Transulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure
|
|
- Antonia Wilkins
- 8 years ago
- Views:
Transcription
1 Transulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure Pedro Beraldo de Andrade, MD, Marden André Tebet, MD, Ederlon Ferreira Nogueira, MD, Vinícius Cardozo Esteves, MD, Mônica Vieira Athanazio de Andrade, RN, André Labrunie, MD, PhD, and Luiz Alberto Piva e Mattos, MD, PhD São Paulo, Brazil Background Unsuccessful radial artery puncture, inability to advance the guide catheter to the ascending aorta, and inadequate guide catheter support represent mechanisms of transradial approach failure. With the rationale of sharing the same efficacy and safety promoted by radial access, the transulnar approach represents an alternative access site for percutaneous coronary procedures. Methods Between May 2007 and May 2012, 11,059 coronary invasive procedures were performed in a single institution: 10,108 by transradial approach (91.4%), 541 by transfemoral approach (4.9%), and 410 by transulnar approach (3.7%). Patients who underwent coronary procedures through transulnar access were included in a prospective registry of effectiveness and safety. Results Diagnostic procedures accounted for 71.8% of cases, and the right ulnar access was the most common route (88.9%). Procedure success was high (98.5%), with a crossover rate of 1.5% (6 cases), of which 5 were achieved through the contralateral radial access and 1 through femoral approach. Complications related to access site were low (3.9%), consisting mostly of minor bleeding due to subcutaneous hematomas. There were no cases of major bleeding, nerve injury, pseudoaneurysm, arteriovenous fistula, or necessity of vascular surgical repair. Conclusions The transulnar approach represents an alternative to the transradial approach in selected cases when performed by radial-trained operators, sharing a high success rate and extremely low incidence of access-site complications. (Am Heart J 2012;164:462-7.) Beyond the proven benefits regarding patient comfort and reduced hospitalization time, the transradial approach has an established role as a bleeding-avoidance strategy among patients undergoing invasive coronary procedures. 1 Such benefits are more evident among radial-trained operators and in patients at high risk for bleeding, especially those with acute coronary syndrome. 2 However, unsuccessful radial artery puncture, inability to advance the guide catheter to the ascending aorta, and inadequate guide catheter support represent mechanisms of transradial approach failure. 3 Even among dedicated radialists, the crossover rate can reach more than 2%. 4 In addition, radial artery occlusion may occur in 5% of From the Santa Casa de Marília, Marília, São Paulo, Brazil. Submitted June 6, 2012; accepted August 3, Reprint requests: Pedro Beraldo de Andrade, MD, Invasive Cardiology, Santa Casa de Marília, Av. Vicente Ferreira, 828 Cascata, Marília, São Paulo, Brazil pedroberaldo@gmail.com /$ - see front matter 2012, Mosby, Inc. All rights reserved. patients at hospital discharge, preventing its reuse in future procedures. 5 In this context, the transulnar approach represents an alternative access site for percutaneous coronary procedures. With the rationale of sharing the same efficacy and safety promoted by radial access, it can be easily performed by operators familiar with the transradial approach. 6-8 The aim of this study was to demonstrate daily practice situations in which the transulnar approach proves a suitable option, reporting the success rate and possible complications related to its use. Methods Patients who underwent coronary procedures through transulnar access were included in a prospective registry of effectiveness and safety. The effectiveness of the technique was evaluated by procedure success rate, defined as completion of coronary angiography and left ventriculography with adequate coronary opacification, and percutaneous coronary intervention obtaining residual lesion less than 20%, with no need of crossover. The procedure and fluoroscopy times were obtained
2 American Heart Journal Volume 164, Number 4 de Andrade et al 463 starting from the arterial puncture until removal of the introducer. Safety was evaluated by the occurrence of inhospital vascular complications related to the puncture site. The registry was approved by our local ethics committee and a written informed consent was obtained from each patient. Definitions Major bleeding was defined as: type 3 [(3a) bleeding with hemoglobin decrease 3 and b5 g/dl, or red blood cell transfusion; (3b) bleeding with hemoglobin decrease 5 g/dl, or cardiac tamponade, or bleeding that requires surgical intervention, or bleeding requiring intravenous vasoactive drugs; (3c) intracranial hemorrhage, confirmed by autopsy or subcategory, image analysis, or lumbar puncture, or intraocular bleeding with impaired vision]; or type 5 [(5a) probable fatal bleeding, (5b) final fatal bleeding] in accordance with the definition of Bleeding Academic Research Consortium. 9 Local hematomas were graded using the EASY classification 10 : type I, 5 cm diameter; type II, 10 cm diameter; type III, N10 cm but not above the elbow; type IV, extending above the elbow; type V, anywhere with ischemic threat of the hand. Asymptomatic arterial occlusion was defined by blocking of ulnar blood flow with no signs of insufficient blood tissue perfusion. Patency of the ulnar artery was controlled before discharge by physical examination and plethysmography, consisting of checking the peripheral oxygen saturation curve of the fifth finger during compression of the radial artery. Doppler ultrasound was not routinely performed, only when a complication was suspected. Ulnar nerve injury was defined by the occurrence of sensitive or mechanical hand compromise after ulnar puncture with persistent signs or symptoms for a period of 24 hours, as a consequence of direct injury by accidental nerve puncture, excessive compression, or extrinsic compression by hematoma or pseudoaneurysm. Other access-site complications included arteriovenous fistula, pseudoaneurysm, complication requiring surgery, or local infection requiring antibiotics. Transulnar approach technique The arm was abducted to approximately 70. Through hyperextension of the wrist and infiltration of 1 to 2 ml of lidocaine 2%, the ulnar artery was punctured at 1 to 3 cm proximal to the pisiform bone, using a 20- to 22-gauge needlemounted intravenous catheter and the Seldinger technique. After the puncture, a inch guide-wire was introduced, followed by a small cutaneous incision with a No.11 surgical blade and the insertion of a 5F or 6F short sheath (Radifocus II, Terumo, Japan). A solution containing 5000 IU unfractionated heparin and 10 mg isosorbide mononitrate was administered through the extension of the sheath. In patients undergoing percutaneous coronary intervention, weight-adjusted unfractionated heparin (100 IU/kg) bolus was administered through a venous line to achieve and maintain an activated clotting time between 250 and 350 seconds. Analgesia and sedation with synthetic opioids and benzodiazepines were used as needed. At the end of the procedure, the introducer was immediately removed and hemostasis was achieved with compressive dressing or with radial compression device (TR Band, Terumo, Japan) adapted to the transulnar technique. It consists in placing the TR Band upside down, allowing adequate alignment of the inflated balloon over the ulnar artery. TR Band was placed Table I. Baseline clinical demographic characteristics Variables N = 387 Women, n (%) 210 (54.3) Mean age, years 61.2 ± 11.4 Diabetes mellitus, n (%) 139 (35.9) Systemic arterial hypertension, n (%) 325 (84.0) Current smoker, n (%) 93 (24.0) Dyslipidemia, n (%) 225 (58.1) Previous myocardial infarction, n (%) 73 (18.9) Previous percutaneous coronary intervention, n (%) 75 (19.4) Previous coronary artery bypass grafting, n (%) 30 (7.8) routinely after percutaneous coronary intervention and after coronary angiography using diameter catheters larger than 5F. Clinical examination of the puncture site and evaluation of the ulnar pulse were performed at the time of hospital discharge, about 2 to 3 hours after completion of the diagnostic procedures and the morning following completion of therapeutic procedures. The Allen test was not routinely performed. Statistical analysis Categorical variables are expressed as frequency and percentage, compared with the chi-square test. Continuous variables are expressed as mean and standard deviation, compared with the Student t test or Fisher's exact test. P b.05 was considered statistically significant. Statistical analyses were carried out using SPSS Statistics software package for Windows, version 19.0 (SPSS Inc, Chicago, IL). No extramural funding was used to support this work. The authors are solely responsible for the design and conduct of this study, all study analyses and drafting and editing of the manuscript. Results Between May 2007 and May 2012, 11,059 coronary invasive procedures were performed in a single institution: 10,108 by transradial approach (91.4%), 541 by transfemoral approach (4.9%), and 410 by transulnar approach (3.7%), the last representing the analyzed sample. 387 patients were included, of whom 210 (54.3%) were women, the mean age was 61.2 ± 11.4 years, and 139 (35.9%) were diabetic. The baseline clinical characteristics of patients are shown in Table I. Stable angina or silent ischemia was the predominant indication (55.3%), followed by non ST-segment elevation acute myocardial infarction (39.3%), and ST-segment elevation acute myocardial infarction (5.4%). The procedure characteristics are expressed in Table II. Diagnostic procedures accounted for 71.8% of cases, and the right ulnar access was the most common route (88.9%). The indication for ulnar approach was: a wider and easily palpable pulse compared to the radial in 73.2% of the cases, thus aiming to avoid the occurrence of vasospasm, patient discomfort or procedure failure; occurrence of radial artery spasm in 10.8%; absence of radial pulse in 9.0%; severe tortuosity of the radial artery in 5.7%, where the progression of the guide-wire was not possible; and
3 464 de Andrade et al American Heart Journal October 2012 Table II. Procedure characteristics Variables N = 410 Indication of the procedure Stable angina/silent ischemia/valvulopathy, n (%) 227 (55.3) Non ST-segment elevation myocardial infarction, n (%) 161 (39.3) ST-segment elevation acute myocardial infarction, n (%) 22 (5.4) Type of procedure Coronary angiography, n (%) 287 (70) Right and left heart catheterization, n (%) 6 (1.5) Intravascular ultrasound, n (%) 1 (0.3) Elective percutaneous coronary intervention, n (%) 86 (20.9) Ad hoc percutaneous coronary intervention, n (%) 30 (7.3) Number of catheters used, MD±DP Coronary angiography 2.1 ± 0.7 Percutaneous coronary intervention 1.2 ± 0.4 Ad hoc percutaneous coronary intervention 2.6 ± 0.8 Catheter diameter size Coronary angiography 5F, % F, % 5.8 Percutaneous coronary intervention 6F, % F, % 2.5 Ad hoc percutaneous coronary intervention 5F, % 3.6 6F, % 96.4 Procedure duration, min Coronary angiography 19.6 ± 8.3 Percutaneous coronary intervention 40.3 ± 13.9 Ad hoc percutaneous coronary intervention 59.6 ± 29.1 Fluoroscopy time, min Coronary angiography 3.2 ± 2.0 Percutaneous coronary intervention 10.4 ± 5.9 Ad hoc percutaneous coronary intervention 17.8 ± 12.8 Figure Reasons for transulnar approach. hypoplasia of the radial artery in 1.3% of the cases (Figure). From our entire cohort of transulnar procedure patients, 211 (54.5%) had undergone a previous coronary invasive procedure, of whom 133 (63.0%) through the transradial approach and 39 (18.5%) through the transulnar approach. Of these, the totality had been submitted to transulnar percutaneous coronary intervention the following day after transulnar coronary angiography. Table III. Technical features related to access site failure Reasons for crossover N (%) Ulnar puncture failure 3 (50.0) Severe ulnar spasm 1 (16.6) Ulnar artery chronic occlusion 1 (16.6) Severe subclavian tortuosity 1 (16.6) Table IV. In-hospital access site complications Access site complications N = 410 Hematoma, n (%) 13 (3.2) Type I, n (%) 8 (61.5) Type II, n (%) 1 (7.7) Type III, n (%) 2 (15.4) Type IV, n (%) 2 (15.4) Type V, n (%) 0 Major bleeding, n (%) 0 Pseudoaneurysm, n (%) 0 Arteriovenous fistula, n (%) 0 Asymptomatic occlusion of the ulnar artery, n (%) 3 (0.7) Ulnar nerve lesion, n (%) 0 Good-quality coronary angiography images were obtained for all diagnostic procedures but one, owing to a severe spasm making it impossible to conclude the procedure. To perform coronary angiography, the use of 5F Judkins right and left catheters were predominant (94%), whereas in percutaneous coronary intervention, 6F catheters (Voda Left or Extra Back-up to left coronary artery and Judkins Right or Amplatz Left to right coronary artery) with an internal lumen of in and stent implantation were used in 97% of the procedures. Procedure success was high (98.5%), with a crossover rate of 1.5% (6 cases), of which 5 were achieved through the contra lateral radial access and one through femoral approach. Success was not achieved in these cases due to failure in obtaining ulnar access (3); occurrence of severe ulnar spasm (1); previous ulnar artery occlusion, in spite of a prominent palpable distal pulse (1); and severe tortuosity of subclavian artery and ascending aorta making it unsuitable to obtain reasonable back-up for the performance of a percutaneous coronary intervention in a saphenous vein graft (1) (Table III). Complications related to access site were low, consisting mostly of minor bleeding due to subcutaneous hematomas (Table IV). There were no cases of major bleeding, nerve injury, pseudoaneurysm, arteriovenous fistula, or necessity of vascular surgical repair. Moderate to severe spasm was reported in 1.5% of procedures, vasovagal reaction in 0.5%, and asymptomatic occlusion of the ulnar artery at the time of hospital discharge in 0.7% of cases. Bailout ipsilateral transulnar approach after radial access failure, presented in 46 cases, exhibited similar patterns of complications when compared with de novo ulnar artery puncture. Efficacy and safety data
4 American Heart Journal Volume 164, Number 4 de Andrade et al 465 Table V. Efficacy and safety results of transulnar approach studies Author, Year Patients (n) Procedures (n) Size Success (%) Crossover (%) Complications (n) Terashima, (Cath) Dashkoff, Talwar, Limbruno, Lanspa, (Cath) Mangin, F local hematomas 5-6F F F local hematomas 5F F local hematomas 1 large hematoma 1 pseudoaneurysm Aptecar, F local hematomas 1 asymptomatic 1 pseudoaneurysm Gourassas, F (PCI) Lanspa, F (Cath) Rath, F local hematoma 1 artery perforation 1 transient paraesthesia Aptecar, F large hematoma 5 local hematomas 1 arteriovenous fistula 5 asymptomatic Knebel, Andrade, Vassilev, Li, F local hematomas 2 asymptomatic 6F F local hematomas 2 large hematomas 5-7F local hematomas 2 asymptomatic 6F Agostoni, James, Sheathless 7F Andrade, F local hematomas 2 large hematomas 3 asymptomatic Cath, Coronary angiography; PCI, percutaneous coronary intervention; TRA, transradial approach regarding transulnar approach in coronary invasive procedures, including the results of our new registry and totaling 1,309 patients are summarized in Table V. During the same time interval of five years 9,609 patients in our institution underwent 10,108 transradial coronary invasive procedures. The mean age was 61.4 ± 11.2 years, 40.1% were female, 78.6% had diagnoses of systemic hypertension, 28.9% of diabetes and 26.6% were current smokers. Compared to the transulnar group, the baseline demographic and procedure characteristics were well balanced, except for a high percentage of women and diabetic patients in the transulnar population. Efficacy and safety access site endpoints were comparable between the 2 strategies (Table VI). Discussion In the present registry, we report the results of 410 coronary procedures performed using the transulnar approach. During 5 years, 387 patients, representing approximately 4% of the cases, were selected for the transulnar approach, when the radial approach proved to
5 466 de Andrade et al American Heart Journal October 2012 Table VI. Access-site efficacy and safety comparison between transradial and transulnar approach Transradial (n = 10,108) Transulnar (n = 410) P Successful access site, n (%) 9,936 (98.3) 404 (98.5).86 Crossover rate, n (%) 171 (1.7) 6 (1.5).87 Procedure duration, minutes 21.0 ± ± 15.5 b.0001 Fluoroscopic time, minutes 5.2 ± ± Number of catheters used, 2.0 ± ± MD±DP Local hematoma, n (%) 353 (3.5) 13 (3.2).83 Large hematoma, n (%) 70 (0.7) 2 (0.5).85 Asymptomatic artery occlusion, n (%) 91 (0.9) 3 (0.7).7 be unavailable or prone to technical failure, especially for a small caliber or weak pulse on physical examination, justifying the high percentage of women in our sample. We achieved a high success rate of the technique in our series, (N98%), with a low crossover rate (1.5%). Ulnar access represents our second choice in the case of inability to use the radial approach, but this decision is always based on the presence of an easily palpable and broad enough ulnar pulse. In the randomized PCVI-CUBA trial, consecutive unselected patients were randomized to ulnar or radial approach before palpation of the forearm pulses and Allen's test were done. Successful access was obtained in 93.1% of patients in the ulnar group and in 95.5% of patients in the radial group (P =.82). 11 However, we observe in the daily practice a more difficult perception of an ulnar artery feasible for percutaneous puncture when compared to radial. In a report of 131 consecutive unselected patients undergoing ulnar coronary procedures by operators experienced with the radial approach, the authors reported the absence of palpable or sufficiently broad ulnar pulse in 29.8% of cases, and failed attempts to obtain access in 25.2%, representing a success rate of only 45%. 12 The studies also differ in determining which is the largest branch of the brachial artery, with some analysis using Doppler ultrasound showing similar diameters between the radial and ulnar arteries. 11,13 The course of the radial artery is more superficial, making it more readily palpable and easily compressible, thus making it our preferable access route, currently representing more than 90% of procedures. In 46 procedures (11.2%), the transulnar access was used after a failed attempt to obtain the ipsilateral transradial access, mostly due to spasms. Although possible questions may arise concerning the safety of following the procedure through the transulnar approach after radial artery spasm, we did not find any cases of ischemia of the hand, or even pain during the procedure. Similar findings were reported in a study where 12 patients who underwent transulnar procedures after radial access failure had an angiogram of the hand at the end of the procedure. 14 Seven of the 12 cases showed a patent radial artery, indicating a transient spasm. One patient showed chronic occlusion of the radial artery, with collateral branches from both arteries supplying the palmar arch. Even the remaining four cases with possible acute occlusion exhibited flow to the palmar arch through collateral circulation without evidence of ischemia. Simultaneous presence of 2 sheaths in the ipsilateral radial and ulnar artery has also been described as feasible during the performance of primary percutaneous coronary intervention. 15 The rationale for the use of the transulnar approach in these circumstances would be to not waste time in preparing the other arm or leg, especially in emergency situations such as an acute myocardial infarction, the possibility of using the same introducer, guide, and needle initially employed, and preservation of a possible contralateral radial graft conduit in cases of coronary artery bypass grafting indication, beyond the recognized benefits in reducing vascular complications. Vascular complication rates in our series were low, restricted mainly to subcutaneous hematomas without clinical symptoms. Although there is a higher prevalence of diagnostic procedures, thus setting a lower risk population, the absence of episodes of major bleeding certifies the premise that the transulnar approach shares the same benefits offered by the transradial approach. Ulnar nerve injury, a potentially serious complication, was not observed in our registry, in accordance with similar publications. 16 Limitations of our study are its non-randomized nature, though the registries play an important role in reflecting the real-world clinical practice. In addition, patients were selected from those with an ulnar pulse feasible for percutaneous access. The results are restricted to the period of hospitalization, without routine Doppler ultrasound assessment, which could underestimate asymptomatic complications such as arterial occlusion, pseudoaneurysm, or arteriovenous fistula. However, there was no clinical evidence of hand ischemia. The total number of patients and procedures, although small, represents the largest series reported to date on the use of the transulnar approach for coronary invasive procedures. Conclusions Our registry adds data to the available evidence regarding the feasibility, efficacy, and safety of the transulnar approach for invasive coronary procedures. Since bleeding complications are associated with increased morbidity and mortality, the transulnar approach represents an elegant alternative to the transradial approach in selected cases when performed by radialtrained operators, sharing a high success rate and extremely low incidence of access site complications.
6 American Heart Journal Volume 164, Number 4 de Andrade et al 467 References 1. Subherwal S, Peterson ED, Dai D, et al. Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: a report from the National Cardiovascular Data CathPCI Registry. J Am Coll Cardiol 2012;59: Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011;377: Dehghani P, Mohammad A, Bajaj R, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. J Am Coll Cardiol Interv 2009;2: Burzotta F, Trani C, Mazzari MA, et al. Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures. Am Heart J 2012;163: Stella PR, Kiemeneij F, Laarman GJ, et al. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diagn 1997;40: Terashima M, Meguro T, Takeda H, et al. Percutaneous ulnar artery approach for coronary angiography: a preliminary report in nine patients. Cathet Cardiovasc Interv 2001;53: Dashkoff N, Dashkoff PB, Zizzi JA, et al. Ulnar artery cannulation for coronary angiography and percutaneous coronary intervention: case reports and anatomic considerations. Cathet Cardiovasc Interv 2002; 55: Limbruno U, Rossini R, De Carlo M, et al. Percutaneous ulnar artery approach for primary coronary angioplasty: safety and feasibility. Cathet Cardiovasc Interv 2004;61: Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123: Bertrand OF, De Larochellière R, Cabau JR, et al. A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation 2006;114: Aptecar E, Pernes JM, Chabane-Chaouch M, et al. Transulnar versus transradial artery approach for coronary angioplasty: the PCVI- CUBA Study. Cathet Cardiovasc Interv 2006;67: Vassilev D, Smilkova D, Gil R. Ulnar artery as access for cardiac catheterization: anatomical considerations. J Interv Card 2008;21: Aptecar E, Dupouy P, Chabane-Chaouch M, et al. Percutaneous transulnar artery approach for diagnostic and therapeutic coronary intervention. J Invasive Cardiol 2005;17: Lanspa TJ, Willians MA, Heirigs RL. Effectiveness of ulnar artery catheterization after failed attempt to cannulate a radial artery. Am J Cardiol 2005;95: Agostoni P, Zuffi A, Biondi-Zoccai G. Pushing wrist access to the limit: homolateral right ulnar artery approach for primary percutaneous coronary intervention after right radial failure due to radial loop. Catheter Cardiovasc Interv 2011;78: Roberts EB, Palmer N, Perry RA. Transulnar access for coronary angiography and intervention: an early review to guide research and clinical practice. J Invasive Cardiol 2007;19: Talwar S, Owens PE, Motwani JG. The ulnar artery revisited: a useful alternative access site for coronary angiography and intervention [abstract]. Heart 2003;89(Suppl 1):A Lanspa TJ, Reyes AP, Oldemeyer JB, et al. Ulnar artery catheterization with occlusion of corresponding radial artery. Catheter Cardiovasc Interv 2004;61: Mangin L, Bertrand OF, De La Rochelliere R, et al. The transulnar approach for coronary intervention: a safe alternative to transradial approach in selected patients. J Invasive Cardiol 2005;17: Gourassas JT, Papadopoulos CE, Louridas GE. Percutaneous ulnar artery approach for coronary angioplasty. Hellenic J Cardiol 2004; 45: Rath PC, Purohit BV, Navasundi GB, et al. Coronary angiogram and intervention through transulnar approach. Indian Heart J 2005;57: Knebel AV, Cardoso CO, Rodrigues LHC, et al. Safety and feasibility of transulnar cardiac catheterization. Tex Heart Inst J 2008;35: Andrade PB, Tebet MA, Andrade MV, et al. Primary percutaneous coronary intervention through transulnar approach: safety and effectiveness. Arq Bras Cardiol 2008;91:e49-52, e Li Y, Zhou Y, Zhao Y, et al. Safety and efficacy of transulnar approach for coronary angiography and intervention. Chin Med J 2010;123: James D, Huang Y, Kwan TW. Percutaneous coronary intervention via transulnar sheathless approach. J Invasive Cardiol 2012;24:E157-8.
How to transform you into a radialist: tips and tricks
How to transform you into a radialist: tips and tricks Part II Caroline Frangos a, Stéphane Noble b a Hôpital de La Tour, Meyrin, Genève b Hôpitaux Universitaires de Genève Summary The transradial approach
More informationAn Overview of Transradial Patient Set-up. Susan R. Cooney RN,BSN,CCRN Durham VAMC Cardiac Catheterization Lab Duke University School of Nursing
An Overview of Transradial Patient Set-up Susan R. Cooney RN,BSN,CCRN Durham VAMC Cardiac Catheterization Lab Duke University School of Nursing Advantages of the Transradial Approach from a Nursing Perspective!!
More informationEndovascular Repair of an Axillary Artery Aneurysm: A Novel Approach
Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach Bao- Thuy D. Hoang, MD 1, Jonathan- Hien Vu, MD 2, Jerry Matteo, MD 3 1 Department of Surgery, University of Florida College of Medicine,
More informationSection Two: Arterial Pressure Monitoring
Section Two: Arterial Pressure Monitoring Indications An arterial line is indicated for blood pressure monitoring for the patient with any medical or surgical condition that compromises cardiac output,
More informationRight Heart Catheterization from the Arm
Right Heart Catheterization from the Arm Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor of Medicine 1 Disclosure Statement of Financial Interest Within the
More informationCardiac Catheterization Curriculum for Fellows in Cardiology Dartmouth-Hitchcock Medical Center Level 1 and Level 2 Training 2008-2009
Cardiac Catheterization Curriculum for Fellows in Cardiology Dartmouth-Hitchcock Medical Center Level 1 and Level 2 Training 2008-2009 I. Overview of Training in Cardiac Catheterization Cardiac catheterization
More informationGroin Dressing post Cardiac Catheterization: Traditional pressure Versus Transparent Film. BSN, MSN, Clinical nursing, Critical Care Nursing
Groin Dressing post Cardiac Catheterization: Traditional pressure Versus Transparent Film BSN, MSN, Clinical nursing, Critical Care Nursing Introduction Transfemoral percutaneous coronary procedures have
More informationComplications of Femoral Catheterization. Daniel Kaufman, MD University Hospital of Brooklyn December 16, 2005
Complications of Femoral Catheterization Daniel Kaufman, MD University Hospital of Brooklyn December 16, 2005 Case Presentation xx yr old female presents with fever, chills, and painful swelling of R groin
More informationCalifornia Health and Safety Code, Section 1256.01
California Health and Safety Code, Section 1256.01 1256.01. (a) The Elective Percutaneous Coronary Intervention (PCI) Pilot Program is hereby established in the department. The purpose of the pilot program
More informationPercutaneous coronary intervention (PCI) continues
Developing a Same-Day Discharge Program How to identify appropriate patients for safe and efficient discharge. BY CAROLYN A. DICKENS, MSN, APN, AND ADHIR SHROFF, MD, MPH Percutaneous coronary intervention
More informationExperience of Direct Coronary Stenting at National Institute of Cardiovascular Diseases
Experience of Direct Coronary Stenting at National Institute of Cardiovascular Diseases T. Masood,T. Sagheer,D. Jan,N. Qamar,A.M.A. Faruqui ( National Institute of Cardiovascular Diseases (NICVD), Karachi.
More informationCardiac Catheterization
Page 1 Cardiac Catheterization What Other Terms Are Used To Describe Cardiac Catheterization? Heart Cath (catheter) Angiogram What Is Cardiac Catheterization? This procedure is nonsurgical and is performed
More informationThe left internal mammary artery (LIMA) is the
Case Report 925 Direct Stenting of a Transradial Left Internal Mammary Artery Graft Wei-Chin Hung, MD; Bih-Fang Guo, MD, PhD; Chiung-Jen Wu, MD; Chien-Jen Chen, MD; Chih-Yuan Fang, MD Taking the transfemoral
More informationPolicies and Procedures. Related to. IABP Therapy
Policies and Procedures Related to IABP Therapy Courtesy of Datascope Corp. Clinical Support Services The following policies and procedures are intended to serve as guidelines for developing hospital policy.
More informationCilostazol versus Clopidogrel after Coronary Stenting
Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background
More informationClinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up
Hellenic J Cardiol 45: 379-383, 2004 Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up PETROS S. DARDAS, DIMITRIS
More informationTunneled Hemodialysis Catheters: Placement and complications
Tunneled Hemodialysis Catheters: Placement and complications Arif Asif, M.D. Director, Interventional Nephrology Associate Professor of Medicine University of Miami, FL Tunneled Hemodialysis Catheters:
More informationDuration of Dual Antiplatelet Therapy After Coronary Stenting
Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are
More informationRadial Artery Access for Diagnostic and Interventional Procedures
for Diagnostic and Interventional Procedures Steven L. Almany, MD, FACC William W. O'Neill, MD, FACC 1999 by Accumed Systems, Inc. Ann Arbor, Michigan 1 Forward To be honest, I was extremely skeptical
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationCardiac catheterization and complications: initial experience
Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-2, 1-6 Original Article Cardiac catheterization and complications: initial experience L. Dubey 1, S. K. Sharma 1 DM Resident,Cardiology, College
More informationThe Cardiac Society of Australia and New Zealand
The Cardiac Society of Australia and New Zealand Guidelines on Support Facilities for Coronary Angiography and Percutaneous Coronary Intervention (PCI) including Guidelines on the Performance of Procedures
More informationAntiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty
Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor
More informationDonor Adverse Events
Donor Adverse Events Common terminology Frequency Risk factors Hold still, Mrs. Brown, while I draw your blood Mindy Goldman, MD Canadian Blood Services IHN Seminar, Paris March 11, 2016 Outline Donor
More informationThe Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 5, NO. 1, 2012 2012 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2011.08.011 The Leipzig
More informationCardiac Catheterization Lab Procedures
UW MEDICINE PATIENT EDUCATION Cardiac Catheterization Lab Procedures This handout describes how cardiac catheterization works. It also explains how to prepare for your procedure and the self-care needed
More informationImaging of Thoracic Endovascular Stent-Grafts
Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial
More informationDisclosures. Goals. It Is All in the Wrist Radial Approach to Cardiac Catheterization. I have nothing to disclose with regards to this presentation
It Is All in the Wrist Radial Approach to Cardiac Catheterization Denise Rhodes MS APC-BC AACC Interventional Cardiology Penn State Hershey Medical Center Disclosures I have nothing to disclose with regards
More informationSteven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators
Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,
More informationLiau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006.
Citation Liau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006. Full Text An anesthesiologist inserted a 14-gauge peripheral
More informationUnderstanding Coronary Artery Disease, Cardiac Catheterization, and Treatment Options. A Guide for Patients
Understanding Coronary Artery Disease, Cardiac Catheterization, and Treatment Options A Guide for Patients Coronary Artery Disease If you or a member of your family has been diagnosed with coronary artery
More informationFort Hamilton Hospital Specialty: Cardiology Department of Medicine Delineation of Privileges
NAME Fort Hamilton Hospital Specialty: Cardiology Department of Medicine Delineation of Privileges GENERAL CARDIOLOGY Required Qualifications for General Cardiology Education/Training/Experience Must have
More informationAre venous catheters safe in terms of blood tream infection? What should I know?
Are venous catheters safe in terms of blood tream infection? What should I know? DIAGNOSIS, PREVENTION AND TREATMENT OF HAEMODIALYSIS CATHETER-RELATED BLOOD STREAM INFECTIONS (CRBSI): A POSITION STATEMENT
More informationA Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs
A Patient s Guide to Primary and Secondary Prevention of PATIENT EDUCATION GUIDE What Is Cardiovascular Disease? Cardiovascular disease (CVD) is a broad term that covers any disease of the heart and circulatory
More informationCoronary angiogram : An author view Patwary MSR
The ORION Medical Journal 2008 Sep;31:599-601 Coronary angiogram : An author view Patwary MSR Abstract It is relatively safe, though minimally invasive, test. Coronary angiogram is an x-ray of the coronary
More informationTreating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
More informationREPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES
REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES Effective January 1, 2015, there was a change in CPT that affects reporting specific endovascular services provided in the
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
More information6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology
Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die
More informationCatheter Reduction Program: Creating the Ideal Vascular Access Culture. Presented by: Diane Peck, RN, CNN
Catheter Reduction Program: Creating the Ideal Vascular Access Culture Presented by: Diane Peck, RN, CNN Fistula First Initiative The superiority of an AVF over an AVG is an accepted fact. For this reason
More informationAntonio Colombo MD on behalf of the SECURITY Investigators
Second Generation Drug-Eluting Stents Implantation Followed by Six Versus Twelve-Month - Dual Antiplatelet Therapy - The SECURITY Randomized Clinical Trial Antonio Colombo MD on behalf of the SECURITY
More informationX-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary
X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary Introduction A Subclavian Inserted Central Catheter, or subclavian line, is a long thin hollow tube inserted in a vein under the
More informationSTONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY
STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY Per Medical Board decision March 18, 2008: These credentialing standards do NOT apply to peripheral angiography performed in the context
More informationCARDIOLOGY Delineation of Privileges
CARDIOLOGY Delineation of Privileges APPLICANT: INITIAL APPOINTMENT REQUIREMENTS: BASIC EDUCATION: M.D. or D.O. from an accredited school of medicine or osteopathy. Successful completion of an ACGME or
More informationAngioplasty and Stent Education Guide
Angioplasty and Stent Education Guide Table of Contents Treating coronary artery disease...2 What is coronary artery disease...3 Coronary artery disease treatment options...4 What are coronary artery
More informationNOVOSTE BETA-CATH SYSTEM
HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve
More informationAnkle Block. Indications The ankle block is suitable for the following: Orthopedic and podiatry surgical procedures of the distal foot.
Ankle Block The ankle block is a common peripheral nerve block. It is useful for procedures of the foot and toes, as long as a tourniquet is not required above the ankle. It is a safe and effective technique.
More informationAppendix. Costing Case Samples for OOHCA
Appendix Costing Case Samples for OOHCA The patient (ICD-1) Treatment Codes (OPCS 4) Patient 27 Admitted to ICU following percutaneous cardiac intervention (PCI) with 2 drugeluting stents following a VF
More informationMeasure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
More information12276408.3. Instructions for Use Cordis EXOSEAL TM VASCULAR CLOSURE DEVICE
12276408.3 Instructions for Use Cordis EXOSEAL TM VASCULAR CLOSURE DEVICE Figure 1: Components of the EXOSEAL TM Vascular Closure Device 1. Handle Assembly 2. Plug Deployment Button 3. Indicator Window
More informationUniversity of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital
PROGRAM DIRECTOR: Dr. Steven Laster University of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital 1 Interventional Cardiology Fellowship Training Program
More informationANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head
ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY Dr. Mahesh Vakamudi Professor and Head Department of Anesthesiology, Critical Care and Pain Medicine Sri Ramachandra University INTRODUCTION
More informationSamir B. Pancholy, MD, FACC, FSCAI 570-840-9852
Samir B. Pancholy, MD, FACC, FSCAI 570-840-9852 Medical School: B.J. Medical College, Ahmedabad, India 6-1981 to 5-1987. Residency: State University of New York at Stony Brook, Stony Brook, NY, Internal
More informationA Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III
A Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III Gilles Montalescot, MD, PhD Pitié-Salpêtrière Hospital, Paris, France
More informationUpper Extremity Arterial Duplex Evaluation
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Upper Extremity Arterial Duplex Evaluation This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound
More informationIs Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?
Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital
More informationCardiac Catheterisation. Cardiology
Cardiac Catheterisation Cardiology Name: Cardiac catheterisation Version: 1 Page 1 of 7 Contents Page Number(s) 1. Introduction 3 2. Management pre operative 3 3. Management post operative 5 4. Discharge
More informationESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease. Erich Minar Medical University Vienna
ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease Erich Minar Medical University Vienna for the Task Force on the Diagnosis and Treatment of Peripheral
More informationIs it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine
Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of
More informationCMS Limitations Guide - Radiology Services
CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationCLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014
CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 e 55 0495 2 Emergency Department (ED)- 1 Emergency Department Throughput Median time from
More informationThe Independent Order Of Foresters ( Foresters ) Critical Illness Rider (Accelerated Death Benefit) Disclosure at the Time of Application
The Independent Order of Foresters ( Foresters ) - A Fraternal Benefit Society. 789 Don Mills Road, Toronto, Canada M3C 1T9 U.S. Mailing Address: P.O. Box 179 Buffalo, NY 14201-0179 T. 800 828 1540 foresters.com
More informationObjectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History
Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize
More informationCARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN
HOSPITALIZATION CASE #: 2 8 8 0 H FY288BH4CN Has the participant indicated any of the following reasons for being admitted overnight for this case? 1. Suspected or confirmed problems with the heart, circulation,
More informationFemoral artery bypass graft (Including femoral crossover graft)
Femoral artery bypass graft (Including femoral crossover graft) Why do I need the operation? You have a blockage or narrowing of the arteries supplying blood to your leg. This reduces the blood flow to
More informationIschemia and Infarction
Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Badizadegan Ischemia and Infarction HST.035 Spring 2003 In the US: ~50% of deaths are due to
More informationUpper Extremity Vein Mapping for Placement of a Dialysis Access
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Upper Extremity Vein Mapping for Placement of a Dialysis Access This Guideline was prepared by the Professional Guidelines Subcommittee of the Society
More informationVascular Technology (VT) Content Outline Anatomy & physiology 20% Cerebrovascular Cerebrovascular normal anatomy Evaluate the cerebrovascular vessels
Vascular Technology (VT) Content Outline Anatomy & physiology 20% normal anatomy Evaluate the cerebrovascular vessels hemodynamics Evaluate the cerebrovascular vessels for normal perfusion normal anatomy
More informationPolicies & Procedures. I.D. Number: 1087
Policies & Procedures Title: CARDIAC CATHETERIZATION CARE OF THE CLIENT I.D. Number: 1087 Authorization: [X] SHR Nursing Practice Committee Source: Heart Health Cross Index: Date Revised: November 2013
More informationMajestic Trial 12 Month Results
Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.
More informationCh. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES GENERAL PROVISIONS
Ch. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES Sec. 138.1 Principle. 138.2. Definitions. GENERAL PROVISIONS PROGRAM, SERVICE, PERSONNEL AND AGREEMENT REQUIREMENTS
More information2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions
2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions IC-221010-AA Jan 2014 Page 1 of 10 Interventional Cardiology This for interventional cardiology procedures provides coding
More informationAtrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
More informationECG may be indicated for patients with cardiovascular risk factors
eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,
More informationRegions Hospital Delineation of Privileges Cardiology
Regions Hospital Delineation of s Cardiology Applicant s Name: Last First M. Instructions: Place a check-mark where indicated for each core group you are requesting. Review education and basic formal training
More informationA Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair
A Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair Table of Contents The AFX Endovascular AAA System............................................ 1 What is an Abdominal Aortic Aneurysm
More informationDifficult Vascular Access Alternative Approaches & Troubleshooting Tips
Difficult Vascular Access Alternative Approaches & Troubleshooting Tips Michelle Lin, MD Associate Professor of Clinical Emergency Medicine UC San Francisco - San Francisco General Hospital Michelle.Lin@emergency.ucsf.edu
More informationHeart Center Packages
Heart Center Packages For more information and appointments, Please contact The Heart Center of Excellence at the American Hospital Dubai Tel: +971-4-377-6571 Email: heartcenter@ahdubai.com www.ahdubai.com
More informationRenal Vascular Access Having a Fistula For Haemodialysis
Renal Vascular Access Having a Fistula For Haemodialysis Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
More informationSAMPLE. Asia-Pacific Interventional Cardiology Procedures Outlook to 2020. Reference Code: GDMECR0061PDB. Publication Date: May 2014
Asia-Pacific Interventional Cardiology Procedures Outlook to 2020 Reference Code: GDMECR0061PDB Publication Date: May 2014 Page 1 1 Table of Contents 1 Table of Contents... 2 1.1 List of Tables... 4 1.2
More informationUnderstanding your Renal Stent Procedure. A patient Guide (COVER PAGE) TABLE OF CONTENTS (inside front page)
Understanding your Renal Stent Procedure. A patient Guide (COVER PAGE) TABLE OF CONTENTS (inside front page) The Kidney and the Renal Arteries... 1 Renal Artery Disease... 2 Diagnosis of Renal.Artery Disease...
More informationGuidelines for diagnosis and management of acute pulmonary embolism
Guidelines for diagnosis and management of acute pulmonary embolism By Dr. Ahmed Zaghloul M.D. Anesthesia & Critical Care 2014 Predisposing factors for VTE Predisposing factor Strong predisposing factors
More informationVascular Access. Chapter 3
Vascular Access Chapter 3 Vascular Access Introduction Obtaining vascular access in infants and children can be difficult even under optimal conditions. Attempting emergent access in a hypotensive, struggling
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationYour Guide to Express Critical Illness Insurance Definitions
Your Guide to Express Critical Illness Insurance Definitions Your Guide to EXPRESS Critical Illness Insurance Definitions This guide to critical illness definitions will help you understand the illnesses
More informationRight Heart Catheterization
Right Heart Catheterization Ian C Gilchrist, MD, FSCAI Professor of Medicine Heart & Vascular Institute Penn State/Hershey Medical Center Hershey, PA DUKE 2010 Presenter Disclosure Information Ian C. Gilchrist,
More informationThe Bioresorbable Vascular Stent Dr Albert Ko
The Bioresorbable Vascular Stent Dr Albert Ko Dr Albert Ko MB BS, FRACP, FCSANZ Interventional/General Cardiologist Ascot Cardiology Symposium 2013 Treatment Goals for Coronary Artery Disease Relieve of
More informationChapter 6. Hemorrhage Control UNDER FIRE KEEP YOUR HEAD DOWN
Hemorrhage Control Chapter 6 Hemorrhage Control The hemorrhage that take[s] place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him. Colonel
More informationMEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE
DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE Effective Date: October 1, 2015 Review Dates: 10/11, 10/12, 10/13, 8/14, 8/15 Date Of Origin: October 12, 2011 Status: Current Summary of Changes Clarifications:
More informationEndoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter
Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter Endoskopische Venenentnahme (EVH) - Einführung 1979 Tevaearai und Kollegen haben
More informationCredentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions
Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions David Sacks, MD, Gary J. Becker, MD, and Terence A.S. Matalon, MD J Vasc Interv Radiol 2003;
More informationCOMMON METHODOLOGICAL ISSUES FOR CER IN BIG DATA
COMMON METHODOLOGICAL ISSUES FOR CER IN BIG DATA Harvard Medical School and Harvard School of Public Health sharon@hcp.med.harvard.edu December 2013 1 / 16 OUTLINE UNCERTAINTY AND SELECTIVE INFERENCE 1
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationVascular Quality Initiative - Carotid Artery Stent. Last Name First Name Middle Initial
Vascular Quality Initiative - Carotid Artery Stent Last Name First Name Middle Initial Date of Birth Medical Record Social Security General Information Patient Data Zip/Postal Code Gender Male Female Ethnicity
More informationPATIENT INFORMATION BOOKLET
PATIENT INFORMATION BOOKLET Wingspan Stent System with Gateway PTA Balloon Catheter TABLE OF CONTENTS Definitions... 2 What is the Purpose of This Booklet?... 3 What is an Intracranial Lesion?... 3 Who
More informationCardiacAdvantage. Catheterization. Patient Guide. Cardiac
Cardiac Catheterization Patient Guide CardiacAdvantage CardiacAdvantage Cardiac Catheterization For more information, please visit: stjoeshealth.org/cardiovascular Understanding Your Cardiac Catheterization
More informationProvided by the American Venous Forum: veinforum.org
CHAPTER 17 SURGICAL THERAPY FOR DEEP VALVE INCOMPETENCE Original author: Seshadri Raju Abstracted by Gary W. Lemmon Introduction Deep vein valvular incompetence happens when the valves in the veins (tubes
More informationPercutaneous Transluminal Angioplasty (PTA) and Stenting For PVS Patients
Percutaneous Transluminal Angioplasty (PTA) and Stenting For PVS Patients There are two types of blood vessels in the body arteries and veins. Arteries carry blood rich in oxygen from the heart to all
More informationPRACTICE GUIDELINE TITLE: INTRAVENOUS LINE INSERTION: PERIPHERAL AND CENTRAL
PRACTICE GUIDELINE Effective Date: 9-17-04 Manual Reference: Deaconess Trauma Services TITLE: INTRAVENOUS LINE INSERTION: PERIPHERAL AND CENTRAL PURPOSE: To outline the indications and options for intravenous
More information