Académique Documents
Professionnel Documents
Culture Documents
Indications:
a) To establish presence or absence of coronary artery stenosis. b) Define Therapeutic options. c) Determine the prognosis of patients with sign symptoms of CAD. d) To evaluate serial changes following PCI or pharmacological therapy as a research tool.
Class IIa
CCS class III or iv which improves to class I or II with medical therapy Worsening non invasive testing Patients with angina & severe illness that precludes risk stratification. CCS class I or II angina with intolerance to medical therapy Individnals whose occupation affects the safety of others.
Class IIa
Suspected MI due to coronary embolism, arteritis, trauma, certain metabolic diseases. Survivors of acute MI with LVEF <40% CHF, Prior PCI, CABG, Malignant ventricular arrhythmia.
Class IIa
Recurrent symptomatic ischemia within 12 months of CABG. Non-invasive evidence of high risk criteria occuring any time after CABG. Recurrent angina inadequately controlled by medications.
Contraindications:
Unexplained fever. Untreated infections Severe anaemia with Hb<8gldi. Severe electrolyte imbalance Severe active bleeding Uncontrolled systemic HTN Digitalis toxicity Previous contrast reaction but no pretreatment with corticosteroids. Ongoing stroke Acute renal failure Decompensated CHF Severe inrinsic or iatrogenic congulopathy (INR >2.0) Active endocarditis
Complication:
1. 2. 3. 4. 5. 6. 7. 8. Vascular access site complication Myocardial infarction Cerebravascular accident Arrhythmia Contrast reaction Hemodynamic complications Perforation of heart chamber Radiodrematitis related to prolonged x-ray exposure 9. Mortality
Complications:
Major vascular access site bleeding is defined as causing 15% hematocrit fall (or Hb 5gldl) from baseline. Minor bleeding is defined as causing as 10% drop in hematocrit Less severe vascular access site bleeding is defined as insignificant.
Retroperitoneal bleeding
inguinal ligament
Sign sumptoms Suprainguinal tenderness & fullness in 100% cases. Severe back & lower quadrant pain 64%. Femoral neuropoathy 36%
Suspicion of RPH due to Lower quadrant /flank pain Lower extremity pain Unexplained hypotension Falling hematocrit without obvious source of bleeding Diagnosis confirm by pelvic CT Management Hemodynamic stability secured - If necessary surgical repair of the culprit site.
Pseudoaneunrysm
Pseudoaneunrysm is a pulsatils hemotoma that communicates with an artery through a disruption in the arterial wall/
Cause : 1) Faulty technique involving multiple arterial puncture 2) Lower puncture site 3) Large sheath size 4) Intense anticoagulation 5) Obesity
Diagnosis-
Treatment- i) Manual compression ii) Ultrasonic compression iii) Surgical repair iv) Thrombin injection
A-V fistulas
A femoral A-V fistula is a connection between the femoral artery or its branches & the femoral vein or its branches Cause-1. Faulty arterial puncture below the femoral bifurcation which simultaneously enters the superficial femoral artery or the profunda femoral & its corresponding veins. Diagnosis-1. By clinical examination of bruit confirmed by duplex:
Treatment1) Manual compression 2) Coil embolization 3) Covered stent 4) Surgical repair is the sold stranded
Proximal path RAO caudal LAO Cranial RAO cranial Mid path - LAO cranial RAO cranial AP cranial Lateral Distal path LAO cranial RAO cranial Diagnosis Ostium by RAO cranial LAO cranial