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Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A deflated balloon attached to a catheter is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn. Angioplasty has come to include all manner of vascular interventions that are typically performed percutaneously.
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery and descends along the anteromedial part of the thigh in the femoral triangle. It enters and passes through the adductor canal, and becomes the popliteal artery as it passes through the adductor hiatus in the adductor magnus near the junction of the middle and distal thirds of the thigh.
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performed by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.
In surgery, a percutaneous procedure is any medical procedure or method where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed.
Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.
Restenosis is the recurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed. This is usually restenosis of an artery, or other blood vessel, or possibly a vessel within an organ.
Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist Charles Dotter.
Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portuguese neurologist Egas Moniz at the University of Lisbon, who also helped develop thorotrast for use in the procedure.
In medicine, aortoiliac occlusive disease is a form of central artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries.
Intermittent claudication, also known as vascular claudication, is a symptom that describes muscle pain on mild exertion, classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest. It is classically associated with early-stage peripheral artery disease, and can progress to critical limb ischemia unless treated or risk factors are modified and maintained.
Transcatheter arterial chemoembolization (TACE) is a minimally invasive procedure performed in interventional radiology to restrict a tumor's blood supply. Small embolic particles coated with chemotherapeutic drugs are injected selectively through a catheter into an artery directly supplying the tumor. These particles both block the blood supply and induce cytotoxicity, attacking the tumor in several ways.
Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). The stent delivery balloon from the angioplasty catheter is inflated with media to force contact between the struts of the stent and the vessel wall, thus widening the blood vessel diameter. After accessing the blood stream through the femoral or radial artery, the procedure uses coronary catheterization to visualise the blood vessels on X-ray imaging. After this, an interventional cardiologist can perform a coronary angioplasty, using a balloon catheter in which a deflated balloon is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such as stents can be deployed to keep the blood vessel open. Various other procedures can also be performed.
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery. FMD has been found in nearly every arterial bed in the body although the most common arteries affected are the renal and carotid arteries.
Carotid artery stenting is an endovascular procedure where a stent is deployed within the lumen of the carotid artery to treat narrowing of the carotid artery and decrease the risk of stroke. It is used to treat narrowing of the carotid artery in high-risk patients, when carotid endarterectomy is considered too risky.
The history of invasive and interventional cardiology is complex, with multiple groups working independently on similar technologies. Invasive and interventional cardiology is currently closely associated with cardiologists, though the development and most of its early research and procedures were performed by diagnostic and interventional radiologists.
Fractional flow reserve (FFR) is a diagnostic technique used in coronary catheterization. FFR measures pressure differences across a coronary artery stenosis to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle.
Embolectomy is the emergency interventional or surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi, and is then referred to as thromboembolectomy or thrombectomy. Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to an organ leads to necrosis. Other involved therapeutic options are anticoagulation and thrombolysis.
Atherectomy is a minimally invasive technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine whether it is superior to angioplasty. It has also been used to treat coronary artery disease, albeit without evidence of superiority to angioplasty.
Transradial catheterization is an endovascular procedure or catheterization procedure performed to diagnose and treat arterial disease. Endovascular procedure can be performed achieving access in to body’s arterial system from either femoral artery, brachial artery or radial artery in the wrist. The transfemoral approach to perform cardiac catheterization has typically been more prevalent in invasive cardiology. But radial access has gained popularity due to technical advances with catheters and lower complication rates than transfemoral access. The European Society of Cardiology and the American Heart Association both support a radial-first approach in acute coronary syndrome.
References
- ↑ Spinosa DJ, Leung DA, Matsumoto AH, Bissonette EA, Cage D, Harthun NL, Kern JA, Angle JF, Hagspiel KD, Crosby IK, Wellons HA, Tribble CG, Hartwell GD (2004). "Percutaneous intentional extraluminal recanalization in patients with chronic critical limb ischemia". Radiology. 232 (2): 499–507. doi:10.1148/radiol.2322030729. PMID 15286320.
- ↑ Prakash Krishnan (2014-10-17). Peripheral Vascular Disease, An Issue of Interventional Cardiology Clinics. Elsevier Health Sciences. pp. 2–. ISBN 978-0-323-32617-9.
- ↑ Jack L. Cronenwett; K. Wayne Johnston (2014-03-12). Rutherford's Vascular Surgery. Elsevier Health Sciences. pp. 1782–. ISBN 978-0-323-24306-3.
- ↑ Met R, Van Lienden KP, Koelemay MJ, Bipat S, Legemate DA, Reekers JA (2008). "Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review". Cardiovasc Intervent Radiol. 31 (4): 687–97. doi:10.1007/s00270-008-9331-7. PMC 2515568 . PMID 18414946.
- ↑ Reed, A.B. (January 2006). "Percutaneous Intentional Extraluminal Recanalization in Patients With Chronic Critical Limb Ischemia". Yearbook of Vascular Surgery. 2006: 242–243. doi:10.1016/s0749-4041(08)70186-6. ISSN 0749-4041.
- 1 2 Klimach, S.G.; Gollop, N.D.; Ellis, J.; Cathcart, P. (April 2014). "How does subintimal angioplasty compare to transluminal angioplasty for the treatment of femoral occlusive disease?". International Journal of Surgery. 12 (4): 361–364. doi:10.1016/j.ijsu.2014.01.007. ISSN 1743-9191. PMID 24480239.
- 1 2 3 4 5 6 7 8 9 10 11 Met, Rosemarie; Van Lienden, Krijn P.; Koelemay, Mark J. W.; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A. (2008-04-15). "Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review". CardioVascular and Interventional Radiology. 31 (4): 687–697. doi:10.1007/s00270-008-9331-7. ISSN 0174-1551. PMC 2515568 . PMID 18414946.
- 1 2 Reekers, Jim A; Bolia, Amman (October 1998). "Percutaneous intentional extraluminal (subintimal) recanalization: how to do it yourself". European Journal of Radiology. 28 (3): 192–198. doi:10.1016/s0720-048x(98)00114-4. ISSN 0720-048X. PMID 9881251.
- ↑ Bolia, A.; Miles, K. A.; Brennan, J.; Bell, P. R. F. (November 1990). "Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection". CardioVascular and Interventional Radiology. 13 (6): 357–363. doi:10.1007/bf02578675. ISSN 0174-1551. PMID 2149672. S2CID 1924296.