withstand a load up to 100N that was applied axially and transversely, respectively, without showing any signs of damage. During testing the socket with 5 participants for evaluating its comfort and function, the socket has succeeded to achieve full contact with the residual limbs, while offering volume-adjustability that accommodated the differences in size and properties of the residual limbs among participants. Not only that, but also, the socket succeeded to allow full elbow extension, a range of flexion up to 95°, and donning and doffing in less than 10 secon, Mechanical Engineering | BioMechanical Design

L'autor d'aquest projecte és un gran apassionat dels esports, especialment del ciclisme, per tant, que uns altres no puguin gaudir d'ells per motius aliens a la seva pròpia decisió és una cosa que li fa sentir impotent. Aquest projecte sorgeix de voler, d'una manera o una altra, fer una petita aportació. A continuació, es mostra un treball centrat en desenvolupar un dispositiu protètic per a amputats transradiales, enfocat en el ciclisme. D'aquesta manera s'aconsegueix que persones que volen practicar ciclisme i no poden a causa de la seva discapacitat puguin realitzar-ho sense impediments. Per a dur a terme el projecte s'establiran uns objectius, els quals es pretenen aconseguir mitjançant dues metodologies de disseny completament compatibles: el Design thinking i la metodologia de doble diamant. Mitjançant la seva combinació es desenvolupen diversos punts, entre els més destacats es troben el Brífing, amb el qual s'aconsegueix una major informació del producte i usuari i la identificació del problema, on s'usen fins a 9 eines. Gràcies a tota la informació recopilada en els punts esmentats s'idea el producte i posteriorment es realitza un modelatge 3D. Mitjançant aquest modelatge es realitzen una sèrie de simulacions i càlculs d'esforços per a comprovar que el dispositiu protètic dissenyat és segur. Finalment, es defineix el producte definitiu mitjançant plans 2D i renderitzats 3D, gràcies als renderitzats el client es pot fer una idea aproximada de com serà el producte, però per a facilitar-li el treball es realitza una maqueta amb la qual podrà veure diferents aspectes com a forma, grandària o proporcions. Una vegada finalitzat, s'extreuen unes conclusions que valoren positivament el treball realitzat., El autor de este proyecto es un gran apasionado de los deportes, especialmente del ciclismo, por tanto, que otros no puedan disfrutar de ellos por motivos ajenos a su propia decisión es algo que le hace sentir impotente. Este proyecto surge de querer, de una manera u otra, hacer una pequeña aportación. A continuación, se muestra un trabajo centrado en desarrollar un dispositivo protésico para amputados transradiales, enfocado en el ciclismo. De este modo se consigue que personas que quieren practicar ciclismo y no pueden debido a su discapacidad puedan realizarlo sin impedimentos. Para llevar a cabo el proyecto se establecerán unos objetivos, los cuales se pretenden alcanzar mediante dos metodologías de diseño completamente compatibles: el Design thinking y la metodología de doble diamante. Mediante su combinación se desarrollan diversos puntos, entre los más destacados se encuentran el Briefing, con el cual se consigue una mayor información del producto y usuario y la identificación del problema, donde se usan hasta 9 herramientas. Gracias a toda la información recopilada en los puntos mencionados se idea el producto y posteriormente se realiza un modelado 3D. Mediante este modelado se realizan una serie de simulaciones y cálculos de esfuerzos para comprobar que el dispositivo protésico diseñado es seguro. Finalmente, se define el producto definitivo mediante planos 2D y renderizados 3D, gracias a los renderizados el cliente se puede hacer una idea aproximada de cómo será el producto, pero para facilitarle el trabajo se realiza una maqueta con la que podrá ver diferentes aspectos como forma, tamaño o proporciones. Una vez finalizado, se extraen unas conclusiones que valoran positivamente el trabajo realizado., The author of this project is a great passionate about sports (especially cycling) and that others cannot enjoy them for reasons beyond their own decision is something that produces impotence, from that impotence the idea of this project was born. The project focuses on developing a prosthetic device for transradial amputees focused on cycling and thus ensuring that people who want to practice cycling and cannot due to their disability can do it without impediments. To execute the project, objectives will be established, which will be achieved through two completely compatible design methodologies, these are Design thinking and the double diamond methodology, through the combination of these two methodologies, various points are developed, among the most outstanding are They find the Briefing with which they get more information about the product, user, etc and the identification of the problem where up to 9 tools are used to identify it. Thanks to all the information collected in the aforementioned points, the product is designed and subsequently a 3D modeling is carried out, through this modeling a series of simulations and stress calculations are carried out to verify that the designed prosthetic device is safe. Finally, the final product is defined by means of 2D plans and 3D renderings, thanks to the renderings the client can get an approximate idea of what the product will be like, but to facilitate the work a model is made with which they can see different aspects such as shape, size, proportions, etc. Once the project is finished, a series of conclusions are made of all the work carried out and the result of the project is positively valued.

The conventional fabrication process of prosthetic sockets is known for being labor-intensive and time-consuming. It takes the user to wait 2-5 weeks to receive the prosthetic socket. In addition, most of the conventional sockets have fixed volumes that do not consider the volume fluctuations that the user experience daily because of muscle activities and comorbid medical conditions. 3D printing has shown promising results in producing lower limb sockets; however, upper limb sockets are overlooked. The goal of this master thesis is to design and fabricate a volume-adjustable, affordable, 3D printable transradial, prosthetic socket. In this research, the V3D (Volume-adjustable, 3D printable) socket has been developed with a material cost of only €30. The socket provides a volume-adjustable closure system around the residual limb, easiness of donning and doffing without skin shearing, full elbow extension, high range of flexion, low weight, and breathability. The socket was designed to be able to withstand a load of 50N that can be applied axially or transversely at the tip of the socket without breakage. The designed socket was 3D printed using the Fused Deposition Modeling (FDM) printing technique, from tough Polylactic Acid (tough PLA). Mechanical and human assessments have been conducted to evaluate the strength, function, and comfort of the developed socket. Results have shown that the socket managed to withstand a load up to 100N that was applied axially and transversely, respectively, without showing any signs of damage. During testing the socket with 5 participants for evaluating its comfort and function, the socket has succeeded to achieve full contact with the residual limbs, while offering volume-adjustability that accommodated the differences in size and properties of the residual limbs among participants. Not only that, but also, the socket succeeded to allow full elbow extension, a range of flexion up to 95°, and donning and doffing in less than 10 secon, Mechanical Engineering | BioMechanical Design

Prostheses are challenging to obtain in low-income countries due to a lack of experts, remote locations, unfortunate production circumstances and an inadequate amount of research. A 3D printed WILMER open fitting for transradial amputees has been developed, which can solve this problem. It is entirely 3D printed and connects the prosthesis to the residual limb. However, the current design is not breathable nor volume adjustable. This is a significant obstacle since the residual limb perspires and dilates/diminishes during the day. Therefore, the aim of this paper is to design a breathable, volume adjustable, parametric, 3D printed socket for transradial amputees in low-income countries. This new design consists of straps connected with hinges which improve the range of motion. The material used for the socket is TPU 95A. The straps are perforated to improve the breathability of the socket. Furthermore, a clickable spacer, which is strong enough to withstand a force of 200 N, is attached to make the socket volume adjustable. The complete socket is also subjected to strength tests which resulted in a maximum manageable force of 100 N, attached to the prosthetic hand. However, the socket has not been evaluated by patients, which means that real-life wearing conditions are not achieved. Therefore, it would be a recommendation for future research to examine the socket on patients. Overall, this study provides the design of an affordable, comfortable, aesthetically pleasing, durable, parametric socket for amputees in low-income countries., ARM3D, Mechanical Engineering | BioMechanical Design

Prostheses are challenging to obtain in low-income countries due to a lack of experts, remote locations, unfortunate production circumstances and an inadequate amount of research. A 3D printed WILMER open fitting for transradial amputees has been developed, which can solve this problem. It is entirely 3D printed and connects the prosthesis to the residual limb. However, the current design is not breathable nor volume adjustable. This is a significant obstacle since the residual limb perspires and dilates/diminishes during the day. Therefore, the aim of this paper is to design a breathable, volume adjustable, parametric, 3D printed socket for transradial amputees in low-income countries. This new design consists of straps connected with hinges which improve the range of motion. The material used for the socket is TPU 95A. The straps are perforated to improve the breathability of the socket. Furthermore, a clickable spacer, which is strong enough to withstand a force of 200 N, is attached to make the socket volume adjustable. The complete socket is also subjected to strength tests which resulted in a maximum manageable force of 100 N, attached to the prosthetic hand. However, the socket has not been evaluated by patients, which means that real-life wearing conditions are not achieved. Therefore, it would be a recommendation for future research to examine the socket on patients. Overall, this study provides the design of an affordable, comfortable, aesthetically pleasing, durable, parametric socket for amputees in low-income countries., ARM3D, Mechanical Engineering | BioMechanical Design

Introduction and objectives: Today it has become increasingly common to perform procedures without withdrawing oral anticoagulation. However, the need to withdraw oral anticoagulants prior to cardiac catheterization in patients chronically anticoagulated (OACs) remains controversial. We evaluated the efficacy and safety of performing transradial catheterization in outpatients without withdrawing direct-action oral anticoagulants (DOACs). Methods: Prospective and observational study where 270 patients who underwent elective transradial cardiac catheterization were included from January 2013 through November 2017, divided into 3 groups of 90 patients based on their anticoagulant intake: group A (without OAC), with group B (with vitamin K antagonist), and group C (with DOACs), and matched according to the date of completion. In no case was the OAC discontinued before the procedure. We evaluated the complications of radial access within the first 24 h and 1 month after the procedure. Results: The group of patients on DOACs had a higher proportion of men compared to the vitamin K antagonist group (71.1% vs 47.8%; p = .01) and patients were younger in the group without OAC (63.45 ± 11.47 vs 70.22 ± 9.35; p = .03). Group B had a lower percentage of diabetic patients (22.2% vs 36.67% in group C, p = .03). In group A, patients were more prone to having a history of ischemic heart disease compared to the groups of anticoagulated patients (27.84% vs 14.44% in group C, p = .028) in addition to a more frequent intake of antiplatelet drugs. Radial access was the access of choice in most patients (98.2%). There were no significant differences when it comes to vascular access complications among the groups being the rate of hematoma and/or bleeding at discharge equal to 1.1% in the DOACs group and the arterial occlusion rates both at discharge and at 1 month between 0% and 2.2%. Conclusions: In our experience performing transradial diagnostic cardiac catheterizations without discon, Introducción y objetivos: Actualmente es cada vez más habitual realizar procedimientos sin retirar la anticoagulación oral (ACO), pero la necesidad o no de suspender la ACO antes del cateterismo cardiaco sigue siendo una cuestión controvertida. Se evalúan la eficacia y la seguridad de la realización de un cateterismo transradial en pacientes ambulatorios sin retirar los anticoagulantes orales de acción directa (ACOD). Métodos: Estudio observacional, prospectivo, que incluye 270 pacientes sometidos a cateterismo transradial electivo desde enero de 2013 hasta noviembre de 2017, divididos en 3 grupos de 90 pacientes: grupo A (sin ACO), grupo B (con antagonista de la vitamina K), grupo C (con ACOD), emparejados según la fecha de realización del cateterismo. No se suspendió la ACO antes del procedimiento. Se evalúan las complicaciones del acceso radial en las primeras 24 h y un mes después del cateterismo. Resultados: Había más varones tratados con ACOD que con un antagonista de la vitamina K (71,1 frente a 47,8%; p = 0,01) y los pacientes eran más jóvenes en el grupo sin ACO (63,45 ± 11,47 frente a 70,22 ± 9,35 años; p = 0,03). En el grupo B hubo menos diabéticos (22,2 frente a 36,67% en el grupo C; p = 0,03). En el grupo A, los pacientes tenían más antecedentes de cardiopatía isquémica que los pacientes con anticoagulación (27,84 frente a 14,44% en el grupo C; p = 0,028), además de la toma concomitante de fármacos antiplaquetarios. El acceso fue radial en la mayoría de los pacientes (98,2%). No hubo diferencias significativas en las complicaciones del acceso vascular, con una tasa de hematoma o hemorragia al alta del 1,1% en el grupo con ACOD y tasas de oclusión arterial tanto al alta como al mes del 0-2,2%. Conclusiones: En nuestra experiencia, la realización de un cateterismo diagnóstico transradial sin interrupción de los ACOD es seguro, con tasas bajas de complicaciones trombóticas y hemorrágicas, sin diferencias respecto a los pacientes en tratamiento con un antag

Prosthetic devices remain inaccessible for many amputees in low-income countries. The lack of trained professionals and resources to fit a prosthetic (interface) are principle reasons. The low cost at which additive manufacturing technology (AM) is able to produce a custom made part could change this. As such, the aim of this study was to design an AM transradial interface specifically for low-income countries. It was decided to adopt the WILMER Open Socket design for AM. The interface was not manufactured in its final form. Instead it was decided to print the interface perfectly flat and reassemble it post-manufacturing for increased print reliability and optimal material properties. Flexible yet durable TPU 95A filament was chosen for this purpose. Reassembling the separate pieces occurred with two different locking mechanisms, which were designed specifically for this purpose. These locks were validates using tensile strength tests. The fully assembled interface was tested as well in two different orientations to validate its strength. In contrast to traditional interface fitting, the new design requires merely anthropomorphic measurements, as the actual surface of the residual limb remains mostly uncovered. This study proposes a different approach to AM prosthetic interface design. The fabrication method has been embraced fully, resulting in a comfortable, visually appealing, and durable design for low-income and challenging settings., Biomedical Engineering | BioMechatronics

Background-—The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results-—Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=0.8; P=0.006). Ultimately, when a center’s balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions-—The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach., Funding agencies: General Electric (GE) Healthcare; TeraRecon Inc.; Saul and Edna Goldfarb Research Chair in Cardiac Imaging

Background-—The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results-—Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=0.8; P=0.006). Ultimately, when a center’s balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions-—The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach., Funding agencies: General Electric (GE) Healthcare; TeraRecon Inc.; Saul and Edna Goldfarb Research Chair in Cardiac Imaging

Upper-limb prosthetic device rejection rates have been estimated at up to 26\% for adult users and up to 45\% for pediatric users, while non-wear rates are estimated at 20\% and 16\%, respectively. Yet, upper-limb prostheses are of focus in only 20\% of the reviewed published literature (60\% less than lower-limb prostheses), with less than half of the publication addressing engineering design to improve these devices. The prosthesis-limb interface, such as a conventional socket, is a critical component in upper-limb prostheses, necessary for force transfer to and from the wearer and thus important for control and comfort of the device. Though volume management of the residual limb is accounted for in some sockets designs, pediatric residual limb growth is not, aside from compensatory padding techniques. o Due to the growth of a child, replacement of an upper-limb prosthetic device is necessary every 1-2 years, while adjustments are more frequent. Limited availability of properly-sized components and the combined costs of hardware and clinical visits pose technical and financial challenges for families. Lack of proper adjustment or replacement of the device may lead to poor fit and function, resulting in rejection or physical injury. o Transradial deficiency is the most common major upper-limb deficiency in children. To extend the functional lifetime of the related prosthetic device and thereby reduce frequency and cost of replacement, the aim of this study is to design an adaptable transradial limb-prosthetic interface to accommodate pediatric growth., Mechanical, Maritime and Materials Engineering, Biomechanical Engineering

Background-—The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results-—Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=0.8; P=0.006). Ultimately, when a center’s balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions-—The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach., Funding agencies: General Electric (GE) Healthcare; TeraRecon Inc.; Saul and Edna Goldfarb Research Chair in Cardiac Imaging

Upper-limb prosthetic device rejection rates have been estimated at up to 26\% for adult users and up to 45\% for pediatric users, while non-wear rates are estimated at 20\% and 16\%, respectively. Yet, upper-limb prostheses are of focus in only 20\% of the reviewed published literature (60\% less than lower-limb prostheses), with less than half of the publication addressing engineering design to improve these devices. The prosthesis-limb interface, such as a conventional socket, is a critical component in upper-limb prostheses, necessary for force transfer to and from the wearer and thus important for control and comfort of the device. Though volume management of the residual limb is accounted for in some sockets designs, pediatric residual limb growth is not, aside from compensatory padding techniques. o Due to the growth of a child, replacement of an upper-limb prosthetic device is necessary every 1-2 years, while adjustments are more frequent. Limited availability of properly-sized components and the combined costs of hardware and clinical visits pose technical and financial challenges for families. Lack of proper adjustment or replacement of the device may lead to poor fit and function, resulting in rejection or physical injury. o Transradial deficiency is the most common major upper-limb deficiency in children. To extend the functional lifetime of the related prosthetic device and thereby reduce frequency and cost of replacement, the aim of this study is to design an adaptable transradial limb-prosthetic interface to accommodate pediatric growth., Mechanical, Maritime and Materials Engineering, Biomechanical Engineering

Background: The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure-a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results: Overall, 10 centers were included from 6 countries-Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=-0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=-0.8; P=0.006). Ultimately, when a center's balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions: The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency-a guiding principle for centers adopting the TR approach., Funding Agencies:General Electric (GE) HealthcareTeraRecon Inc.Saul and Edna Goldfarb Research Chair in Cardiac Imaging

Background-—The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results-—Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=0.8; P=0.006). Ultimately, when a center’s balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions-—The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach., Funding agencies: General Electric (GE) Healthcare; TeraRecon Inc.; Saul and Edna Goldfarb Research Chair in Cardiac Imaging

Background-—The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results-—Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=0.8; P=0.006). Ultimately, when a center’s balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions-—The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach., Funding agencies: General Electric (GE) Healthcare; TeraRecon Inc.; Saul and Edna Goldfarb Research Chair in Cardiac Imaging

Objectives The aim of this study was to analyze the change of upper limb function when percutaneous coronary procedures were performed through the radial artery. Background It is currently unknown if upper limb function is affected by transradial (TR) catheterization. Methods Between January 2013 and February 2014, upper limb function was assessed in a total of 338 patients undergoing coronary catheterization in an ambulatory setting (85% radial approach, 15% femoral approach). Upper limb function was assessed with the self-reported shortened version of the Disabilities of Arm, Shoulder, and Hand questionnaire. The presence and severity of upper extremity cold intolerance was assessed with the self-reported Cold Intolerance Symptom Severity questionnaire. Both questionnaires were completed before the catheterization and at 30-day follow-up. Higher scores represent worse upper limb functionality or symptoms. The nonparametric Wilcoxon signed-rank test was used to assess the change of upper limb function and symptoms over time. Results Upper limb function did not change significantly over time when catheterization was performed through the radial artery (p = 0.06). The number of procedure-related extremity complaints that persisted during 30-day follow-up were not different between both access groups (TR access 10.5%, transfemoral access 11.5%; p = 0.82). The upper extremity was not affected by cold intolerance after TR access at 30-day follow-up (p = 0.91). Conclusions Upper limb function was not affected when coronary catheterizations and interventions were performed through the radial artery.

Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimete

We describe our solution to the unusual situation of an inflated, large coronary stent (3.5 mm diameter) which became dislodged from the ostium of the right coronary artery after deployment during a transradial procedure. We discussed tips for retrieval from the radial artery while preserving the access for completion of the procedure.

Manual thrombus aspiration improves the efficacy of percutaneous coronary interventions (PCIs) in ST-elevation acute myocardial infarction (STEMI). The transradial approach (TRA) is an emerging vascular approach for PCI but is associated with specific technical requirements. As data on the combination of thrombus aspiration and TRA are scarce, we sought to assess the feasibility of TRA manual thrombus aspiration in STEMI patients.

Sometimes children are born with (part of) an arm missing. Next to congenital loss, children or adults can loose their arm due to an accident or illness. The missing arm can be replaced with a prosthesis, connected to the arm remnant by a socket. Existing sockets tend to have a hot and humid climate and some sockets are difficult to don and doff. The WILMER open socket is adjustable but looks bulky. All these disadvantages result in reduced wearing of the prosthesis. After the current prostheses are evaluated, the existing patents and available literature are investigated, a list of requirements was made for a new design. With the requirements, the problem can be solved by improving a current socket and designing new sockets. The application of new materials in prosthetics is evaluated, resulting in several new designs. The WILMER open socket is improved, resulting in another design. From these designs one concept is chosen and detailed. The chosen concept is made of stainless steel wire mesh, with an adjustable condyle brace and a standard forearm shell over the mesh., Biomechatronics, BioMechanical Engineering, Mechanical, Maritime and Materials Engineering

Sometimes children are born with (part of) an arm missing. Next to congenital loss, children or adults can loose their arm due to an accident or illness. The missing arm can be replaced with a prosthesis, connected to the arm remnant by a socket. Existing sockets tend to have a hot and humid climate and some sockets are difficult to don and doff. The WILMER open socket is adjustable but looks bulky. All these disadvantages result in reduced wearing of the prosthesis. After the current prostheses are evaluated, the existing patents and available literature are investigated, a list of requirements was made for a new design. With the requirements, the problem can be solved by improving a current socket and designing new sockets. The application of new materials in prosthetics is evaluated, resulting in several new designs. The WILMER open socket is improved, resulting in another design. From these designs one concept is chosen and detailed. The chosen concept is made of stainless steel wire mesh, with an adjustable condyle brace and a standard forearm shell over the mesh., Biomechatronics, BioMechanical Engineering, Mechanical, Maritime and Materials Engineering

Among patients undergoing coronary procedures, patients with coronary artery bypass grafts represent an important, high risk subgroup. Routine transradial approach may be successfully adopted in these patients to reduce access-site complications. However, transradial cannulation of the grafts may result technically demanding. In this article we discuss the specific technical issues and we present a series of tips and tricks which may facilitate angiography and interventions on both internal mammary and aorto-coronary grafts.