is a therapeutic radiologic procedure designed to dilate or reopen stenotic or occluded areas within a vessel using a catheter introduced by the Seldinger technique.
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENT PLACEMENT (PTA)
PTA First described by ? & ? in ? using ?method.
Dotter and Judkins
1964
coaxial catheter
In ?
both ? & ?introduced double lumen balloon tipped catheter.
1974 Gruntzig and Hopff
Balloon diameter is often the measure of the normal artery ? to the stenosis
● After guidewire is positioned across the stenosis, the angiographic catheter is removed over the wire and the balloon tip catheter is inserted.
adjacent
A mixture of ? & ? material is used to inflate the balloon. The contrast material helps to visualize the balloon when it is inflated.
● The balloon catheter also has ? (either at the center or on either side of the balloon). This helps the angiographer know the location of the otherwise “invisible” balloon.
saline and contrast
metallic markers
? and ? in ?described the use of balloon angioplasty for dilation of strictures w/in the billiary system
● Is also conducted in venous structures and in ureteral and GI tracts
Molnar and Stockum (1978)
A mixture of ? & ? material is used to inflate the balloon. The contrast material helps to visualize the balloon when it is inflated.
● The balloon catheter also has ? (either at the center or on either side of the balloon). This helps the angiographer know the location of the otherwise “invisible” balloon.
saline and contrast
metallic markers
Some technologies involve the use of lasers. In laser-tipped angioplasty, laser energy is directed through a special catheter and pulsed at the atheromatous mass to vaporize it.
● In ? a laser heated probe is advance through an atheroma to recanalize the vessel lumen.
thermal angioplasty
?catheter system has a blunt cam at the distal tip of the catheter that rotates at speeds of ? rpm. A fluid mixture is infused through the catheter as the cam rotates. Together the rotating cam and fluid spray cut and recirculate atheroslecrotic material until it s vaporized
Kensey
100,000
?catheter has, at its distal end, a cylindrically shaped chamber open along one side and balloon on the other.
Simpson atherectomy
Transcatheter embolization was first described by ? in ?. vessel occlusion for closure of arteriovenous fistula
● Transcatheter embolization involves the therapeutic introduction of various substances to occlude or drastically reduce blood flow w/in a vessel
Brooks in 1930.
?was first described by Brooks in 1930. vessel occlusion for closure of arteriovenous fistula
● involves the therapeutic introduction of various substances to occlude or drastically reduce blood flow w/in a vessel
Transcatheter embolization
- When occlusion is temporary, for example in GI bleeding, occlusion need only be sustained until adequate hemostasis occurs.
○ Is a spongelike substance that can be formed into large or small pledgets, may be used and injected into the vessels. CM is injected after to check progress of occlusion. Gelfoam will remain intact for a number of days.
Gelfoam
can be used to temporarily reduce blood flow. It does not function as an emboli but drastically constricts the vessels w/c results to hemostasis
Vasoconstricting drugs
When permanent occlusion is desired, as in trauma to the pelvis that causes hemorrhage or when vascular tumors are supplied by large vessels, the ?s most widely used.
Gianturco stainless steel coil i
Looped segment of guidewire w/ ? fibers attached that functions to produce thrombogenesis. Numerous coils can be “stacked” as needed to occlude the vessel
dacron
– used to treat symptomatic fibroids. Embolization of the uterine artery can shrink the fibroids and eliminate pain and bleeding, thus replacing hysterectomy
Uterine fibroid embolization
– most commonly used for hepatic malignancies.
Chemotherapy agent is injected into the tumor vasculature
Chemoembolization
– this provides an alternative to patients w/ brain aneurysms that are inoperable or of high surgical risk. With the use of specially designed microcatheters, this procedure employs detachable coils to completely occlude the aneurysmal sac and neck
Intracranial endovascular coil embolization
is usually a blood clot, but it does not form in the lungs. Instead, it forms as a thrombus, usually in the deep veins of the leg. When such thrombus becomes dislodged and migrates, it is called an embolus.
pulmonary embolus
An? is indicated for patients who have recurrent pulmonary emboli or who are at high risk for developing them (e.g.,
patients with pelvic and lower extremity fractures after trauma).
IVC filter
The filters are percutaneously inserted through a ?(3) usually for placement in the inferior vena cava just inferior to the renal veins.
● Placement inferior to the renal veins is important to prevent renal vein thrombosis, which can occur if the vena cava is occluded superior to the level of the renal veins by a large thrombus in a filter
femoral, jugular, or antecubital vein,
● Used for administering chemotherapy or large amounts of antibiotics, for frequent blood test, and for total parenteral nutrition (TPN)
Venous Access Devices
?– may remain for 6 months. Proximal tip is placed near the R. atrium and distal tip remains exposed and must be covered
Peripherally Inserted Central Catheter (PICC line)
