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Vascular emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
CT aortography A relatively rapid and non-invasive investigation that will confirm the diagnosis in stable patients and with contrast image enhancement visualise the extent of the dissection. It is not appropriate for haemodynamically unstable patients.
Management of Acute Intestinal Ischaemia
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Michael J. Stamos, John V. Gahagan
Endovascular approaches to the management of acute mesenteric ischaemia are still in evolution. A purely percutaneous endovascular approach does not allow for direct visual assessment of intestinal viability. This modality may be best suited for the management of chronic mesenteric ischaemia when the concern for acute intestinal threat is minimal. Access is typically gained through the common femoral artery or, less commonly, through the brachial artery. A catheter can then be placed to perform aortography and angiography to evaluate the extent of disease. Cross table images are used to evaluate the origins of the coeliac artery and SMA, whilst anteroposterior images are used to evaluate the more distal arterial segments. Additional, the coeliac or SMA can be individually cannulated for more selective imaging. Lesions that are completely occlusive can be initially managed with local infusion of thrombolytic agents. Residual stenotic segments can be treated with balloon angioplasty and stent placement as necessary.
Ventriculography and aortography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Aortography is the radiographic technique used to opacify the lumen of the aorta, the superior aspect of the aortic valve leaflets, and all of the vessels that arise from the aorta.[26] Noninvasive radiographic evaluation of the aorta and its branches has evolved rapidly because of advancements in imaging techniques such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Nevertheless, catheter-based angiographic evaluation remains an integral part of the diagnostic process and the main guide to choosing an intervention (either endovascular or surgical). An ascending aortogram allows one to determine the competency of the aortic valve, the anatomy and diameter of the ascending thoracic aorta, and the presence of aortic dissection or of patent aortocoronary bypass grafts. When the catheter is positioned proximal to the innominate artery, the examiner may evaluate the anatomy of the aortic arch and its major arterial branches (e.g., to guide percutaneous revascularization of the subclavian or the carotid arteries), detect the presence of a persistent ductus arteriosus or coarctation, and gain information about the descending thoracic aorta. When the catheter is positioned more distally, one may evaluate aneurysms, dissections, and abnormalities of the abdominal aorta and its arterial branches (Figure 21.9).
Pathways Towards Lean TAVR
Published in Structural Heart, 2020
Maarten P. Van Wiechen, Joris F. Ooms, Thijmen W. Hokken, Marjo J. De Ronde-Tillmans, Jeannette A. Goudzwaard, Joost Daemen, Peter P. De Jaegere, Francesco U. Mattace-Raso, Nicolas M. Van Mieghem
Local anesthesia precludes the use of transesophageal echocardiography (TEE) during the procedure, which is traditionally used for paravalvular leak (PVL) assessment. In our practice, TEE has been replaced by the integration of contrast aortography and calculation of the aortic regurgitation index (ARI). The ARI is the ratio of the transvalvular gradient to systolic blood pressure, where the transvalvular gradient is determined by the difference between diastolic blood pressure and left ventricular end-diastolic pressure. ((DBP – LVEDP/SBP)x100)21 (Figure 1). Using the dicrotic notch index (DNI) to assess for PVL is currently under investigation.22 The DNI does not require LV measurements, alleviating the need for a LV pigtail, which can further strip down the TAVR-procedure.
Multi-Pigtail Technique is Associated with Decreased Contrast Use and Fluoroscopic Adjustment for Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
Maia L. Eng, Sarah A. Chen, Garima Agrawal, Jeffrey A. Southard, Thomas W. R. Smith, Garrett B. Wong, Walter D. Boyd, Reginald I. Low, Gagan D. Singh
There was no significant difference between the two groups in rates of any vascular complications (24 events in the OP group vs 38 events in the MP group, p = 0.59; Table 3). When broken down by primary and secondary access site complications, there was no differences based on the OP vs MP approach. Rates of AKI, in-hospital MACE, 30d MACE, and 1-year MACE were not different between the two groups. In a linear regression analysis accounting for differing baseline demographics, use of MP technique was independently associated with reduced contrast volume (ß −34.0; 95% CI −50 to −18; p = 0.001) and fluoroscopy time use (ß −4.4; 95% CI −8.0 to –0.6; p = 0.022). Use of MP technique was not independently associated with a number of aortography (ß −0.3; 95% CI –0.9 to 0.3; p = 0.366) and time to deployment (ß −3.0; 95% CI −6.9 to 1.0; p = 0.143).
Quantitative assessment of aortic regurgitation following transcatheter aortic valve replacement
Published in Expert Review of Cardiovascular Therapy, 2021
Mitsunobu Kitamura, Maximilian Von Roeder, Mohamed Abdel-Wahab
The major advantage of using these invasive parameters is the possibility of immediate evaluation during the index procedure, which is relevant for the decision-making process for additional corrective procedures after THV implantation. Indeed, the combination of aortography and hemodynamic assessment has been routinely integrated in the clinical setting, whereas transthoracic (or transoesophageal) echocardiography is useful to specify the mechanism of AR and to optimize the following therapeutic decision. As a major limitation, these parameters require an invasive left-sided catheterization and simultaneous pressure recording of the aorta and LV, which narrows the utilization for the immediate implantation setting and not for follow-up assessment.