This document summarizes a case report of a thrombus migrating during a percutaneous coronary intervention (PCI) for a heart attack. A 69-year-old woman presented with chest pain and was found to have a blocked left anterior descending coronary artery. During balloon angioplasty of this artery, the thrombus migrated downstream, blocking a side branch artery. Further interventions restored blood flow in this new blocked artery. The summary cautions that thrombus migration is a risk during PCI and operators should pay attention to side branches as well as the initial blocked artery. Aspiration catheters may help reduce this complication risk.
A lecture about the management approaches for abdominal vascular injuries. Injury to the major arteries and veins in the abdomen are technical challenge to the surgeon and are often fatal. All vessels are susceptible to injury with penetrating trauma. Vascular injuries in blunt trauma are far less common and usually involve the renal arteries and veins, though all other vessels, including the aorta, can be injured. Blunt trauma results from deceleration, AP compression or pelvic fractures.
The principles of vascular repair with sutures were established in the first decade of the 20th century by Alexis Carrel, who in 1912 was awarded the Nobel Prize for medicine for his work .Since then, technical refinements of suture materials have made possible surgical reconstruction of most arteries from the root of the aorta to microvascular anastomosis or repair of the smallest vessels, e.g., digital arteries or those on the surface of the brain.
A lecture about the management approaches for abdominal vascular injuries. Injury to the major arteries and veins in the abdomen are technical challenge to the surgeon and are often fatal. All vessels are susceptible to injury with penetrating trauma. Vascular injuries in blunt trauma are far less common and usually involve the renal arteries and veins, though all other vessels, including the aorta, can be injured. Blunt trauma results from deceleration, AP compression or pelvic fractures.
The principles of vascular repair with sutures were established in the first decade of the 20th century by Alexis Carrel, who in 1912 was awarded the Nobel Prize for medicine for his work .Since then, technical refinements of suture materials have made possible surgical reconstruction of most arteries from the root of the aorta to microvascular anastomosis or repair of the smallest vessels, e.g., digital arteries or those on the surface of the brain.
Case of the week - superficial femoral artery pseudoaneurysmDr Abdalla M. Gamal
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 16 years old male, victim of stab wound in the lower part of the back of the right thigh, and was found to have a pseudoaneurysm in the superficial femoral artery when he was examined by ultasound one month after the injury.
The presentation contains 37 slides, and is divided into the following parts :
1 - The case
2 - Pseudoaneurysms
3 - Imaging of pseudoaneurysms
4 - Treatment of pseudoaneurysms
This presentation was prepared and presented by me in cooperation with D.Mabroka Ellafi in the tutorials of the Radiology Department of Sebha Medical Center.
A brief History of Coronary Artery Bypass Grafting (CABG)Abhijit Joshi
this presentation traces the early reports of angina, when it was thought to be a disease of the breast, goes on to describe the stepping stones leading to myocardial revascularisation.
Grand Rounds given at Holy Redeemer hospital 1/2017 on the many amazing treatments offered by interventional radiologists.
Including microwave ablation, Y90 radioembolization, UFE, Arterial inteventions, Varicose veins, and more!
Case of the week - superficial femoral artery pseudoaneurysmDr Abdalla M. Gamal
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 16 years old male, victim of stab wound in the lower part of the back of the right thigh, and was found to have a pseudoaneurysm in the superficial femoral artery when he was examined by ultasound one month after the injury.
The presentation contains 37 slides, and is divided into the following parts :
1 - The case
2 - Pseudoaneurysms
3 - Imaging of pseudoaneurysms
4 - Treatment of pseudoaneurysms
This presentation was prepared and presented by me in cooperation with D.Mabroka Ellafi in the tutorials of the Radiology Department of Sebha Medical Center.
A brief History of Coronary Artery Bypass Grafting (CABG)Abhijit Joshi
this presentation traces the early reports of angina, when it was thought to be a disease of the breast, goes on to describe the stepping stones leading to myocardial revascularisation.
Grand Rounds given at Holy Redeemer hospital 1/2017 on the many amazing treatments offered by interventional radiologists.
Including microwave ablation, Y90 radioembolization, UFE, Arterial inteventions, Varicose veins, and more!
Chronic Total Occlusions: The Road Less TraveledAllina Health
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
CHAPrER 21 r Cardiovascular SystemUsing the CPT and ICD-10.docxsleeperharwell
CHAPrER 21 r Cardiovascular System
Using the CPT and ICD-10-CM/ICD-9-CM manuals, code the fallowing:
41. Valvuloplasty of the aortic valve using transventdcular dilation with
cardiopulmonary bypass.
CPT Code:
,/
i+
y'+2. Xeptacement aortic valve, with cardiopulmonary bypass, with prosthetic
valve.
CPT Code:
43. Valvuloplasty, tricuspid valve, with ring insertion.
CPT Code:
d p"puirof a coronary arteriovenous fistula, without cardiopulmonary
bypass.
CPT Code:
d *r"rnal electrical cardioversion.
CPT Code:
47. Percutaneous balloon angioplasty; one coronary vessel.
CPT Code:
t*{. Cpp.(Cardiopulmonary resuscitatio4).
CPT Code:
49. Electrocardiogram with interpretation and report only.
CPT C6de:
C rrrurs graft of the common carotid-ipsilateral iriternal carotid artery
using synthetic vein.
CPT Code:
5L. Ligation of temporal artery.
CPT Code:
Odd-numbered answers are located in Appendtx B, while the full arrrwer key ts only avallable tn the TEACE
Instructor Resources on Evolve.
Copyrlght @ 2015 by Saunde$, an imprint of Elsevier Irrc. All rights reseryed.
45. Routine ECG with
components.
CPT Code:
L2leads with both the professional and technical
CHAPTER 21
a
I Cardiovascular System
,/
v52. Ligation of a common iliac vein.
CPT Code:
53. Open ftansluminal balloon angioplasty aorta.
CPT Code:
,An. Coronary artery bypass, single artery, for coronary atherosclerosis of
native coronary artery in a transplanted heart.
CPT Code:
ICD-10-CM Code:
(ICD-9-CM Code:
four veins, no arteries. Diagnosis of acute55. Coronary artery bypass,
coronary insufficiency.
& cpr code(s):
& tco-ro-cM code(s):
(& ICD-q-cM Code(s):
teriovenous fistula of a'Iower extremity.
CPT Code(s):
ICD-10-CM Code(s):
ICD-9-CM Code(s):
& Ur". to declde number of codes necessary to conectly answer the question.
Odd-numbered ansyyers are located in Appendix B, while the full anxwer key is only avallable in the TEACH
Instructof Resources on Evolve,
&
&
@
/
g/SO. nepair of injury to intra-abdominal blood vessel, inferior vena cava,
hepatic vein, with a vein graft.
& cpr code(s):
& tco-ro-cM Code(s):
(& ICD-o-cM code(s):
57. Percutaneous insertion of an intra-aortic balloon assist device due to
initial episode of acute myocardial infarction apd cardiogenic shock.
& cpr code(s):
& tco-ro-cM code(s):
/ (& ICD-o-cM code(s):
I
VSa. nepair of a traumatic ar
Copy,right @ 2015 by Saunders, an impdnt of Elsevier Inc. Al1 rights teserved.
59. Repair congenital
CHAITTER 21 r
atrial septal defect, secundum, with
Cardiovasculat System
bypass and patch.
& cpr code(s):
& Ico-to-cM code(s):
.1& lco-o-cM code(s): )
ffiO. Repair of a patent ductus arteriosus by division on a 16-year-old patient.
& cpr code(s):
& Ico-ro-cM code(s):
1& Ico-e-cM code(s):
61. Reoperation of one arterial coronary bypass graft and one vein bypass
graft for arteriosclerosis of native arteries, 3 months following the initial
procedure.
& cpr Code(s):
& tco-ro-c.
Radial artery pseudoaneurysm (RAP) at the site of transradial access (TRA) for coronary angiography is rare. A clean puncture, secure bandage, and watchful follow-up are must to prevent complete occlusion and aneurysm formation at the access site. This illustration describes surgical repair as one of the successful strategies to repair a postcatheterization RAP after TRA.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
Trans sternal trans pericardial closure of post pneumonectomy bronchopleural ...Abdulsalam Taha
The occurrence of a broncho-pleural (BPF) after pneumonectomy is an infrequent but severe complication accompanied by a high morbidity and mortality. Small BPFs may heal either spontaneously or with drainage only. However, the majority of patients with persistent BPFs require operative intervention. There is no standard treatment to this complication and the successful management is a challenge to the thoracic surgeon. While most of the treatment options are staged operations, the trans-sternal trans-pericardial (TSTP) closure is attractive as it is a one stage operation that avoids the infected pneumonectomy space and does not result in patient’s disfigurement. The technique was first used in Italy and then used extensively in the former Soviet Union. Herein, we report a case of chronic BPF after pneumoectomy successfully closed via the TSTP approach. The relevant literature is reviewed to throw light on the indications and the results of this operation.
Key Words: BPF, Pneumonectomy, Empyaema and TSTP Approach.
Publication Date: Mar 2010
Publication Name: Basra Journal of Surgery
view on iasj.net
1. Migration of a thrombus
in coronary arteries
Sakhov O.S., Kenzhebaev A.M., Mukanov S.M.
City Heart Center, Almaty, Kazakhstan
2. History
Patient I., female, 69 y.o.
Risk factors: dyslipidemia
Diagnosis: STEMI
Chest pain with 5 hours duration, without
previous coronary anamnesis
ECG: 4 mm ST elevation in anterior leads
Troponin: 0,352 ng/ml
3. Coronaroangiography:
LAD – occlusion of ostium.
Cx – no significant stenosis
RCA - dominant, no stenosis.
A. intermediate – stenosis (40%) in proximal segment.
4. Primary PCI
Right femoral access. Guiding catheter 6 Fr JL 4.0.
The occlusion was easily crossed using a 0.014” BMW guidewire.
Predilation with a 2.0x15mm Sprinter balloon at 12atm.
Antegrade filling of the distal segment LAD (TIMI 2).
5. Stenting of infarct-related artery
Diagonal branch was not protected.
Stent Cypher Select 3.0x23mm was implanted at 18 atm.
6. Result
• Good angiographic effect, DB is not occluded
• But patient had intensive chest pain
• Analysis of the previous series showed that the intermediate
artery was occluded after 1st balloon inflation in the LAD.
•2nd guide wire crossed trough the occlusion and performed pre-
dilatation of proximal segment of intermediate artery.
7. New lost artery
Patency of the a.intermediate was restored.
Now was occluded distal segment of obtuse marginal.
Several balloon dilatations were performed without improvement
of distal flow. Intervention was stopped.
Patient was discharged on the 4th day in stable condition.
8. Resume:
Migrationof a thrombus is dangerous complication
with the risk of new MI.
Duringthe PCI, the operator's attention should be
not only in the occluded artery.
Using of aspiration catheter could reduce the risk of
this complication.
