Peripheral vascular angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Peripheral arterial disease (PAD) is a condition that describes atherosclerosis involving major vascular beds. These vessels include the aorta, aortic arch vessels, mes- enteric, upper extremity, iliacs, femoral, popliteal, and tibio-plantar circulation. The prevalence of PAD has been increasing worldwide and the number of patients suffering from PAD is expected to increase by 15% in Western coun- tries and 30% in developing countries. [1] This increase is a reflection of other comorbidities driving the rise in numbers. Patients with PAD suffer from higher morbidity and mortal- ity. [2,3] There are multiple modalities to evaluate patients with PAD. Endovascular revascularization of patients with PAD is becoming a front-line strategy. This has been adopted by multiple disciplines, including vascular surgery, radiology, and cardiology. Bypass surgery is an excellent procedure in appropriately selected patients. [4,5] However, many PAD patients may not be adequate candidates for surgical bypass. Endovascular therapy has been fueled by continuous inno- vation in techniques and devices. [6] Prior to revascularization, patients need to be adequately assessed by noninvasive and physiological testing. However, there are some limitations in applying these tests. Peripheral vascular angiography may be argued as the gold standard when it comes to assessing vessel patency. This chapter focuses on evaluation of vessel patency from an endovascular revascularization perspective.
Peripheral Vascular Disease in Older Adults with Diabetes
Medha N. Munshi, Lewis A. Lipsitz in Geriatric Diabetes, 2007
The goal of arterial reconstructive surgery is to restore adequate blood flow, decrease claudication, decrease rest pain, and heal ulcers. To achieve this, the treatment plan involves bypassing all major occlusions, and with diabetic tissue loss, to restore a palpable pulse. In diabetes, the typical pattern of atherosclerosis in the lower extremities is tibial vessel occlusion with restoration of the foot vessels. Generally, because of the extent of the disease, bypasses are performed to the foot itself. Contraindications to bypass surgery include active angina, recent myocardial infarction, acute renal failure following an arteriogram, sepsis, and recent congestive heart failure. Other patients who may not be appropriate candidates for arterial reconstruction include those with dementia and/or other organic brain syndromes, who are nonambulatory or bedridden and have no likelihood of successful rehabilitation. Similarly, patients with severe flexion contractures of the knee or hip are poor candidates.
Open central and peripheral venous reconstructionComplications and strategies for managing these complications
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
Complications from the saphenopopliteal vein bypass include: surgical site infection, hematoma, and early graft occlusion/failure. The clinical presentation of these complications may manifest as chronic lower extremity edema and venous claudication that is refractory to medical and surgical treatment. Early postoperative complications benefit most from operative intervention, so it is imperative to maintain close surveillance to detect hematomas or signs of early graft occlusion/failure. This includes the use of venous duplex scan for bypass surveillance. Hematomas may cause external compression and subsequent early graft occlusion, and as such early surgical decompression is recommended.30 Open thrombectomy of the occluded vein bypass may be warranted in the scenario where the hematoma has already caused graft thrombosis. Early graft occlusion or failure, defined to occur within 30 days of initial bypass surgery, without concomitant hematoma also requires intervention depending on the etiology. Graft patency does not seem to be associated with severity of disease (CEAP score).30 Graft revision should always be considered to restore secondary patency. Some causes of early graft occlusion include, but are not limited to, kinking and twisting of the graft, inadequate inflow or outflow, and inadequate anticoagulation. Following the additional intervention, good venous health practices should continue as described above.
Numerical study of hemodynamics in a complete coronary bypass with venous and arterial grafts and different degrees of stenosis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Shila Alizadehghobadi, Hasan Biglari, Hanieh Niroomand-Oscuii, Meisam H. Matin
One of the most prevalent cardiovascular diseases is coronary artery disease which is the leading cause of death all over the world (Wong 2014). The stenosis or blockage of the artery brings about a reduction of blood flow to the heart muscle and therefore causes problems for blood supply to the heart. One of the main treatments for the coronary artery blockage is bypass surgery in which an alternative graft is used to compensate for the blood flow reduction through the coronary artery (Arima et al. 2005; Deb et al. 2013). This graft is connected to the aorta from upstream and to the coronary artery from downstream. Internal thoracic artery (ITA) and small saphenous vein are the commonly used vessels in bypass. The main issue encountered after the bypass surgery is stenosis or partial blockage of the graft which occurs due to the variations in the hemodynamic conditions leading to the failure of the grafting. The hemodynamic conditions strongly depends on the mechanical properties of the artery tissues. Since the accurate experimental evaluation of the parameters is almost elusive due to the challenges associated with the ultrasonic velocity measurement, numerical simulations can examine the flow conditions and hemodynamics conveniently but with some limitations. Owida et al. (2012) provided an overview on numerical simulations of the flow pattern and wall shear stress in the occluded coronary arteries.
How Will the Heart Team Evolve?
Published in Structural Heart, 2019
Anthony N. DeMaria
Taken at face value, it would appear that those likely to be most affected by the changing role of transcatheter and surgical interventions for cardiovascular patients will be cardiac surgeons. While surgical volumes may decrease a bit in the future, l believe that there will still be a sizable group of patients that are best treated with an operative approach. It is clear that many coronary artery disease patients are currently best managed with bypass surgery. In addition, it has long been recognized that many heart valve patients with an established indication for interventional therapy are not being referred for treatment. The attraction of percutaneous therapy is likely to lead to the referral of many more of these patients for intervention, and it is to be expected that a number of these patients will be better candidates for surgery than catheter intervention. Obvious situations in which valve surgery would probably be most desirable include concomitant morbidities such as CAD or aortic aneurysm. In addition, it is anticipated that surgical procedures will continue to advance in the future, becoming less invasive and even more effective. So I see little reason to believe that surgical volumes will decrease dramatically.
Combined liver transplantation and off-pump coronary artery bypass grafting: a report of two cases
Published in Acta Chirurgica Belgica, 2022
Tumay Uludag Yanaral, Gokhan Ertugrul, Mustafa Ozer Ulukan, Pelin Karaaslan, Ibrahim Oguz Karaca, Murat Dayangac
In our institution, all liver transplant candidates are referred to the cardiology department for clinical and functional assessment. Cases with critical coronary artery stenosis (>70%) in coronary angiography are further discussed in a multidisciplinary cardiology meeting. Principally, patients who are eligible for percutaneous coronary intervention (PCI) are referred to the interventional cardiology unit. Following PCI using drug-eluting stents, dual antithrombotic therapy, including acetylsalicylic acid and clopidogrel is continued for a minimum of three months, and then switched to monotherapy with acetylsalicylic acid for LT surgery. Combined coronary artery bypass surgery (CABG) and LT are considered in patients with multi-vessel CAD who are not candidates for PCI or in severe ESLD cases that cannot tolerate the three-month waiting period after PCI.
Related Knowledge Centers
- Angina
- Coronary Artery Disease
- Great Saphenous Vein
- Stenosis
- Ischemia
- Cardiopulmonary Bypass
- Radial Artery
- Surgical Anastomosis
- Left Anterior Descending Artery
- Anatomy of The Human Heart