This document provides an overview of chronic lower limb ischemia and the role of angioplasty in treating it. It begins with definitions and descriptions of chronic lower limb ischemia and its causes. It then discusses the diagnosis of chronic lower limb ischemia through tests like ankle-brachial index measurements and contrast angiography. The document reviews endovascular procedures like percutaneous transluminal angioplasty and stenting as options for revascularization, compared to surgical options. It provides details on how to perform angioplasty and discusses factors that determine the success of endovascular interventions. The document concludes by discussing potential complications of these procedures.
Technique of peripheral angiogram and complicationMai Parachy
The document discusses techniques for peripheral angiograms and potential complications. It covers operating room preparation including equipment such as needles, guide wires, sheaths, and catheters. Access site selection is discussed including the common femoral, popliteal, tibial, brachial, subclavian, and radial arteries. The angiogram procedure is outlined including artery puncture, sheath placement, guidewire insertion, catheter selection, contrast injection, and closure techniques such as manual compression or closure devices. Complications from the procedure are also mentioned.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 and is used to visualize the coronary arteries and assess for stenosis. It can determine treatment options and prognosis. Complications are rare but include vascular injury and contrast reactions. Proper angiographic views are important for evaluating different coronary artery segments.
Peripheral Angioplasty / Endovascular Management of PVD - PrinciplesSaurabh Joshi
This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
Guide catheters in coronary interventionRohitWalse2
Guide catheters are essential for coronary interventions as they deliver hardware into the arteries. The document discusses the properties and types of guide catheters, highlighting how their structure provides support and torque control. It describes commonly used guide catheters like the Judkins, Amplatz and EBU catheters, noting what vessels each is best suited for. Specialty guide catheters for difficult anatomies are also reviewed. Proper guide selection and positioning are emphasized for coaxial engagement and optimal device delivery during interventions.
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
The document discusses various coronary artery anomalies that can be identified through angiography. It presents several case examples of different anomalous coronary artery origins and courses, including the left main coronary artery arising from the right coronary sinus and coursing between the aorta and pulmonary artery, which is the highest risk type. It also discusses anomalies like an anomalous right coronary artery taking off from the left coronary sinus. The cases are demonstrated through angiographic images.
Technique of peripheral angiogram and complicationMai Parachy
The document discusses techniques for peripheral angiograms and potential complications. It covers operating room preparation including equipment such as needles, guide wires, sheaths, and catheters. Access site selection is discussed including the common femoral, popliteal, tibial, brachial, subclavian, and radial arteries. The angiogram procedure is outlined including artery puncture, sheath placement, guidewire insertion, catheter selection, contrast injection, and closure techniques such as manual compression or closure devices. Complications from the procedure are also mentioned.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 and is used to visualize the coronary arteries and assess for stenosis. It can determine treatment options and prognosis. Complications are rare but include vascular injury and contrast reactions. Proper angiographic views are important for evaluating different coronary artery segments.
Peripheral Angioplasty / Endovascular Management of PVD - PrinciplesSaurabh Joshi
This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
Guide catheters in coronary interventionRohitWalse2
Guide catheters are essential for coronary interventions as they deliver hardware into the arteries. The document discusses the properties and types of guide catheters, highlighting how their structure provides support and torque control. It describes commonly used guide catheters like the Judkins, Amplatz and EBU catheters, noting what vessels each is best suited for. Specialty guide catheters for difficult anatomies are also reviewed. Proper guide selection and positioning are emphasized for coaxial engagement and optimal device delivery during interventions.
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
The document discusses various coronary artery anomalies that can be identified through angiography. It presents several case examples of different anomalous coronary artery origins and courses, including the left main coronary artery arising from the right coronary sinus and coursing between the aorta and pulmonary artery, which is the highest risk type. It also discusses anomalies like an anomalous right coronary artery taking off from the left coronary sinus. The cases are demonstrated through angiographic images.
This document provides information about cardiac catheters and guidewires used in cardiac catheterization procedures. It discusses the history of cardiac catheters, ideal characteristics, parts of a catheter, materials used in construction, types of catheters including pigtail catheters, and features of guidewires. Characteristics such as size, stiffness, memory, and friction coefficient are compared for different catheter materials. The document also includes images and descriptions of specific catheters and guidewire tips.
Intravascular ultrasound (IVUS) uses sound waves to visualize the inside of arteries. There are two types of IVUS systems - mechanical systems using a rotating internal cable and solid-state systems using externally mounted transducers. Both produce 360-degree images with a resolution of 100-150 μm. IVUS is used to assess plaque, vessel dimensions, stent deployment, and more. It produces cross-sectional images showing the lumen, layers of the artery wall, and plaque composition and size. Measurements include diameters, areas, plaque burden, and indices of eccentricity. IVUS helps identify vulnerable plaque and has diagnostic and interventional applications.
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
This document discusses abdominal aortic aneurysms (AAAs) and their endovascular repair (EVAR). It defines AAAs as a dilatation of the abdominal aorta over 3cm in diameter. EVAR involves inserting a folded graft through the femoral artery which expands to exclude the aneurysm sac from blood flow and pressure. The benefits of EVAR over open repair include lower peri-operative mortality and complications. Proper patient assessment including vascular anatomy and medical comorbidities is important for determining candidacy for EVAR. The procedure involves deploying graft components in the aorta and iliac arteries under imaging guidance. Post-operative surveillance with imaging is needed to monitor for complications like endoleaks.
This document discusses guide catheter selection for transradial coronary procedures. It provides guidance on the most commonly used guide catheters for accessing the left and right coronary arteries from the radial approach. Specific catheter shapes like the Judkins left and extra backup are recommended for the left coronary while the Judkins right is suitable for the right coronary. Newer catheter technologies including hydrophilic sheathless catheters are also reviewed. The conclusion emphasizes that knowledge of guide catheter selection and engagement technique enables successful transradial PCI.
The document provides an overview of transcatheter aortic valve implantation (TAVI), including a brief history of its development, descriptions of the Edwards Sapien valve and delivery systems, approaches for TAVI, and complications. It also discusses patient screening and risk stratification, as well as newer valve devices that are being developed.
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
interventional cardiology, Guiding catheters, wires, and balloons equipment...salman habeeb
This document provides an overview of guiding catheters, guide wires, and balloons which are core equipment used in percutaneous coronary interventions (PCI). It describes the design characteristics, advantages, and disadvantages of over-the-wire and rapid exchange balloon catheters. Key attributes of balloons like entry, tracking, and compliance are defined. Guiding catheters are discussed in terms of size, shape, and selection for accessing different coronary arteries. Finally, guide wire features such as core material, coating, and tip design are reviewed alongside common wire types used in various clinical scenarios.
This document discusses angiographic projections and views used for imaging specific coronary artery segments and congenital heart diseases. It provides the standard angiographic views and degrees of angulation used for visualizing the left main, left anterior descending, circumflex, right coronary arteries, pulmonary arteries, and structures like VSDs and ASDs. The document also lists patient, angiographer, and equipment factors that can cause poor angiograms.
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.
This document provides information about percutaneous transvenous mitral commissurotomy (PTMC), a procedure used to treat mitral stenosis. It discusses the stages and severity of mitral stenosis, indications and contraindications for PTMC, assessment of valve morphology, the PTMC procedure technique, instruments used, balloon size selection, post-procedure evaluation, complications, follow-up care, and long-term prognosis. PTMC is performed to improve the opening of a stenosed mitral valve by splitting the fused commissures using a balloon catheter, and is an important therapeutic option for treating symptomatic mitral stenosis.
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
Intravascular ultrasonography (IVUS) provides images of coronary arteries and other blood vessels. It plays a critical role in understanding coronary disease and guiding interventional cardiology procedures. IVUS uses a catheter-mounted ultrasound transducer to create images. It can assess plaque, guide stent placement, detect complications, and characterize lesion morphology. IVUS provides detailed information to evaluate patients and optimize interventional strategies.
BMV,PTMC,BALLOON MITRAL VALVOTOMY, BAL, VIRBHAN BALAI, DR VIRBHANDr Virbhan Balai
This document discusses balloon mitral valvuloplasty (BMV) and balloon aortic valvuloplasty (BAV). It describes the indications for BMV as symptomatic or asymptomatic severe mitral stenosis. The Inoue technique for BMV is explained in detail, including transseptal puncture and sequential balloon inflation. Complications of BMV include severe mitral regurgitation, mortality, and cardiac perforation. BAV was used historically but was abandoned due to high restenosis rates and no improvement in patient survival.
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
1. The document discusses peripheral arterial occlusive disease (PAOD), also known as peripheral artery disease (PAD), which refers to obstruction of arteries outside the heart and brain.
2. Risk factors for PAOD include smoking, diabetes, hypertension, hyperlipidemia, older age, male sex, family history of vascular disease, and certain ethnicities.
3. Symptoms range from intermittent claudication to critical limb ischemia with rest pain and tissue loss. Physical exam findings and tests like the ankle-brachial pressure index can help in diagnosis.
4. Management options discussed include conservative treatment for mild cases as well as endovascular and surgical revascularization procedures for more severe cases.
The document discusses coronary angioplasty, including what it is, why it is performed, and where it should be performed. It is a minimally invasive procedure to open blocked or narrowed coronary arteries by inflating a balloon to reshape the plaque or deploying a stent. It is primarily used for myocardial infarction and chronic stable angina. The optimal treatment is primary PCI within 90 minutes of diagnosis for STEMI patients. However, challenges exist for performing primary PCI in the dispersed population served by Raigmore Hospital due to its small cardiology team and long drive times for some patients.
This document provides information about cardiac catheters and guidewires used in cardiac catheterization procedures. It discusses the history of cardiac catheters, ideal characteristics, parts of a catheter, materials used in construction, types of catheters including pigtail catheters, and features of guidewires. Characteristics such as size, stiffness, memory, and friction coefficient are compared for different catheter materials. The document also includes images and descriptions of specific catheters and guidewire tips.
Intravascular ultrasound (IVUS) uses sound waves to visualize the inside of arteries. There are two types of IVUS systems - mechanical systems using a rotating internal cable and solid-state systems using externally mounted transducers. Both produce 360-degree images with a resolution of 100-150 μm. IVUS is used to assess plaque, vessel dimensions, stent deployment, and more. It produces cross-sectional images showing the lumen, layers of the artery wall, and plaque composition and size. Measurements include diameters, areas, plaque burden, and indices of eccentricity. IVUS helps identify vulnerable plaque and has diagnostic and interventional applications.
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
This document discusses abdominal aortic aneurysms (AAAs) and their endovascular repair (EVAR). It defines AAAs as a dilatation of the abdominal aorta over 3cm in diameter. EVAR involves inserting a folded graft through the femoral artery which expands to exclude the aneurysm sac from blood flow and pressure. The benefits of EVAR over open repair include lower peri-operative mortality and complications. Proper patient assessment including vascular anatomy and medical comorbidities is important for determining candidacy for EVAR. The procedure involves deploying graft components in the aorta and iliac arteries under imaging guidance. Post-operative surveillance with imaging is needed to monitor for complications like endoleaks.
This document discusses guide catheter selection for transradial coronary procedures. It provides guidance on the most commonly used guide catheters for accessing the left and right coronary arteries from the radial approach. Specific catheter shapes like the Judkins left and extra backup are recommended for the left coronary while the Judkins right is suitable for the right coronary. Newer catheter technologies including hydrophilic sheathless catheters are also reviewed. The conclusion emphasizes that knowledge of guide catheter selection and engagement technique enables successful transradial PCI.
The document provides an overview of transcatheter aortic valve implantation (TAVI), including a brief history of its development, descriptions of the Edwards Sapien valve and delivery systems, approaches for TAVI, and complications. It also discusses patient screening and risk stratification, as well as newer valve devices that are being developed.
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
interventional cardiology, Guiding catheters, wires, and balloons equipment...salman habeeb
This document provides an overview of guiding catheters, guide wires, and balloons which are core equipment used in percutaneous coronary interventions (PCI). It describes the design characteristics, advantages, and disadvantages of over-the-wire and rapid exchange balloon catheters. Key attributes of balloons like entry, tracking, and compliance are defined. Guiding catheters are discussed in terms of size, shape, and selection for accessing different coronary arteries. Finally, guide wire features such as core material, coating, and tip design are reviewed alongside common wire types used in various clinical scenarios.
This document discusses angiographic projections and views used for imaging specific coronary artery segments and congenital heart diseases. It provides the standard angiographic views and degrees of angulation used for visualizing the left main, left anterior descending, circumflex, right coronary arteries, pulmonary arteries, and structures like VSDs and ASDs. The document also lists patient, angiographer, and equipment factors that can cause poor angiograms.
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.
This document provides information about percutaneous transvenous mitral commissurotomy (PTMC), a procedure used to treat mitral stenosis. It discusses the stages and severity of mitral stenosis, indications and contraindications for PTMC, assessment of valve morphology, the PTMC procedure technique, instruments used, balloon size selection, post-procedure evaluation, complications, follow-up care, and long-term prognosis. PTMC is performed to improve the opening of a stenosed mitral valve by splitting the fused commissures using a balloon catheter, and is an important therapeutic option for treating symptomatic mitral stenosis.
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
Intravascular ultrasonography (IVUS) provides images of coronary arteries and other blood vessels. It plays a critical role in understanding coronary disease and guiding interventional cardiology procedures. IVUS uses a catheter-mounted ultrasound transducer to create images. It can assess plaque, guide stent placement, detect complications, and characterize lesion morphology. IVUS provides detailed information to evaluate patients and optimize interventional strategies.
BMV,PTMC,BALLOON MITRAL VALVOTOMY, BAL, VIRBHAN BALAI, DR VIRBHANDr Virbhan Balai
This document discusses balloon mitral valvuloplasty (BMV) and balloon aortic valvuloplasty (BAV). It describes the indications for BMV as symptomatic or asymptomatic severe mitral stenosis. The Inoue technique for BMV is explained in detail, including transseptal puncture and sequential balloon inflation. Complications of BMV include severe mitral regurgitation, mortality, and cardiac perforation. BAV was used historically but was abandoned due to high restenosis rates and no improvement in patient survival.
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
1. The document discusses peripheral arterial occlusive disease (PAOD), also known as peripheral artery disease (PAD), which refers to obstruction of arteries outside the heart and brain.
2. Risk factors for PAOD include smoking, diabetes, hypertension, hyperlipidemia, older age, male sex, family history of vascular disease, and certain ethnicities.
3. Symptoms range from intermittent claudication to critical limb ischemia with rest pain and tissue loss. Physical exam findings and tests like the ankle-brachial pressure index can help in diagnosis.
4. Management options discussed include conservative treatment for mild cases as well as endovascular and surgical revascularization procedures for more severe cases.
The document discusses coronary angioplasty, including what it is, why it is performed, and where it should be performed. It is a minimally invasive procedure to open blocked or narrowed coronary arteries by inflating a balloon to reshape the plaque or deploying a stent. It is primarily used for myocardial infarction and chronic stable angina. The optimal treatment is primary PCI within 90 minutes of diagnosis for STEMI patients. However, challenges exist for performing primary PCI in the dispersed population served by Raigmore Hospital due to its small cardiology team and long drive times for some patients.
Below the knee intervention; balloons or stentsMohamed Ashraf
This document discusses endovascular interventions for below-the-knee peripheral artery disease. It reviews the use of plain balloon angioplasty, bare-metal stents, drug-eluting stents, and drug-coated balloons. While balloon angioplasty alone has high restenosis rates, bare-metal stents provide improved outcomes but drug-eluting stents have been shown to further reduce restenosis and reintervention rates compared to bare-metal stents. Drug-coated balloons have potential benefits but large clinical trials have produced mixed results regarding their efficacy compared to plain balloon angioplasty. The optimal treatment remains an area of ongoing investigation.
Angioplasty is a minimally invasive procedure used to open blocked blood vessels by inserting a balloon catheter and inflating the balloon to compress plaque and widen the vessel. It is commonly used to treat coronary artery disease and heart attacks. During angioplasty, a balloon is guided to the blockage where it is inflated to open the artery. Sometimes a stent is placed to keep the artery open. Angioplasty allows faster treatment of heart attacks with good long-term outcomes and is generally safer than alternative procedures like bypass surgery.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
1) This study examined the effects of intracoronary (IC) versus intravenous (IV) administration of abciximab in STEMI patients undergoing primary PCI using cardiac magnetic resonance imaging (CMR).
2) CMR results showed no differences between IC and IV groups in infarct size, myocardial salvage, microvascular obstruction, or left ventricular function.
3) Clinical outcomes at 12-month follow up including death, reinfarction, congestive heart failure, and major adverse cardiac events were also similar between the two groups.
4) The CMR results of this large substudy confirm the main findings of the parent AIDA STEMI trial that IC abciximab administration did
1) The study compared outcomes of STEMI patients undergoing primary PCI with thrombectomy (Group T) versus without thrombectomy (Group S).
2) MRI results at 3 months showed significantly smaller infarct size and less transmurality in Group T compared to Group S.
3) Procedural results favored Group T with higher rates of TIMI 3 flow and complete ST resolution. One-year outcomes also favored Group T with lower rates of MACE.
Tolvaptan is an oral selective vasopressin V2 receptor antagonist used for the treatment of hyponatremia. [1] It produces significant aquaresis and increases serum sodium levels without affecting electrolyte levels. [2] Clinical trials showed tolvaptan effectively corrected hyponatremia in heart failure and cirrhosis patients. [3] In acute decompensated heart failure, tolvaptan provided relief of symptoms without affecting mortality, renal function, or electrolyte levels long-term. [3] The most common side effects are thirst, dry mouth, and polyuria. [4]
CTEPH is a deadly disease that causes pulmonary hypertension. It is caused by blood clots in the lungs that do not fully resolve, leading to blockages in the pulmonary arteries. While medical therapies exist, they have mostly been tested in advanced cases. Without treatment, CTEPH progresses rapidly once symptoms appear. The disease is insidious in onset and can be misdiagnosed for years due to non-specific symptoms like dyspnea and exercise intolerance. This delays correct treatment and leads to right heart failure and death if left untreated.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Diabetes and hypertension frequently occur together and amplify cardiovascular risk. Aggressive blood pressure control is especially important for diabetics to prevent events like heart disease and stroke. The document discusses the history of diabetes and hypertension, complications, diagnosis criteria, treatment goals, and pharmacological and lifestyle approaches to managing hypertension in diabetes. The key goals are achieving a blood pressure under 130/80 mmHg through lifestyle changes and often multiple drug classes like ACE inhibitors or ARBs to protect the kidneys and reduce cardiovascular risk.
A 47-year-old male presented with angina and a history of hypertension and smoking. Tests showed T-wave inversion and normal left ventricular function. He underwent bifurcation stenting of a true bifurcation lesion where both the main branch and side branch were significantly narrowed. The current preferred approach for treating non-true bifurcations is provisional stenting of the main vessel with optional stenting of the side branch. A two-stent strategy may be used for large side branches supplying a significant area of myocardium, especially when the side branch arises at a shallow angle.
This document provides information on Ebstein's anomaly, including its anatomy, embryology, clinical presentation, diagnosis, and natural history. Some key points:
- Ebstein's anomaly is a congenital defect involving downward displacement of the tricuspid valve into the right ventricle. This can cause dilation of the right atrium and dysfunction of the right ventricle.
- Clinical presentation varies from neonatal congestive heart failure to later cyanosis, arrhythmias, and right heart failure in adults. Associated defects are common.
- Diagnosis is made through echocardiogram demonstrating displacement of the tricuspid valve leaflets. Other tests like ECG, chest x-ray, and
This document discusses the assessment, investigation, and treatment of chronic stable angina. It defines chronic stable angina as chest pain or discomfort that is reproducibly associated with exertion or stress and relieved by rest. The document outlines how to evaluate patients presenting with chest pain through history, physical exam, risk factor assessment, and probability estimation models. It recommends initial tests like ECG, cardiac biomarkers, and stress testing. Treatment focuses on lifestyle changes, medications like aspirin, beta-blockers, calcium channel blockers, and revascularization if needed. Regular patient follow up and education are also emphasized.
The document discusses wide complex tachycardia, providing definitions and discussing the differential diagnosis, ECG diagnosis, and electrophysiological approach. It notes that wide complex tachycardia can be ventricular tachycardia or supraventricular tachycardia with aberrancy or preexcitation. The ECG is important for diagnosis but often inconclusive. An electrophysiology study can help determine the site of origin through evaluating AV dissociation, measuring HV intervals, and inducing arrhythmias.
Dr. Awadhesh Kumar Sharma is a consultant cardiologist who has extensive training and experience in cardiology. The goal of this session is to provide a basic understanding of ECG waves and intervals, ECG interpretation, and the clinical application of ECGs. The document then discusses the history of ECGs, the fundamentals of how they work, normal ECG components including intervals, leads, and rhythms, as well as how to interpret ECGs and some common abnormalities.
The document discusses the role of peroxisome proliferator activated receptor gamma (PPARγ) agonists in treating type 2 diabetes and reducing cardiovascular risk. PPARγ agonists like thiazolidinediones improve insulin sensitivity and have beneficial effects on lipids, inflammation, and vascular cell proliferation. They may reduce cardiovascular events in type 2 diabetes through these metabolic and anti-inflammatory mechanisms. However, PPARγ agonists can also cause side effects like fluid retention, weight gain, and congestive heart failure, so their risks and benefits must be carefully weighed.
The document discusses cardiogenic shock, outlining its definition, causes, pathophysiology, diagnosis and management, with a focus on shock complicating myocardial infarction. Cardiogenic shock occurs in 5-8% of patients hospitalized with ST-elevation myocardial infarction and has a high mortality rate of 70-80% despite emerging treatments. The document provides details on the hemodynamic parameters defining cardiogenic shock and reviews the various mechanisms that can lead to left or right ventricular failure and shock.
This document discusses different designs of coronary stents. It begins by providing background on the development of coronary stents and their approval for use. It then describes some of the earliest stent designs, including the Gianturco-Roubin coil stent and the Palmaz-Schatz slotted tube stent. The document goes on to discuss various aspects of stent design that can impact performance, such as the geometric configuration, materials used, coatings, and drug-eluting capabilities. Key design considerations like strut thickness, number of struts, and mechanical properties are also reviewed.
La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e va...ASMaD
Presentazione a cura del Professor Angelo Cioppa - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
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 a study of 89 cases of peripheral vascular disease examined using CT angiography. The study found that hypertension was the most common risk factor, affecting 46.1% of patients. The predominant lesion observed was stenosis (5.61%), followed by hematoma and arteriovenous malformation. The abdominal aorta was the most commonly affected artery (58.43%), followed by the lower limbs. CT angiography provided a noninvasive means to image peripheral vascular disease and obtain data on morphological patterns and risk factors in Bangladeshi patients, which previously lacked disease-specific research.
Study of 89 Cases of Peripheral Vascular Disease by CT AngiographyM A Hasnat
The purpose of this study was to observe the morphological pattern by CT angiography
and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering
from peripheral vascular disease using a multidetector scanner in the evaluation of patients with
peripheral vascular disease.
By the end of the module, you will be able to:
Define Arterio Venous Fistula and Arterio Venous Graft
Identify Complications and Management
Familiarise and use the Pre Needling Cannulation Tool
The document describes the anatomy of the carotid arteries and their branches, evaluation and imaging of carotid artery disease, and treatment strategies including lifestyle modifications to reduce risk factors, carotid endarterectomy to remove plaques from significantly stenotic arteries, and outcomes data from clinical trials on endarterectomy for symptomatic and asymptomatic carotid stenosis. Imaging modalities like carotid duplex ultrasound, CTA, and MRA are described for evaluating the degree of carotid stenosis. The benefits of carotid endarterectomy are greater for symptomatic high-grade stenosis while more moderate for asymptomatic disease.
Peripheral arterial disease (PAD) is the obstruction or deterioration of arteries other than those supplying the heart and brain. PAD prevalence increases with age and is more common in Black individuals compared to Whites. A study in Ghana found higher PAD prevalence in Ghanaians living in Ghana compared to migrant Ghanaians in Europe. Risk factors for PAD include smoking, hypertension, diabetes, hyperlipidemia, and renal insufficiency. Treatment involves lifestyle modifications, medications, and revascularization procedures like angioplasty, stenting, or bypass surgery depending on the severity and location of arterial blockages. Amputations may be required for gangrenous or critically ischemic limbs.
This document summarizes the diagnosis and management of local complications associated with transradial access for coronary procedures. It discusses radial artery occlusion, hand ischemia, radial artery spasm, forearm hematoma, compartment syndrome, catheter entrapment, pseudoaneurysm, and arteriovenous fistula. Predictors and treatments for various complications are provided. The incidence of radial artery occlusion can range from 0.8-30% depending on the time and method of assessment. Hand ischemia due to radial artery occlusion is rare but can occur in systemically unwell patients with prolonged radial cannulation. Radial artery spasm is common and treatments include antispasmodic medications and adequate analgesia/sedation.
PAD can be diagnosed in asymptomatic individuals by a combination of physical examination and simple, noninvasive Doppler ultrasonography to measure the ankle–brachial index
Management of steal syndrome || Dr Ravi BansalAVATAR
This document discusses steal syndrome, which is arterial insufficiency caused by an arteriovenous dialysis access. It can cause hand pain, numbness, and tissue damage. The document describes methods for assessing and classifying steal syndrome severity. Treatment options aim to reverse ischemia while preserving access function, and include percutaneous and surgical interventions like angioplasty, stenting, banding, and distal revascularization-interval ligation. Risk factors include diabetes, peripheral vascular disease, and brachial accesses. Monitoring access flows can help prevent steal syndrome.
Surgical management of valvular heart diseaseSaurabh Potdar
This document discusses the surgical management of valvular heart disease. It covers general considerations for valve disease etiology and diagnosis. It describes the different types of prosthetic valves including mechanical and bioprosthetic options. It provides details on the surgical treatment of specific valve diseases like aortic stenosis, aortic regurgitation, and choices for valve replacement or repair. Surgical intervention is usually recommended for severe symptomatic valve disease and aims to improve hemodynamics and clinical outcomes, though risks vary based on patient factors.
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.
MDCT Evaluation of Varices in Portal HypertensionVishwanath R S
MDCT is useful for identifying portosystemic collateral vessels in patients with portal hypertension. It can accurately demonstrate the majority of collateral channels. Dynamic CT with contrast allows visualization of varices in the esophagus, stomach, rectum, and other locations. Precise mapping of collateral vessels is important before surgical or interventional procedures to avoid blood loss. MDCT plays an invaluable role in managing portal hypertension.
Role of retrograde transpopliteal angioplasty for superficial femoral artery ...SAMEH ATTIA ALI ABDELHAMID
This document discusses retrograde transpopliteal angioplasty for treating superficial femoral artery occlusion. It provides details on:
- The inclusion/exclusion criteria for patients in the study evaluating this technique's effectiveness and safety.
- The procedure, which involves accessing the popliteal artery from behind the knee and recanalizing the femoral artery in a retrograde manner.
- The results of the study, which found the technique achieved technical success in all cases and led to significantly improved ankle-brachial indices. Post-operative complications were minor. At 6-month and 1-year follow-ups, most arteries remained patent.
- The conclusion that retrograde popliteal access is a
Thoraco Abdominal Aortic Aneurysm technique for present ok.pptxPeter Flash
1) The document discusses various techniques for organ protection during surgery for thoracoabdominal aortic aneurysm (TAAA), including spinal cord, renal, and visceral protection.
2) For spinal cord protection, techniques discussed include maintaining adequate blood pressure and cerebrospinal fluid drainage to decrease pressure on the spinal cord. Renal protection methods include intermittent cold crystalloid perfusion or localized hypothermia to protect the kidneys from ischemia.
3) The document also discusses maintaining perfusion to other organs like the brain and heart, as well as distal perfusion techniques using left heart bypass or fem-fem bypass to maintain lower body blood flow during aortic clamping.
Surgical management of tetralogy of fallotrahul arora
This document discusses the diagnosis and management of Tetralogy of Fallot. It begins with describing the clinical examination findings and various investigations used. Echocardiography, ECG, chest x-ray, cardiac catheterization, CT, and MRI are discussed. Palliative treatments like Blalock-Taussig shunt are explained. Factors deciding definitive repair are covered, along with the surgical techniques and risks of early and late complications. Post-operative care and follow up are briefly mentioned.
This document provides an anatomical review of the vertebral artery, basilar artery, and posterior cerebral artery. It discusses the physiology of blood flow in the brain and the circle of Willis. It then covers various pathologies that can affect the vertebral arteries like stenosis. Diagnostic tools and treatments for vertebral artery disease are outlined including endovascular interventions like angioplasty and stenting. Subclavian steal syndrome is also defined.
This document summarizes the long-term outcomes of the Senning operation for repair of transposition of the great arteries (TGA). It discusses:
1) The Senning operation was initially developed as a complete repair for TGA but has fallen out of favor due to risks of right ventricular failure and arrhythmias. It is still used for anatomic repair of congenitally corrected transposition of the great arteries (CCTGA).
2) Long-term follow-up studies of Senning operations show risks of reduced exercise capacity, arrhythmias, and sudden death even in asymptomatic patients. Surgical re-intervention is also required in some cases due to complications.
3) While initial mortality
Trans catheter intervention is emerging field in cardiac intervention. due to complex anatomy of mitral valve understanding of anatomy and three dimensional imaging is most important aspect of successful intervention and could be life saving in high risk surgical candidate
1. The document describes how to properly hold and use a stethoscope to listen to heart sounds and murmurs. It discusses positioning the ear tips, chest piece, and avoiding touching the tubing to reduce extra noises.
2. Key aspects of cardiac murmurs are defined, including their timing within the cardiac cycle, causes, pitch, quality, location, and how they change with maneuvers. Common murmurs from conditions like aortic stenosis, mitral regurgitation, and ventricular septal defects are detailed.
3. Dynamic auscultation, or how murmurs change with respiration, body position, and other stresses, is an important part of diagnosis. Variations
Rosuvastatin is an effective treatment for cardiovascular disease (CVD) prevention and risk reduction. It provides significant reductions in LDL cholesterol levels with doses as low as 10 mg per day and can reduce LDL by over 50% at higher doses. Multiple studies have shown that rosuvastatin lowers rates of major adverse cardiac events compared to placebo in both primary and secondary prevention populations. Rosuvastatin has also demonstrated plaque regression in coronary arteries and slowed progression of atherosclerosis. It is considered a first-line agent by guidelines for lowering cholesterol and reducing CVD risk.
1) Heart failure treatment has evolved from an initial "Fantastic 4" drugs to a current "Fantastic 4 plus vericiguat and intravenous iron", providing more options to reduce hospitalizations and mortality.
2) A recent large trial showed that the new drug vericiguat reduced the composite of cardiovascular death and heart failure hospitalization when added to existing heart failure treatments.
3) New guidelines now recommend initiating quadruple heart failure therapy including an ARNI, beta-blocker, MRA, and SGLT2 inhibitor rapidly and titrating doses aggressively, as well as considering vericiguat for high-risk patients and administering intravenous iron for patients with iron deficiency.
CT coronary angiography (CTA) is indicated for evaluating stable chest pain when CAD is unknown or known, and after nonconclusive functional tests. It can assess plaque characteristics like vulnerability features. CTA guides treatment by identifying obstructive CAD needing revascularization versus non-obstructive CAD managed medically. Interpretation considers stenosis severity per CAD-RADS, and plaque features like low attenuation or positive remodeling indicate high risk. Motion artifacts must be distinguished from noncalcified plaque. CTA accurately rules out flow-limiting CAD and guides appropriate medical versus invasive management.
CTA is an accurate, noninvasive alternative to invasive coronary angiography (ICA) for initial CAD evaluation in patients with stable chest pain and intermediate pretest probability for obstructive CAD. Evidence from trials such as PROMISE and SCOT-HEART show that an initial CTA strategy results in similar cardiovascular outcomes as functional testing and is associated with a lower incidence of major adverse cardiovascular events compared to usual care. CTA has excellent sensitivity for identifying flow-limiting disease and high negative predictive value, making it well-suited for initially ruling out CAD. However, factors such as a history of prior stenting, obesity, arrhythmias, or breathing issues may favor ICA over CTA for initial evaluation.
1. Cardiovascular disease is a leading cause of mortality in India, with ischemic heart disease and stroke responsible for over 80% of CVD deaths. Recurrent ischemic events remain challenging to manage in patients with acute coronary syndromes.
2. Diagnostic tools for ACS include ECG, biomarkers like high-sensitivity cardiac troponin, and transthoracic echocardiogram. Management involves oxygen, nitrates, beta-blockers, and selecting an invasive reperfusion strategy like primary PCI or fibrinolysis if PCI cannot be done within 120 minutes.
3. Pharmacological treatments aim to lower lipids, control blood pressure, prevent clotting, and manage diabetes; vaccinations and ensuring adherence to lifestyle
This document discusses heart sounds and murmurs. It describes the characteristics of normal heart sounds S1 and S2, as well as abnormal sounds including S3, S4, opening snaps, and pericardial knocks. It discusses the causes, locations, and clinical recognition of these various sounds. Key points include that S1 is produced by mitral and tricuspid valve closure, S2 by aortic and pulmonary valve closure, S3 indicates rapid ventricular filling, and S4 occurs during atrial contraction. Abnormal sounds can indicate conditions like ventricular dysfunction, valvular incompetence, or constrictive pericarditis.
This document provides information on auscultating heart murmurs, including how to properly hold a stethoscope and define heart murmurs. It describes the timing, location, quality, and changes with maneuvers of common murmurs like aortic stenosis, mitral regurgitation, ventricular septal defect, and innocent murmurs. Dynamic auscultation is emphasized as murmurs may vary with respiration, body position, exercise, and other factors. The physiology of murmur production and distinguishing characteristics of various murmurs, clicks, and gallops are thoroughly outlined.
This document discusses rheumatic fever, including its etiology as a delayed complication of streptococcal sore throat, epidemiology showing higher rates in developing countries, pathogenesis involving autoimmune cross-reactivity, and clinical manifestations most commonly involving the heart valves. It provides details on the evolution of the Jones criteria for diagnosis and highlights carditis as the most frequent major manifestation, usually affecting the mitral valve and presenting as mitral regurgitation.
The document discusses evaluation of myocardial and coronary blood flow and its role in coronary intervention. It covers fundamental concepts of coronary physiology used in clinical practice today. Physiologic lesion assessment using indices like fractional flow reserve (FFR) and coronary flow reserve (CFR) have become routine before percutaneous coronary intervention (PCI) to determine hemodynamic significance, as angiography alone cannot accurately reflect ischemia potential. Several studies demonstrated using FFR to guide PCI decision-making resulted in fewer stents, less contrast, lower costs and better long-term outcomes than angiography-guided PCI. While FFR remains the gold standard, indices like instantaneous wave-free ratio (IFR) may provide more accurate assessment, especially in complex
Mechanical circulatory support devices such as left ventricular assist devices (LVADs) are increasingly being used as an alternative to cardiac transplantation for patients with advanced heart failure. LVADs are mechanical pumps that are implanted to support the left ventricle and improve cardiac output. They can be used as a bridge to transplantation, destination therapy for those ineligible for transplant, or potentially as a bridge to recovery in some cases. Common LVAD devices are continuous flow pumps that are more pulsatile than earlier generation pulsatile pumps. LVADs have been shown to improve symptoms, quality of life and survival for advanced heart failure patients.
This document provides an overview of pacemaker basics and timing cycles. It discusses the components of a pacemaker circuit including the implantable pulse generator containing a battery and circuitry. It describes pacemaker leads which deliver electrical impulses from the pulse generator to the heart. The document outlines characteristics of pacemaker leads including fixation mechanisms, insulation materials, and polarity. It also discusses concepts such as stimulation threshold, polarization, impedance, and how these factors interact based on Ohm's law relationships.
This document provides information on performing and interpreting cardiac auscultation. It describes:
1. How to properly hold a stethoscope and the parts of the stethoscope.
2. The definition of a heart murmur as an auditory vibration caused by increased turbulence in blood flow.
3. Guidelines for describing a murmur, including timing in the cardiac cycle, location, intensity, pitch, quality, and how it changes with maneuvers.
4. Characteristics of common murmurs from conditions like aortic stenosis, mitral regurgitation, ventricular septal defect, and more. It provides details on identifying murmurs and distinguishing between similar murmurs.
Vitamin D is an important prohormone for optimal intestinal calcium absorption for mineralization of bone. Because the vitamin D receptor is present in multiple tissues, there has been interest in evaluating other potential functions of vitamin D, particularly, in cardiovascular diseases (CVD). Cross-sectional studies have reported that vitamin D deficiency is associated with increased risk of CVD, including hypertension, heart failure, and ischemic heart disease. Initial prospective studies have also demonstrated that vitamin D deficiency increases the risk of developing incident hypertension or sudden cardiac death in individuals with preexisting CVD. Very few prospective clinical studies have been conducted to examine the effect of vitamin D supplementation on cardiovascular outcomes. The mechanism for how vitamin D may improve CVD outcomes remains obscure; however, potential hypotheses include the downregulation of the renin-angiotensin-aldosterone system, direct effects on the heart, and vasculature or improvement of glycemic control. This review will examine the epidemiologic and clinical evidence for vitamin D deficiency as a cardiovascular risk factor and explore potential mechanisms for the cardioprotective effect of vitamin D.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
Hypertension is a common medical and social problem leading to cardiovascular diseases worldwide. Antihypertensive drugs are clinically applied to decrease the morbidity and mortality induced by hypertension itself and its complications. The 2014 hypertension guideline of the Eighth Joint National Committee (JNC8) for hypertension therapy in the United States has made several significant changes with respect to the clinical management of hypertension and the initiative medications, as compared with the previous guidelines. In addition to the instructions that pharmacologic treatment should be initiated when blood pressure (BP) is 150/90 mmHg or higher in adults over 60 years, 140/90 mmHg in adults younger than 60 years, or 140/90 mmHg or higher (regardless of age) in patients with hypertension and diabetes, a thiazide-type diuretic, calcium (Ca2+) channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) should be considered to start an initial antihypertensive medication in non-black population. In black population with or without diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. Thus, CCB has become one of the most important initial agents for antihypertensive monotherapy. Furthermore, since CCBs have been proved not to increase the risk of coronary events and stroke,CCBs appear to be a favorable choice for monotherapy as well as for combination with other agent classes in the treatment of hypertension and may provide specific benefits beyond BP lowering.Nowadays, dihydropyridine (DHP) CCBs are one group of most frequently prescribed antihypertensive medications in China and other Eastern Asian countries.
Among patients with or at high risk of CVD, use of an FDC strategy for blood pressure, cholesterol, and platelet control vs usual care resulted in significantly improved medication adherence.Polypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.
A transesophageal echocardiogram (TEE) uses echocardiography to assess the structure and function of the heart. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves. When the transducer is placed at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer displays the echoes as images of the heart walls and valves.
A traditional echocardiogram is done by putting the transducer on the surface of the chest. This is called a transthoracic echocardiogram. A transesophageal echocardiogram is done by inserting a probe with a transducer down the esophagus. This provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. The TEE probe is much closer to the heart since the esophagus and heart are right next to each other.
This document summarizes recent advances in the treatment of pulmonary arterial hypertension (PAH). It discusses new drugs such as macitentan and riociguat that have been shown to improve outcomes in clinical trials. It also describes an experimental treatment called pulmonary artery denervation that aims to reduce pulmonary artery pressure by ablating nerve endings around the pulmonary arteries. The document reviews the clinical evidence from trials of these new treatments and identifies limitations and areas needing further study to improve outcomes for patients with PAH.
This document provides an overview of pulmonary hypertension (PH), including:
- Definitions and classifications of PH
- Genetics and pathophysiology involving genes like BMPR2
- Causes like pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease
- Presentation with symptoms linked to right ventricular dysfunction
- Diagnostic workup including right heart catheterization as the gold standard
- Treatment options for different PH types including medications, surgery, transplantation.
More from LPS Institute of Cardiology Kanpur UP India (20)
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
South African Journal of Science: Writing with integrity workshop (2024)
Angioplasty in chronic lower limb ischemia
1. Role of angioplasty in chronic
lower limb ischemia
DR AWADHESH KUMAR SHARMA
PGIMER & DR RML HOSPITAL
NEW DELHI
2. Chronic lower limb
ischemia
Definition:
Form of PAD or PAOD.
Occlusive disease of the arteries of
the lower extremity.
Most common cause:
o Atherothrombosis
Pathophysiology:
•
Arterial narrowing Decreased blood flow =
Pain
•
Pain results from an imbalance between supply
and demand of blood flow that fails to satisfy
ongoing metabolic requirements.
3.
4. The Facts:
The prevalence: >55 years is 10%–25%
Pt’s with PVD alone have the same relative risk of death
from cardiovascular causes.
Patients with PAD require medical management to prevent
future coronary and cerebral vascular events.
Prognosis at 1 yr in patient’s with Critical Limb Ischemia (rest
pain):
• Alive with two limbs — 50%
• Amputation — 25%
• Cardiovascular mortality 25%
J Vasc Surg. 2007;45:S5–S67
5. History:
1. INTERMITTENT CLAUDICATION
• Derived from the Latin word ‘to limp’
• “Reproducible pain on exercise which is relieved by rest”
2. Other Symptom/Signs:
• A burning or aching pain in the feet (especially at night)
• Cold skin/feet
• Increased occurrence of infection
• Non-healing Ulcers
3. Critical Stenosis = >60%, impending acute ischemic limb:
- rest pain
- ischemic ulceration
- gangrene
8. Abdominal aorta bifurcates at the level
of the fourth lumbar vertebra
External iliac artery gives off other
branches, namely the deep circumflex,
cremasteric, and several muscular and
cutaneous branches, before it
continues as the CFA
CFA after giving branches to
surrounding tissues, such as the
pudendal arteries and the superficial
circumflex artery becomes the
superficial femoral artery (SFA) after
giving rise to the profunda femoris
artery (PFA), roughly 3.5 cm distal to
the inguinal ligament.
9. The PFA arises laterally and
posteriorly from the CFA, whereas
the SFA continues its pathway, to
end as the popliteal artery. It
terminates into the anterior tibial
artery and the tibioperoneal trunk.
PFA gives off perforating branches
(usually three, with the end of the
PFA as the fourth perforating
branch), the circumflex (lateral and
medial) arteries, and muscular
branches.
10. Anterior tibial artery descends
down to the ankle and then
continues to the dorsum of the
foot, where it becomes the dorsalis
pedis artery
After giving rise to the peroneal
artery, the tibioperoneal trunk
continues as the posterior tibial
artery behind the leg. It passes
behind the medial malleolus to end
by giving rise to the arteries of the
foot— namely the calcaneal artery,
which anastomoses with the
calcaneal and malleolar branches of
the peroneal, and the medial and
lateral planter arteries.
15. Contrast Angiography
Despite recent advances in the noninvasive evaluation of
lower extremity PAD, contrast angiography remains the
gold standard.
Abdominal aortogram in the anteroposterior projection
is done using a straight pigtail catheter (5 or 6 Fr) placed
at the level of the L1-L2 vertebrae.
Angulated views (30 degrees left anterior oblique) can
then be used to visualize the iliac and femoral
bifurcations without overlap.
Vasc Endovascular Surg. 2002;36:439–445
18. Commonly used angiographic
views
Most favorable angulation for iliac angiography is the
contralateral oblique angle, generally 30 to 40 °
The optimal view for the common femoral bifurcation is 30
to 45° of ipsilateral oblique angulation
SFA can be imaged in an anteroposterior view with the
addition of an oblique angle if a stenosis is suspected.
The popliteal artery, tibeoperoneal trunk, and trifurcation
are best imaged in an ipsilateral oblique angle (30°).
Infrapopliteal runoff can be performed in either an
anteroposterior or an ipsilateral oblique projection
N Engl J Med. 2006;354:379 –386
Vasc Endovascular Surg. 2002;36:439–445
21. Selecting revascularization:
endovascular vs. surgical
Historically, aortobifemoral bypass surgery gold
standard -excellent long-term patency rates (85%90% at 5 years, 75%-80% at 10 years, and 60% at 20
years); however, may be associated with an
intraoperative mortality rate of approximately 1% to
3% and a major complication rate of 5% to 10%.
de Vries S, Hunink M. Results of aortic bifurcation grafts for aortoiliac occlusive disease: a
meta-analysis. J Vasc Surg 1997;26(4):558-69
Excellent intermediate- to long-term patency rates
after percutaneous intervention-emergence as an
attractive alternative
22. SWEDISH RANDOMIZED CONTROLLED TRIAL
In the iliac disease subgroup(37%), the patency rate at 1
year was 90% in the PTA arm and 94% in the surgical arm.
Adverse events included a 1-year death rate of approximately 10% and a reocclusion
rate of 5% (in both treatment groups)
A major amputation rate of 5.7% for PTA versus 16% for
surgery
The infection and embolization rates were 8.2% each
Whyman MR, et al. J Vasc Surg 1997;26:551-557.
23.
24. BASIL trial
PTA vs. bypass surgery
Overall survival
Th
e
sa
m
e
Amputation-free survival
Bradbury et al. (2010) . Journal of Vascular Surgery, 51, 5S-17S.
FMRP 2011 –
5
25. Endovascular treatment
Percutaneous transluminal angioplasty is a minimally invasive
therapy for the treatment of patients with peripheral artery
disease who suffer from chronic lower limb ischemia.
A low complication rate ranging between 0.5% and 4%, a
high technical success rate approaching 90% even in long
occlusions, and an acceptable clinical outcome.
Dormandy JA, Rutherford RB. Management of
peripheral arterial disease
(PAD): TASC Working Group: TransAtlantic InterSociety Consensus
(TASC). J Vasc Surg. 2000;31:S1–S296.
26. PTA still is the first and most frequently used methodology.
However, high rates of failure resulting from an unacceptable
incidence of restenosis, particularly in long and complex
disease, are the main limitations of PTA.
A mean pressure gradient of 10 mm Hg at rest or 15 mm Hg
after vasodilators across the lesion is considered significant.
Johnston KW. Femoral and popliteal arteries:
reanalysis of results of balloon angioplasty.
Radiology. 1992;183:767–771.
27. 3 major parameters determine the success of any
endovascular procedure:
1. Passage of the recanalization wire through the obstruction,
2. Removal of the obstruction by an endovascular tool, and
3. Keeping the artery open in the short and long term.
28.
29. Indications
Symptom relief in patients with IC for whom medical
therapy has failed,
Management of CLI (rest pain, ulceration, or gangrene).
As part of the preparation for a planned distal lower
extremity bypass surgery to restore or preserve the inflow
to the lower extremity.
Treatment of flow-limiting dissection after invasive
catheterization-based procedures
30. Aor toiliac Occlusive Disease:
Angioplasty With or Without Stenting
High procedural success rates
(90%)
Excellent long-term patency (>70%
at 5 years)
Factors associated with a poor
outcome:
Long segment occlusion
Multifocal stenoses
Eccentric calcification
Poor runoff
48. Vascular access
Ipsilateral retrograde femoral artery for high iliac lesions
if the FA is relatively free of disease and there is an
adequate “landing zone” for the sheath
Contralateral retrograde femoral artery access with a
crossover sheath very effective for most common iliac,
internal iliac, and external iliac lesions, especially useful
if the patient’s ipsilateral disease hinders access.
Vascular medicine and endovascular interventions.
Rooke TW et al [Editors]; Malden: Blackwell Futura
2007.
49. Both ipsilateral and contralateral femoral access,
particularly with aortoiliac bifurcation disease, chronic
occlusions, and during interventions when a dissection
may have occurred and it is critical to preserve the vessel
via the true lumen
Uncommon scenarios- popliteal, brachial or radial artery
access
Vascular medicine and endovascular
interventions. Rooke TW et al [Editors];
Malden: Blackwell Futura 2007.
50. Antegrade access
Considered more challenging technically
Limits angiography to the ipsilateral leg, but it offers a more stable
platform for intervention.
The patient's orientation is reversed
As in retrograde access, the desired site of entry is in the middle of
the CFA below the inguinal ligament, but given the different
angulation, the skin puncture is made at or above the top of the
femoral head
A 9-cm needle is frequently required, as compared with the standard
7-cm needle used for retrograde access.
A less acute needle angle, generally <45°, facilitates catheter and
sheath insertion by avoiding the kinking associated with a steeperangled entry.
51. Antegrade femoral artery puncture. The skin nick at the top of the femoral head (needle), with
ideal entry at the middle of the common femoral artery with angle <45°.
52. To confirm the site of antegrade access, angiography with 30
to 50° of ipsilateral oblique angulation will define the
arteriotomy site in relation to the common femoral
bifurcation.
Anticoagulation should be administered once the correct
position of the access point has been confirmed.
Extra care should be taken to remove the antegrade sheath
promptly following the procedure to minimize
complications,consider reversing anticoagulation to facilitate
immediate sheath removal in the catheterization laboratory.
Peripheral Endovascular Interventions.
White RA, et al.; New York: Springer; 1999
53. Intravenous heparin (3000–6000 units);activated clotting
time (ACT) of at least 200 seconds
Usually, 0.035-mm guidewires are used, but 0.018 or 0.014
guidewires may be used. For nonocclusive lesions, a regular
nonhydrophilic guidewire may be used, but, if crossing such
lesions is difficult, then the use of hydrophilic wires is
indicated
Acta chir belg, 2004, 104, 532-539
54. Balloon angioplasty
Because of their large lumen and high flow rates, the iliac
arteries have less risk of restenosis and occlusion than
most other arteries of the periphery and are thus
excellent targets for percutaneous reperfusion.
Percutaneous transluminal balloon angioplasty (PTA) of
the iliac arteries is an established, safe, and effective
technique with immediate technical success reported in
various series in the 85–97% range
55.
56.
57. Stents
PTA alone of the iliac artery is highly successful but limited
by elastic recoil of the vessel which decreases acute gain,
acute closure, and restenosis of the occluded segment; and
by intimal dissections which can sometimes be flow limiting.
In addition, PTA has been less successful with certain lesion
characteristics: irregular, ulcerated stenoses, occlusions,
eccentric, or long lesions
The deployment of stent primarily or immediately after
PTA has significantly reduced the impact of each of these
limitations.
58.
59.
60.
61.
62. Endovascular Treatment for Claudication:
Iliac Arteries
I IIa IIb III
Provisional stent placement is indicated
for use in iliac arteries as salvage therapy
for suboptimal or failed result from balloon
dilation (e.g. persistent gradient, residual
diameter stenosis >50%, or flow-limiting
dissection).
I IIa IIb III
Stenting is effective as primary therapy for
common iliac artery stenosis and
occlusions.
I IIa IIb III
Stenting is effective as primary therapy in
external iliac artery stenosis and occlusions.
ACC Guidelines 2011
63.
64. When the lesion to be stented is located in a tortuous
arterial segment, Self-expandable stents are more flexible
and better able to conform to the tortuous vessel segment.
They are better in areas in which there is a quick transition
of vessel diameter, such as from the common iliac artery to
the external iliac artery
Stents in general are not recommended for placement across
the joints, however if no other options for revascularization
are present, then a self-expandable stent should be selected
because it is more crush-resistant and less likely to have
stent fracture
65. Balloon-expandable stents are generally sized 1:1 to the
reference vessel diameter
Operator should seek to achieve full expansion of the
balloon and stent with no evidence of a “waist” within
the stent length.
Post-dilatation may be required for persistent narrowing
66. Self-expanding stents are generally sized approximately 1
mm larger than the reference vessel diameter such that they
will continue to exert radial pressure along the length of the
lesion.
They are also sized approximately 1 cm longer than the
lesion due to the difficulty in precise deployment of the
stent and because the stent will shorten beyond its nominal
length as it is post-dilated
67. COVERED STENTS
Covered stents playing an increasing role
Covered stents are usually self-expandable but balloon-
expandable covered stents are also available.
The major disadvantage to covered stents is the higher
profile of the delivery systems.
J Vasc Surg. 2005;42:185–193.
70. Technical success is commonly defined as less than 30%
residual stenosis (anatomic success), a postintervention
mean translesional gradient of <5 mm Hg, and an
increase in the ABI of at least 0.1 and/or a decrease in
symptoms by one category (hemodynamic success).
71.
72. Complications
Access site complications - groin hematoma, retroperitoneal
bleed, pseudoaneurysm, arteriovenous fistula formation
Thrombosis at the site of PTA, arterial rupture, and distal
embolization.Rate of less than 5% to 6% in most series.
Death, contrast-induced nephropathy, myocardial
infarction, and cerebrovascular accident occur at a rate of
less than 0.5%.
The need for urgent vascular repair is reported to be about
2%.
J Endovasc Ther. 2006;13:281–290.
81. Profunda Femoris Artery
Revascularization of the PFA may be needed in the setting of
total occlusion of the SFA or of a femoropopliteal bypass
graft.
May be tried in the setting of severe limb-threatening
ischemia if surgery is contraindicated or if the disease
involves the distal portion of the descending branch of the
PFA, which is less accessible to the surgeons.
No available data regarding the placement of stents .
J Endovasc Ther. 2001;8:75– 82
82.
83. A meta analysis of 19 interventional studies performed
between 1999 and 2003 showed that in patients with limbthreatening ischemia, 3-year patency rates were 30–43%
following angioplasty and 60–65% following stent
placement.
Conrad, MF, Cambria, RP, Stone, DH, et
al. Intermediate results of percutaneous
endovascular therapy of femoropopliteal
occlusive disease: a contemporary series.
J Vasc Surg 2006; 44: 762–769.
84.
85. Advantage of placing a stent in the SFA is that it limits
elastic recoil, scaffolds flow-limiting dissection, and
provides a higher acute technical support.
However, these advantages are counterbalanced by the
stent-induced enhanced endothelial hyperplasic
response, which may result in in-stent restenosis and
negate the noted advantages of stenting on long term
follow-up.
86.
87.
88. Trend for greater efficacy in the sirolimus-eluting stent group, no
statistically significant differences in any of the variables
89. Zilver® PTX™
Paclitaxel only
No polymer or binder
3 µg/mm2 dose density
Zilver®, self-expanding nitinol stent
Flexible, durable platform
Uncoated
PTX™ Coated
101. Laird J, Jaff MR, Biamino G, McNamara T, Scheinert D,
Zetterlund P,Moen E, Joye JD. Cryoplasty for the treatment
of femoropopliteal arterialdisease: results of a prospective,
multicenter registry. J Vasc Interv
Radiol. 2005;16:1067–1073.
102.
103. PELA Trial
Peripheral Excimer Laser Angioplasty Trial
Randomized 251 patients with claudication & total SFA
occlusion to either PTA or laser assisted PTA.
At 1 year follow up no benefit.
Steinkamp HJ, Rademaker J, Wissgott C, Scheinert D, Werk M, Settmacher
U, Felix R. Percutaneous transluminal laser angioplasty versus
balloon dilation for treatment of popliteal artery occlusions. J Endovasc
Ther. 2002;9:882– 888.
Scheinert D, Laird JR Jr, Schroder M, Steinkamp H, Balzer JO, Biamino
G. Excimer laser-assisted recanalization of long, chronic superficial
femoral artery occlusions. J Endovasc Ther. 2001;8:156 –166.
109. Though first reported case of endovascular intervention in
the management of infrapopliteal PAD as early as in 1964 by
Dotter and Judkins- endovascular therapy has had a limited
role in the management of infrapopliteal PAD.
In patients with IC secondary to infrapopliteal PAD, medical
therapy is the most appropriate initial strategy, limited by
recurrence.
Endovascular procedures below the popliteal artery are
usually indicated for limb salvage.
Dorros, G, Lewin, RF, Jamnadas, P, Mathiak, LM.
Below the-knee angioplasty: tibioperoneal vessels, the
acute outcome.
Cathet Cardiovasc Diagn 1990; 19: 170–178.
110. Angioplasty of infrapopliteal vessels is reported to have limb
salvage rates of between 92% and 95% in CLI patients.
Primary stent placement yields primary patency and limb
salvage rates similar to those of angioplasty alone.
Current guidelines acknowledge the role for provisional
(bail-out) stent placement.
Siablis, D, Kraniotis, P, Karnabatidis, D, et al. Sirolimuseluting versus
bare stents for bailout after suboptimal infrapopliteal angioplasty for
critical limb ischemia: 6-month angiographic results from a
nonrandomized prospective single-center study.
J Endovasc Ther 2005; 12: 685–695.
111. Tibial angioplasty usually performed with 2- to 4-mm
balloons on catheter shafts of 4 French and smaller.
In general, 3- and 4-mm balloons are used in the
proximal to mid tibial vessels, 2- and 3-mm balloons are
used in the mid- to distal tibial vessels, and 2-mm
balloons are used in the foot vessels.
115. Results
Head-to-head comparisons showed that sirolimus-eluting
stents were superior to balloon-expandable bare metal
stents in preventing restenosis and increasing primary
patency (both p<0.001).
Sirolimus-eluting stents were also better than paclitaxeleluting stents in terms of primary patency (p<0.001) and
repeat revascularizations (p=0.014).
Biondi-Zoccai et al, J Endovasc Ther 2009
120. CONCLUSION
Endovascular treatment of lower-extremity PAD
continues to evolve, with the expectation of
improvement in acute success rates and safety and the
anticipation of improving long-term durability with
newer technologies ranging from local drug delivery to
bioabsorbable stents.
In future, increasing use of endovascular techniques
likely to replace surgical revascularization
There are currently insufficient data to recommend routine population screening for asymptomatic PAD using the ABPI.
- In recent years, it has become evident that PAD is an important predictor of substantial coronary and cerebral vascular risk
Patients with symptomatic PAD have a 15-year accrued survival rate of about 22%, compared with a survival rate of 78% in patients without symptoms of PAD.
Patients with critical leg ischaemia, who have the lowest ABPI values, have an annual mortality of 25%
Asymptomatic — 20 to 50 percent ** Unfortunately, however, a PAD diagnosis can be missed since nearly 50% of patients are asymptomatic or have atypical symptoms. Thus, a high index of suspicion is necessary in patients presenting with potential risk factors.
Classic claudication — 10 to 35 percent
Critical limb ischemia — 1 to 2 percent
Cramp or tingling which recurs on walking the same distance
Angioplasty with or without stenting for aortoiliac occlusive disease had a success rate of 90% and results in 5-year patency rates as high as 70%.
However, primary stenting offers no clear benefit compared with angioplasty plus selective stent placement.
Factors associated with a poor outcome of angioplasty for aortoiliac occlusive disease include long segment occlusion, multifocal stenoses, eccentric calcification, and poor runoff.