What Is a Coccygectomy?

Percutaneous transluminal angioplasty uses the principle of coaxial dilation of blood vessels. The catheter is inflated to a moderate pressure (approximately 5 atmospheres) from a catheter with a capsular bag inserted into and through the renal artery stenosis. Increase renal artery lumen diameter. The success of the technique can be confirmed by postoperative angiography. Gruzig was the first to successfully treat renal artery stenosis in 1987, and has been widely used in clinical practice. The recent results are still good, with an effective rate of 70% to 80%, which can be expanded multiple times. ^[1]

Percutaneous transluminal angioplasty

Right!

Percutaneous transluminal angioplasty uses the principle of coaxial dilation of blood vessels. The catheter is inflated to a moderate pressure (approximately 5 atmospheres) from a catheter with a capsular bag inserted into and through the renal artery stenosis. Increase renal artery lumen diameter. The success of the technique can be confirmed by postoperative angiography. Gruzig was the first to successfully treat renal artery stenosis in 1987, and has been widely used in clinical practice. The recent results are still good, with an effective rate of 70% to 80%, which can be expanded multiple times. ^[1]

Chinese name

Percutaneous transluminal angioplasty

Indication

Vascular stenosis that affects organ function

Contraindication

Severe bleeding tendency.

Steps

Know the extent and length of vascular stenosis.

Indications

In principle, vascular stenosis (occlusion) that affects organ function is an indication.

Contraindications

1. Severe bleeding tendency.

2. Ischemic organ function has been lost.

3. Aortic inflammation active phase.

4. The guidewire and catheter have not been inserted through the narrowed (occluded) section of the vessel.

Steps

1. Perform angiography first to understand the extent and length of vascular stenosis.

2. Pass the narrow section with a guide wire and follow up with the catheter after success. When difficult to pass, you can use ultra-smooth or thinner guidewires and catheters. Patients with vena cava occlusion can use a guide wire hard head or atrial septum puncture needle to pass through this operation. This operation should be performed under two-way adjustment of the line to prevent false tract formation or damage to the pericardium.

3. After the catheter passes through the stenosed segment, first inject contrast medium to show the vascular condition after stenosis, and then inject heparin 6250u. Insert the extra-long guide wire to withdraw the imaging catheter.

4. The balloon catheter is guided along the guidewire into the stenosed segment. When difficult, can use super hard guide wire to assist, or can use a small balloon catheter to pre-dilate the narrow section, and then sent to the large balloon catheter.

5. Make sure the balloon is located in the stenosed segment and begin dilation. With a 5ml syringe, the contrast medium diluted to 1/3 was drawn and injected into the balloon to inflate slightly. The radiograph of the stenosis on the balloon can be seen under perspective. If the indentation is located in the effective dilation section of the balloon, the injection can be continued under pressure until the indentation disappears. Each expansion usually lasts 15s to 30 seconds, and can be repeated 2 to 3 times.

6. Withdraw the balloon catheter with a 20ml syringe to withdraw it to facilitate passage through the catheter sheath. Then insert the catheter for angiographic observation.

7. For patients with central venous stenosis, intravascular pressure measurement can be performed before and after surgery for comparison. For those with limb arterial stenosis, the blood pressure of the affected limb can be measured before and after surgery.

8. Postoperative management: Closely observe the vital signs and puncture site of the patient to prevent complications such as bleeding. Follow-up observation of the diseased blood vessels can use ultrasound Doppler examination. Continue anticoagulation with oral medication