Lower extremity fractures
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Proximal tibial physeal fractures are rare injuries that usually occur with a high-energy mechanism, often during sports [72, 73]. Because the popliteal artery is tethered posteriorly and the spike of the metaphyseal fragment in these fractures displaces posteriorly, arterial injury should be evaluated whenever this fracture is encountered [72, 74, 75]. X-rays should be obtained. The diagnosis is easily made if the fracture is displaced, but it is possible for the fracture to have spontaneously reduced or to have been reduced by coaches, parents, or medical personnel prior to presentation to the emergency department (Figure 20.3.38) [72, 74, 75]. Due to the risk of arterial injury at the time of injury, promp diagnosis of this fracture is important. Ankle-brachial index measurement and frequent monitoring for arterial insufficiency is important. Angiography should be considered if there are any concerns for arterial injury. Compartment syndrome and peroneal nerve injury are also potential complications of these injuries [72]. Reduction in the emergency department may be considered if there is no neurovascular compromise. If there is concern for a vascular injury, reduction should be performed in the operating room under anesthesia. If the fracture is unstable after reduction, crossed pins may be placed to stabilize the fracture. A long leg cast is applied and can be bivalved if there are concerns for swelling or compartment syndrome.
Other devices and how to use them
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
During infusion with thrombolytic agent, the patient undergoes intermittent laboratory analysis including hematocrit, platelet level, thrombin level, prothrombin time, and partial thromboplastin time. If the thrombin level drops below 100 IU/mL, the lytic agent should be stopped. The complications of chemical thrombolysis increase with the time required for the infusion and the overall dose. A typical dosing regimen for tPA for an occluded lower extremity bypass is to lace the clot with 2–6 mg of tPA then run the infusion at 1 mg/hour for 4 hours and then decrease it to 0.5 mg/hour after that. Most of the improvement that can be expected will be seen within the first 8 hours. Typically, if there is a change clinically or if several hours have gone by, then it is time to repeat the angiography and check the progress. Chemical thrombolysis may be combined with aspiration thrombectomy. A standard aspiration catheter may be placed over the guidewire and used to aspirate any thrombus that can be removed in this manner.
Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
The abdominal aortogram is first performed in a standard PA projection using digital subtraction. Our practice is to use a 5-Fr system with a total volume of 10-20 mL of contrast at a rate of 10 mL/sec. Patients should be instructed not to breathe or move prior to angiography. Lateral projection aortography may then be performed to visualize the mesenteric arteries since these vessels arise anteriorly (Figure 24.6). This should also be done with digital subtraction, and similar settings may be used. If the renal arteries are the sole focus of the study, a 15° LAO projection is recommended and can be performed using a smaller amount of contrast (10 mL/sec for 10 mL total). For these studies, the contrast may be diluted as 70% dye and 30% heparinized saline. This dilution technique reduces the total contrast exposure and still results in acceptable image quality.
Intravenous fluids for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography and cardiac catheterization
Published in Expert Review of Cardiovascular Therapy, 2020
Winston Y Hong, Mohamad Kabach, George Feldman, Ion S Jovin
Contrast-induced nephropathy (CIN) has been a well-studied phenomenon since its first description by Bartels et al. in 1954 [1]. Iodine-based contrasted studies have had multiple clinical applications, from diagnostic to therapeutic interventions in several organ systems. Angiography involves the injection of radiopaque contrast into the vasculature, in order to properly visualize both organs and blood vessels. Contrast is injected into either the arterial or venous systems depending on the study. The iodinated contrast is eventually renally cleared. The contrast exposure can often lead to side effects, the most common being CIN, making it the third-leading cause of acute kidney injury in the hospital [2]. Many studies define CIN as a 25% relative increase in serum creatinine within 3 days of contrast exposure while others define it as an absolute increase of 0.3 mg/dL above baseline [3], across the same timeframe. There is not a universally agreed-upon definition of CIN at this time. Essentially, it is an acute kidney injury (AKI) in the setting of contrast use.
In-hospital outcomes of angiography versus intravascular ultrasound-guided percutaneous coronary intervention in ST-elevation myocardial infarction patients
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Mazin Khalid, Neel Kumar Patel, Birendra Amgai, Ahmed Bakhit, Mowyad Khalid, Paritosh Kafle, Sandipan Chakraborty, Vijay Gayam, Osama Mukhtar, Yuri Malyshev, Arsalan Hashmi, Jignesh Patel, Jacob Shani, Vinod Patel
Our analysis showed a statistically significant difference in the rate of coronary dissection in patients undergoing IVUS with a fourfold increase in the OR. This increase might be due to factors related to the culprit lesion. As angiography is an invasive procedure; therefore, it is considered operator dependent, and the complications can be attributed to the different techniques used during the procedure. IVUS has been widely used to assist in the diagnosis of spontaneous coronary artery dissection due to better visualization of the flap or intramural hematoma [20]. The high number of coronary artery dissection cases observed in the IVUS group may be due to a primary spontaneous coronary artery dissection (SCAD) presenting as a STEMI, rather than an iatrogenic dissection caused by the procedure. Available literature reported a general complication rate of 0.5% to 4% when IVUS is used. The reported complications included coronary spasms, coronary dissection, femoral artery aneurysms, and rarely coronary rupture [1]. SIPS trial reported similar coronary dissection in 3% of the cases where IVUS was utilized and 3.2% in angiography arm [21].
Optical coherence tomography angiography (OCTA) flow speed mapping technology for retinal diseases
Published in Expert Review of Medical Devices, 2018
Malvika Arya, Ramy Rashad, Osama Sorour, Eric M. Moult, James G. Fujimoto, Nadia K. Waheed
Optical coherence tomography angiography (OCTA) is a noninvasive imaging technique that provides depth-resolved imaging of retinal vasculature. While fluorescein angiography (FA) has been the gold standard for the diagnosis of retinal and choroidal vasculopathies, OCTA is now able to provide most of the same information. FA and indocyanine green angiography (ICGA) allow for the visualization of chorioretinal vessels, but their procedures require the injection of a contrast agent. Dye-based angiography provides two-dimensional images and requires imaging of initial, intermediate, and late phases, extending over several minutes. Potential systemic adverse effects, such as nausea, vomiting, and anaphylaxis further limit the frequency with which FA/ICGA can be performed in a clinical setting. Kwan et al. found 132 adverse events from 11,898 FA injections, with nausea and vomiting being the most common [1]. However, despite these drawbacks, FA and ICGA currently offer certain advantages over OCTA, such as the ability to image a wider field, the visualization of vessel leakage, and the improved detection of microaneurysms and areas of slow flow [2–6].
Related Knowledge Centers
- Fluoroscopy
- Vein
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- X-Ray
- Radionuclide Angiography
- Carbon Dioxide Angiography