Centers of Excellence in Interventional Cardiology and Radiology

Interventional radiology

Aortic abdominal aneurysm

PROCEDURE WITHOUT SURGERY , 24 HOURS AFTER DISCHARGE!

Our center has saved the lives of over 4,500 patients in the last 4 years

The most modern equipped angiography room , an exceptional medical team

We have the most famous abroad specialists! Team from Romania, Israel, Greece and Germany!

Only 24 hours hospitalization

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Generalities

Chronic mesenteric ischemia is a rare afection, wich in 95% of cases is caused by difuse atherosclerosis ( fats accumulation in your blood vessels walls, leading to their narrowing wich decrease the flow of blood to the bowel). Disease’ s progression is associated with more striking symptoms. Almost half of patients present simultaneous the affecting of heart’s blood vessels, but also peripheral artery disease.

Nonatheromatous conditions include: compression of celiac artery, Takayasu arteritis, thromboangitiitis obliterans, radiation-induced vascular injury. The disease generally presents in patients over 60 years and the incidence is three times higher in women. Symptoms commonly occurs when there are two blood vessels affected ( celiac trunk, superior mesenteric artery, inferior mesenteric artery).

Digestive tube receive blood from three main vessels: celiac trunk, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The celiac artery suppllies most of blood to the lower esophagus, stomach, duodenum, liver, pancreas and spleen. The SMA commes off the aorta and supplies blood to duodenum, jejun, ileum, cecum and colon. IMA commes also off the aorta and supplies blood to the distal transverse, descending and sigmoid colon and the rectum. Many communications exist within these arteries so as we pointed above, tipically, symptomps appears when there are at least two vessels affected.

Usually, patients are asymptomatics, because of these communication between vessels. Though, symptoms appear when there is a high need of blood, wich excel the real contribution of bowel’s circulation.

Most typical symptoms include: “fear of eating”, postprandial abdominal pain, weight loss, nausea, vomiting, anorexia, diarrhea or constipation, flatulence. Physical exam may reveal difuse abdominal pain, some abdominal bruits (but rare; produced beacuse of blood pass through the narrowing area).

Diagnosis

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There are some imaging studies: mesenteric sonography duplex, multi-slice computer tomography, magnetic resonance imagistic and angiography ( the gold standard tehnique).

Except diagnosis of mesenteric ischemia (acute or cronic), mesenteric aretriography has also other indications, such as:

to find the source of bleeding in the gastrointestinal tract

to find tha cause of ongoing pain and weight loss when no cause can be identified

when other studies do not provide enough information about abnormal growths along the intestinal tract

to look at blood vessel damage after an abdominal injury

Indications

Treatment of chronic mesenteric ischemia is essential for preventing acute ischemia ( wich can lead to the bowel infarction and a high risk of death).

Treatment consists of two methods: the surgical way or the interventional way – minimally invasive.

Surgical techniques used involves transaortic endarterectomy of the celiac or SMA, retrograde bypass from external iliac artery and anterograde bypass, wich provides the best orientation of the graft to the aorta.

Yet, the risks associated with the surgical method are high, that’s why the endovascular treatment was develop. This is a minimallly invasive treatment wich consists of dilating the artery using a balloon with or without stenting (placing a small, metal tube called stent into an artery to help hold it open). Also, high risk surgical patients can be eligible for thisd kind of treatment, with a lower risk profile. Usually, asymptomatics patients do not need treatment ( except for those patients who need other abdominal surgical treatment wich can lead to loss of blood vessel communications and the rapid progression of disease).

Procedure

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Interventional treatment is a minimally-invasive (without a large abdominal incision), performed in ours catheterism labs, under local or general anesthesia, respecting the asepsy rules. You will receive aslo heparin iv (a drug wich prevents clots).

The doctor will make a small incision in each groin to visualize the femoral arteries in each leg. More frequent the femoral approach is used, but the interventionist may also use the brachial or radial (rare) approach. With the use of special endovascular instruments, along with X-ray images for guidance, a catheter will be inserted through the femoral artery and advanced up into the aorta to the site of occluded vessels. An aortogram (injection of contrast dye to visualize the occluded vessels and adjacent blood vessels) will be performed. Then the angioplasty is performed ( this means that the doctor will wide the narrow artery with a small balloon inflated with diluted contrast dye). After angioplasty a stent may be placed in the narrowing area, for maintaning the artery opened.

An aortogram will be repeated to check for the stent position and residual stenosis. Also, if needed, angioplasty may be performed after stenting.

When the procedure is done, the interventionist will remove the catheter.

Is it painful?

The doctor may use general anesthesia or local anesthesia, so the patient will not feel any pain, and after the procedure it will received pain drugs.

How long does it take?

The procedure lasts about 1-2 hours and is performed in the cath lab.

Risks

The complications are rare and they are reduced by the proper preparation and the continuous surveillance of the patient. Potential complications:

• allergic reactions to administered substances, including renal disfunction

• reactions to anesthetic compounds

• arteriovenous fistulas at the vascular puncture site

• bleeding at the vascular puncture site

• fever

• headache, migraine

• infection

• gaseous embolism

• lessions of the artery punctured

• aortic dissection or rupture

• restenosis or stent migration

Before procedure

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You will be asked to sign a consent form that gives permission to do the procedure.

In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.

You will be asked to fast for eight hours before the procedure, generally after midnight.

If you are pregnant or suspect that you are pregnant, you should notify your health care provider.

Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).

Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

You may receive a sedative prior to the procedure to help you relax.

Based on your medical condition, your doctor may request other specific preparation.

After procedure

You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication for incisional pain or you may have had an epidural during surgery which will help with postoperative pain.

Since the procedure is minimally invasive, the postprocedural recovery is usually very fast. The majority of patients can leave the hospital the following day. Indications about recovery and postprocedural treatment will be clearly specified to all patients.

Your activity will be gradually increased as you get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as tolerated. Arrangements will be made for a follow-up visit with your doctor. Check out for fever, pain or alteration at the incision plance, but also for neurologic events.

Important!

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The percutaneous treatment it’s a modern, minimally invasive procedure, so the recovery will be rapid. Within our centres of excellence, both the patient and his/her doctor can choose the interventional cardiologist from our reputable team. As soon as a procedure is performed, the patient will receive a written report and a CD containing recorded images of the intervention and the doctor is informed about his/her patient’s health status.

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Sună Mesaj