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Interventional Procedures (interventional + procedure)

Distribution by Scientific Domains

Medical Sciences	92%
2 Other Domains	8%

Distribution within Medical Sciences

Cardiovascular Disease	31%
Surgery & Surgical Specialties	23%
9 Other Subdomains	46%

Selected Abstracts

Assuring quality in HPB surgery , efficacy and safety

HPB, Issue 5 2007
Prof G.J. MADDERN
Surgical innovations have made enormous contributions towards the welfare of patients when they have been appropriate, effective and applied with expertise and overall care. However, the potential for advancement and for harm of new surgical techniques, and the level of expertise necessary for their safe introduction, are not always immediately apparent. Furthermore, it is difficult and time-consuming to assess the efficacy and safety of new procedures in the clinical setting. In 1998 the Royal Australasian College of Surgeons established ASERNIP-S, the Australian Safety and Efficacy Register of New and Interventional Procedures , Surgical, to help ensure that new technologies that are being introduced are well proven in concept, are as safe and effective as possible, and are utilized with high levels of skill underpinned by the level of training. [source]

Application of Interventional Procedures Adapted for Device Implantation: New Opportunities for Device Implanters

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2007
SETH WORLEY M.D.
First page of article [source]

ASERNIP-S: INTERNATIONAL TREND SETTING

ANZ JOURNAL OF SURGERY, Issue 10 2008
Guy Maddern
The Australian Safety and Efficacy Register of New Interventional Procedures , Surgical (ASERNIP-S) came into being 10 years ago to provide health technology assessments specifically tailored towards new surgical techniques and technologies. It was and remains the only organisation in the world to focus on this area of research. Most funding has been provided by the Australian Government Department of Health, and assessments have helped inform the introduction of new surgical techniques into Australia. ASERNIP-S is a project of the Royal Australasian College of Surgeons. The ASERNIP-S program employs a diverse range of methods including systematic reviews, technology overviews, assessments of new and emerging surgical technologies identified by horizon scanning, and audit. Support and guidance for the program is provided by Fellows of the Royal Australasian College of Surgeons. ASERNIP-S works closely with consumers to produce health technology assessments and audits, as well as consumer information to keep patients fully informed of research. Since its inception, the ASERNIP-S program has developed a strong international profile through the production of over 60 reports on evidence-based surgery, surgical technologies and audit. The work undertaken by ASERNIP-S has evolved from assessments of the safety and efficacy of procedures to include guidance on policies and surgical training programs. ASERNIP-S needs to secure funding so that it can continue to play an integral role in the improvement of quality of care both in Australia and internationally. [source]

Issues of consent and privacy affecting the functioning of ASERNIP,S

ANZ JOURNAL OF SURGERY, Issue 8 2002
Maggi Boult
The Australian Safety and Efficacy Register for New Interventional Procedures , Surgical (ASERNIP,S) undertakes horizon scanning, systematic reviews and audits. By disseminating information derived from these processes, ASERNIP,S aims to improve the quality of health care. In the present article, we discuss some of the legal and ethical issues surrounding the collection of identified data for the purposes of audit. The individual's right to privacy is considered as well as the benefits of improving the quality of surgical health care. [source]

Early and Midterm Results of an Alternative Procedure to Homografts in Primary Repair of Truncus Arteriosus Communis

CONGENITAL HEART DISEASE, Issue 3 2010
Pedro Curi-Curi MD
ABSTRACT Background., Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results. Methods., From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit. Results., Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6,51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%. Conclusions., Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis. [source]

Acute Monoplegia After Lysis of Epidural Adhesions: A Case Report

PAIN PRACTICE, Issue 5 2008
DAAPM, Kok-Yuen Ho MBBS, MMed (Anaes)
Abstract Lysis of epidural adhesions is an interventional procedure performed to treat refractory low back pain or radicular pain due to epidural scarring. A 39-year-old female with a diagnosis of failed back surgery syndrome underwent lysis of epidural adhesions using a Racz catheter. She developed acute monoplegia of her right lower extremity immediately after the procedure. Radiographic imaging did not reveal an epidural hematoma. Motor and sensory function in the right lower limb returned after 5 days. Large volumes of fluid injected during neuroplasty could have caused transient nerve injury from compression within loculated epidural compartments. [source]

Changing patterns in interventional bronchoscopy

RESPIROLOGY, Issue 4 2009
Nikolaos ZIAS
ABSTRACT Background and objective: Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach. Methods: A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted. Patients were categorized into two groups according to the procedure used, that is, RB (251 patients), and FB (161 patients) groups. Patients with malignancies were included as a separate subgroup, comprising 178 RB and 117 FB patients. For every procedure, the location of the lesion, patient survival from the first interventional procedure performed, and in patients with malignancy, additional treatments received such as chemotherapy and radiation were recorded. Results: Ninety per cent of RB procedures were performed in patients with tracheal or main stem lesions, while over half the patients undergoing FB had more distal lesions. A trend towards increasing use of FB for interventional procedures in recent years was noted. Conclusions: FB is a valuable alternative to RB for treating less advanced malignant disease or distal airway lesions. [source]

Renal allograft arteriovenous fistula and large pseudoaneurysm

CLINICAL TRANSPLANTATION, Issue 1 2003
Tatsuya Nakatani
Abstract:, The patient was a 51-year-old female. Post-biopsy arteriovenous fistula (AVF) and pseudoaneurysm in a renal allograft were diagnosed 5 yr and 4 months after she received a renal transplantation. Four years after the diagnosis, interventional treatment for the AVF and pseudoaneurysm was performed because of a high risk of pseudoaneurysm rupture. Although the longitudinal diameter of the pseudoaneurysm was more than 5 cm, this AVF and pseudoaneurysm were treated successfully by a percutaneous transluminal embolization, and renal function has remained stable after embolization. A selective interventional procedure proved effective for the large pseudoaneurysm in the renal allograft. Therefore, when a transcutaneous needle biopsy of the renal allograft is performed, although there are no apparent symptoms or signs of vascular complications during the clinical course, periodical examinations such as echo-Doppler imaging should be made on the allograft. [source]

Anaphylactic reaction to intralesional corticosteroid injection

CONTACT DERMATITIS, Issue 2 2007
M. E. Laing
We report the case of anaphylactic reaction to carboxymethylcellulose, a dispersant in corticosteroid preparation and contrast media. Skin prick testing in this patient revealed a positive response to carboxymethylcellulose at a dilution of 1/1000. Anaphylaxis secondary to carboxymethylcellulose has previously been reported. To avoid further problems, this patient was advised to alert medical staff for the presence of allergy to carboxymethylcellulose in the event of the need for further interventional procedures. Care should be taken when giving intradermal steroids to patients with a history of anaphylaxis after contrast media. [source]

MR imaging in assessing cardiovascular interventions and myocardial injury

CONTRAST MEDIA & MOLECULAR IMAGING, Issue 1 2007
Alexis Jacquier
Abstract Performing an MR-guided endovascular intervention requires (1) real-time tracking and guidance of catheters/guide wires to the target, (2) high-resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X-ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR-guidance. Iron particles, or gadolinium- or dysprosium-chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR-guided minimally invasive catheter-based procedures will open up new avenues in treating end-stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real-time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non-invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications. Copyright © 2007 John Wiley & Sons, Ltd. [source]

The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2009
ANDY SC YONG M.B.B.S.
The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory. [source]

Evaluation of Propofol-Ketamine Anesthesia for Children Undergoing Cardiac Catheterization Procedures

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2007
F.F.A. (DUBLIN), F.R.C.A. (LOND), Parthasarathi GAYATRI M.D.
The aim of this study was to assess the safety and efficacy of the continuous intravenous administration of a combination of propofol and ketamine for children undergoing cardiac catheterization procedures (CCP). Thirty-two children scheduled for CCP in a university teaching hospital were included in this prospective randomized study. Patients in group 1 (n = 15) were given a combination of propofol (25 ,g/kg per minute) and ketamine (25 ,g/kg per minute), whereas patients in group 2 (n = 17) received a combination of propofol (25 ,g/kg per minute) and ketamine (12.5 ,g/kg per minute) for the maintenance of anesthesia. There were no statistically significant differences with age, weight, duration of the procedure, and the number of diagnostic and interventional procedures between the two groups. There was no hemodynamic instability, airway compromise, excessive salivation, or arterial desaturation in either of the two groups. There was more incidence of movements in patients who received less dose of ketamine; however, it did not reach to statistically significant level. The total dose of ketamine used in group 1 was 309.25 ± 90.97 ,g/min, whereas in group 2, it was 148.06 ± 34.05 ,g/min. The time to awakening was significantly less in group 2 (P < 0.05). We conclude that a combination of propofol (25 ,g/kg per minute) and two different doses of ketamine (25 and 12.5 ,g/kg per minute, respectively) are safe and efficacious for CCP in children. Although the time to awaken was more in patients receiving 25 ,g/kg per minute of ketamine compared to those receiving 12.5 ,g/kg per minute of ketamine, it was well within acceptable limits. [source]

Closure of a Femoral Pseudoaneurysm by Transcutaneous Short Guidewire Embolization

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2003
D.N.B., RAGHURAMAN BAGIRATH M.D.
Femoral pseudoaneurysm (PSA) is a well-recognized complication following catheter-based diagnostic or interventional procedures. We report a patient who developed a pseudoaneurysm following the insertion of a Steinman pin for a fractured shaft of the right femur following a road traffic accident. The treatment of choice for a femoral pseudoaneurysm is ultrasound-guided compression repair. As this modality of treatment was not applicable to our patient, the pseudoaneurysm was closed by transcutaneous short guidewire embolization technique. (J Interven Cardiol 2003;16:351,355) [source]

ORIGINAL ARTICLE: Radiological review of intercostal artery: Anatomical considerations when performing procedures via intercostal space

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2010
S Choi
Abstract Introduction: The aim of this study was to closely examine the course of the intercostal arteries within the intercostal spaces particularly with regard to where the arteries were located in relation to their adjacent ribs. The degree of tortuosity of the arteries was also examined, along with anatomical differences in different age groups. Methods: A total of 81 patients between the age of 30 and 90 years who had underwent a CT examination of the chest for any indication were included in the study. All studies were performed on a dual source 64 slice CT (Siemens Definition Erlangen Germany). Analysis of the intercostal arteries was performed on a CT workstation using volume rendered 3D reconstructions F, or each patient the 10'n intercostals pacesb ilaterally were examined for the course and tortuosity of the intercostal arteries. Results: The ICA is located relatively inferiorly in the intercostal space at costovertebral junction and it gradually becomes more superiorly positioned within the intercostal space it as courses laterally. This finding was consistent in all age groups. In addition, analysis of the data demonstrated increasing intercostal artery tortuosity with advancing age. Conclusion: In this study we have examined the course of the posterior intercostal arteries using MDCT. This study confirms the classical description of the course of ICA. We have shown that in the medial chest, posteriorly, the artery is located in the inferior half of the intercostal space. As it moves away from the costovertebral junction it travels closer to the inferior border of the rib above and reaches the intercostal groove. We have also shown that the artery tends to be more tortuous in elderly patients, decreasing the area of "safe" space for interventions. Both of these findings are relevant to radiologists and non-radiologists performing interventional procedures via the intercostal space. [source]

Intravascular bioresorbable polymeric stents: A potential alternative to current drug eluting metal stents

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 11 2007
Tahmer Sharkawi
Abstract Stent implantation following angioplasty is the standard treatment of coronary artery disease necessitating interventional procedures. The use of stents as a platform for local drug delivery is a popular strategy to achieve local pharmacological treatment to the diseased artery. Drug eluting stents (DES) are now largely preferred to bare metal stents when stent implantation is necessary. Lately, there have been several reports questioning the long-term safety of DES. An alternative to these drug eluting metal stents are bioresorbable polymeric stents (BPS) because of the many advantages of bioresorbable material. However, the fundamental differences in polymeric and metallic materials make the development of such an alternative a significant challenge. This review discusses the different advantages of BPS and the many constrains and requirements of such devices. An up to date commented review of published data concerning BPS is presented. Considerations are given on using BPS as local drug delivery systems as well as on evaluating BPS performances. © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 96: 2829,2837, 2007 [source]

Visualization of active devices and automatic slice repositioning ("SnapTo") for MRI-guided interventions

MAGNETIC RESONANCE IN MEDICINE, Issue 4 2010
Ashvin K. George
Abstract The accurate visualization of interventional devices is crucial for the safety and effectiveness of MRI-guided interventional procedures. In this paper, we introduce an improvement to the visualization of active devices. The key component is a fast, robust method ("CurveFind") that reconstructs the three-dimensional trajectory of the device from projection images in a fraction of a second. CurveFind is an iterative prediction-correction algorithm that acts on a product of orthogonal projection images. By varying step size and search direction, it is robust to signal inhomogeneities. At the touch of a key, the imaged slice is repositioned to contain the relevant section of the device ("SnapTo"), the curve of the device is plotted in a three-dimensional display, and the point on a target slice, which the device will intersect, is displayed. These features have been incorporated into a real-time MRI system. Experiments in vitro and in vivo (in a pig) have produced successful results using a variety of single- and multichannel devices designed to produce both spatially continuous and discrete signals. CurveFind is typically able to reconstruct the device curve, with an average error of approximately 2 mm, even in the case of complex geometries. Magn Reson Med 63:1070,1079, 2010. © 2010 Wiley-Liss, Inc. [source]

Real-time accelerated interactive MRI with adaptive TSENSE and UNFOLD,

MAGNETIC RESONANCE IN MEDICINE, Issue 2 2003
Michael A. Guttman
Abstract Reduced field-of-view (FOV) acceleration using time-adaptive sensitivity encoding (TSENSE) or unaliasing by Fourier encoding the overlaps using the temporal dimension (UNFOLD) can improve the depiction of motion in real-time MRI. However, increased computational resources are required to maintain a high frame rate and low latency in image reconstruction and display. A high-performance software system has been implemented to perform TSENSE and UNFOLD reconstructions for real-time MRI with interactive, on-line display. Images were displayed in the scanner room to investigate image-guided procedures. Examples are shown for normal volunteers and cardiac interventional experiments in animals using a steady-state free precession (SSFP) sequence. In order to maintain adequate image quality for interventional procedures, the imaging rate was limited to seven frames per second after an acceleration factor of 2 with a voxel size of 1.8 × 3.5 × 8 mm. Initial experiences suggest that TSENSE and UNFOLD can each improve the compromise between spatial and temporal resolution in real-time imaging, and can function well in interactive imaging. UNFOLD places no additional constraints on receiver coils, and is therefore more flexible than SENSE methods; however, the temporal image filtering can blur motion and reduce the effective acceleration. Methods are proposed to overcome the challenges presented by the use of TSENSE in interactive imaging. TSENSE may be temporarily disabled after changing the imaging plane to avoid transient artifacts as the sensitivity coefficients adapt. For imaging with a combination of surface and interventional coils, a hybrid reconstruction approach is proposed whereby UNFOLD is used for the interventional coils, and TSENSE with or without UNFOLD is used for the surface coils. Magn Reson Med 50:315,321, 2003. Published 2003 Wiley-Liss, Inc. [source]

Changing patterns in interventional bronchoscopy

Safety of Elective Hand Surgery Following Axillary Lymph Node Dissection for Breast Cancer

THE BREAST JOURNAL, Issue 3 2007
Dan D. Hershko MD
Abstract:, The development of lymphedema is the most feared complication shared by breast cancer survivors undergoing hand surgery after prior axillary lymph node dissection (ALND). Traditionally, these patients are advised to avoid any interventional procedures in the ipsilateral upper extremity. However, the appropriateness of some of these precautions was recently challenged by some surgeons claiming that elective hand operations can be safely performed in these patients. The purpose of this study was to evaluate our experience and determine the safety of elective hand operations in breast cancer survivors. The medical records of patients operated for different hand conditions after prior breast surgery and ALND at our institution between 1983 and 2002 were reviewed. The techniques and preventive measures performed, use of antibiotics, and upper extremity complications associated with the operations were analyzed. Overall, we operated on 27 patients after prior ALND performed for breast cancer. Follow-up was available for 25 patients. Four patients had pre-existing lymphedema. The surgical technique used was similar to that performed in patients without prior ALND and antibiotic prophylaxis was not given. Delayed wound healing was observed in one patient and finger joint stiffness in another. Two patients with pre-existing lymphedema developed temporary worsening of their condition. None of the patients developed new lymphedema. The results of the present study support the few previous studies, suggesting that hand surgery can be safely performed in patients with prior ALND. Based on these findings, the appropriateness of the rigorous precautions and prohibitions regarding the care and use of the ipsilateral upper extremity may need to be reconsidered. [source]

The case for MR-compatible robotics: a review of the state of the art

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2008
Haytham Elhawary
Abstract Background The numerous imaging capabilities of magnetic resonance imaging (MRI) coupled with its lack of ionizing radiation has made it a desirable modality for real-time guidance of interventional procedures. The combination of these abilities with the advantages granted by robotic systems to perform accurate and precise positioning of tools has driven the recent development of MR-compatible interventional and assistive devices. Methods The challenges in this field are presented, including the selection of suitable materials, actuators and sensors in the intense magnetic fields of the MR environment. Results Only a small number of developed systems have made it to the clinical level (only two have become commercial ventures), showing that the field has not yet reached maturity. Conclusions A brief overview of the current state of the art is given, along with a description of the main opportunities, possibilities and challenges that the future will bring to this exciting and promising field. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Visualisation of needle position using ultrasonography

ANAESTHESIA, Issue 2 2006
G. A. Chapman
Summary Anaesthetists and intensivists spend a considerable proportion of their working time inserting needles and catheters into patients. In order to access deeper structures like central veins and nerves, they have traditionally relied on surface markings to guide the needle into the correct position. However, patients may present challenges due to anatomical abnormalities and size. Irrespective of the skill of the operator, there is the ever-present risk of needle misplacement with the potential of damage to structures like arteries, nerve bundles and pleura. Repeated attempts, even if ultimately successful, cause patient suffering and probably increase the risk of infection and other long term complications. Portable and affordable, high-resolution ultrasound scanners, has accelerated the interest in the use of ultrasound guidance for interventional procedures. Ultrasound guidance offers several advantages including a greater likelihood of success, fewer complications and less time spent on the procedure. Even if the target structure is identified correctly there is still the challenge to place the needle or other devices in the optimum site. The smaller and deeper the target, the greater the challenge and potential usefulness of ultrasound guidance. As a result of limited training in the use of ultrasound we believe that many clinicians fail to use it to its full potential. A lack of understanding, with regard to imaging the location of the needle tip remains a major obstacle. Needle visualisation and related topics form the basis for this review. [source]

New horizons in simulation training for endoscopic surgery

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010
D. King
Abstract In recent years there has been both a paradigm shift in the way surgery is carried out and also in the way in which we train health professionals undertaking interventional procedures. Endoscopic procedures have replaced many traditional operations and the benefits of such an approach to patient care are well documented. However, evidence exists of higher patient complications during a surgeon's learning curve in endoscopic surgery, and it is now considered essential that endoscopic skills are learned in training laboratories rather than on patients. A new model of structured education, where surgical skills are practiced on models and virtual reality simulators, is set to replace the traditional apprenticeship model of training. Simulation is a rapidly evolving field that can provide a safe and increasingly realistic learning environment for trainees to practice in. This paper explores the current role of simulation in endoscopic training and provides a review of the developments in the field, including advances in simulation technology, progress in curriculum design and the use of simulation in nontechnical skills training. [source]

Thromboembolic events after carotid endarterectomy are not prevented by aspirin, but are due to the platelet response to adenosine 5,-diphosphate

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000
P. D. Hayes
Background: Aspirin therapy fails to prevent a number of postprocedural thrombotic events, yet it still remains the standard antiplatelet regimen in most vascular surgical centres. After carotid endarterectomy (CEA), thrombosis of the endarterectomized vessel is preceded by increasing numbers of microemboli that can be detected with transcranial Doppler (TCD). The number and rate of emboli is highly predictive of thrombotic stroke. It was hypothesized that a preoperative test of platelet function might identify the mechanism(s) underlying post-CEA thrombosis. Methods: Blood was taken from 120 patients using a standardized phlebotomy technique. Platelet fibrinogen binding was measured by whole blood flow cytometry, in unstimulated samples, and in response to adenosine 5,-diphosphate (ADP) (10,5,10,7 mol l,1) and thrombin (0·02,0·16 units ml,1). Platelet aggregation was measured using ADP (4,20 × 10,7 mol l,1). The ability of aspirin to inhibit platelets was assessed by the aggregation induced by arachidonic acid. For the first 3 h after operation, the number of emboli occurring was quantified using TCD. Results: Of the 120 patients studied, 110 were monitored by TCD. These were divided into patients with more than 25 postoperative emboli (n = 22) and those with fewer than 25 emboli (n = 88). The degree of platelet inhibition induced by aspirin was not significantly different between the two groups (P = 0·89). However, platelets from the group with high rates of embolization bound 58 per cent more fibrinogen on flow cytometry in response to stimulation with a physiological dose of ADP (10,7 mol l,1) (P = 0·006). Aggregation of platelets from this group was also increased in response to ADP (35 per cent) relative to the group with few emboli (P = 0·001). ADP also induced more rapid aggregation in the patients with more than 25 emboli (P = 0·04). There was no difference in the activity of resting platelets (P = 0·4) or platelets stimulated by thrombin (P = 0·43), between the two groups of patients. Conclusion: These data suggest that it is the platelet response to ADP which is important in arterial thrombotic complications rather than products of the cyclo-oxygenase pathway. This observation could have significant therapeutic implications for other vascular or interventional procedures in which the endothelium is disrupted. © 2000 British Journal of Surgery Society Ltd [source]

The safety and efficacy of an extravascular, water-soluble sealant for vascular closure: Initial clinical results for MynxÔ

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2007
D. Scheinert MD
Abstract Objective: The purpose of this study was to evaluate the hemostatic efficacy and safety of the Mynx extravascular sealant for femoral artery closure. Background: The Mynx device is an extra-arterial vascular closure technology utilizing a water-soluble, porous, polyethylene glycol matrix that immediately seals the arteriotomy by rapidly absorbing subcutaneous fluids and expanding in the tissue tract and then, resorbs within 30 days. Methods: The Mynx study was a prospective, multicenter, single-arm clinical investigation conducted at five European centers. The safety and effectiveness of the Mynx device was evaluated in patients following diagnostic or interventional endovascular procedures performed through 5 Fr, 6 Fr, or 7 Fr introducer sheaths in the common femoral artery. The primary safety endpoint was the combined rate of major complications within 30 days (±7 days). The primary efficacy endpoints were time to hemostasis and time to ambulation. Results: Patient enrollment included 190 patients with 50% having undergone diagnostic catheterization and 50% interventional procedures with a mean activated clotting time of 221 sec. One (0.5%) major vascular complication (transfusion) occurred in one patient. No device-precipitated complications associated with serious clinical sequelae were reported. Mean (± standard deviation) times to hemostasis and ambulation were 1.3 ± 2.3 min and 2.6 ± 2.6 hr, respectively. There was no significant difference in median times to hemostasis between diagnostic and interventional patients (0.5 vs. 0.6 min). Conclusions: The initial experience with the extra-arterial Mynx closure technology supports hemostatic safety and efficacy in patients undergoing diagnostic and interventional catheterization procedures. © 2007 Wiley-Liss, Inc. [source]

Reproducibility and variability of activated clotting time measurements in the cardiac catheterization laboratory

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005
Terence M. Doherty
Abstract The objective of this study was to characterize the reproducibility and variability in the measurement to the activated clotting time (ACT) when performed on two different types of instruments, the HemoTec ACT (Medtronic) and the Hemochron 801 (International Technidyne). The ACT has evolved into the most common point-of-care test used in the cardiac catheterization lab to manage patient heparinization. Since the test has not been standardized, different systems frequently produce different results under the same clinical conditions. Duplicate paired ACT tests (n = 885) from 359 patients were performed on both instruments. Prothrombin times (PT) and activated partial thromboplastin times (aPTT) were also determined on subsets of these same samples (PT = 533; aPTT = 487). The performance and relationships between the two tests were determined using a variety of statistical analytical techniques. The average difference between the ACT devices was only 8 sec, yet more than 60% of the measurements varied by more than 10%. Over one-fourth of measurements varied by more than 20%. The reproducibility to the HemoTec instrument was superior to the Hemochron instrument across the entire range of ACTs measured (mean coefficient of variation 2.4% 54± 3.1% vs. 7.2% 54± 6.1% for HemoTec and Hemochron, respectively; P < 0.00001; range = 65,555 sec). The relationship between the two ACTs was nonlinear. In therapeutic ranges used for interventional procedures (200,350 sec), HemoTec and Hemochron ACTs are not comparable to one another. Statistical comparative analysis indicated that the HemoTec ACT has better overall performance. © 2005 Wiley-Liss, Inc. [source]

Cardiac veins: A review of the literature

CLINICAL ANATOMY, Issue 1 2009
Marios Loukas
Abstract Cardiac veins have long stood in the shadow of their more extensively studied counterparts, the coronary arteries. The clinical importance of the coronary venous system, nonetheless, should not be underestimated. Intricate and beneficial therapeutic options are increasingly being developed that depend on knowledge of the structure of this venous network. Such interventions have been shown greatly to promote cardiac health, and to enhance the efficacy of cardiac pacing. A comprehensive appreciation of the architecture of the coronary venous system, therefore, is crucial to optimal cardiac care. It is possible to provide an overview of the arrangement of the cardiac veins, with the larger veins draining to the coronary sinus, and thence to the right atrium, but with smaller and minimal veins draining directly to the cavities of the atrial chambers. The venous pathways, nonetheless, are highly variable, making exceptions the commonly accepted rule. As such, unique solutions for imaging, and simple attentiveness to possible venous variations, can greatly enhance clinical outcomes. For example, identifying the diameter, course, and valves of the cardiac veins allows for anticipation of impediments during interventional procedures, and allows for informed clinical decision-making. Also of significance is awareness of alternate arrangements that may be encountered in terms of venous drainage, and the importance of intramural venous collecting spaces in these patterns. The objective of our review, therefore, is to explore and describe the anatomical distribution of the coronary veins Clin. Anat. 22:129,145, 2009. © 2008 Wiley-Liss, Inc. [source]

X-ray Burns,Painful, Protracted, and Preventable

CLINICAL CARDIOLOGY, Issue 4 2008
Ronald E. Vlietstra MB CHB
Abstract Very high doses of x-ray may produce deep burns in the backs of patients having fluoroscopically guided cardiac interventional procedures. While these incidents are uncommon they can be prevented by judicious limitation of fluoroscopy and timely repositioning of the x-ray tube. Better education and improved methods for dose mapping should make these distressing complications a thing of the past. Copyright © 2008 Wiley Periodicals, Inc. [source]