Coronary artery bypass grafting (CABG) is the most common cardiac surgical operation performed in western countries, and is also increasingly being performed in developing countries. However the long-term results of CABG using the saphenous vein graft have not been satisfactory. Surgeons have therefore been seeking a better conduit. The radial artery (RA) is a potentially suitable alternative conduit and has to date provided good early results. This thesis investigates the utility of the RA as a coronary artery bypass graft from a number of perspectives. It demonstrates the safety of RA harvesting by examining hand collateral circulation using anatomical dissection, physical examination using the modified Allen test, measuring digital blood pressure, and examining the flow velocity in the digital artery using Doppler ultrasound. Anatomical examinations revealed consistent continuity between the RA and ulnar artery in the hand through either superficial or deep palmar arches. The modified Allen test was found to be useful as a screening test compared with the Doppler dynamic test and digital blood pressure index. A histological comparison was made between pre-existing intimal disease in the RA compared with that in the standard conduit the internal thoracic artery (ITA). The RA showed a higher prevalence and degree of intimal disease than ITA. Risk factors for intimal hyperplasia in the RA were age, diabetes, smoking and peripheral vascular disease. The only predictor for medial calcification was age. (For complete abstract open document)

Submitted by IGOR RIBEIRO DE CASTRO BIENERT (bienert@terra.com.br) on 2016-01-29T14:19:19Z No. of bitstreams: 2 Tese Igor R C Bienert versao final para arquivamento.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Bienert_et_al BMJ Innovations.pdf: 1803372 bytes, checksum: 31c4180b21a1482a1a0afcc7856c9b78 (MD5) / Rejected by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: Foram submetidos 2 arquivos PDF’s, apenas 1 arquivo deve ser submetido (o que contém a Tese ou Dissertação) Corrija estas informações e realize uma nova submissão contendo o arquivo correto. Agradecemos a compreensão. on 2016-02-02T12:39:46Z (GMT) / Submitted by IGOR RIBEIRO DE CASTRO BIENERT (bienert@terra.com.br) on 2016-02-19T20:50:56Z No. of bitstreams: 2 Tese Igor R C Bienert versao final para arquivamento.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Bienert_et_al BMJ Innovations.pdf: 1803372 bytes, checksum: 31c4180b21a1482a1a0afcc7856c9b78 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-02-23T13:21:58Z (GMT) No. of bitstreams: 1 bienert_irc_dr_bot.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) / Made available in DSpace on 2016-02-23T13:21:58Z (GMT). No. of bitstreams: 1 bienert_irc_dr_bot.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Previous issue date: 2016-01-26 / Introdução: A cardiologia intervencionista requer necessariamente um acesso vascular invasivo, sendo esta via de acesso uma escolha do médico operador. Nesta escolha interfere o tipo de procedimento, impacto ao paciente, risco ao profissional e experiência técnica. O acesso via artéria femoral é o mais difundido globalmente e a técnica de acesso pela artéria radial tem sido progressivamente adotada devido ao maior conforto para o paciente, menores taxas de complicações e em alguns cenários, de mortalidade. Um dos focos de interesse crescente é a exposição à radiação ionizante e medidas para minimizar o risco ao paciente e ao profissional. Escassa é a literatura disponível na área e conflitantes são seus resultados. Objetivo: Avaliar os níveis de radiação recebidos pelo médico operador de acordo com as diferentes técnicas de acesso, bem como mapear áreas de escape de radiação. Após essa etapa, o estudo visou desenvolver e validar dispositivo de radioproteção dedicado à técnica radial (TRIPTable) voltado à redução da radiação ao médico operador, comparando o seu impacto à técnica femoral e radial padrão no cenário de pacientes portadores de síndrome coronária aguda randomicamente alocados para cateterismo com intenção de tratamento percutâneo. Métodos: A fase inicial pré-clínica do estudo foi constituída de avaliação em ambiente controlado dos níveis de radiação em pontos pré-especificados de um operador simulado com phantom de água. A fase clínica do estudo foi um ensaio clínico prospectivo, randomizado, unicêntrico, comparativo entre três grupos denominados técnica femoral, técnica radial e técnica radial com dispositivo radioprotetor TRIPTable, recrutados no Hospital das Clínicas de Marília (Marília/SP) e randomizados na proporção 1:1:1 (108 pacientes - 36 por grupo) avaliando a radiação recebida pelo operador em três diferentes pontos (gônadas, tireoide e olhos). Os resultados foram comparados com o grupo controle de 108 pacientes provenientes de coorte randomizada externa entre técnica radial e femoral 1:1, utilizando critérios similares, porém com operadores cegos aos objetivos de avaliação de radiação visando detecção de vieses de técnica (efeito Hawthorne) e validação de resultados. Resultados: Não houve diferença entre o estudo e a coorte externa ou entre os grupos do estudo quanto a características clínicas, desfechos dos procedimentos ou parâmetros de exposição radiológica ao paciente. Os resultados indicam maior radiação recebida pelo operador com a técnica radial (12,5 mSv), seguida da femoral (10,1 mSv) e TRIPTable (6,8 mSv). Em relação aos locais de exposição, o território de gônadas teve maior sensibilidade radiológica com uso da técnica radial (p=0,001). Com uso da técnica femoral não houve diferença entre os três territórios (p=0,398), porém na análise ad hoc o território de gônadas foi mais sensível quando comparado à exposição aos olhos (p=0,016) e limítrofe em comparação à tireoide (p=0,056). No grupo do dispositivo TRIPTable não houve diferença significativa entre qualquer um dos territórios analisados (p=0,180). Conclusões: O estudo indica equivalência entre os resultados do procedimento entre os grupos e quanto à exposição radiológica ao paciente. Contudo, demonstrou maior impacto radiológico para o operador que utilizou a técnica radial, em comparação à técnica femoral e à técnica radial com uso do dispositivo TRIPTable. O uso do dispositivo reduziu o impacto radiológico comparado ainda à técnica femoral. Tais diferenças derivaram primordialmente da variação em território de gônadas. Os achados demonstram um campo de exposição radiológica heterogêneo ao corpo do operador, benefício do dispositivo testado e oportunidade de novas formas de desenvolvimento de medidas de radioproteção. Registros: UTN/OMS - U1111-1158-8591 Plataforma Brasil - CAAE 32767514.0.1001.5413 Clinical Trials - NCT 02200783. / Background: Interventional cardiology requires an invasive vascular access, a choice of medical operator. This choice is affected by type of procedure, patient impact, professional risk and technical experience. Interventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates, and reduced mortality in some scenarios. One area of interest is radiation exposure and ways to minimizing it. Most studies focusing on patient radiation risk demonstrated conflicting results, and there is no consensus for increased exposure with any technique. Objective: The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths. After this stage, the study developed a radiological protection device for the transradial technique (TRIPTable), comparing its impact as compared to standard femoral and radial techniques in the setting of patients with acute coronary syndrome randomly assigned for catheterization with intent to percutaneous treatment. Methods: Radiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurized ionization chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid, and eyes at different angles during real procedures. The clinical phase of the study is a prospective clinical trial, single-center, randomized, and comparing three groups (femoral technique, radial technique, and radial technique with radioprotective device), admitted in the Emergency Department of Hospital das Clinicas de Marilia (Marilia / SP – Brazil). Patients were randomized in a 1:1:1 proportion (108 patients - 36 per group) evaluating the radiation received by the operator measured by dosimetry at three different points (gonads, thyroid and eyes). As it is impossible to blind operators to study techniques, the results were compared to an external control cohort of patients including 108 individuals with similar inclusion and exclusion criteria, randomized for radial and femoral technique, but with blinded operators to radiation objectives, aiming technical bias detection (Hawthorne effect) and validation of results. Results: There was no difference between groups regarding clinical characteristics, procedures or patient radiation exposure outcomes. The results indicate higher radiation received by the operator with the radial technique (12.5 mSv) as compared to femoral technique (10.1 mSv) and TRIPTable technique (6.8 mSv). Regarding exposure locations, the gonad region had a higher radiation sensitivity with radial technique (p=0.001). With femoral technique there was no difference between the three territories (p=0.398) but the ad hoc analysis indicated higher radiosensibility in gonads when compared to eyes exposure (p=0.016) and borderline compared to thyroid exposure (p=0.056). In the TRIPTable device group there was no significant difference between any of the territories analyzed (p=0.180). Conclusions: The study indicates no difference of radiation exposure to the patients between the groups. However, there was a greater radiologic impact to the operator who used the radial technique, compared to the femoral technique and TRIPTable device technique. The device reduced the radiological impact even compared to the femoral technique. Such differences derived primarily from variation in gonads exposure. The findings demonstrate a heterogeneous radiation exposure to the operator body, device benefit and an opportunity to develop new ways to improve radiation protection. Registration: UTN/OMS - U1111-1158-8591 Plataforma Brasil - CAAE 32767514.0.1001.5413 Clinical Trials - NCT 02200783.

Orientador: Katashi Okoshi / Resumo: Introdução: A cardiologia intervencionista requer necessariamente um acesso vascular invasivo, sendo esta via de acesso uma escolha do médico operador. Nesta escolha interfere o tipo de procedimento, impacto ao paciente, risco ao profissional e experiência técnica. O acesso via artéria femoral é o mais difundido globalmente e a técnica de acesso pela artéria radial tem sido progressivamente adotada devido ao maior conforto para o paciente, menores taxas de complicações e em alguns cenários, de mortalidade. Um dos focos de interesse crescente é a exposição à radiação ionizante e medidas para minimizar o risco ao paciente e ao profissional. Escassa é a literatura disponível na área e conflitantes são seus resultados. Objetivo: Avaliar os níveis de radiação recebidos pelo médico operador de acordo com as diferentes técnicas de acesso, bem como mapear áreas de escape de radiação. Após essa etapa, o estudo visou desenvolver e validar dispositivo de radioproteção dedicado à técnica radial (TRIPTable) voltado à redução da radiação ao médico operador, comparando o seu impacto à técnica femoral e radial padrão no cenário de pacientes portadores de síndrome coronária aguda randomicamente alocados para cateterismo com intenção de tratamento percutâneo. Métodos: A fase inicial pré-clínica do estudo foi constituída de avaliação em ambiente controlado dos níveis de radiação em pontos pré-especificados de um operador simulado com phantom de água. A fase clínica do estudo foi um ensaio clíni... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Interventional cardiology requires an invasive vascular access, a choice of medical operator. This choice is affected by type of procedure, patient impact, professional risk and technical experience. Interventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates, and reduced mortality in some scenarios. One area of interest is radiation exposure and ways to minimizing it. Most studies focusing on patient radiation risk demonstrated conflicting results, and there is no consensus for increased exposure with any technique. Objective: The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths. After this stage, the study developed a radiological protection device for the transradial technique (TRIPTable), comparing its impact as compared to standard femoral and radial techniques in the setting of patients with acute coronary syndrome randomly assigned for catheterization with intent to percutaneous treatment. Methods: Radiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurized ionization chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid, and eyes at different angles during real procedures. The clinical phase of the study is a prospective cli... (Complete abstract click electronic access below) / Doutor

Abstract This thesis describes the development of pressure sensor arrays and a range of methods suitable for the long-term measurement of heart rate and blood pressure determination using a cuff and a pressure sensor array on the radial artery. This study also reviews the historical background of noninvasive blood pressure measurement methods, summarizes the accuracies achieved and explains the requirements for common national and international standards of accuracy. Two prototype series of pressure transducer arrays based on electro-mechanical film (EMFi) were designed and tested. By offering high (∼TΩ) resistance, EMFi is an excellent material for low-current long-term measurement applications. About 50 transducer arrays were built using different configurations and electrode materials to sense low-frequency pressure pulsations on the radial artery in the wrist. In addition to uniform quality, essential requirements included an adequate linear response in the desired temperature range. Transducer sensitivity was tested as a function of temperature in the range of 25–45 °C at varying static and alternating pressures. The average sensitivity of the EMFi used in the transducers proved adequate (∼2.2 mV/mmHg and ∼7 mV/mmHg for normal and high sensitive films) for the intended purpose. The thesis also evaluates blood pressure measurements by the electronic palpation method (EP) and compares the achieved accuracy to that of the oscillometric method (OSC) using average intra-arterial (IA) blood pressure as a reference. All of these three measurements were made simultaneously for each person. In one test group, measurements were conducted on healthy volunteers in sitting and supine position during increasing and decreasing cuff pressure. Another group, comprising elderly cardiac patients, was measured only in the supine position during cuff inflation. The results showed that the EP method was approximately as accurate as the OSC method with the healthy subjects and slightly more accurate with the cardiac patient group. The advantage of the EP method is that also the wave shape and velocity of arterial pressure pulses is available for further analysis, including the assessment of arterial stiffness.

If unaccounted for, differences in human anatomy can lead to adverse clinical outcomes for patients. The literature describes numerous variations of branches of the brachial artery; the most common anomaly is found as high as 25% of the time, in which the brachial artery passes over the median nerve, splitting the brachial artery into superficial and deep branches. Another common variation of the forearm arterial supply includes branching of the radial artery from the brachial artery proximal to the antecubital fossa (12.5%). Herein, we report a unique variation found in a 96-year-old white whole-body formalin-fixed male donor, dissected with typical dissection techniques. Although predictably bifurcating at the cubital fossa, the relative calibers and distribution of the ulnar and radial arteries in the forearm were notably atypical. The common interosseous artery branched from the radial artery rather than the ulnar artery, and distally branched into the anterior and posterior interosseous arteries. This morphology resulted in the deep anterior forearm and entirety of the posterior forearm relying on the radial artery for perfusion. There was also a notable size difference between the ulnar and radial arteries in which the radial artery was much larger. A review of the literature revealed two articles reporting this unique anomaly. It is important clinically to understand this abnormal branching pattern, as various medical procedures involve the radial artery. The radial artery is commonly used to gain access to circulation for cardiac catheterization and stent placement and can also be accessed for cannulation for a variety of medical procedures. Awareness of radial artery dominance reduces the possibility of iatrogenic injury and increases positive clinical outcomes. This protocol was reviewed by the VCOM IRB (#2022-050).

A novel technique for saphenous vein (SV) graft harvesting, the No-touch technique (NT), has been developed at the Dept. of Cardiovascular surgery, Örebro University hospital. With NT the SV is harvested with a pedicle of surrounding tissue. This avoids graft spasm and eliminates the need for distension. The surrounding tissue acts as a structural support and is a rich source of vaso-dilating agents. A randomized controlled trial (RCT) has shown a significantly higher patency rate for NT SV grafts compared to SV grafts harvested with conventional technique (CT). This thesis evaluates some of the properties of the surrounding tissue and compares patency rates between NT SV and radial artery (RA) grafts and patency rates for internal thoracic artery (ITA) grafts harvested with and without surrounding tissue. Paper I investigated vasa vasorum (VV) in SV grafts and showed that the NT preserves an intact VV whereas CT does not. This could be one of the mechanisms underlying the improved patency for NT SV grafts. Paper II evaluated VV and associated nitric oxide (NO) in SV and arterial grafts. SV grafts showed a higher number and larger VV, which correlated with NO production, compared to arterial grafts. NT SV grafts showed higher activity for e-NOS compared to CT SV grafts. Paper III is a RCT comparing patency rates between NT SV and RA grafts, three years after surgery, showing a significantly higher patency rate for NT SV grafts. Paper IV is a RCT comparing patency rates for ITA graft harvested with and without surrounding tissue and did not show any difference between graft preparations. In conclusion, the NT for SV graft harvesting preserves an intact vasa vasorum and associated NO production. NT SV grafts show a higher patency rate than RA grafts. Harvesting of ITA with or without surrounding tissue does not affect patency rate.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: When a soft tissue injury occurs the blood vessels and surrounding tissue are damaged leading to haemorrhaging and inflammation. Cryotherapy (cold therapy) is generally acknowledged as the preferable treatment by manual therapists during this immediate post-traumatic period of an injury. Cryotherapy has been shown to result in vasoconstriction decreasing the rate of blood flow which has a favourable effect on inflammation and pain. The commercially available cooling cuff is a relatively new cryotherapy modality offering a mechanism of cooling that does not require freezing and is easy to use. The polymer granules within the cooling cuff are activated by emersion in water therefore freezing is not required making the cooling cuff readily available compared to more traditional forms of cryotherapy. Aim: The aim of this study was to determine the effect of a moist ice pack and a commercially available cooling cuff radial artery blood flow (cm.s-1) and radial artery lumen diameter (mm) after 15 minutes of application. Method: This study was a pre-test post-test design utilising 43 asymptomatic participants that were randomly allocated to one of two groups. Each group either received a standard moist ice pack or a commercially available cooling cuff, placed on the ventral surface of the participants forearm, over the radial artery, for a duration of 15 minutes. Measurements were taken with a Doppler ultrasound to determine radial artery blood flow and lumen diameter, prior to the intervention and 15 minutes after the cryotherapy application. Data analysis was performed using IBM SPSS VERSION 20 (IBM Corp. Released 2010.IBM SPSS Statistics for Windows, Version 19.0. Armonk, New York: IBM Corp.). Statistical significance was set at a p< 0.05 level. Intra-group and inter-group comparisons were measured using repeated measures ANOVA testing. Results: Both the moist ice pack and commercially available cooling cuff resulted in a significant decrease in radial artery blood flow (p< 0.001) after 15 minutes of application with no significant changes being observed in radial artery diameter Conclusions: The commercially available cooling cuff resulted in a similar effect on radial artery blood flow and lumen diameter as moist ice, indicating that the commercially available cooling cuff may be utilised in the acute phase of an injury to alter blood flow. / M

Student Number :9900127Y - MSc (Eng) dissertation - Faculty of Engineering and the Built Environment / Arterial pulse wave analysis studies the wave shape of the blood pressure pulse. The pulse wave provides more information than the extreme systolic and dia- stolic pressures, measured with a cuff sphygmomanometer. The aim of the research is to investigate the design issues in a pulse wave analysis system, and to compare these to a commercially available system. The system was compared and validated by measuring the pulse wave at the radial artery (wrist) using the non-invasive technique of arterial tonometry. The design conformed to the IEC-601 safety standard to ensure patient safety. The data was compared against the data from the commercial system and analysis was performed in the time and frequency domain. The performance of the design suggests that, in some respects, the design was comparable to the commer- cial system, however, a number of performance characteristics fell short of the commercial system. Suggestions have been made to address these problems in further research.

Evidências favoráveis impulsionaram o uso da técnica transradial nos últimos anos. Estudos originais que apresentam o uso dessa prática apontam baixo risco de complicações locais, maior conforto para os pacientes, possibilidade de mobilização e deambulação precoce após procedimento, diminuição do período de internação hospitalar e redução de custos hospitalares. Entre as complicações possíveis, a mais temida é a oclusão da artéria radial (OAR). Embora seja preocupante essa complicação, ainda não há consenso quanto à avaliação rotineira da patência da artéria antes da alta hospitalar e sua relação com o dispositivo hemostático utilizado. Visando preencher essa lacuna do conhecimento, este estudo foi planejado para comparar o efeito de dois dispositivos de hemostasia após cateterismo cardíaco realizado por acesso transradial na ocorrência de OAR. Foi conduzido um ensaio clínico randomizado (ECR) de dois grupos, aberto, no Laboratório de Hemodinâmica (LH) de um hospital público e universitário da região metropolitana de Porto Alegre, Rio Grande do Sul. O período de coleta foi de novembro de 2015 a outubro de 2016. Foram incluídos pacientes adultos ambulatoriais e internados, submetidos a cateterismo cardíaco diagnóstico e/ou terapêutico por acesso transradial, em caráter eletivo e/ou de urgência. Os participantes foram randomizados em dois grupos: Grupo Intervenção (GI) – hemostasia com dispositivo TR Band; e Grupo Controle (GC) – hemostasia com dispositivo de gaze e bandagem elástica adesiva. O desfecho primário foi a OAR imediata ao procedimento e em 30 dias; os desfechos secundários foram a migração dos padrões das curvas após retirada imediata do dispositivo e em 30 dias, a necessidade de tempo a mais para alcance da hemostasia, as demais complicações vasculares relacionadas ao sítio de punção (sangramento e hematoma) e a presença e intensidade de dor. Foram incluídos 600 pacientes: GI (n=301) e GC (n=299), predominantemente do sexo masculino, com média de idade de 63 ± 10 anos; a OAR imediatamente após a remoção do dispositivo ocorreu em 24 (8%) e 19 (6%), no GI e GC, respectivamente; em 30 dias para um terço da amostra foi de 5 (5%) e 7 (6%), no GI e GC, respectivamente. Para estes dois períodos não foram demonstradas diferenças estatísticas; o tempo de hemostasia adicional, assim como o tempo necessário para outro tipo de compressão, foi significativamente maior no GI, p=0,006 e p<0,001, respectivamente; pacientes de ambos os grupos mantiveram um padrão e migração de curvas semelhantes na avaliação pré procedimento, imediatamente após a retirada dos dispositivos e em 30 dias; o sangramento menor foi significativamente maior no GI, quando comparado ao GC, 67 (22%) vs. 40 (13%), respectivamente, p = 0,006; o hematoma foi semelhante entre os dois grupos. O relato de dor foi similar entre os grupos, e a intensidade relatada foi moderada. Os resultados deste estudo permitem concluir que a incidência de OAR foi semelhante entre os grupos TR Band e bandagem elástica adesiva. Os padrões de curva do teste de Barbeau foram semelhantes em todas as avaliações. Pacientes que utilizaram TR Band precisaram de mais tempo adicional de hemostasia assim como mais tempo com outro tipo de compressão. O sangramento menor foi mais incidente no grupo TR Band, enquanto o hematoma foi semelhante entre os grupos. A ocorrência de dor moderada foi semelhante entre os dois grupos. / Favorable evidence increase the use of the transradial technique in recent years. Original studies that address this approach suggest low risk of local complications, greater comfort for patients, the possibility of early mobilization and ambulation after the procedure, a shorter hospital stay and reduced hospital costs. Among the possible complications, the most feared is radial artery occlusion (RAO). Although RAO is of concern, there is still no consensus regarding the routine assessment of radial artery patency before discharge and its relationship to the hemostatic device used. In order to fill this knowledge gap, this study was planned to compare the effect of two hemostasis devices after cardiac catheterization performed by transradial access on the appearance of RAO. A two-group Randomized Clinical Trial (RCT) was conducted at the Hemodynamic Laboratory (HL) of the Hospital de Clínicas of Porto Alegre (HCPA), a public university hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. The collection period was from November 2015 to October 2016. Adult patients from the outpatient clinic and hospitalized patients undergoing cardiac diagnostic and / or therapeutic catheterization due to transradial access, in an elective and / or emergency manner, were included. Participants were randomized into two groups: intervention group (IG) - hemostasis with TR Band device; Control Group (CG) - hemostasis with gaze device and adhesive elastic bandage. The primary outcome was immediate RAO to the procedure and in 30 days; secondary outcomes were migration of the curvature patterns after immediate device removal and in 30 days, the need for extra time to reach hemostasis other vascular complications related to the puncture site (bleeding and hematoma), and the presence and intensity of pain. A total of 600 patients were included: IG (n=301) and CG (n=299), predominantly males with a mean age of 63 ± 10 years; RAO immediately following device removal occurred in 24 (8%) and 19 (6%), in the IG and CG groups, respectively; in 30 days for a third of the sample was 5 (5%) and 7 (6%) in IG and CG, respectively. For these two periods no statistical difference was demonstrated. The additional hemostasis time, as well as the time required for another type of compression, was significantly higher in IG, p=0.006 and p<0.001, respectively; patients from both groups maintained a pattern of migration of similar curves in the pre-procedure assessment, immediately after the device withdrawal and in 30 days; The lowest bleeding was significantly higher in the IG, compared to the GC, 67 (22%) vs 40 (13%), respectively, p = 0.006; the hematoma was similar between the two groups. The reported pain was similar between the groups, and the reported intensity was moderate. The results of this study allow us to conclude that the incidence of RAO was similar between TR Band groups and adhesive elastic bandage. The standards of the Barbeau test curve were similar in all assessments. Patients who used TR Band required more extra hemostasis time as well as more time with another type of compression. Minor bleeding was more incident in the TR Band group, while the hematoma was similar between the groups. The occurrence of moderate pain was similar between the two groups.

O objetivo é comparar o fluxo sanguíneo total (FS) e a reserva de fluxo coronariano (RFC) aos ramos revascularizados pelas artérias torácica interna esquerda (ATIE) e radial (AR) nos enxertos compostos com os enxertos isolados. Foi realizado um ensaio clínico randomizado de 42 pacientes que foram distribuídos em grupo A ou ATIE e AR composta em Y(n=14), grupo B ou ATIE e AR composta modificada(n=14) e grupo C ou ATIE pediculada para DA e AR aorto-coronariana(n=14). Os pacientes foram submetidos a fluxometria no pós-operatório imediato. A RFC foi de 2,1 ± 0,44, 1,96 ± 0,3 e 2,06±0,42 nos grupos A,B e C, (p=0.7208 A, B x C) e o FS, em ml/min, foi 110±30, 145±59 e 136±58, respectivamente (p=0.3232 A,B x C). Concluindo, não houve diferença significativa do FS total e nem da RFC nos grupos estudados / The objective is to compare the total blood flow (Bf) and coronary flow reserve (CFR) to the left coronary branches that were revascularized with left internal thoracic (LITA) and radial artery (RA) in composite and independent arterial grafts. A randomized trial was realized and 42 patients assigned in group A or composite LITA-RA in a Y configuration (n=14), group B or modified composite LITA-RA(n=14) and group C or pedicled LITA to LAD and aorto-coronary RA (n=14). Patients were submitted to postoperative Bf velocity analysis. CFR was 2,1 ± 0,44, 1,96 ± 0,3 e 2,06±0,42 in groups A,B and C (p=0.7208 A, B x C) and Bf, in ml/min, was 110±30, 145±59 and 136±58, respectively (p=0.3232 A, B x C). In conclusion there was no difference in Bf and CFR in the groups studied