Tạo hình mạch máu

Tạo hình mạch máu (Angioplasty) Định nghĩa Tạo hình mạch máu thuật ngữ mô tả thủ thuật làm rộng (nong) học mạch máu bị hẹp tắc hồn tồn Thủ thuật có nhiều kiểu khác tên gọi liên quan với kiểu vào mạch máu thiết bị sử dụng Ví dụ, tạo hình mạch máu xun lịng mạch qua da (parcutaneous transluminal angioplasty-PTA) vào qua da điều hướng đến vùng mạch máu liên quan thông qua mạch máu máu máu thơng nối với (xuyên lòng mạch) Trong trường hợp thủ thuật liên quan với động mạch vành, điểm vào động mạch đùi bẹn hệ thống ống thông/dây dẫn qua động mạch chủ đến tim nguyên ủy động mạch vành đáy động mạch chủ phía ngồi van động mạch chủ Thuật ngữ “angioplasty” từ kết hợp từ “angio” (tiếng La tinh/ Hy lạp nghĩa mạch máu) từ “plasticos” (tiếng Hy lạp nghĩa tạo hình) Tạo hình mạch máu bóng Mục đích Ở người bị bệnh mạch máu tắc nghẽn xơ vữa động mạch, dòng máu đến quan (như tim) đến phần xa thể (nhu chi dưới) bị suy yếu hẹp lịng mạch lắng đọng mỡ tích tụ calcium Mạch máu bị hẹp Vì cần nong mạch máu để dịng máu lưu thơng đầy đủ Mạch máu bị hẹp lại theo thời gian vị trí nên thủ thuật phải làm lại Chú ý Thủ thuật tạo hình mạch máu phải thực bệnh nhân nội trú để dễ theo dõi hồi sức Nếu thủ thuật thực động mạch vành, bệnh nhân phải bác sĩ ý tá chuyên khoa chun gia mạch máu chăm sóc Thơng thường, bệnh nhân dùng thuốc chống đông trước làm thủ thuật để phòng ngừa huyết khối Tuy nhiên, việc dùng thuốc chống đơng gây khó bít điểm vào mạch máu Thủ thuật thực sụ hướng dẫn huỳnh quang thuốc cản quang Vì việc định làm tạo hình mạch máu sau chụp mạch chẩn đốn, cần phải biết bệnh nhân có bị mẫn cảm với thuốc cản quang iode khơng Thủ thuật dùng thuốc cản quang khơng ion hóa Mơ tả Ban đầu thủy thuật tạo hình mạch máu thực cách làm giãn mạch máu với việc đưa vào ống thông cứng lớn qua không gian hẹp Biến chứng thủ thuật làm cho nhà nguyên cứu phát triển cách làm rộng mạch máu việc dùng thiết bị có kích thước tối thiểu Ngày nay, ống thơng chứa bóng bơm căng để làm rộng mạch máu giá đỡ (stent) để nâng đỡ cấu trúc mạch máu Laser dùng để giúp phá vỡ mảng vôi mỡ Ống thơng gắn dây quay mũi khoan để làm mảng xơ vữa Angioplasty Definition Angioplasty is a term describing a procedure used to widen vessels narrowed by stenoses or occlusions There are various types of these procedures and their names are associated with the type of vessel entry and equipment used For example, percutaneous transluminal angioplasty (PTA) describes entry through the skin (percutaneous) and navigates to the area of the vessel of interest through the same vessel or one that communicates with it (transluminal) In the case of a procedure involving the coronary arteries, the point of entry could be the femoral artery in the groin and the catheter/guidewire system is passed through the aorta to the heart and the origin of the coronary arteries at the base of the aorta just outside the aortic valve In balloon angioplasty, plaque is pushed out of the clogged artery by the inflation of the balloon device (Illustration by Argosy Inc.) Purpose In individuals with an occulsive vascular disease such as atherosclerosis, blood flow is impaired to an organ (such as the heart) or to a distal body part (such as the lower leg) by the narrowing of the vessel's lumen due to fatty deposits or calcium accumulation This narrowing may occur in any vessel but may occur anywhere Once the vessel has been widened, adequate blood flow is returned The vessel may narrow again over time at the same location and the procedure could be repeated Precautions Angioplasty procedures are performed on hospital inpatients in facilities for proper monitoring and recovery If the procedure is to be performed in a coronary artery, the patient's care is likely to be provided by specially trained physicians, nurses, and vascular specialists Typically, patients are given anticoagulants prior to the procedure to assist in the prevention of thromboses (blood clots) Administration of anticoagulants, however, may impede the sealing of the vascular entry point The procedure will be performed using fluoroscopic guidance and contrast media Since the decision to perform angioplasty may have been made following a diagnostic angiogram, the patient's sensitivity to iodinated contrast media is likely to known The procedure may then require the use of non-ionic contrast agents Description Angioplasty was originally performed by dilating the vessel with the introduction of larger and larger stiff catheters through the narrowed space Complications of this procedure caused researchers to develop means of widening the vessel using a minimally sized device Today, catheters contain balloons that are inflated to widen the vessel and stents to provide structural support for the vessel Lasers may be used to assist in the break up of the fat or calcium plaque Catheters may also be equipped with spinning wires or drill tips to clean out the plaque Key terms cardiac catheterization — A procedure to pass a catheter to the heart and its vessels for the purpose of diagnosing coronary artery disease, assessing injury or disease of the aorta, or evaluating cardiac function EKG — Electrocardiogram, used to study and record the electrical activity of the heart plaque — In atherosclerosis, a swollen area in the lining of an artery formed by fatty deposits Angioplasty may be performed while the patient is sedated or anesthetized, depending on the vessels involved If a percutaneous transluminal coronary angioplasty (PTCA) is to be performed, the patient will be kept awake to report on discomfort and cough if required PTCA procedures are performed in cardiac catheterization labs with sophisticated monitoring devices If angioplasty is performed in the radiology department's angiographic suite, the patient may be sedated for the procedure and a nurse will monitor the patient's vital signs during the procedure If performed by a vascular surgeon, the angioplasty procedure will be performed in an operating room or specially designed vascular procedure suite The site of the introduction of the angioplasty equipment is prepared as a sterile surgical site Although many procedures are performed by puncturing the vessel through skin, many procedures are also performed by surgically exposing the site of entry Direct view of the vessel's puncture site aids in monitoring damage to the vessel or excessive bleeding at the site Once the vessel is punctured and the guidewire is introduced, fluoroscopy is used to monitor small injections of contrast media used to visualize the path through the vessel If the fluoroscopy system has a feature called 'roadmap', the amount of contrast media injected will be greater in order to define the full route the guidewire will take The fluoroscopy system will then superimpose subsequent images over the roadmap while the vessel is traversed, that is, the physician moves the guidewire along the map to the destination Having reached the area of stenosis, the physician will inflate the balloon on the catheter that has been passed along the guidewire Balloons are inflated in size and duration depending on the size and location of the vessel In some cases, the use of a stent (a mesh of wire that resembles a Chinese finger puzzle) may also be used The vessel may be widened before, during, or after the deployment of the stent Procedures for deploying stents are dependent on the type of stent used In cases where the vessel is tortuous or at intersections of vessels, the use of a graph may be necessary to provide structural strength to the vessel Stents, graphs, and balloon dilation may all be used together or separately The procedure is verified using fluoroscopy and contrast media to produce an angiogram or by using intravascular ultrasound or both All equipment is withdrawn from the vessel and the puncture site repaired Risks During the procedure there is a danger of puncturing the vessel with the guidewire This is a very small risk Patients must be monitored for hematoma or hemorrhage at the puncture site There is also a small risk of heart attack, emboli, and although unlikely death Hospitalization will vary in length by the patient's overall condition, any complications, and availability of home care Resources Periodicals "The angioplasty correct follow up strategy after stent implantation." Heart 84, no (April, 2001): 363 Carnall, Douglas "Angioplasty." The Western Journal of Medicine 173, no (September 2000): 201 "New Imaging Technique Could Improve Outcome of Popular Heart Procedure." Heart Disease Weekly May 13, 2001: "Success clearing clogged arteries." Science News 159, no (February 3, 2001): 72 Other "Cardiovascular System" Miami Heart Research Institute 2001 [cited July 5, 2001] 〈http://www.miamiheartresearch.org/Learning Center/YourCardiovascular…/Cardiovascular.htm〉 "Coronary angioplasty: Opening clogged arteries" MayoClinic.com, Condition Centers, Treatments and Tests 2000 [cited July 5, 2001] http://www.mayoclinic.com "Heart American Heart Association online 2000 [cited July 5, 2001] 〈http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/angiol.html〉 "STS Patient Information: What to Expect after your Heart Surgery." Society of Thoracic Surgeons online 2000 [cited July 5, 2001] http://www.sts.org/doc/3563 "When you need to have Angioplast: A patient guide" Heart Information Network 2000 [cited July 5, 2001] http://www.heartinfo.org/news97/gdangio111897.htm Gale Encyclopedia of Medicine Copyright 2008 The Gale Group, Inc All rights reserved angioplasty /an·gio·plas·ty/ (an´je-o-plas″te) an angiographic procedure for elimination of areas of narrowing in the blood vessels balloon angioplasty inflation and deflation of a balloon catheter inside an artery, stretching the intima and leaving a ragged interior surface, triggering a healing response and breaking up of plaque Balloon angioplasty, the expanded balloon pressing against a stenotic site in an artery percutaneous transluminal angioplasty a type of balloon angioplasty in which the catheter is inserted through the skin and through the lumen of the vessel to the site of the narrowing percutaneous transluminal coronary angioplasty (PTCA) percutaneous transluminal angioplasty to enlarge the lumen of a sclerotic coronary artery Dorland's Medical Dictionary for Health Consumers © 2007 by Saunders, an imprint of Elsevier, Inc All rights reserved an·gi·o·plas·ty ( n j - -pl s t ) n Surgical reconstruction of a blood vessel Balloon angioplasty The American Heritageđ Medical Dictionary Copyright â 2007, 2004 by Houghton Mifflin Company Published by Houghton Mifflin Company All rights reserved angioplasty [an′jēōplas′tē] Etymology: Gk, angeion, vessel, plassein, to mold the reconstruction of blood vessels damaged by disease or injury, often performed by inflating a balloon within the vessel lumen at the site of narrowing to reconstitute flow See also balloon angioplasty Mosby's Medical Dictionary, 8th edition © 2009, Elsevier angioplasty (an´jē plas´tē), n a medical procedure used to treat angina or blockage of the coronary arteries The procedure involves the insertion of a balloon-tipped catheter into the body through a small incision, usually in the groin The catheter is guided to the blockage using radiographs and injected dye Once the blockage is reached, the balloon on the catheter is gently inflated to open the blood vessel Also called percutaneous transluminal coronary angioplasty (PTCA) Mosby's Dental Dictionary, 2nd edition © 2008 Elsevier, Inc All rights reserved angioplasty surgical repair of blood vessels or lymphatic channels percutaneous transluminal angioplasty dilatation of a blood vessel by means of a balloon catheter inserted through the skin and into the chosen vessel and then passed through the lumen of the vessel to the site of the lesion, where the balloon is inflated to flatten plaque against the artery wall Called also PCTA Saunders Comprehensive Veterinary Dictionary, ed © 2007 Elsevier, Inc All rights reserved angioplasty Any interventional repair of a blood vessel See Balloon angioplasty, Deferred adjunctive coronary angioplasty, Immediate adjunctive coronary angioplasty, Kissing balloon coronary angioplasty, Percutaneous transluminal coronary angioplasty, Primary coronary angioplasty, Rescue adjunctive coronary angioplasty, Rescue renal angioplasty McGraw-Hill Concise Dictionary of Modern Medicine © 2002 by The McGraw-Hill Companies, Inc Anode A positively charged electrode that attracts electrons from the negatively charged cathode which serves as a target source for x-ray photons There are two types of anodes, rotating and stationary http://www.radiologystudents.com/radiology-dictionary/anode/ ... bệnh mạch máu tắc nghẽn xơ vữa động mạch, dòng máu đến quan (như tim) đến phần xa thể (nhu chi dưới) bị suy yếu hẹp lịng mạch lắng đọng mỡ tích tụ calcium Mạch máu bị hẹp Vì cần nong mạch máu. .. thủy thuật tạo hình mạch máu thực cách làm giãn mạch máu với việc đưa vào ống thông cứng lớn qua không gian hẹp Biến chứng thủ thuật làm cho nhà nguyên cứu phát triển cách làm rộng mạch máu việc... dùng thuốc chống đơng gây khó bít điểm vào mạch máu Thủ thuật thực sụ hướng dẫn huỳnh quang thuốc cản quang Vì việc định làm tạo hình mạch máu sau chụp mạch chẩn đoán, cần phải biết bệnh nhân có