Sphygmomanometer-induced hemostasis following iatrogenic guidewire perforation during lower extremity angioplasty

Objectives Iatrogenic guidewire perforation is a well-known complication of lower extremity angioplasty that is often benign or can be easily treated with endovascular techniques. However, perforations that occur in arterial side branches may be more challenging to manage. If bleeding persists, open surgery and fasciotomy may be required to evacuate the resulting hematoma and prevent compartment syndrome. These subsequent procedures increase morbidity and, if the angioplasty was performed in the outpatient setting, necessitate patient transfer to a hospital. To address these challenges, we describe a non-invasive hemostasis technique involving serial sphygmomanometer cuff inflations over the affected site in a series of five patients who experienced this complication at our office. Methods We retrospectively reviewed the medical records of consecutive patients undergoing lower extremity angioplasty that were found to have an arterial guidewire perforation on completion angiogram at our outpatient center between February 2012 and February 2017. Patients found to have iatrogenic guidewire perforations were administered intravenous protamine sulfate and were transferred to the surgical recovery room. Patients received ibuprofen or acetaminophen for pain management. A blood pressure cuff was placed around the site of perforation, and patients received serial cuff inflation cycles with repeated examinations of both limbs until patients reported cessation of pain and there were no signs of a developing hematoma. Patients were observed for two hours before they were discharged home. A follow-up duplex ultrasound examination was completed within one week of the intervention. Results Over the course of five years, 536 angioplasties were performed at our outpatient office. Five of these patients experienced iatrogenic guidewire perforation (0.93%). Perforations occurred in branches of the anterior or posterior tibial artery. All of these patients were successfully managed with the aforementioned hemostasis technique. None of these patients required transfer to a hospital for further management, and no complications were reported at follow-up. Conclusions Complications of iatrogenic guidewire perforations in lower extremity arterial side branches can be safely and effectively managed by applying external compression around the affected site with an automatic blood pressure cuff.

Basic technology and proper usage of home health monitoring devices

Home health monitoring devices are consumer-grade devices that help to monitor the health of individuals at home. These devices are usually low-cost and easily procurable, and they can be operated by patients or their caretakers with minimal training. However, improper usage of these devices may provide erroneous results, which can lead to an unnecessary hospital visit or teleconsultation. In this article, we discuss the basic technology and proper usage of some of these devices, namely automatic blood pressure monitors, blood glucose monitors, body fat monitors, pulse oximeters, electrocardiographs, digital thermometers, and infrared thermometers. This brief document intends to help primary health care professionals and their patients use these devices.

PP313 Patient Preference For Blood Pressure Measurement: Sphygmomanometers Or Automatic Monitors?

IntroductionThe development of more accurate algorithms has encouraged the replacement of sphygmomanometers with automatic blood pressure (BP) monitors in adults. From the perspective of health professionals, these technologies are advantageous for their practicality and are less susceptible to observer errors, and many devices validated by standardized protocols are available for both clinical and home use. However, adherence to these technologies also depends on patient acceptance. No studies to date have examined patient preference for BP measurement in the Brazilian population, although Brazil has undertaken initiatives to replace auscultatory measurement with oscillometric measurement. This study aims to analyze patient preferences between sphygmomanometers and automatic monitors for BP measurement.MethodsAn analytic study was conducted with 93 subjects in a Brazilian outpatient care facility. A random sampling method was used to select participants. After obtaining informed consent, all subjects had their BP measured using a sphygmomanometer and then an automatic monitor for clinical use, both in a quiet room after 10 minutes rest. A structured interview on discomfort and preferences was then conducted. An unpaired t-test and a chi-square test were used.ResultsThe mean age was 39.11 (±14.22) years. Minor discomfort was identified when an automatic monitor was used (2.34 versus 2.52). Confidence was higher with the sphygmomanometers (73.11%), and 60.21 percent preferred this technology. There was no association between gender and preferences (p = 0.88), but an association with age was identified. The average age of subjects who preferred sphygmomanometers was higher compared to those who preferred automatic monitors (p < 0.05).ConclusionsThis study revealed that, although BP measurement using automatic monitors is less uncomfortable, patients rely more on sphygmomanometers. Results show that preference is related to age, as younger people tend to prefer automatic monitors. The findings of this study indicate the need to widely disseminate information regarding the accuracy of automatic monitors among patients, especially older ones, in order to make them part of the decision-making process for replacing sphygmomanometers with automatic monitors.

Arterial Stiffness and its Association with Dyslipidemia

Introduction: Cardiovascular diseases (CVD) are the leading cause of mortality in Malaysia as well as in other countries. It is associated with many risk factors, such as increasing age, hypertension, diabetes, dyslipidemia, oxidative stress and autonomic dysfunction and arterial stiffness. The objectives of this study were to measure the prevalence of arterial stiffness and to assess its association with dyslipidemia. Methods: A cross sectional study was conducted in a rural community in Malaysia involving 146 subjects. Data were collected using an interviewer administered questionnaire which included three sections – sociodemographic characteristics, personal profile, and past medical history. In addition, Seca Body Meter (Seca 220) was used to measure height and weight. Sphygmomanometer (OMRON Automatic Blood Pressure Monitor HEM 907) and SphygmoCor-AtCor MM3 SERIAL/RS-232 were used for blood pressure and augmentation index (AIx) measurement. Data were analysed using the SPSS for Windows, Version 18.0. Results: The mean age of respondents was 49.5 years, SD±15.6. The prevalence of arterial stiffness was 23.3% (95% Confidence Interval (CI): 16.44 – 30.16). The prevalence of dyslipidemia was 82.9% (95% CI: 76.79 – 89.01). Multivariate logistic regression revealed that total cholesterol was significantly associated with arterial stiffness (OR=4.56, CI 1.10-18.90). Conclusion: The prevalence of dyslipidemia was high. Despite an insignificant association between dyslipidemia and AIx, there is a significant association between TC level and AIx.