The restoration of the lumen of the artery using angioplasty vessels
Experts note that the number of patients with the diagnosis CHD (coronary heart disease) increases with every year. The share of specified diseases account for up to 50% of cardiac mortality.
The basis of pathology lies atherosclerotic narrowing of coronary vascular, leading to insufficient blood supply to the myocardium. One way of treating coronary artery disease is balloon angioplasty, aimed at restoring the lumen of the artery. Is intravascular (endovascular) surgery, which is performed through a microscopic incision.
According to medical reports, the effectiveness of the treatment reaches 95%. In the concept of efficiency includes the complete absence of signs of angina, increased tolerance to physical stress and long-term preservation of the beneficial results of the operation.
The concept of angioplasty
The full name of the technique — percutaneous transluminal balloon angioplasty (balloon angioplasty).
The phrase stands for:
- Percutaneous — performed through a small puncture in the skin, without wide surgical access to the affected area.
- Transluminal — traumatic surgery with the introduction of a flexible instrument into the hollow organ, in this case a vessel.
- Balloon as a dilator for the arteries used rubber spray.
- Angioplasty — reconstruction of a narrowed or occluded vessel (from Greek angeion — vessel).
The balloon angioplasty procedure begins with a small incision in the femoral artery located in the groin crease. The hole entered the sheath (flexible hollow tube) in which it is promoted to the place of constriction. Further, the tube carried in the catheter.
At the end of the reinforced container. The sheath may be embedded not only in the femoral, but in the radial artery located in the wrist. All manipulations are visible on the monitor of a fluoroscope - an x-ray machine.
After the balloon in the narrowed area in the catheter under the pressure of the injected saline. The balloon is slowly inflated, rupturing the plaque and enlarging the lumen of the vessel. The result of the operation becomes the normal blood supply to the body.
The principle of operation is the same, but instead of a catheter with a balloon into the bloodstream start flexible quartz filament.
When the conductor reaches the narrowed area, turn on the laser and affect plaque a high temperature. Cholesterol is gradually destroyed, freeing the lumen of the vessel.
Laser angioplastyshown in atherosclerotic deposits at the mouth of the coronary vascular occlusion (complete obstruction) of the arteries, in cases of severe calcification of the plaques.
Indications for endovascular surgery
Surgery is recommended in all patients. After the pre-angiography (an x-ray of affected vascular) only a third of patients sent for an angioplasty. The rest is prescribed coronary artery bypass grafting (CABG) or drug therapy.
However, the list of indications for intravascular surgery is quite broad:
- The narrowing of the major arteries.
- Atherosclerosis of the legs. Originally the method was created to expand the blood vascular of the lower extremities, as their stenosis often ends in gangrene and subsequent amputation. Balloon angioplasty of lower limb arteries is a good alternative to surgery.
- Insufficiency of blood supply to certain organ.
- The defeat of peripheral vascular.
- Stenosis of the renal or carotid artery.
- Ulcers, gangrene, leg pain in the absence of physical activity.
Any surgery is the risk of complications and stress for the person. And until the patient satisfactorily cope with their daily tasks, doctors recommend to limit the intake of drugs.
Contraindications to CTBA
- Myocardial infarction;
- Marked atherosclerosis of the arteries with the formation of calcification;
- Severe stage of hypertension and diabetes;
- Inflammation of the endocardium;
- The presence of narrowing in the artery supplying a significant portion of the myocardium;
- Stenosis in the left main coronary artery;
- Infectious disease;
- Violation of blood coagulability;
- Pulmonary edema;
- Iodine Allergy that is part of the radiopaque solutions.
Medical technology is not standing still, so the indications for CTBA are expanding with every year. The main treatment strategy — how you can continue to defer surgery CABG.
Preparation for the procedure
The operation of this kind carried out in the angiography laboratory. Patient hospitalitynet to the clinic. After receipt of the written consent to carrying out medical manipulations, the cardiologist prescribes necessary tests, angiography of vascular, radiography, and electrocardiography. You must inform your doctor about pregnancy and take medical drugs.
Each hospital has its own protocols of individual work with the patient. Typically, a patient is taken a conversation about the stages of treatment, but sometimes this point is missed.
Then it is best to ask the doctor and nurses, as will beto conducted interference. The patient is entitled to discuss with the surgeon their concerns.
Before the operation it is better not to eat Breakfast. Should be prepared in advance and a half to two liters of mineral water. Excessive drinking speeds up the excretion of contrast agents.
If access to the affected area will be carried out through the femoral artery in the groin shave. The patient is premedication — intramuscular sedative and analgesic drugs under whose influence he may not remember the procedure itself.
To the extremities of the patient joining the electrodes for ECG: the physician during the operation, constantly monitors the functioning of the heart. In a vein of the arm mounted cubital catheter for the introduction of the necessary preparations.
The order of operation is
Coronary angioplasty is performed under local anesthesia. The skin incision does not exceed 2 mm. In artery insert a long transparent tube (trocar) and gently advance it into the vessel. Then it is injected with radiopaque drug to find the exact location of the stenosis. Everything that happens is displayed on the monitor of a fluoroscope.
Identifying the affected area, it down the bougie a wire with coating for maximum glide. The Explorer finds in the plaque passage for the cylinder. Next to the site of the lesion serves a catheter with a tiny reservoir at the tip. The cartridge slips into a narrow place and inflated with a syringe-tube manometer.
Cracking down, destroys the capacity of lipid plaque and restores the patency of the vessel. At this point, the surgeon is usually asked to hold your breath for a few seconds and the patient feels discomfort and pain behind the breastbone.
To audit the vessel up again fill with contrast agent. If CTBA is successful, the handler and the balloon is removed. The catheter is in the artery a few hours after surgery. Angioplasty vascular of the heart lasts 1-2 hours, in difficult cases longer.
Over the puncture site impose a pressure bandage and prescribe bed rest for a day. If applied to wound closure, period of immobilization is shortened to 6 hours.
The advantages of percutaneous transluminal angioplasty:
- High performance.
- Low invasiveness.
- The local anaesthetic.
- Rapid rehabilitation of the patient.
- The absence of operational scars.
With all the advantages of the technique experts recommend CTBA if struck one or two of the coronary vessel during normal operations of the left ventricle. More severe cases require coronary bypass surgery.
To eliminate the risk of renarrowing (restenosis) of the vessel, the surgeon sets in the extended area of the stent. It is a steel wire mesh cage of cylindrical shape that holds the artery wall at a predetermined position. It is needed in order to align the torn edges of the plaque to the vessel wall.
The frame is usually mounted on the balloon and expands with it, but there is a self-extracting design. The technique of direct stenting (without balloon) reduces trauma to the vessel wall, reduces operation time, reduces the radial load on the body. Developed stents with drug coating that prevents the development of scar stenosis.
The postoperative period
Of the operating unit of the patient taken to the intensive care unit. The first day it is connected to the ECG device. Constantly checked the blood counts and the status of the incision site. The leg, which made the puncture, bend prohibited. On the cut, apply a bandage and put it on consignment to compress a bleeding artery.
Patients are in the hospital until the bleeding from the vessel. The next day, allowed to stand. A week later the man can back into the mainstream of everyday life. For the first time after angioplasty of coronary vascular prohibited from driving cars and lifting weights.
Almost half of the cases occur after angioplasty coronary artery spasm. It is removed by the introduction of drugs — calcium antagonists, or nitrates.
Another common postoperative problem is bleeding and pain at the puncture site. Sometimes with the introduction of the catheter occurs tear (dissection) of the inner layer of the artery. Slight damage to heal on their own, but a large defect requires immediate treatment. For the relief dissection is repeated angioplasty with stenting.
In severe cases, shows the emergency coronary artery bypass grafting.
One of the serious complications is the stent thrombosis. Inside the wire frame is formed a blood clot (thrombus). This occurs as a result of interaction of metal with components of blood. The clot can cause the stop of blood flow, threatening serious consequences.
Before and after surgery the patient is assigned means for the prevention of thrombosis:
You must immediately inform the doctor if after surgery you have shortness of breath, high fever, leg pain, numbness or bleeding in the puncture site.
These signs can be symptoms of such complications
- Allergic to contrast material;
- Perforation or dissection of the artery wall;
- Formation of hematoma at the puncture site;
- Displacement of the stent;
- Myocardial infarction;
- The development of stroke during the probing of the carotid arteries;
- Blockage of the vessel below the stent.
Most of these episodes occur in the first 30 days of the postoperative period. The risk of complications increases if the patient smokes, avoids physical activity, overweight and high blood pressure.
Currently using angioplasty can stop a stenosis in any vascular segment from the circulatory system of the brain to the arteries of the foot. However, patients should remember that surgery removes only the consequences of the disease. If we neglect the prevention and treatment of atherosclerosis, new complications will not keep you waiting.