This document discusses endovascular procedures for renovascular disease. It covers technical considerations for contrast arteriography used to evaluate renal arteries, including patient preparation, arterial access routes, optimal imaging views, and findings associated with atherosclerotic disease and fibromuscular dysplasia. It also summarizes preoperative evaluation, operative planning including patient preparation, and correlation of angiographic findings with clinical information to guide treatment.
This study evaluated 52 patients who underwent cone reconstruction surgery for Ebstein's anomaly between 1993-2006. The surgery successfully repaired the tricuspid valve without need for replacement in any patients. Early postoperative results showed improved tricuspid regurgitation and right ventricular size and function. At long-term follow-up of 57 months on average, patients had significant improvement in heart failure symptoms. Reoperations were needed in 4 patients for tricuspid valve issues. The technique showed low mortality and effective long-term repair of the tricuspid valve and right ventricle.
Acs0609 Surgical Treatment Of Carotid Artery Diseasemedbookonline
1) Surgical treatment of carotid artery disease aims to prevent stroke by operating on patients with carotid stenosis.
2) Carotid endarterectomy has been shown to reduce stroke risk in patients with symptomatic stenosis >50% or asymptomatic stenosis >60%.
3) Preoperative evaluation assesses patient health and imaging identifies carotid lesions. Proper positioning and anesthesia are also important.
4) The operative technique involves incising along the carotid sheath and carefully exposing and mobilizing the carotid artery and bifurcation while protecting surrounding nerves.
This document discusses infrainguinal arterial procedures, focusing on femoropopliteal bypass surgery. It begins with an overview of preoperative testing and imaging, including duplex scanning, MRI angiography, CT angiography, and conventional angiography. The key steps of an above-the-knee femoropopliteal bypass are then described in detail, including harvesting the great saphenous vein, exposing the femoral artery, and exposing the popliteal artery distally. The bypass is performed by anastomosing the vein graft proximally to the femoral artery and distally to the popliteal artery above the knee. Precise surgical technique is important for successful bypass outcomes.
Acs0619 Endovascular Procedures For Lower Extremity Diseasemedbookonline
This document discusses endovascular procedures for treating lower extremity vascular disease. It begins with an overview of basic endovascular techniques including pre-procedural evaluation and planning, selective angiography, and crossing lesions. It describes diagnostic imaging that can be used pre-procedurally including duplex ultrasound, ankle-brachial indices, CT angiography, and MRI angiography. Alternative contrast agents like carbon dioxide and gadolinium are also discussed. Troubleshooting tips provided include using hydrophilic wires and catheters when crossing bifurcations or lesions. The document provides guidance on technique, equipment, and strategies for performing endovascular interventions in the lower extremities.
Cardiac imaging in prosthetic paravalvular leaksPaul Schoenhagen
This document discusses cardiac imaging techniques used in the diagnosis and treatment of prosthetic paravalvular leaks (PVLs). Echocardiography, especially 3D transoesophageal echocardiography (TEE), plays a key role in initially diagnosing PVLs, guiding percutaneous closure procedures, and evaluating outcomes. While transthoracic echocardiography is often first used, TEE is needed to confirm clinically significant leaks. Additional techniques like CT, MRI, and angiography can provide further detail. Intraprocedural imaging with TEE and fluoroscopy helps interventional cardiologists properly position closure devices and confirm adequate sealing of leaks.
1) The document describes the use of off-pump coronary artery bypass grafting (OPCAB) and hybrid procedures combining OPCAB and angioplasty to perform minimally invasive coronary revascularization without cardiopulmonary bypass.
2) Of 216 patients who underwent OPCAB, the procedure was successful in achieving technically complete revascularization in 84% of patients with multivessel disease, either through multivessel OPCAB or a hybrid approach.
3) Postoperative outcomes were good with a low mortality rate of 1.4% and few complications. Graft patency rates improved to over 93% with the use of heart stabilizers during surgery. The hybrid procedures were effective but carried a risk
This document discusses hybrid coronary revascularization (HCR), which combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). HCR was introduced in 1996 as a treatment for multivessel coronary artery disease. It aims to reduce surgical trauma while preserving long-term survival and minimizing adverse events. The hybrid approach involves using a left internal mammary artery graft for the left anterior descending artery and PCI for other lesions. This takes advantage of the excellent outcomes of the arterial graft and improvements in stents. HCR may provide benefits for higher surgical risk patients and allow shorter recovery times compared to traditional CABG. However, some debate remains around its additional complexity and costs compared to established treatments.
Hybrid procedures – from boxing ring to synchronizedArindam Pande
The document discusses various hybrid cardiovascular procedures that combine traditional surgery and percutaneous interventions. It provides details on hybrid CABG/PCI procedures, including advantages of a 1-stop approach over 2-staged, and indications. It also discusses hybrid valve/PCI procedures to allow for minimally invasive valve surgery in patients with coronary artery disease. Finally, it summarizes hybrid approaches for complex thoracic aortic aneurysms/dissections and arrhythmia/AF procedures.
This study evaluated 52 patients who underwent cone reconstruction surgery for Ebstein's anomaly between 1993-2006. The surgery successfully repaired the tricuspid valve without need for replacement in any patients. Early postoperative results showed improved tricuspid regurgitation and right ventricular size and function. At long-term follow-up of 57 months on average, patients had significant improvement in heart failure symptoms. Reoperations were needed in 4 patients for tricuspid valve issues. The technique showed low mortality and effective long-term repair of the tricuspid valve and right ventricle.
Acs0609 Surgical Treatment Of Carotid Artery Diseasemedbookonline
1) Surgical treatment of carotid artery disease aims to prevent stroke by operating on patients with carotid stenosis.
2) Carotid endarterectomy has been shown to reduce stroke risk in patients with symptomatic stenosis >50% or asymptomatic stenosis >60%.
3) Preoperative evaluation assesses patient health and imaging identifies carotid lesions. Proper positioning and anesthesia are also important.
4) The operative technique involves incising along the carotid sheath and carefully exposing and mobilizing the carotid artery and bifurcation while protecting surrounding nerves.
This document discusses infrainguinal arterial procedures, focusing on femoropopliteal bypass surgery. It begins with an overview of preoperative testing and imaging, including duplex scanning, MRI angiography, CT angiography, and conventional angiography. The key steps of an above-the-knee femoropopliteal bypass are then described in detail, including harvesting the great saphenous vein, exposing the femoral artery, and exposing the popliteal artery distally. The bypass is performed by anastomosing the vein graft proximally to the femoral artery and distally to the popliteal artery above the knee. Precise surgical technique is important for successful bypass outcomes.
Acs0619 Endovascular Procedures For Lower Extremity Diseasemedbookonline
This document discusses endovascular procedures for treating lower extremity vascular disease. It begins with an overview of basic endovascular techniques including pre-procedural evaluation and planning, selective angiography, and crossing lesions. It describes diagnostic imaging that can be used pre-procedurally including duplex ultrasound, ankle-brachial indices, CT angiography, and MRI angiography. Alternative contrast agents like carbon dioxide and gadolinium are also discussed. Troubleshooting tips provided include using hydrophilic wires and catheters when crossing bifurcations or lesions. The document provides guidance on technique, equipment, and strategies for performing endovascular interventions in the lower extremities.
Cardiac imaging in prosthetic paravalvular leaksPaul Schoenhagen
This document discusses cardiac imaging techniques used in the diagnosis and treatment of prosthetic paravalvular leaks (PVLs). Echocardiography, especially 3D transoesophageal echocardiography (TEE), plays a key role in initially diagnosing PVLs, guiding percutaneous closure procedures, and evaluating outcomes. While transthoracic echocardiography is often first used, TEE is needed to confirm clinically significant leaks. Additional techniques like CT, MRI, and angiography can provide further detail. Intraprocedural imaging with TEE and fluoroscopy helps interventional cardiologists properly position closure devices and confirm adequate sealing of leaks.
1) The document describes the use of off-pump coronary artery bypass grafting (OPCAB) and hybrid procedures combining OPCAB and angioplasty to perform minimally invasive coronary revascularization without cardiopulmonary bypass.
2) Of 216 patients who underwent OPCAB, the procedure was successful in achieving technically complete revascularization in 84% of patients with multivessel disease, either through multivessel OPCAB or a hybrid approach.
3) Postoperative outcomes were good with a low mortality rate of 1.4% and few complications. Graft patency rates improved to over 93% with the use of heart stabilizers during surgery. The hybrid procedures were effective but carried a risk
This document discusses hybrid coronary revascularization (HCR), which combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). HCR was introduced in 1996 as a treatment for multivessel coronary artery disease. It aims to reduce surgical trauma while preserving long-term survival and minimizing adverse events. The hybrid approach involves using a left internal mammary artery graft for the left anterior descending artery and PCI for other lesions. This takes advantage of the excellent outcomes of the arterial graft and improvements in stents. HCR may provide benefits for higher surgical risk patients and allow shorter recovery times compared to traditional CABG. However, some debate remains around its additional complexity and costs compared to established treatments.
Hybrid procedures – from boxing ring to synchronizedArindam Pande
The document discusses various hybrid cardiovascular procedures that combine traditional surgery and percutaneous interventions. It provides details on hybrid CABG/PCI procedures, including advantages of a 1-stop approach over 2-staged, and indications. It also discusses hybrid valve/PCI procedures to allow for minimally invasive valve surgery in patients with coronary artery disease. Finally, it summarizes hybrid approaches for complex thoracic aortic aneurysms/dissections and arrhythmia/AF procedures.
This document discusses hybrid operating rooms and procedures that combine endovascular and open surgical techniques. It begins by explaining the rationale for hybrid approaches, which allow treating more complex cardiac conditions while minimizing invasiveness. A hybrid OR has capabilities for both endovascular interventions and open surgery simultaneously. Key components include cath lab and surgical equipment that can be used together. The document discusses examples like using a stent graft with open surgery for aortic aneurysm or replacing valves percutaneously along with coronary artery bypass. It emphasizes teamwork and convergence of specialties to determine the best individualized approach. Hybrid procedures may reduce recovery time compared to traditional open surgery alone.
Hybrid coronary revascularization (HCR) combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to treat multivessel coronary artery disease. HCR aims to perform CABG on the left anterior descending artery using a left internal mammary artery graft via minimally invasive surgery while treating other vessels with PCI. This approach seeks to provide the benefits of CABG for the LAD while reducing surgical trauma compared to traditional CABG. The optimal strategy and order of CABG versus PCI, as well as antiplatelet management, are debated due to the lack of large randomized controlled trials on HCR. HCR shows promise for high surgical risk patients but further research is still needed to define appropriate patient selection
Anestesia para px con aneurisma (colocación de stent)kiria5
This document discusses anesthesia considerations for patients undergoing endovascular stenting for aortic aneurysms. Endovascular stenting carries less risk than open surgery by avoiding aortic dissection, blood loss, and fluid shifts. However, long term outcomes remain uncertain compared to open surgery. Anesthesia aims to properly place the stent graft to seal tears, decompress false lumens, and reduce rupture risk while monitoring for complications. Transesophageal echocardiography is used to guide the procedure and ensure exclusion of lesions. Care is taken to exclude initial intimal tears in dissections. Endovascular stenting is generally preferred over open surgery for patients with multiple comorbidities.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
This document discusses development of percutaneous mitral valve repair techniques and clinical trials. It provides background on chronic mitral regurgitation (MR) and the limitations of medical and surgical treatment. Percutaneous mitral valve repair offers benefits over surgery like reduced morbidity and shorter recovery. The document describes the four main percutaneous repair methods and focuses on the MitraClip edge-to-edge leaflet repair system, including patient selection criteria, procedure steps, and clinical trial results demonstrating safety and effectiveness for treating MR.
The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the
deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed
wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described.
The document discusses carotid artery disease and treatment options such as carotid angioplasty and stenting. It notes that stroke is a major cause of death and disability in the US. Carotid artery stenosis over 75% poses a high risk of stroke without treatment. Newer techniques like carotid stenting aim to achieve low stroke/death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Success requires choosing the right tools, techniques, and protection devices tailored to each patient's anatomy and plaque characteristics. Ongoing studies evaluate newer neuroprotection systems to further reduce embolic risks of carotid stenting.
Laparoscopic intrahepatic Glissonian technique for liver surgery. Hepatectomi...Marcel Autran Machado
The main advantage of the intrahepatic Glissonian procedure over other techniques is the possibility of gaining a rapid and precise access to the left Glissonian sheaths facilitating left hemihepatectomy, bisegmentectomy 2-3, and individual resections of segments 2, 3, and 4. The authors believe that the intrahepatic Glissonian technique facilitates laparoscopic liver resection and may increase the development of segment-based laparoscopic liver resection.
This document discusses carotid artery disease and carotid stenting procedures. It provides background on carotid artery atherosclerosis and how vulnerable plaques can lead to strokes. It then summarizes guidelines for diagnosing and treating symptomatic and asymptomatic carotid stenosis, including the risks and benefits of medical therapy, carotid endarterectomy, and carotid artery stenting. The document concludes by outlining the key steps for performing carotid artery stenting, including patient selection, imaging, vascular access, stent placement, and complications to consider.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
This document discusses endovascular interventions for infrapopliteal peripheral vascular disease. Infrapopliteal disease is rising due to an aging population and increased rates of diabetes and kidney disease. Surgical and early endovascular interventions historically had high failure rates in this region. Endovascular procedures now provide an alternative to bypass surgery for treating critical limb ischemia in the infrapopliteal arteries, with the goal of establishing straight line blood flow to the foot. Success depends on factors like number of vessels opened, inflow status, and addressing more proximal disease first when needed. Complications can include access issues, vessel spasm or perforation, embolism, and contrast nephropathy.
This document summarizes the results of a study on the long-term outcomes of balloon angioplasty for discrete native coarctation of the aorta in adolescents and adults. The study followed 58 patients for up to 22 years after undergoing balloon angioplasty. Immediate results showed a reduction in peak gradient across the coarctation from 60 mm Hg to 8.5 mm Hg. At 12-month follow-up, the residual gradient was 5 mm Hg. Long-term follow-up with MRI, echocardiography and catheterization found excellent long-term results, with only a small number developing restenosis or aneurysms. The results support balloon angioplasty as a good first option for treating
07 stemi treatment in areas remote from primary pci centresNPSAIC
1) In remote areas far from PCI centers, it is impossible to perform PCI within recommended time limits. For these patients, fibrinolysis should be the primary reperfusion treatment.
2) Following fibrinolysis, patients should be transferred to a PCI center as soon as possible for rescue PCI or routine angiography and PCI if needed. Recent trials suggest performing routine angiography 2-12 hours after fibrinolysis.
3) A well-organized STEMI network is needed to identify patients for on-site fibrinolysis or transfer for PCI, ensure therapies are available 24/7, and allow early transfer after fibrinolysis. Such networks can improve outcomes by minimizing treatment delays.
Management of aaa clinical practice guidelines of the esvsuvcd
This document provides guidelines for the management of abdominal aortic aneurysms (AAA). It includes 130 recommendations across 7 chapters covering topics such as screening, decision-making for repair, pre- and post-operative imaging, management of ruptured and non-ruptured AAAs, and follow-up after repair. The guidelines are based on a systematic review of the literature and aim to standardize care and improve outcomes for AAA patients across Europe.
Carotid artery disease is a major cause of stroke. Left untreated, carotid stenosis over 75% carries a risk of stroke of 2-5% per year. Carotid endarterectomy has been shown in clinical trials such as NASCET and ACAS to significantly reduce stroke risk compared to medical management alone, with perioperative stroke or death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Carotid artery stenting is an alternative treatment that utilizes embolic protection devices and stent placement to treat carotid stenosis, but requires technical expertise to achieve outcomes comparable to surgery.
B. kim current cabg strategies and hybrid proceduresAlysia Smith
Betty S. Kim, MD, FACS presents on "Current CABG Strategies and Hybrid Procedures" for the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
A technical modification of carotid endarterectomy experience with 400 pati...uvcd
This document discusses techniques for carotid endarterectomy based on the experience of 400 patients. It finds that eversion carotid endarterectomy had a lower restenosis rate of 1.7% compared to 9.3% for primary closure and 6.5% for patch angioplasty. Additionally, eversion carotid endarterectomy had a faster mean operative time of 31 minutes compared to 39 minutes for primary closure and 46 minutes for patch angioplasty. Finally, a study of over 1,900 carotid endarterectomies found primary closure was associated with significantly higher risks of perioperative stroke at 5.6% and stroke or death at 6.0% compared to 2.2-2.5% for
This document discusses carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for treatment of carotid artery stenosis. It provides details on patient selection criteria and describes the CAS procedure, including diagnostic arteriography, embolic protection device placement, stent placement, and post-procedure care. Several major clinical trials are summarized that demonstrated CAS to be non-inferior to CEA for reducing risk of stroke in both symptomatic and asymptomatic patients.
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
Acs0622 Open Procedures For Renovascular Diseasemedbookonline
This document discusses open surgical procedures for renovascular disease. It describes the indications for open surgery including failed percutaneous procedures or disease not amenable to percutaneous methods. The most common open procedures discussed are aortorenal bypass, renal artery thromboendarterectomy, and renal artery reimplantation. Technical details are provided for each procedure along with considerations for patient selection and operative planning.
Changes in the Local Therapy of Primary and Secondary Liver Tumors with Curat...semualkaira
Malignant liver tumors encompass a wide range of primary malignancies, and the liver is a vital target organ for metastases from various cancers. Commonly accompanied by systemic therapy, surgical treatment is a well-established option. Numerous innovations made even complex liver resections with extensive tumor burden safe and effective.
This document discusses hybrid operating rooms and procedures that combine endovascular and open surgical techniques. It begins by explaining the rationale for hybrid approaches, which allow treating more complex cardiac conditions while minimizing invasiveness. A hybrid OR has capabilities for both endovascular interventions and open surgery simultaneously. Key components include cath lab and surgical equipment that can be used together. The document discusses examples like using a stent graft with open surgery for aortic aneurysm or replacing valves percutaneously along with coronary artery bypass. It emphasizes teamwork and convergence of specialties to determine the best individualized approach. Hybrid procedures may reduce recovery time compared to traditional open surgery alone.
Hybrid coronary revascularization (HCR) combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to treat multivessel coronary artery disease. HCR aims to perform CABG on the left anterior descending artery using a left internal mammary artery graft via minimally invasive surgery while treating other vessels with PCI. This approach seeks to provide the benefits of CABG for the LAD while reducing surgical trauma compared to traditional CABG. The optimal strategy and order of CABG versus PCI, as well as antiplatelet management, are debated due to the lack of large randomized controlled trials on HCR. HCR shows promise for high surgical risk patients but further research is still needed to define appropriate patient selection
Anestesia para px con aneurisma (colocación de stent)kiria5
This document discusses anesthesia considerations for patients undergoing endovascular stenting for aortic aneurysms. Endovascular stenting carries less risk than open surgery by avoiding aortic dissection, blood loss, and fluid shifts. However, long term outcomes remain uncertain compared to open surgery. Anesthesia aims to properly place the stent graft to seal tears, decompress false lumens, and reduce rupture risk while monitoring for complications. Transesophageal echocardiography is used to guide the procedure and ensure exclusion of lesions. Care is taken to exclude initial intimal tears in dissections. Endovascular stenting is generally preferred over open surgery for patients with multiple comorbidities.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
This document discusses development of percutaneous mitral valve repair techniques and clinical trials. It provides background on chronic mitral regurgitation (MR) and the limitations of medical and surgical treatment. Percutaneous mitral valve repair offers benefits over surgery like reduced morbidity and shorter recovery. The document describes the four main percutaneous repair methods and focuses on the MitraClip edge-to-edge leaflet repair system, including patient selection criteria, procedure steps, and clinical trial results demonstrating safety and effectiveness for treating MR.
The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the
deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed
wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described.
The document discusses carotid artery disease and treatment options such as carotid angioplasty and stenting. It notes that stroke is a major cause of death and disability in the US. Carotid artery stenosis over 75% poses a high risk of stroke without treatment. Newer techniques like carotid stenting aim to achieve low stroke/death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Success requires choosing the right tools, techniques, and protection devices tailored to each patient's anatomy and plaque characteristics. Ongoing studies evaluate newer neuroprotection systems to further reduce embolic risks of carotid stenting.
Laparoscopic intrahepatic Glissonian technique for liver surgery. Hepatectomi...Marcel Autran Machado
The main advantage of the intrahepatic Glissonian procedure over other techniques is the possibility of gaining a rapid and precise access to the left Glissonian sheaths facilitating left hemihepatectomy, bisegmentectomy 2-3, and individual resections of segments 2, 3, and 4. The authors believe that the intrahepatic Glissonian technique facilitates laparoscopic liver resection and may increase the development of segment-based laparoscopic liver resection.
This document discusses carotid artery disease and carotid stenting procedures. It provides background on carotid artery atherosclerosis and how vulnerable plaques can lead to strokes. It then summarizes guidelines for diagnosing and treating symptomatic and asymptomatic carotid stenosis, including the risks and benefits of medical therapy, carotid endarterectomy, and carotid artery stenting. The document concludes by outlining the key steps for performing carotid artery stenting, including patient selection, imaging, vascular access, stent placement, and complications to consider.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
This document discusses endovascular interventions for infrapopliteal peripheral vascular disease. Infrapopliteal disease is rising due to an aging population and increased rates of diabetes and kidney disease. Surgical and early endovascular interventions historically had high failure rates in this region. Endovascular procedures now provide an alternative to bypass surgery for treating critical limb ischemia in the infrapopliteal arteries, with the goal of establishing straight line blood flow to the foot. Success depends on factors like number of vessels opened, inflow status, and addressing more proximal disease first when needed. Complications can include access issues, vessel spasm or perforation, embolism, and contrast nephropathy.
This document summarizes the results of a study on the long-term outcomes of balloon angioplasty for discrete native coarctation of the aorta in adolescents and adults. The study followed 58 patients for up to 22 years after undergoing balloon angioplasty. Immediate results showed a reduction in peak gradient across the coarctation from 60 mm Hg to 8.5 mm Hg. At 12-month follow-up, the residual gradient was 5 mm Hg. Long-term follow-up with MRI, echocardiography and catheterization found excellent long-term results, with only a small number developing restenosis or aneurysms. The results support balloon angioplasty as a good first option for treating
07 stemi treatment in areas remote from primary pci centresNPSAIC
1) In remote areas far from PCI centers, it is impossible to perform PCI within recommended time limits. For these patients, fibrinolysis should be the primary reperfusion treatment.
2) Following fibrinolysis, patients should be transferred to a PCI center as soon as possible for rescue PCI or routine angiography and PCI if needed. Recent trials suggest performing routine angiography 2-12 hours after fibrinolysis.
3) A well-organized STEMI network is needed to identify patients for on-site fibrinolysis or transfer for PCI, ensure therapies are available 24/7, and allow early transfer after fibrinolysis. Such networks can improve outcomes by minimizing treatment delays.
Management of aaa clinical practice guidelines of the esvsuvcd
This document provides guidelines for the management of abdominal aortic aneurysms (AAA). It includes 130 recommendations across 7 chapters covering topics such as screening, decision-making for repair, pre- and post-operative imaging, management of ruptured and non-ruptured AAAs, and follow-up after repair. The guidelines are based on a systematic review of the literature and aim to standardize care and improve outcomes for AAA patients across Europe.
Carotid artery disease is a major cause of stroke. Left untreated, carotid stenosis over 75% carries a risk of stroke of 2-5% per year. Carotid endarterectomy has been shown in clinical trials such as NASCET and ACAS to significantly reduce stroke risk compared to medical management alone, with perioperative stroke or death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Carotid artery stenting is an alternative treatment that utilizes embolic protection devices and stent placement to treat carotid stenosis, but requires technical expertise to achieve outcomes comparable to surgery.
B. kim current cabg strategies and hybrid proceduresAlysia Smith
Betty S. Kim, MD, FACS presents on "Current CABG Strategies and Hybrid Procedures" for the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
A technical modification of carotid endarterectomy experience with 400 pati...uvcd
This document discusses techniques for carotid endarterectomy based on the experience of 400 patients. It finds that eversion carotid endarterectomy had a lower restenosis rate of 1.7% compared to 9.3% for primary closure and 6.5% for patch angioplasty. Additionally, eversion carotid endarterectomy had a faster mean operative time of 31 minutes compared to 39 minutes for primary closure and 46 minutes for patch angioplasty. Finally, a study of over 1,900 carotid endarterectomies found primary closure was associated with significantly higher risks of perioperative stroke at 5.6% and stroke or death at 6.0% compared to 2.2-2.5% for
This document discusses carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for treatment of carotid artery stenosis. It provides details on patient selection criteria and describes the CAS procedure, including diagnostic arteriography, embolic protection device placement, stent placement, and post-procedure care. Several major clinical trials are summarized that demonstrated CAS to be non-inferior to CEA for reducing risk of stroke in both symptomatic and asymptomatic patients.
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
Acs0622 Open Procedures For Renovascular Diseasemedbookonline
This document discusses open surgical procedures for renovascular disease. It describes the indications for open surgery including failed percutaneous procedures or disease not amenable to percutaneous methods. The most common open procedures discussed are aortorenal bypass, renal artery thromboendarterectomy, and renal artery reimplantation. Technical details are provided for each procedure along with considerations for patient selection and operative planning.
Changes in the Local Therapy of Primary and Secondary Liver Tumors with Curat...semualkaira
Malignant liver tumors encompass a wide range of primary malignancies, and the liver is a vital target organ for metastases from various cancers. Commonly accompanied by systemic therapy, surgical treatment is a well-established option. Numerous innovations made even complex liver resections with extensive tumor burden safe and effective.
Changes in the Local Therapy of Primary and Secondary Liver Tumors with Curat...semualkaira
Malignant liver tumors encompass a wide range of primary malignancies, and the liver is a vital target organ for metastases from various cancers. Commonly accompanied by systemic therapy, surgical treatment is a well-established option. Numerous innovations made even complex liver resections with extensive tumor burden safe and effective.
Changes in the Local Therapy of Primary and Secondary Liver Tumors with Curat...semualkaira
Malignant liver tumors encompass a wide range of primary malignancies, and the liver is a vital target organ for metastases from various cancers. Commonly accompanied by systemic therapy, surgical treatment is a well-established option. Numerous innovations made even complex liver resections with extensive tumor burden safe and effective.
This document discusses various interventional therapies for resistant hypertension and renal artery stenosis, including renal sympathetic nerve ablation (RDN), baroreceptor activation therapy (BAT), and arteriovenous shunt creation. It provides details on techniques such as radiofrequency ablation and ultrasound ablation for RDN. It outlines trial results showing reductions in blood pressure from RDN, BAT, and arteriovenous shunts. It also discusses limitations of renal artery stenting based on recent trials. In summary, the document reviews novel interventional approaches for treating difficult cases of high blood pressure.
This document summarizes management of renal artery stenosis and discusses various treatment options. It outlines moderators and departments from Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It then discusses goals of treatment, the role of revascularization, protocols for medical vs interventional management, and results from studies on angioplasty, stenting, and surgery. Complications and patient selection criteria for different procedures are also outlined.
This document summarizes surgical procedures for treating mesenteric ischemia, focusing on techniques for chronic or acute intestinal ischemia. It describes preoperative evaluation including imaging, and planning considerations for chronic cases. Surgical options for chronic ischemia include visceral endarterectomy, transaortic endarterectomy, and mesenteric arterial bypass via antegrade or retrograde routes. Bypass grafts can be prosthetic or autologous vein. The document explains the techniques for these procedures.
Perioperative care of patients with kidney diseases prof (1). ahmed rabeeFarragBahbah
This document discusses perioperative care of patients with kidney disease. It covers preoperative assessment and investigations, renal risk assessment, surgical risks in chronic kidney disease (CKD) patients, and preventing acute kidney injury. Key points include performing a comprehensive evaluation of CKD patients' medical history and comorbidities; adjusting dosages of renally excreted drugs; optimizing fluid, electrolyte and acid-base balance; considering preoperative dialysis for volume overloaded patients; and involving nephrologists in care of transplant recipients. Emergent surgery and advanced CKD carry higher surgical risks. The goal is to identify and address risks to avoid worsening of renal function in the perioperative period.
Acs0613 Surgical Treatment Of The Infected Aortic Graftmedbookonline
This document discusses surgical treatment options for infected aortic grafts. The primary goal is to remove all infected material while maintaining adequate circulation. Options include extra-anatomic bypass, aortic allografts, antibiotic-treated prosthetic grafts, and in situ replacement with a femoral-popliteal vein graft. The preferred method is in situ replacement with an autogenous femoral-popliteal vein graft due to its excellent long-term patency and resistance to reinfection. The procedure involves harvesting the vein, controlling the femoral vessels, removing the infected graft, and reconstructing with the vein graft. Meticulous technique is required to minimize complications.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
Acs0522 Procedures For Benign And Malignant Biliary Tract Disease 2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It describes common operations to treat biliary tract diseases, emphasizing details of operative planning and technique. Key points include:
- Thorough preoperative imaging is important to define anatomy accurately.
- Biliary obstruction can cause secondary issues like infection, renal dysfunction, impaired immunity, and malnutrition, so these should be addressed preoperatively if possible.
- Exposure of the hepatoduodenal ligament and porta hepatis is critical during open procedures. Adhesions may require specific dissection techniques.
- Biliary anastomoses generally heal well if blood supply is preserved, tension is avoided, and sutures are placed
1) The document discusses aortoiliac aneurysms, including definitions, epidemiology, risk factors, rupture risk, associated aneurysms, pathophysiology, diagnosis, imaging, decision making for treatment, medical management, and indications for intervention.
2) Key risk factors for aneurysm rupture include diameter greater than 5.5 cm, female sex, smoking, and saccular aneurysm morphology. Imaging recommendations include ultrasound screening and CT or MRI for diagnosis.
3) Treatment is generally recommended for aneurysms greater than 5.5 cm in men or 5 cm in women, or those showing rapid growth. Immediate repair is indicated for ruptured aneurysms.
1. Nephron sparing surgery (NSS), also known as partial nephrectomy, aims to remove renal tumors while preserving as much healthy kidney tissue as possible.
2. NSS has similar oncologic outcomes as radical nephrectomy but offers advantages like preserving renal function and reducing risks of chronic kidney disease.
3. While NSS was historically more complex and risky than radical nephrectomy, advances in surgical techniques like laparoscopic and robotic partial nephrectomy have reduced risks and made NSS a viable option for more patients with renal cell carcinoma.
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemiaguestd58ac53
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Juza Chen and Avi Bery
Director of Sexual Dysfunction Clinic
Department of Urology
Tel-Aviv Sourasky Medical Center
Sackler Faculty of Medicine Tel-Aviv University
Moscow 2010
The role of ercp in diseases of the biliary tract and pancreasThorsang Chayovan
This document provides guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) on the role of endoscopic retrograde cholangiopancreatography (ERCP) in diseases of the biliary tract and pancreas. It was developed using an evidence-based methodology including a literature review. The guidelines are intended to apply to all physicians performing GI endoscopy. ERCP is described as useful for diagnosing and treating conditions like gallstones, biliary strictures, pancreatic disease, and leaks or injuries to the biliary tract. Outcomes of ERCP for various conditions are discussed along with appropriate patient selection and techniques.
This document discusses carotid artery stenting as an alternative to carotid endarterectomy for treating carotid artery stenosis. It provides details on:
1) Clinical trials that have established carotid stenting as an equivalent option to carotid endarterectomy for reducing risk of stroke, with some trials finding stenting superior for certain patient groups.
2) Guidelines from organizations like the ACC/AHA that recommend carotid stenting as a Class I or IIa option for symptomatic and select asymptomatic patients.
3) The procedure of carotid artery stenting, including patient preparation, diagnostic arteriogram, techniques for embolic protection and stent placement.
Furosemide with matched hydration using the RenalGuard System was found to decrease the incidence of contrast-induced acute kidney injury (CI-AKI) compared to control treatments in patients undergoing interventional procedures. The RenalGuard System delivers intravenous fluids matched to urine output with hydration, furosemide, and continuous monitoring to maintain urine output over 300 ml/hr. A meta-analysis found the RenalGuard System reduced CI-AKI and need for renal replacement therapy with no increase in adverse events. However, more randomized trials are still needed to further evaluate the safety of the RenalGuard System.
prophylatic inferior vena cava (IVC) filters in traumaMubasharHashmi1
This document summarizes a multicenter randomized controlled trial that evaluated the use of retrievable inferior vena cava (IVC) filters for thromboprophylaxis in severely injured trauma patients. The trial randomized 240 patients with contraindications to anticoagulation and Injury Severity Score >15 to either receive an IVC filter within 72 hours or no filter. The primary endpoints were symptomatic pulmonary embolism and death within 90 days. Secondary endpoints included DVT rates, bleeding complications, and costs. Preliminary results found the groups to be balanced at baseline. The study aims to determine if early IVC filter placement reduces pulmonary embolism rates compared to no filter in high-risk trauma patients who cannot receive antico
Acs0626 Medical Management Of Vascular Diseasemedbookonline
This document discusses vascular access for hemodialysis patients. It covers:
1) Assessment of the venous system includes checking for stenosis, thrombosis, or damage from prior procedures that could impact access placement. Adequate veins for access need a diameter over 2.5 mm.
2) Assessment of the arterial system involves checking pulses, blood pressure differences between arms, and the Allen test to ensure adequate inflow. Arteries need a diameter over 2 mm.
3) Noninvasive testing like ultrasound can map arteries and veins to identify optimal conduits and mark skin to aid surgery. The goal is to increase autogenous fistulas that have the best outcomes.
Similar to Acs0623 Endovascular Procedures For Renovascular Disease (20)
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document provides reference values for many common clinical chemistry analytes measured in various specimens like plasma, serum, urine, and whole blood. The analytes include metabolic panels, lipids, proteins, electrolytes, vitamins, and more. Reference ranges are given in conventional and SI units for each analyte. The purpose is to provide clinicians with the normal expected ranges to interpret laboratory results at the Massachusetts General Hospital.