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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1998 February;39(1):43-5

lingua: Inglese

Elective or emer­gent inter­ven­tion­al radiol­o­gy through intro­duc­er ­sheath insert­ed dur­ing emer­gent vas­cu­lar sur­gery for crit­i­cal ische­mia

Hafsahl G.*, Dregelid E.

From the Department of Cardiothoracic Surgery, *Department of Radiology, Ullevål Hospital, Oslo, Norway


During per­for­mance of embo­lec­to­my or throm­bec­to­my one ­often encoun­ters arte­ri­al ste­nos­es. These may be treat­ed by adjunc­tive intra­op­er­a­tive angio­plas­ty dur­ing the oper­a­tion or ­delayed per­cut­ane­ous angio­plas­ty (PTA) may be per­formed in the inter­ven­tion­al radiol­o­gy depart­ment. Delayed PTA may ­have to ­wait ­until the ­wound has ­healed, and dur­ing ­this ­time ­there is a ­risk of re-oc­clu­sion. It may ­often be desir­able to per­form the radio­log­ic inter­ven­tion at a lat­er ­time ­than the throm­bo-embo­lec­to­my for logis­tic rea­sons. The vas­cu­lar sur­geon and inter­ven­tion­al radiol­o­gist may per­form ­best ­when work­ing in the envi­ron­ment ­that ­they are accus­tomed to. Also, meas­ure­ment of vas­cu­lar diam­e­ters, and selec­tion of prop­er bal­loon and ­stent siz­es can usu­al­ly be per­formed ­most accu­rate­ly ­with the equip­ment ­that is avail­able in the X-ray depart­ment. We treat­ed select­ed ­patients who under­went throm­boem­bo­lec­to­my or throm­ben­dar­te­rec­to­my in the ­groin for crit­i­cal ische­mia, and who ­also had clin­i­cal­ly impor­tant prox­i­mal or dis­tal ste­nos­es, in the fol­low­ing way: an arte­ri­al ­sheath was insert­ed ­through the ­wound and the ­patients ­were trans­ferred to the inter­ven­tion­al radiol­o­gy labor­a­to­ry ­where ­they under­went PTA. A con­tin­u­ous ­over and ­over ­suture ­with 3 ­bites of a 6-0 poly­pro­py­lene ­suture in the arter­i­ot­o­my for the ­sheath ­appeared to be the ­best way to ­secure hemo­sta­sis. The ­wound was ­closed ­around ­this ­suture and the arte­ri­al ­sheath. After remov­al of the ­sheath ­slight trac­tion was ­applied to the poly­pro­py­lene ­suture and main­tained for 1-2 ­days by appli­ca­tion of a hemo­stat at ­skin lev­el. The tech­nique is illus­trat­ed ­with a ­case ­report.

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