Modern Approach on

Angioplasty

Angiography is a diagnostic tool to produce X-ray pictures of the inside of blood vessels. When blood vessels are blocked, damaged or abnormal in any way, chest pain, heart attack, stroke or other problems may occur. Angiography helps your physician determine the source of the problem and the extent of damage to the blood vessel segments that are being examined.

Femoral Angiography: When the angiogram procedure done through the Femoral route.

Radial Angiography: When the angiogram procedure done through the Radial route.

Radial artery

In our Desun Hospital We Do Radial Angiography with the same cost compared to conventional Femoral Angiogram.

The advantages of Radial Angio are: a time-sparing homeostasis technique

avoidance of post-procedural bed-rest, we do it as Day-care procedure

a lower incidence of local complications

improved quality of life for patients

Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow & this condition is called atherosclerosis.

Coronary angioplasty is a procedure used to open blocked or narrowed coronary (heart) arteries.

The procedure improves blood flow to the heart muscle.

Improve symptoms of CHD, such as angina and shortness of breath. (Angina is chest pain or discomfort.)

Reduce damage to the heart muscle caused by heart attack. A heart attack occurs if blood flow through a coronary artery is completely blocked.

Reduce the risk of death in some patients.

Percutaneous coronary intervention (PCI) Percutaneous intervention Percutaneous transluminal angioplasty Percutaneous transluminal coronary

angioplasty Balloon angioplasty Coronary artery angioplasty

Cardiologists do coronary angioplasties at hospitals.

Doctor will take a medical history (including the medicines you take), a physical exam, and explain the procedure.

some routine tests, such as blood tests, an EKG (electrocardiogram), and a CHEST X Ray.

Consent form

Coronary angioplasty is done in a special part of the hospital called the cardiac catheterization laboratory. The "cath lab" has special video screens and x-ray machines.

In the cath lab, patient lie on a table. An intravenous (IV) line will be placed in your arm to give you fluids and medicines. The medicines will relax you and prevent blood clots.

During angioplasty, patient will be awake but sleepy(conscious sedation).

The doctor will use a needle to make a small hole in an artery in your arm or groin.

A thin, flexible guide wire will be inserted into the artery through the small hole.

The needle is then removed, and a tube called a sheath is placed over the guide wire and into the artery.

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Technical innovations image intensification

three-phase generators

rapid film changers

automatic pressure injectors

advanced catheter technology

all helped to establish angiography as an essential diagnostic tool by the 1960s

• Vascular studies usually require a room or suite of rooms

• specifically designed to accommodate the sophisticated and accessory equipment needed to perform angiography and interventional procedures

Angiographic Equipment

& Room Design

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The procedure room should be large enough to accommodate all of the equipment as well as radiologic and ancillary staff

Special procedures sometimes require a general anesthetic that necessitates extra equipment and staff.

These procedures are also more hazardous to the patient and each room must be equipped to deal with emergencies that may occur

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Remote computerized equipment should also be housed adjacent to the special room.

Although there must be adequate protection for all operators and staff, there must at all times be clear access and view of the patient being examined

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Biplane C-arm digital imaging  Autoinjector syringes, a heating device, a high-pressure mechanism a control panel    Image Intensifying screen   Sliding table

Rapid film changer (NOW DIGITAL*)   Cut film 6 & Cassette changer/magazine

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1. Puncture Needle      Stylet and  Cannula large cannula size

(1.6mm)

2. Guide WireSoft flexible wire with

the strength to pass through curved vessels

(.6 – 1.0)

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(having 2 tubes simultaneously)

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A C-arm or U-arm device is preferable

the equipment can be rotated rather than the patient when visualization of the catheter is critical

simultaneous biplane visualization exposures are needed to reduce the numberof injections of contrast required

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Generator:

This must be a three-phase or high-frequency 12-pulse machine and at least 1000 mA to accommodate the rapid, short, and high exposure values required in angiography

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X-ray tube:

High-speed rotating anode tubes. The object of an angiogram is to produce the highest quality radiographs in the shortest time possible

a 0.3 mm small focal spot will produce the best detail

tube rating can be exceeded because of the rapid succession of exposures needed

usual to have a 0.6-mm focal spot tube

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In most angiographic studies contrast must be administered at a

consistent speed either faster as in abdominal angiography or slower as in lymphangiography

SAFETY MEASURES: P 638LIGHT / ALARM /

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Warms contrast – improve viscosity Piston – motor driven plunger SAFETY MEASURES (p.638) Flashing light – audible tone – message OPERATIONAL ERROR – OMISSION PREVENTS EXESSIVE PRESSURE FLOW RATE

CONTROLLED

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After coronary angioplasty, pt will be moved to a special care unit.

He stay there for a few hours or overnight.

He must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely.

Nurses will check pt heart rate and blood pressure.

They also will check your arm or groin for bleeding.

After a few hours, pt will be able to walk with help.

The place where the catheter (Sheath) were inserted may feel sore or tender for about a week.

How much activity or exercise pt can do.

When pt should follow up with his doctor.

What medicines patient should take.

What you should look for such as a signs of infection around the area where the sheath was inserted.

When pt should call his doctor. For example, you may need to call if you have shortness of breath; a fever; or signs of infection, pain, or bleeding.

Your doctor will prescribe medicine to prevent blood clots .

Taking medicine as prescribed is very important.

If you got a stent during angioplasty, the medicine reduces the risk that blood clots will form in the stent.

Blood clots in the stent can block blood flow and cause a heart attack.

Lifestyle changes may include: Changing diet. Quit smoking Doing physical activity regularly. Losing weight or maintaining a healthy weight. Reducing stress.

Arterial sheaths will be removed by designated personnel, or a cardiologist.

When: No hematoma will develop at sheath site. Patient will maintain adequate perfusion to

affected extremity.

Discontinue heparin drip, as per doctor order.

Verify that dressing supplies are available - 4x4 elastoplasts.

Have 0.9% NS IV infusion set up.

Have Atropine available as per doctor order.

Monitor HR, B/P and O2 saturation q 10 minutes x 30 minutes immediately after sheath removal.

Follow your hospital policy. Then monitor vital signs q 15 minutes x 1 hour, then

q 30 minutes x 1 hour, then q 1 hour x 2 hours.

Assess circulation, motion and sensation to both feet.

Apply PRESSURE to site not less than 30 minute and as per doctor order. ( FemoStop).

FemoStop / Gold Compression Assist DeviceThe FemoStop Gold Compression Assist Device includes an integrated digital manometer and transparent, inflatable dome that offer precise, hands-free femoral artery or vein compression.

Compared to manual compression, FemoStop Gold has been shown to help achieve homeostasis quicker and more comfortably, while helping to improve staff efficiency.

Maintain bed rest while pressure is in place. No bending of groin is permitted. May turn side

to side for back care. May resume diet, per doctor order.

Obtain 12-lead EKG.

Notify your doctor for: a. Absent or diminished pulse in affected limb. b. Presence of a hematoma. c. Symptomatic bradycardia or other arrhythmia. d. Bleeding at insertion site. e. Recurrence of chest pain.

PATIENT TEACHING: Reinforce need for: no bending of affected limb, frequent

vital signs and pulse checks, bed rest per doctor order post sheath removal.

Instruct patient to report any numbness, tingling or acute pain of affected limb, or right/left lower quadrant abdominal pain.

Image

IVUS brings the diagnostic process to a new level of detail. By sending, receiving and processing sound waves, IVUS creates a cross-sectional picture of an artery. This cross sectional picture can offer a tremendous amount of information:

Plaque compositionLumen measurementsImportant morphologic featuresPre and Post-therapeutic assessment

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Stenting of smaller vessels Vessels ≤ 3mm

Intra-stent restenosis Visualize the stent

Difficult to assess lesions More sensitive plaque detection