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Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The main venous intervention is to treat thrombus. A sheath is placed antegradely into the contralateral femoral vein or the ipsilateral popliteal vein, under ultrasound guidance, with the patient in the supine or prone position, respectively. Pre-treatment baseline images are acquired either through the popliteal sheath or by passing a catheter from the contralateral femoral vein, over the IVC confluence and down the ipsilateral femoral vein. Usually only the above knee segment is visualised and treated angiographically. There are a variety of techniques for clearing the thrombus. These include lacing of the thrombosed vessel with a bolus of recombinant tissue plasminogen activator, followed by a thrombolysis infusion. Other techniques may be performed as an adjunct to thrombolysis, such as thrombo-aspiration using a large bore catheter or a dedicated mechanical thrombectomy device. Any underlying stenosis must be treated or the thrombus will recur, so venoplasty and stenting may also be necessary.
Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
If a peripheral vessel in the arms or legs is affected, the risk of a surface thrombus releasing from the surface is high. Embolization of a blood clot leads to a vessel blockage and reduces blood flow downstream, which deprives the tissue of oxygen and leads to necrosis and limb amputation. Embolectomy balloon catheters are part of the market for clot management devices (CMDs), which was valued at US $1.26 billion in 2015 and is projected to grow at an annual rate of 4.6% through 2024.6 Clot management devices include percutaneous thrombectomy devices, used to aspirate blood clots, and catheter-directed thrombolysis devices, which dispense clot-dissolving medication at the thrombus site. Both the increase in atherosclerosis and venous thromboembolism rates and the demonstrated effectiveness of catheter-based therapies contribute to the anticipated growth of the CMD market.
Catheter directed interventions for pulmonary embolism: current status and future prospects
Published in Expert Review of Medical Devices, 2020
Adham N. Abou Ali, Zein Saadeddin, Rabih A. Chaer, Efthymios D. Avgerinos
The contemporary use of CDI has expanded to include catheter interventions with or without thrombolytics. The latter may involve thrombus fragmentation and/or aspiration/suction thrombectomy techniques; typically in patients with major contraindications to thrombolysis. Their safety and efficacy remains controversial but newer devices appear prormising [3,32,47]. Depending on patient factors, contraindications to thrombolytics and physician preference, the appropriate CDI technique is selected.