LUC ROTENBERG, GREGORY LENCZNER, ULTRASOUND GUIDED VENOUS ACCESS CHEST PORT IMPLANTATION, SUBCLAVIAN ACCESS, NO TUNELISATION, DELTOPECTORAL GROOVE INCISION AND ACCESS , TIP POSITION XRAY CONTROL
Dr. Iyad Feteih presents information on the history and development of inferior vena cava (IVC) filters. The document discusses early surgical methods of IVC interruption and their complications. It then summarizes the development of endoluminal IVC filters beginning with the Mobin-Uddin umbrella in 1967 and the iconic Greenfield filter in 1973. The document provides details on various commercially available IVC filters from companies such as Bard, Cook Medical, Cordis, and Crux Biomedical including specifications, clinical trial results, and complications.
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New HorizonesDr Pradeep Jain Reviews
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones. High volume experience of Dr Pradeep Jain means better outcome for patients.
Endovascular Repair of Thoracoabdominal AneurysmPAIRS WEB
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
This document discusses surgical techniques for debranching the aortic arch in hybrid procedures to treat aortic arch aneurysms. It describes how open surgery is used to reroute blood flow from the supra-aortic vessels before placing an endograft. Various zones of the aortic arch are defined based on the vessels involved, and the specific bypass procedures for each zone are outlined. The hybrid approach aims to reduce risks compared to open surgery alone by combining debranching with endovascular exclusion of the aneurysm. While outcomes are promising, mortality and morbidity rates are still significant and patient fitness must be considered.
Visceral debranching for the treatment of taaauvcd
The document discusses visceral debranching for the treatment of thoracic aortic aneurysms (TAAAs). It describes the hybrid technique which involves extra-anatomic revascularization of the celiac, superior mesenteric artery (SMA), and renal arteries, followed by exclusion of the TAAA using endovascular stent grafts. This reduces visceral ischemic time, avoids aortic cross-clamping, and has advantages over open surgery such as lower morbidity and mortality. The operative technique, outcomes, and examples of patients treated with this approach are provided.
LUC ROTENBERG, GREGORY LENCZNER, ULTRASOUND GUIDED VENOUS ACCESS CHEST PORT IMPLANTATION, SUBCLAVIAN ACCESS, NO TUNELISATION, DELTOPECTORAL GROOVE INCISION AND ACCESS , TIP POSITION XRAY CONTROL
Dr. Iyad Feteih presents information on the history and development of inferior vena cava (IVC) filters. The document discusses early surgical methods of IVC interruption and their complications. It then summarizes the development of endoluminal IVC filters beginning with the Mobin-Uddin umbrella in 1967 and the iconic Greenfield filter in 1973. The document provides details on various commercially available IVC filters from companies such as Bard, Cook Medical, Cordis, and Crux Biomedical including specifications, clinical trial results, and complications.
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New HorizonesDr Pradeep Jain Reviews
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones. High volume experience of Dr Pradeep Jain means better outcome for patients.
Endovascular Repair of Thoracoabdominal AneurysmPAIRS WEB
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
This document discusses surgical techniques for debranching the aortic arch in hybrid procedures to treat aortic arch aneurysms. It describes how open surgery is used to reroute blood flow from the supra-aortic vessels before placing an endograft. Various zones of the aortic arch are defined based on the vessels involved, and the specific bypass procedures for each zone are outlined. The hybrid approach aims to reduce risks compared to open surgery alone by combining debranching with endovascular exclusion of the aneurysm. While outcomes are promising, mortality and morbidity rates are still significant and patient fitness must be considered.
Visceral debranching for the treatment of taaauvcd
The document discusses visceral debranching for the treatment of thoracic aortic aneurysms (TAAAs). It describes the hybrid technique which involves extra-anatomic revascularization of the celiac, superior mesenteric artery (SMA), and renal arteries, followed by exclusion of the TAAA using endovascular stent grafts. This reduces visceral ischemic time, avoids aortic cross-clamping, and has advantages over open surgery such as lower morbidity and mortality. The operative technique, outcomes, and examples of patients treated with this approach are provided.
The document describes a case where a 81 year old woman with severe aortic stenosis and comorbidities underwent a transaortic aortic valve implantation (TA-AVI) through an upper ministernotomy approach. Key steps included making a 5cm J-shaped incision, inserting an 8Fr sheath through the aorta, crossing the native valve with a wire, inserting a delivery system, performing balloon aortic valvuloplasty, and releasing the new valve. The procedure was successful with normal valve function and recovery. The upper ministernotomy provides an alternative access for patients not suitable for transfemoral approaches and avoids arch crossing.
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.
Medical Device Consulting IVC Filter Doucet Shima TrimbleJason Trimble
The document discusses analyzing and improving the design of an IVC filter medical device used to treat pulmonary embolism. It outlines objectives to analyze the pros and cons of the current IVC filter design, develop an improved design, and analyze the mechanical forces and biocompatibility of the proposed design. The document provides background on deep vein thrombosis, pulmonary embolism, risk factors, current treatment options including IVC filters and blood thinners, failure modes of current IVC filters, and considerations for the novel design including a conical shape, stent structure, deployment procedure, material properties, failure modes, and importance of retrievability.
This document discusses the benefits of using a radial artery approach for carotid artery stenting (CAS) compared to the traditional femoral artery approach. Some key benefits of the radial approach include avoiding complications associated with femoral access in patients with aorto-iliac disease, allowing for early patient mobilization to reduce bleeding risks, and eliminating vascular access site complications which are a major cause of morbidity and mortality after CAS. The document also presents several case examples demonstrating successful CAS procedures performed via the radial approach. However, it notes there is a significant learning curve for new operators and that the radial approach may not be suitable for all anatomies or allow the use of all devices.
Friday 0905 – christiansen – feasibility of a cto pciEuro CTO Club
This document provides guidance on evaluating the feasibility of percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO). Key factors to consider include: the patient's tolerance for a long procedure, contrast load, and radiation exposure; the CTO's proximal cap ambiguity, length, distal landing zone, and presence of interventional collaterals; and ensuring good quality angiography. With adequate planning and use of appropriate CTO techniques, feasibility is nearly always present for symptomatic patients. Success rates of CTO-PCI are reported to be 94% when using a planned approach.
DIAGNOSTIC AND INTERVENTIONAL PROCEDURES WITHIN THE VASCULAR ANGIOGRAPHY SUITEDr Shibu Chacko MBE
This document provides information about diagnostic and interventional procedures performed in a vascular angiography suite. It discusses angiograms, angioplasty, stenting, and thrombolysis procedures. Angiograms are used to visualize arteries and identify stenoses or occlusions. Angioplasty opens arteries at points of stenosis using a balloon catheter. Stenting is often used with angioplasty, employing a hollow wire mesh tube. Thrombolysis aims to break down blood clots and restore perfusion by administering tissue plasminogen activator through a catheter. The document outlines pre-operative care, post-operative care including monitoring, potential complications, and follow-up for these vascular procedures.
This document discusses complications of percutaneous nephrolithotomy (PCNL). It describes the most common complications as acute hemorrhage from the renal parenchyma or collecting system. Delayed hemorrhage can also occur due to arteriovenous fistulas or pseudoaneurysms. Collecting system injuries like tears or perforations need drainage with stents or nephrostomy tubes. Rare but serious complications include visceral injuries to nearby organs, pleural injuries, metabolic disturbances, and neurological issues from positioning. Management involves drainage, angioembolization, or open surgery depending on the complication. The document also reviews drainage techniques after PCNL including tubeless procedures with just ureteral stents or
1. Transcatheter aortic valve implantation (TAVI) was first performed in humans in 2002 in France using a bovine pericardium valve.
2. There are several vascular access approaches for TAVI, including transfemoral, transapical, transaortic, and subclavian approaches.
3. A 2013 feasibility study of a new device for TAVI in patients with aortic insufficiency reported successful deployment in all four patients with no deaths at 30 days and improved aortic insufficiency in all patients.
This document provides an overview of 200-hour training course content on care of arteriovenous (AV) grafts and hemodialysis catheters. The summary covers AV graft placement, maturation, cannulation techniques, and troubleshooting issues like thrombosis. For catheters, topics discussed include insertion sites, ultrasound guidance, dressing changes, infections, and flow issues. Proper handling and decontamination procedures are emphasized to prevent infections.
The prevalence of degenerative valvular disease is increasing in the context of an increasingly ageing population, and despite advances in medical and surgical interventions, is associated with a significantly worse outcome when compared with the general population. Data from the EuroHeart Survey (2003) suggests the commonest relates to native valve disease (predominantly aortic stenosis) however, more than one quarter of patients with valve disease have undergone a previous intervention. According to current guidelines, in general treatment for severe, symptomatic aortic stenosis is surgical aortic valve replacement, which is associated with excellent outcomes, however, despite this around 30% of such patients do not undergo surgical intervention.
The last decade has seen a significant change in the potential therapeutic options for patients with aortic valve disease due to the development of transcatheter techniques for valve implantation. Patented in 1991, the first successful human implant of a transcatheter aortic valve was undertaken in 2002, with currently >500,000 implantations having been undertaken in >70 countries worldwide. The evidence supporting transcatheter aortic valve implantation (TAVI) otherwise known as transcatheter aortic valve replacement (TAVR) came originally from the key PARTNER studies, where patients judged to have inoperable aortic stenosis who underwent TAVI having improved survival and a reduction in hospital admission at 1 year. Following the early safety and efficacy studies, and following increasing recommendations for TAVI as an option for patients at high risk in international guidelines, the use of transcatheter techniques is extending to those of lower risk.
The document discusses various types of radiological equipment and procedures used for diagnostic and interventional purposes. It provides detailed descriptions of common radiological exams including chest X-rays, mammography, CT scans, angiography, myelography, and others. It also covers interventional radiology techniques such as MRI, ultrasound, and nuclear medicine studies. The goal of radiological exams is to produce diagnostic images of the inside of the body to evaluate conditions and guide procedures.
Dr Rahul Tiwari OMFS SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh. A comparison of bone resorption over time. An analysis of the free scapular, iliaccrest and fibular microvascular flaps in mandibular reconstruction
This case involves treating a long CTO of the right coronary artery (RCA) using an antegrade approach in a 71-year-old man with various cardiovascular risk factors and symptoms. The doctor evaluates options for guiding catheter size and wire strategies like single wire, parallel wires, or IVUS-guided re-entry. An initial angiogram is performed. The doctor discusses when a retrograde strategy may be preferable and outlines treatment options for stenting the complex lesion involving the bifurcation.
Georgios Sianos - RETROGRADE STEP BY STEP APPROACHEuro CTO Club
This document provides an overview of retrograde techniques for recanalizing chronic total occlusions (CTOs). It discusses the history and evolution of retrograde techniques, including septal collateral crossing and dilatation. Key steps in the retrograde approach like wire escalation, dissection and re-entry are outlined. Case examples demonstrate the retrograde procedure in detail. Consensus recommendations emphasize the importance of operator experience before performing retrograde CTO PCI independently. Required lab set-up and equipment are also reviewed.
The document discusses engaging bypass grafts and accessing the coronary arteries from the radial approach. It describes the different challenges posed by radial versus femoral access, including navigating the subclavian artery and distortions in aortic arch anatomy. Various catheter options are presented for engaging grafts and specific coronary targets. Case examples demonstrate integrating multiple catheters to access native vessels and grafts from a single radial puncture. Guide selection considerations for graft PCI are also reviewed.
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
This document provides information about laparotomy procedures, including:
1. It lists 10 different types of laparotomy incisions and identifies the correct technical term is celiotomy.
2. It describes the proper positioning of the patient for laparotomy as supine with arms positioned and use of a Foley catheter and NGT.
3. It outlines the layers of the midline laparotomy incision including the external oblique, internal oblique, transversalis muscle, and linea alba.
This document discusses techniques for performing transradial cardiac catheterization and preventing radial artery occlusion (RAO). It presents data showing that using a higher dose of heparin (5000 units vs 2000-3000 units) and perfused hemostasis can reduce rates of RAO. The document also proposes that transient ulnar artery compression may treat subacute RAO by increasing blood flow through collateral vessels. Studies are presented demonstrating improved radial artery flow after one hour of manual ulnar compression. In conclusions, the document advocates for perfused hemostasis and higher dose heparin as best practices, and endorses transient ulnar compression as an effective method for treating early diagnosed RAO.
Estado actual del cierre de orejuela, por Juan Miguel Ruiz NodarFundacion EPIC
Presentación del caso "Estado actual del cierre de orejuela", por Juan Miguel Ruiz Nodar en el webinar Epic Learning Focus On Fast Track en Cierre de Orejuela Izquierda el 30 de marzo de 2021.
This document discusses Natural Orifice Transluminal Endoscopic Surgery (NOTES), a new surgical technique. NOTES involves performing surgery using an endoscope inserted through natural openings like the mouth, vagina, or anus without external incisions. The document provides a brief history of NOTES, describes some procedures that have been performed, and discusses potential advantages as well as challenges to further development and acceptance of the technique.
Laparoscopy involves using small incisions and a camera to perform abdominal surgeries. It was pioneered in the early 1900s and has since been used for procedures like cholecystectomy and appendectomy. Advantages include less pain, scarring and faster recovery compared to open surgeries. Proper patient positioning, insufflation, trocars and energy devices are required. Complications can include injuries from access and cautery. Recent advances include natural orifice translumenal endoscopic surgery and single-incision laparoscopic surgery.
The document describes a case where a 81 year old woman with severe aortic stenosis and comorbidities underwent a transaortic aortic valve implantation (TA-AVI) through an upper ministernotomy approach. Key steps included making a 5cm J-shaped incision, inserting an 8Fr sheath through the aorta, crossing the native valve with a wire, inserting a delivery system, performing balloon aortic valvuloplasty, and releasing the new valve. The procedure was successful with normal valve function and recovery. The upper ministernotomy provides an alternative access for patients not suitable for transfemoral approaches and avoids arch crossing.
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.
Medical Device Consulting IVC Filter Doucet Shima TrimbleJason Trimble
The document discusses analyzing and improving the design of an IVC filter medical device used to treat pulmonary embolism. It outlines objectives to analyze the pros and cons of the current IVC filter design, develop an improved design, and analyze the mechanical forces and biocompatibility of the proposed design. The document provides background on deep vein thrombosis, pulmonary embolism, risk factors, current treatment options including IVC filters and blood thinners, failure modes of current IVC filters, and considerations for the novel design including a conical shape, stent structure, deployment procedure, material properties, failure modes, and importance of retrievability.
This document discusses the benefits of using a radial artery approach for carotid artery stenting (CAS) compared to the traditional femoral artery approach. Some key benefits of the radial approach include avoiding complications associated with femoral access in patients with aorto-iliac disease, allowing for early patient mobilization to reduce bleeding risks, and eliminating vascular access site complications which are a major cause of morbidity and mortality after CAS. The document also presents several case examples demonstrating successful CAS procedures performed via the radial approach. However, it notes there is a significant learning curve for new operators and that the radial approach may not be suitable for all anatomies or allow the use of all devices.
Friday 0905 – christiansen – feasibility of a cto pciEuro CTO Club
This document provides guidance on evaluating the feasibility of percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO). Key factors to consider include: the patient's tolerance for a long procedure, contrast load, and radiation exposure; the CTO's proximal cap ambiguity, length, distal landing zone, and presence of interventional collaterals; and ensuring good quality angiography. With adequate planning and use of appropriate CTO techniques, feasibility is nearly always present for symptomatic patients. Success rates of CTO-PCI are reported to be 94% when using a planned approach.
DIAGNOSTIC AND INTERVENTIONAL PROCEDURES WITHIN THE VASCULAR ANGIOGRAPHY SUITEDr Shibu Chacko MBE
This document provides information about diagnostic and interventional procedures performed in a vascular angiography suite. It discusses angiograms, angioplasty, stenting, and thrombolysis procedures. Angiograms are used to visualize arteries and identify stenoses or occlusions. Angioplasty opens arteries at points of stenosis using a balloon catheter. Stenting is often used with angioplasty, employing a hollow wire mesh tube. Thrombolysis aims to break down blood clots and restore perfusion by administering tissue plasminogen activator through a catheter. The document outlines pre-operative care, post-operative care including monitoring, potential complications, and follow-up for these vascular procedures.
This document discusses complications of percutaneous nephrolithotomy (PCNL). It describes the most common complications as acute hemorrhage from the renal parenchyma or collecting system. Delayed hemorrhage can also occur due to arteriovenous fistulas or pseudoaneurysms. Collecting system injuries like tears or perforations need drainage with stents or nephrostomy tubes. Rare but serious complications include visceral injuries to nearby organs, pleural injuries, metabolic disturbances, and neurological issues from positioning. Management involves drainage, angioembolization, or open surgery depending on the complication. The document also reviews drainage techniques after PCNL including tubeless procedures with just ureteral stents or
1. Transcatheter aortic valve implantation (TAVI) was first performed in humans in 2002 in France using a bovine pericardium valve.
2. There are several vascular access approaches for TAVI, including transfemoral, transapical, transaortic, and subclavian approaches.
3. A 2013 feasibility study of a new device for TAVI in patients with aortic insufficiency reported successful deployment in all four patients with no deaths at 30 days and improved aortic insufficiency in all patients.
This document provides an overview of 200-hour training course content on care of arteriovenous (AV) grafts and hemodialysis catheters. The summary covers AV graft placement, maturation, cannulation techniques, and troubleshooting issues like thrombosis. For catheters, topics discussed include insertion sites, ultrasound guidance, dressing changes, infections, and flow issues. Proper handling and decontamination procedures are emphasized to prevent infections.
The prevalence of degenerative valvular disease is increasing in the context of an increasingly ageing population, and despite advances in medical and surgical interventions, is associated with a significantly worse outcome when compared with the general population. Data from the EuroHeart Survey (2003) suggests the commonest relates to native valve disease (predominantly aortic stenosis) however, more than one quarter of patients with valve disease have undergone a previous intervention. According to current guidelines, in general treatment for severe, symptomatic aortic stenosis is surgical aortic valve replacement, which is associated with excellent outcomes, however, despite this around 30% of such patients do not undergo surgical intervention.
The last decade has seen a significant change in the potential therapeutic options for patients with aortic valve disease due to the development of transcatheter techniques for valve implantation. Patented in 1991, the first successful human implant of a transcatheter aortic valve was undertaken in 2002, with currently >500,000 implantations having been undertaken in >70 countries worldwide. The evidence supporting transcatheter aortic valve implantation (TAVI) otherwise known as transcatheter aortic valve replacement (TAVR) came originally from the key PARTNER studies, where patients judged to have inoperable aortic stenosis who underwent TAVI having improved survival and a reduction in hospital admission at 1 year. Following the early safety and efficacy studies, and following increasing recommendations for TAVI as an option for patients at high risk in international guidelines, the use of transcatheter techniques is extending to those of lower risk.
The document discusses various types of radiological equipment and procedures used for diagnostic and interventional purposes. It provides detailed descriptions of common radiological exams including chest X-rays, mammography, CT scans, angiography, myelography, and others. It also covers interventional radiology techniques such as MRI, ultrasound, and nuclear medicine studies. The goal of radiological exams is to produce diagnostic images of the inside of the body to evaluate conditions and guide procedures.
Dr Rahul Tiwari OMFS SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh. A comparison of bone resorption over time. An analysis of the free scapular, iliaccrest and fibular microvascular flaps in mandibular reconstruction
This case involves treating a long CTO of the right coronary artery (RCA) using an antegrade approach in a 71-year-old man with various cardiovascular risk factors and symptoms. The doctor evaluates options for guiding catheter size and wire strategies like single wire, parallel wires, or IVUS-guided re-entry. An initial angiogram is performed. The doctor discusses when a retrograde strategy may be preferable and outlines treatment options for stenting the complex lesion involving the bifurcation.
Georgios Sianos - RETROGRADE STEP BY STEP APPROACHEuro CTO Club
This document provides an overview of retrograde techniques for recanalizing chronic total occlusions (CTOs). It discusses the history and evolution of retrograde techniques, including septal collateral crossing and dilatation. Key steps in the retrograde approach like wire escalation, dissection and re-entry are outlined. Case examples demonstrate the retrograde procedure in detail. Consensus recommendations emphasize the importance of operator experience before performing retrograde CTO PCI independently. Required lab set-up and equipment are also reviewed.
The document discusses engaging bypass grafts and accessing the coronary arteries from the radial approach. It describes the different challenges posed by radial versus femoral access, including navigating the subclavian artery and distortions in aortic arch anatomy. Various catheter options are presented for engaging grafts and specific coronary targets. Case examples demonstrate integrating multiple catheters to access native vessels and grafts from a single radial puncture. Guide selection considerations for graft PCI are also reviewed.
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
This document provides information about laparotomy procedures, including:
1. It lists 10 different types of laparotomy incisions and identifies the correct technical term is celiotomy.
2. It describes the proper positioning of the patient for laparotomy as supine with arms positioned and use of a Foley catheter and NGT.
3. It outlines the layers of the midline laparotomy incision including the external oblique, internal oblique, transversalis muscle, and linea alba.
This document discusses techniques for performing transradial cardiac catheterization and preventing radial artery occlusion (RAO). It presents data showing that using a higher dose of heparin (5000 units vs 2000-3000 units) and perfused hemostasis can reduce rates of RAO. The document also proposes that transient ulnar artery compression may treat subacute RAO by increasing blood flow through collateral vessels. Studies are presented demonstrating improved radial artery flow after one hour of manual ulnar compression. In conclusions, the document advocates for perfused hemostasis and higher dose heparin as best practices, and endorses transient ulnar compression as an effective method for treating early diagnosed RAO.
Estado actual del cierre de orejuela, por Juan Miguel Ruiz NodarFundacion EPIC
Presentación del caso "Estado actual del cierre de orejuela", por Juan Miguel Ruiz Nodar en el webinar Epic Learning Focus On Fast Track en Cierre de Orejuela Izquierda el 30 de marzo de 2021.
This document discusses Natural Orifice Transluminal Endoscopic Surgery (NOTES), a new surgical technique. NOTES involves performing surgery using an endoscope inserted through natural openings like the mouth, vagina, or anus without external incisions. The document provides a brief history of NOTES, describes some procedures that have been performed, and discusses potential advantages as well as challenges to further development and acceptance of the technique.
Laparoscopy involves using small incisions and a camera to perform abdominal surgeries. It was pioneered in the early 1900s and has since been used for procedures like cholecystectomy and appendectomy. Advantages include less pain, scarring and faster recovery compared to open surgeries. Proper patient positioning, insufflation, trocars and energy devices are required. Complications can include injuries from access and cautery. Recent advances include natural orifice translumenal endoscopic surgery and single-incision laparoscopic surgery.
Laparoscopy in gynaecology presented by drs igbodike emeka philip and dr rotimiigbodikeobgyn
This slide will be helpful if the presentation revolves around laparoscopy in gynaecological practice. Kindly like , clip and share the slide. it is free!
NOTES (Natural Orifice Transluminal Endoscopic Surgery)- By Dr. Onkardronkarsingh
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an experimental surgical technique that performs abdominal operations through natural orifices like the mouth, urethra, anus or vagina without external incisions. NOTES aims to reduce surgical trauma and pain for patients by avoiding incisions. It also shortens recovery time and eliminates risks of complications from external incisions like infections and hernias. While still in development, NOTES shows promise as a less invasive future of surgery.
This document discusses the history and essentials of laparoscopy, also known as minimally invasive surgery. Some of the key points covered include:
- Laparoscopy was pioneered in the early 1900s but gained popularity in the 1980s when procedures like laparoscopic cholecystectomy were developed.
- It allows surgeons to access the abdominal cavity through small incisions rather than large incisions, reducing trauma and recovery time for patients.
- Modern laparoscopy utilizes specialized instruments, high-definition cameras, 3D/4K imaging, and robotic systems to give surgeons better visualization and precision.
- It is now used diagnostically and therapeutically for many abdominal procedures, with
Journal Club on Clinical comparison of ultrasonic surgery and conventional su...Dr Bhavik Miyani
This document summarizes a study comparing ultrasonic surgery to conventional surgical techniques for removing jaw cysts. Eighty-two cysts were removed from 68 patients, with 34 patients undergoing ultrasonic surgery and 34 undergoing conventional surgery. Ultrasonic surgery took longer on average but provided better visibility of the surgical field. No major complications occurred with either technique, and there were no recurrences of cysts. The study found that while ultrasonic surgery increases operation time, it reduces risks of damaging vital structures like nerves when removing cysts in difficult areas requiring delicate manipulation.
NOTES (Natural Orifice Transluminal Endoscopic Surgery) is an experimental surgical technique that performs operations through natural openings in the body without external incisions. This avoids scarring and reduces recovery time. NOTES procedures first began in the 1980s and have included cholecystectomies, appendectomies, and other abdominal surgeries. While still being developed, NOTES may eventually allow many operations to be done as outpatient procedures with even faster recovery times compared to laparoscopic surgery.
Optimising IVF results with good OPU and ET techniquesMangalaDevi9
This document provides guidance on optimizing oocyte pick-up (OPU) and embryo transfer (ET) procedures in IVF. It discusses key steps in OPU including prior assessments, equipment, the procedure itself, and complications. Factors affecting a successful ET are also reviewed such as embryo selection, catheter choice, ultrasound guidance, and embryo placement. The importance of minimizing trauma and having an experienced clinician is emphasized. Quality assurance measures like ongoing training and monitoring outcomes are recommended.
Advancements in modern imaging techniques such as ultrasound, magnetic resonance imaging, computer tomography and other radiological procedures have improved the diagnosis of gynecological conditions to a great extent. However, the establishment of a final diagnosis and the initiation of appropriate treatment requires direct viewing of the uterine cavity as in hysteroscopy. In many cases, the patient can be treated during the initial hysteroscopy.
This document discusses laparoscopic appendectomy techniques and results from United Family Intermed Hospital and Gurvan Gal Hospital. It begins with a brief introduction of laparoscopic appendectomy history and the key steps of the procedure. It then summarizes results from 101 patients, noting common appendicitis types, low complication rates, and short hospital stays. It concludes with a literature review comparing laparoscopic and open appendectomy outcomes, risks for obese patients, and emerging minimally invasive techniques.
Pleuroscopy, also known as medical thoracoscopy, is a minimally invasive procedure that allows visualization of the pleural space using viewing and working instruments. It enables diagnostic and therapeutic procedures such as pleural biopsy and talc insufflation for pleurodesis. Pleuroscopy has a diagnostic yield of 90-95% and is indicated when routine cytology and closed needle biopsy fail to determine the cause of a pleural effusion. It is a safe procedure that is performed by pulmonologists using local anesthesia. Complications are rare but can include pain, hypoxemia, hemorrhage, and injury to organs.
This document provides information on operative hysteroscopy, including therapeutic indications, instruments used, specific procedures, complications, and techniques. Some key points:
- Operative hysteroscopy is used to treat conditions like uterine septum, synechiae, polyps, and myomas. Instruments include a resectoscope, cutting loops, and electrodes.
- Specific procedures discussed include hysteroscopic metroplasty for septate uterus, adhesiolysis for synechiae, transcervical resection of submucous myomas, and endometrial ablation.
- Complications can be perioperative like bleeding, perforation, or fluid absorption syndrome, or postoperative like adhesions or
Percutaneous Drainage of Abscess and Post Operative CollectionsDr.Suhas Basavaiah
Ultrasound guided percutaneous drainage is an image guided minimally invasive procedure to treat accessible fluid collections. It has advantages over CT like real-time visualization and lack of radiation. The document outlines the patient preparation, equipment, techniques, post-procedure care and complications of this procedure. Percutaneous drainage is effective for treating many types of collections when performed carefully under imaging guidance using the correct technique and equipment.
Priniciples of Canine Endoscopic Surgery Prof.Dr. Awad Rizk.pdfAwadRizk
Endoscopy involves using specialized cameras to evaluate areas of the body in a minimally invasive manner. It is commonly used for diagnostic purposes to visualize abnormalities and obtain biopsy samples. Some advantages of endoscopy include it being nonsurgical, allowing direct visualization and sampling, and in some cases performing therapeutic procedures. Common types of endoscopy discussed in veterinary medicine include laparoscopy, arthroscopy, cystoscopy, and rigid endoscopy of various organs.
This document discusses proper vascular access device care and prevention of catheter-related infections. It emphasizes that standardization of care practices like hand hygiene, maximal barrier precautions during insertion, and disinfecting catheter hubs can significantly reduce infections. It also explains the risks of biofilm formation on devices and how microbes within biofilms are highly resistant to antibiotics. Education of healthcare workers and patients on infection prevention is vital to improving outcomes.
1) Al-Zahrawi, an 11th century Arab physician, is considered the first to perform a needle biopsy of the thyroid gland using hollow needles.
2) In the late 19th century, the terms "biopsy" and "bioscopy" were introduced into medical terminology to describe the microscopic examination of living tissue samples.
3) Over the past century, the use of biopsy has evolved from an occasional procedure performed on living organs to a widely adopted diagnostic tool used across many clinical specialties to characterize lesions and diseases.
Endoscopy involves examining the interior of hollow organs using an endoscope. It has become an important tool for both diagnostic and therapeutic purposes in GI surgery. Key developments include the first endoscopes in the early 1800s, and the modern fiberoptic endoscope in the 1950s. Common endoscopic procedures today include upper and lower GI endoscopy, ERCP, EUS, and PEG/PEG-J placement. Endoscopy is used to diagnose and treat conditions like GI bleeding, varices, strictures, cancers, and stones. Procedures include biopsy, polypectomy, dilation, ablation, ligation, and stent/drain placement.
This document discusses hip arthroscopy techniques. It notes that hip arthroscopy requires specific skills due to anatomical challenges like a thick soft tissue mantle and constrained ball-and-socket joint. The surgeon should create a dedicated team and undergo observations before performing the procedure independently. Key steps include precise patient positioning using traction and fluoroscopy to access the central and peripheral compartments, creating portals like the anterolateral portal under fluoroscopy guidance, and using specialized equipment like a 70 degree scope and double cannula sheath. The summary cautions that hip arthroscopy has a long learning curve and can lead to complications for beginners like cartilage damage due to issues with traction.
Tips and tricks to site and maintain nerve cathetersAmit Pawa
This lecture was given on Friday 13th September 2019 at the annual congress of the European Society of Regional Anaesthesia in Bilbao and Spain. The talk was also contributed to by the Twitter Community. Strategies and techniques to site, secure and maintain perineural nerve catheters is discussed
Laparoscpic Cholecystectomy by Dr.nowarNoushin Nowar
This document discusses laparoscopic cholecystectomy, a surgical procedure to remove the gallbladder through small incisions using an endoscope. It outlines the indications, contraindications, anesthesia used, positioning of the patient and surgical team, steps of the procedure, advantages/disadvantages, postoperative care, and some key outcomes data. The overall message is that laparoscopic cholecystectomy is the gold standard gallbladder surgery, with benefits of smaller incisions, less pain and faster recovery compared to open surgery. Careful technique and recognition of anatomy is important to minimize complications.
Similar to Chest port implant access and techniques. Luc Rotenberg 2018 (20)
L rotenberg, g lenczner premalignant breast lesion imaging jfim hanoi 2015 compLuc ROTENBERG
This document discusses breast premalignant lesions, their imaging appearance, diagnosis, and management. It provides information on lesions such as DCIS, ADH, ALH, and LCIS. Imaging modalities like mammography, ultrasound, and MRI can detect these lesions as masses, calcifications or other abnormalities. Biopsy is often used for diagnosis but may underestimate the lesion. Surgical excision is generally recommended when premalignant lesions are found on biopsy to rule out associated malignancy, though careful radiologic-pathologic correlation in some cases can guide observation over excision. Underestimation rates vary by biopsy method and number of specimens obtained.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Chest port implant access and techniques. Luc Rotenberg 2018
1. !!
C h e s t p o r t i m p l a n t a t i o n b y
venous access with US Guidance
Luc Rotenberg, RPO, ISHH
Clinique Hartmann – CMC Ambroise Paré
26-27 bd Victor Hugo, 92200 Neuilly Sur Seine – France
www.radiologieparisouest.com
dr.rotenberg@radiologieparisouest.com
Johannesburg, Oct 4th 2018
2. !
1. PERCUTANEOUS CHEST PORT IMPLANT
2. US GUIDED CHEST PORT IMPLANT
3. CATHETER TIP POSITIONING
12. !
Haematology, acute
leukemia,
HSCT, GM
Endocarditis
(bones, cellulitis, joints…)
Cystic fibrosis,
bronchiectiasis, numerous
cures
Continuous
> 15 days
Cyclic,
prolonged…
Palliative patient,
undernourished
Infection >6months
(bones, joints...)
Choice of central venous access and device
Chemotherapy
Antibiotic treatment
Parenteral Nutrition
Others
Venous insufficiency
Sickle-cell anaemia
Transfusion,
Haemophilia
Prolonged IV
analgesics
Haematology, NHL, HL,
myeloma, myelodysplasia…
Hemodialysis
Chronic
Cytapheresis
Plasmapheresis
Long term central venous
access indications
Solid tumor
13. !
Contraindications to implantable port ? (1)
< 3 months
> 3 months
Tunneled CVC with or without
cuff:
- Onco-haematology intensive
care
- Marrow transplant
- Leukemia induction…
Shared decision(2)
Neediness of high flow rate perfusion ?
YES
NO
Indication
Length of treatment ?
Tunneled CVC
± cuff
PICC
Specific Catheters:
-cytapheresis,
-plasmapheresis, -
haemodialysis.
Implantable Port
NO
Tunneled CVC
± cuff
Continuous Tt.
Intermittent Tt.
Shared decision(3)
YES
Tunneled CVC
± cuff
Shared decision
PICC
Implantable Port
14. !
(1) Implantable Port contraindications :
- Thrombopenia (<50000), hemostasis disorders, DIVC ;
- Implantation site infection, systemic infection or non controlled bacteriemia ;
- Major tumor infiltration of implantation site.
Remark: Mediastinal compression, superior vena cava thrombosis or sclerosis are contraindications to central catheters
implementation in the superior vena cava area : Port, PICC, tunneled catheter with or without cuff.
(2) When a patient rejects an emerging catheter and wants instead an implantable port : to negociate.
(3) Intermittent treatment: when no use between treatments, parenteral nutrition 5/7 days = rather a port.
Continuous treatment: parenteral nutrition 7/7 days, palliative care, PCA morphinic = rather an emerging catheter.
Comments
15. Clinical Pathway
Balistic preoperative consultation
§ Report Study
§ Interrogatory (risk factors…)
§ Balistic approch
§ Targeted
§ Device and guidance technique choice
§ Patient explanation of :
§ Intervention
§ complications
§ Possible results and implications
§ Pricing
§ Written informed consent is required before all interventions +++
临床综合治疗模式
术前靶向方案
25. !
Sub Clavian chest port
• In recent years, the surgical approach to the subclavian vein by sub
clavicular "classic" was partially abandoned in favor of the internal
jugular, supposedly safer.
• The addition of ultrasound guidance helps restore its credentials in this
way, more functional and aesthetic avoiding many of the previous
complications of « blind » puncture.
• Surroundings 10.000 procedures were performed in our institute since
2007, with this technique and this way without first pneumothorax,
arterial puncture or pinch off syndrome.
68. !
Second Key argument
Port position
– Allows to detect if the port is flipped
Correct position of the port
Marking has a « C » shape
like in “Correct”
Flipped port
Marking has a
reverse « C »
shape
C C
Risks of complication:
- Cytotoxic product Extravasations
(cutaneous necrosis)
- Edema, inflammation for non
cytotoxic products
- blunted needle, painful withdrawal
for patient
- Postponed treatment
- Cost increase
Benefit :
àPatient safety
69. !
Third Key argument
adaptable with medical practices
– Unique range of pressure injectable port with RX marking offering :
• 7F and 8F silicone catheters
• Catheter size inferior to 7F à 5F silicone (1 ml/sec, useful for paediatric use and
MRI exams)
SEESITE® range is compatible with doctors practices and habits (not the
opposite) :
o Silicone versus PU,
o Paediatric use,
o Catheters diameter Benefit :
àNo changes in doctors practices
àdoctors comfort
Usual injections flow rate for scanner and MRI
procedures : from 1 to 3 mL/sec.
5 mL/sec injections are rarely used (see table) and not
recommended for risky cases (catheter motions).
70. !
Fourth Key argument
unique complete kit
– Complete accessories offer
• Echo-guided venipuncture set (in
accordance with NICE
recommendations)
• Safety Huber needle PPS® CT
– In accordance with European directive
2010/32 on blood exposure prevention
– Continuity for establishment already using
Polyperf Safe®
Benefit :
àPhysician comfort
Benefit :
àPrevention of catheter obstruction
79. !
Good result
• Small scar (1 to 2 cm)
• Oblique or vertical scar by deltopectoral groove approach
• invisible suture by a buried overlock and/or biological glue
83. !
Lumen obstruction
Lumen obstruction by blood clot (24 % )
• Causes :
• Lack of flush
• Drug precipitation (incompatibility between 2 products, crystallisation)
• Endovenous loops
• Lipid deposits
Clinical signs
• Discomfort or pain in thoracic cavity, neck or in scapular area, in rare cases appearance of arm oedema
• Impossible to inject and absence of blood reflux
• Infectious signs
Recommendations
• X-Ray control and/or opacification (phlebography, CT scanner)
• Urokinase lock (Actosolv) :
– 1ml with 9 ml of NaCl (dosage 5000 UI/mL) leave 1ml of the fibrinolytic solution in contact with the blood clot during 15-20min then suck up
• Treatment of the cause (anticoagulant, thrombolytic agents, antibiotics)
• Device removing in case of failure
84. !
Flushing recommendations
• Technique
– Use a pulsatile flow when flushing
– Use a flush with 10 × 1mL boluses with a time interval of 0.4 s between 2 boluses
– Use the positive pressure technique when disconnecting a syringe
• Volume
– Use a 10mL flush for all IV catheters (except for peripheral cannulas, use 5 mL)
– Use a 20mL flush after infusion of viscous products like blood components, parenteral
nutrition, and contrast media
• Regimen
– Flush with NS before and after administration of drugs of fluids
– Flush with NS before and after blood sampling
85. !
Flushing recommendations
3. As you come towards the last 1ml of the flush,
remove the needle from the PORT AT THE SAME TIME
AS YOU ARE FLUSHING.
2. You will now need to flush the PORT using a push
pause turbulent flush and finishing with a positive
pressure flush.
1. The needle should be correctly placed in the
septum and just touching the bottom plate
86. !
Need of heparin ?
• There is no data confirming the need of heparin to prevent catheter
occlusion or thrombosis
• The half life of heparin is very short
90. !
WHAT IS GOOD FOR THE PATIENT
…IS GOOD FOR THE DOCTOR
THE REVERSE MAY BE WRONG !
Dr Michel BUNODIERE, 2001
91. !
Take home :
ports access
Technique
1. Pre opetative consultation
2. Verticale or oblique scare in deltopectoral groove, 1 to 2 cm
3. US puncture guidance
4. Surgical approach
5. PORT positioning See Site
6. TIP positioning
7. Management and Complication