Management of Acute Intestinal Ischaemia
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 in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Once the SMA is adequately exposed, a portion of the SMA just proximal to the middle colic branch is identified and circumferentially cleared. The artery at this location is sufficiently large to accommodate a bypass procedure, if necessary. If systemic heparinisation was not started pre-operatively, it should be given now. Proximal and distal control is obtained with vessel loops. The artery can then be opened with a transverse arteriotomy. Alternatively, a longitudinal arteriotomy can be made if the vessel is diminutive and should subsequently be closed with a vein patch. The proximal control on the SMA can be released to allow for any clot to be removed. A 3-Fr or 4-Fr balloon catheter can then be inserted to retrieve any proximal embolus or residual clot. Once complete, brisk pulsatile flow will be noted. Proximal control is again obtained, and attention is turned to the distal SMA. A 2-Fr or 3-Fr balloon catheter can be used for distal embolectomy. The distal mesenteric vessels can be fragile, so it is important to perform this manoeuvre with great care so as not to rupture the vessel.
Infection control procedures
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
Infectious risks of interventional cardiology procedures may be classified in several ways. We find it useful to consider separately the risk of blood-borne viruses, infections associated with vascular access or incision sites, and infections related to permanently retained devices. Blood-borne virus infections are uncommon so long as single-use devices are not reprocessed or reused. Such transmission events are generally either patient-to-healthcare-worker, or rarely, healthcare-worker-to-patient. Vascular access infections are uncommon in electrophysiology, due to predominantly venous catheterisation sites and short device dwell-times. Arterial vascular access sites are more prone to infection, particularly if arteriotomy closure devices are used. Infection of coronary stents is remarkably rare.
Carotid Arteriography
Peter A. Schneider, W. Todd Bohannon, Michael B. Silva in Carotid Interventions, 2004
Either a 4 or 5 Fr sheath is used depending upon the anticipated usage of 4 or 5 Fr catheters. The dilator and the sheath are irrigated and wiped with heparinized saline. Lock the dilator hub in place so that it does not back out while the sheath is being advanced. A small-caliber sheath can almost always be placed by using a starting guidewire. The guidewire in place should be advanced far enough so that the floppy tip is well inside the patient and that the entry site is crossed by the sheath while it is on the stiff portion of the guidewire shaft. The sheath is loaded onto the guidewire and advanced all the way to the entry site as the guidewire is pinned by the assistant. The sheath is held along its shaft near the tip so that it does not buckle while going through the skin and soft tissue. Sometimes it is helpful to rotate the sheath back and forth to get through the subcutaneous tissue. Place the sidearm port toward the operator. Pressure is maintained at the arteriotomy with the nondominant hand until the sheath goes into the artery. Advance the sheath to its hub. After the sheath is placed, take out the dilator, aspirate through the sidearm port and flush with heparinized saline. The sheath is flushed intermittently during the case.
The effect of ticagrelor on microarterial thrombosis in an experimental model
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Mehmet İhsan Okur, Ahmet Çetinbaş, Serdar Altun, Mehmet Öztan, Aysun Yıldız Altun, İbrahim Özercan
The subjects were laid on their backs, and the fur in their right and left inguinal regions was shaved. The surgical site was disinfected with povidone/iodine solution (Batticon, ADEKA, Istanbul), and the surgery was started. Following skin incision, a blunt dissection was used for the identification of the femoral pedicle, and both femoral vessels were isolated and cross-clamped. The femoral artery was placed into a double microvascular clamp, and excess adventitia was trimmed. A 180-degree arteriotomy was formed using microscissors, and the repair was initiated. Afterwards, a 180-degree arteriotomy was formed. A 9-0 Prolene monofilament suture was used for to create a ‘tuck’ of adventitia into the lumen of the vessel using an operating microscope and microvascular instruments, as specified by Stepnick et al. [6] (Figure 1). The suture was placed through the vessel's distal end and brought out closer to the arteriotomy site, but still on the distal side. Afterwards, the suture was passed from within the lumen of the arteriotomy out through the proximal wall of the vessel. Additional sutures were placed to assure hemostasis. The cross-clamps were removed and blood flow was observed. Any small leaks observed in the suture line were stopped within 1–2 min after a was buffer made using the fat pad. Up-lift and milking tests were performed distal to the suture line. In these tests performed at the first and fifth and minutes after suturing, blood flow through the suture line was detected in all subjects. The surgery was completed by closing the incision with skin sutures.
Deployment of acute mechanical circulatory support devices via the axillary artery
Published in Expert Review of Cardiovascular Therapy, 2019
Raj Tayal, Colin S. Hirst, Aakash Garg, Navin K. Kapur
Post-procedural hemostasis in the axillary artery is most commonly achieved by the use of suture mediated vascular closure devices (VCD), although their use remains off label [29]. The double Perclose ‘pre-closure’ method is the most commonly employed strategy and has been associated with the highest rates of success [6,8,22]. If prolonged implantation is anticipated, a single ‘pre-closure’ Perclose device is placed to facilitate percutaneous removal of the 9Fr device after peel away sheath is removed and to control arteriotomy site oozing by gently tugging on the non-locking suture. The risk of infection associated with delayed closure of the arteriotomy with pre-closure sutures left in place is low. Of 69/228 patients (30%) with pre-closure sutures placed followed by delayed removal of an Impella CP device after leaving the catheterization laboratory, successful hemostasis was achieved in 99% (68/69) of patients and not one had a localized groin infection or vascular site complication requiring blood transfusion [30].
The Safety and Efficacy of a Minimalist Approach for Percutaneous Transaxillary Transcatheter Aortic Valve Replacement (TAVR)
Published in Structural Heart, 2020
Yumiko Kanei, Waqas Qureshi, Nirmal Kaur, Jennifer Walker, Nikolaos Kakouros
Procedural characteristics are described in Table 2. Device implantation was successful in 100% of patients. All but one patient underwent the procedure with MAC and PEC-1 nerve block. One patient had multiple comorbidities and general anesthesia was chosen based on clinical judgment by the anesthesiologist. The SAPIEN3 balloon-expandable valve (Edwards LifeSciences, Irvine, CA) was used in most patients using 14Fr or 16Fr sheath according to valve size. Fifty-six percent of patients had the left axillary artery approach. Median fluoroscopy time was 20.1 minutes, which was longer than the TF control arm (15.5 minutes, P = 0.0004). Axillary access was closed with 2 Perclose Proglide™ closure devices with proximal balloon occlusion of the subclavian, and based on the subclavian angiogram result, an additional closure device (Angio-Seal™, St. Jude Medical, Austin, TX) was used in 5 patients (22%), with successful hemostasis in all patients. Two patients required balloon angioplasty of the arteriotomy site, and one patient had significant left subclavian artery stenosis requiring subsequent surgical repair. Overall procedure time decreased over time. After excluding the patient who had surgical intervention for subclavian stenosis (case 2) and combined PCI/TAVR procedure (case 16), the median procedure time of the second half of cases was significantly shorter than for the first half of cases (113 minutes vs 87 minutes, P = 0.04).
Related Knowledge Centers
- Scalpel
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