Bile duct stones
David Westaby, Martin Lombard in Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Balloon catheters for stone extraction are available in various sizes allowing a choice of catheter in relationship to the size of the bile duct. The balloon catheter can be advanced into the bile duct either with or without the prior placement of a guidewire. The advantages of a guidewire are the ability to gain repeated access to the duct, particularly in difficult complicated cases. The catheter is advanced beyond the stone and then inflated to a diameter which fills the bile duct at that level. This is then slowly withdrawn with the stone passing through the sphincterotomy under the traction of the balloon catheter. One of the disadvantages of this technique is the ability of stones to roll proximally around the balloon and into the proximal duct. Repeated withdrawals of the balloon catheter under such circumstances may give a false impression that the duct is clear. It is important that a cholangiogram be obtained finally to confirm duct clearance before ending the procedure. The main advantage of the balloon catheter is its ability to sweep from the bile duct any small stones and fragments which would be missed by a standard basket technique.
Angioplasty Balloons and Technique
Vikram S. Kashyap, Matthew Janko, Justin A. Smith in Endovascular Tools & Techniques Made Easy, 2020
The angioplasty balloon has multiple structural parameters. Balloons come in different sizes that correspond to the balloon diameter, balloon length, and length of the balloon catheter. Diameters start as small as 1.0 mm and can go beyond 40 mm (specialty aortic balloons). Smaller balloons typically increase by 0.5-mm increments until they reach a diameter of 5 mm, then increase by 1 mm up until 10 mm, and then increase by 2 mm up to about 24 mm. Balloon length describes the length of the balloon segment and range from about 10 mm to greater than 300 mm. The catheter itself that delivers the balloon can be as short as 40 cm or longer than 170 cm. Selection of the catheter length depends on the site of the lesion to be treated and the access point. If access is in the groin and the lesion is in the ipsilateral iliac artery, then a short catheter will reach. If the target, however, is distal on the contralateral limb, then a long catheter length will be needed.
The intra-aortic balloon pump: Principles and use
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
Infection associated with presence of the balloon catheter is the second most common complication (3%–4% incidence). Balloon rupture occurs in 1%–4% of cases, although a study cited by Baldyga44 reported a mean incidence for 2 years of 9% and 10.1% with a range up to 17%. Balloon rupture and leakage is assumed to occur due to plaque abrasion. It is more likely to occur in patients with a history of hypertension, those who display a marked diastolic augmentation from the IABP, and in women.41 Consequences of IAB rupture are gas embolism and vascular entrapment of the balloon. Gas embolism resulting in neurological sequelae is a very rare occurrence, even following balloon rupture.41 Balloon entrapment may occur following slow leakage as well as sudden rupture. Rupture and leakage are often first detected by presence of blood in the shuttle gas tubing, although the gas leak alarm may sound, or an increased frequency in balloon refilling may be noted.41
Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients
Published in Journal of Investigative Surgery, 2020
Lingzhi Kong, Yaling Yu, Fujian Li, Haomin Cui
Reduction and fixation in the traditional way were performed on the patients in the control group, and balloon occlusion was carried out in the patients who had severely displaced acetabular fractures with reduction difficulty or unmanageable bleeding during surgery (Figure 1). After anesthesia, a 2-cm long longitudinal incision was performed to expose the femoral artery in the inguinal region after sterilization. Five minutes after systemic heparinization, a Fogarty catheter was inserted into the femoral artery, about 20 cm deep (Figure 2). It was confirmed that the balloon was distal to the renal artery and proximal to abdominal aortic bifurcation using the C-arm (Figure 3). The balloon catheter was carefully fixed. Then, the balloon was fixed with contrast medium to pre-occlude the abdominal aorta and the amount (about 8–10 mL) was recorded. Occlusion was confirmed when the contralateral femoral artery pulse disappeared. When it was difficult to control hemorrhage and perform reduction and fixation after fracture exposure, the balloon catheter was gradually filled with the same amount of contrast medium again. The occlusion duration should not exceed 60 minutes. If necessary, a second occlusion may be performed, but there should be an interval of 10–15 minutes.
Evaluation of portal hypertension in the cirrhotic patient: hepatic vein pressure gradient and beyond
Published in Scandinavian Journal of Gastroenterology, 2018
D. S. Karagiannakis, T. Voulgaris, S. I. Siakavellas, G. V. Papatheodoridis, J. Vlachogiannakos
The gold standard method for the assessment of PH is HVPG measurement, which was first introduced in cirrhotic patients in 1953 by Paton et al [6]. In brief, a catheter is inserted through the jugular or through the femoral vein and then advanced into one of the hepatic veins. Once the wedged position has been reached, the wedge hepatic venous pressure (WHVP) can be measured. WHVP in cirrhotic patients is equal to the PH as fibrosis tends to make the sinusoidal network noncompliant. On the other hand, free hepatic venous pressure (FHVP) is measured at a distance of 2–3 cm from the hepatic vein ostium. The difference between these two pressures equals the HVPG. A modification of the conventional method, the balloon catheter technique was described later. With this method, the FHVP and the WHVP are obtained by deflating and inflating a balloon in the tip of the catheter [7]. The estimation of PH by using HVPG measurements began by the necessity to predict those cirrhotic patients being at higher risk to develop clinical decompensation, an event with direct negative impact on their survival. Generally, a HVPG value of 6–9 mmHg corresponds to preclinical sinusoidal PH [8–10], whereas clinically significant portal hypertension (CSPH) is diagnosed when HVPG is ≥10 mmHg, at which point clinical manifestations might appear (varices, bleeding and ascites) [9–13].
Moving preinduction cervical ripening to a lower acuity inpatient setting using the synthetic hygroscopic cervical dilator: a cost-consequence analysis for the United States
Published in Journal of Medical Economics, 2022
Sita J. Saunders, Jody L. Grisamore, Tess Wong, Rafael Torrejon Torres, Rhodri Saunders, Brett Einerson
The primary consequence assessed by the model was staff, in particular nurse, time that was dependent on the CRA being administered. In addition, the impact of each CRA on key clinical efficacy and safety outcomes were compared for: primary cesarean section rate (patients with a previous cesarean section were excluded from the model), vaginal delivery not within 24 h, and fetal hyperstimulation with fetal heart-rate changes. Time to delivery and oxytocin augmentation events were also reported but note that these items were included in the cost estimation of the CRAs. Clinical events were taken from recent US-based clinical trials when available – selected from all studies identified using the described structured literature search (see also the Supplementary Material). Otherwise, incidences were estimated by using a recent Cochrane review14. Clinical studies directly comparing all four prostaglandins to the SHCD were not available, however, all of the CRA agents have been compared to the balloon catheter13,14. For this reason, the balloon catheter was used to normalize clinical and safety outcomes to improve comparability between studies. Full calculations are provided in the Supplementary Material. Neonatal outcomes were not included in this analysis because the focus of this analysis is on the L&D unit, and the care costs for neonates are accrued in a different setting. Furthermore, data comparing neonatal outcomes is mostly of low-quality evidence14.
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