s**********8
发帖数: 25265 | 1 http://en.wikipedia.org/wiki/Balloon_angioplasty
Angioplasty
From Wikipedia, the free encyclopedia (Redirected from Balloon angioplasty)
Jump to: navigation, search
Angioplasty
Intervention
Balloon angioplasty.
ICD-9-CM 00.6, 36.0 39.50
MeSH D017130
Angioplasty is the technique of mechanically widening a narrowed or
obstructed blood vessel, typically as a result of atherosclerosis. An empty
and collapsed balloon on a guide wire, known as a balloon catheter, is
passed into the narrowed locations and then inflated to a fixed size using
water pressures some 75 to 500 times normal blood pressure (6 to 20
atmospheres). The balloon crushes the fatty deposits, opening up the blood
vessel for improved flow, and the balloon is then deflated and withdrawn.
The word is composed of the medical combining forms of the Greek words αγ
γειος angeus meaning "vessel" and πλαστός plastus
meaning "formed" or "moulded". Angioplasty has come to include all manner of
vascular interventions typically performed in a minimally invasive or
percutaneous method.
Contents [hide]
1 History
2 Causes of Coronary Artery Disease
3 Limited value in stable patients
4 After the procedure
5 Peripheral angioplasty
6 Coronary angioplasty
7 Renal artery angioplasty
8 Carotid angioplasty
9 Cerebral arteries angioplasty
10 See also
11 References
12 External links
[edit] History
Diagram of a balloon catheter.Angioplasty was initially described by the US
interventional radiologist Charles Dotter in 1964.[1] Dr. Dotter pioneered
modern medicine with the invention of angioplasty and the catheter-delivered
stent, which were first used to treat peripheral arterial disease. On
January 16, 1964, Dotter percutaneously dilated a tight, localized stenosis
of the superficial femoral artery (SFA) in an 82-year-old woman with painful
leg ischemia and gangrene who refused leg amputation. After successful
dilation of the stenosis with a guide wire and coaxial Teflon catheters, the
circulation returned to her leg. The dilated artery stayed open until her
death from pneumonia two and a half years later.[2] Charles Dotter is
commonly known as the "Father of Interventional Radiology" and was nominated
for the Nobel Prize in medicine in 1978.
The first coronary angioplasty on a waking patient was performed by German
cardiologist Andreas Gruentzig in September 1977.[3]
[edit] Causes of Coronary Artery DiseaseBlockages in the arteries may be
caused by hypertension, diabetes, sedentary lifestyle, smoking, high
cholesterol levels, diets high in saturated fats, and cardiovascular disease
. Removing blockages is done with angioplasty.[4]
Angioplasties are safer than bypass surgery and according to statistics less
than 1% of people die from complications after this procedure.[5]
Complications that may occur after or during an angioplasty are the
following:
Tearing of the artery resulting in total blockage and possible myocardial
infarction - this can usually be repaired with a stent
A dislodged clot may cause a stroke in some circumstances (in less than 1%
of patients who undergo angioplasties);
Bleeding or bruising where the catheters were inserted;
Kidney problems, especially in people with underlying kidney disease and
diabetes - this is caused by the iodine contrast dye used for the X-ray;
intravenous fluids and medications can be given before and after the
procedure to try to reduce this risk.
Arrhythmia (irregular heartbeat);[6]
Allergic reaction to the dye given during the angioplasty;
Myocardial infarction happens in 3 to 5% of the cases;
The need for emergency coronary artery bypass grafting during the procedure
(2-4 percent of people). This may occur if an artery closes down instead of
opening up;
Restenosis is one of the most common complications of angioplasties and it
consists in the gradual re-narrowing of the blood vessels within the next
several weeks to months after the procedure. There are certain conditions
that increase the risk of developing this complication and these are
hypertension, diabetes, angina or kidney disease.
Blood clots (in-stent thrombosis) can form within stents hours or months
after angioplasty and they may cause myocardial infarction.[7]
The risks carried by angioplasty are greater in patients older than 75 years
, patients who suffer from diabetes or kidney disease or who have extensive
heart disease or blood clots in the heart arteries. Also, patients with poor
pumping function in their hearts and women are considered to have an
increased risk for complications.
Complications such as myocardial infarction, stroke or kidney problems are
however among the rarest. The death rate among patients who have angioplasty
is very small, about 0.1% (compared to 1% to 2% for routine bypass surgery).
All in all, the risks are relatively low and acceptable in most cases when
one balances the potential benefit against the expected risk (risk-benefit
ratio).[8]
[edit] Limited value in stable patientsThe value of angioplasty in rescuing
someone having a heart attack (by immediately alleviating an obstruction) is
clearly defined in multiple studies, but studies have failed to find
reduction in hard endpoints for angioplasty vs. medical therapy in stable
angina patients. The artery-opening procedure can temporarily alleviate
chest pain, but does not contribute to longevity. The "vast majority of
heart attacks do not originate with obstructions that narrow arteries".[9]
A more permanent and successful way to prevent heart attacks in patients at
high risk is to give up smoking, increase exercise/yoga and take "drugs to
get blood pressure under control, drive cholesterol levels down and prevent
blood clotting".[9]
[edit] After the procedureAfter angioplasty, most of the patients are
monitored overnight in the hospital but if there are no complications, the
next day, patients are sent home.
The catheter site is checked for bleeding and swelling and the heart rate
and blood pressure are monitored. Usually, patients receive medication that
will relax them to protect the arteries against spasms. Patients are
typically able to walk within two to six hours following the procedure and
return to their normal routine by the following week.[10]
Angioplasty recovery consists in avoiding physical activity for several days
after the procedure. Patients are advised to avoid any type of lifting,
babysitting grandchildren or other strenuous physical activity for a week.[
11] Patients will need to avoid physical stress or prolonged sport
activities for a maximum of two weeks after a delicate balloon angioplasty.[
12]
Patients with stents are usually prescribed an anticoagulant, clopidogrel,
which is taken at the same time as acetylsalicylic acid (aspirin). These
medicines are intended to prevent blood clots and they are usually taken for
at least the first months after the procedure is performed. In most cases,
patients are given these medicines for 1 year.
Patients who experience swelling, bleeding or pain at the insertion site,
develop fever, feel faint or weak, notice a change in temperature or color
in the arm or leg that was used or have shortness of breath or chest pain
should immediately seek medical advice.
[edit] Peripheral angioplastyPeripheral angioplasty refers to the use of a
balloon to open a blood vessels outside the coronary arteries. It is
commonly done to treat atherosclerotic narrowings of the abdomen, leg and
renal arteries. PA can also be done to treat narrowings in veins, etc. Often
, peripheral angioplasty is used in conjunction with peripheral stenting and
atherectomy.
[edit] Coronary angioplasty
A coronary angiogram (an X-ray with radio-opaque contrast in the coronary
arteries) that shows the left coronary circulation. The distal left main
coronary artery (LMCA) is in the left upper quadrant of the image. Its main
branches (also visible) are the left circumflex artery (LCX), which courses
top-to-bottom initially and then toward the centre-bottom, and the left
anterior descending (LAD) artery, which courses from left-to-right on the
image and then courses down the middle of the image to project underneath
the distal LCX. The LAD, as is usual, has two large diagonal branches, which
arise at the centre-top of the image and course toward the centre-right of
the image.Main article: Percutaneous coronary intervention
Percutaneous coronary intervention (PCI), commonly known as coronary
angioplasty is a therapeutic procedure to treat the stenotic (narrowed)
coronary arteries of the heart found in coronary heart disease. These
stenotic segments are due to the build up of cholesterol-laden plaques that
form due to atherosclerosis. PCI is usually performed by an interventional
cardiologist.
Treatment with PCI for patients with stable coronary artery disease reduces
chest pain, but does not reduce the risk of death, myocardial infarction, or
other major cardiovascular events when added to optimal medical therapy.[13]
[edit] Renal artery angioplastyAtherosclerotic obstruction of the renal
artery can be treated with angioplasty of the renal artery (percutaneous
transluminal renal angioplasty, PTRA). Renal artery stenosis can lead to
hypertension and loss of renal function.
[edit] Carotid angioplastyCarotid artery stenosis is treated with
angioplasty and stenting for high-risk patients in many hospitals.
[edit] Cerebral arteries angioplastyIn 1983, the Russian neurosurgeon Zubkov
and colleagues reported the first use of transluminal balloon angioplasty
for vasospasm after aneurysmal SAH.[14][15]
[edit] See alsoAngiogram
Atherectomy
Charles Dotter
Interventional Radiology
Vascular surgery
Stent
[edit] References1.^ Dotter, C.T. and M.P. Judkins. Transluminal treatment
of arteriosclerotic obstruction. Circulation. November 1964, Volume XXX.
Pages 654-670.
2.^ Rosch Josef et al. (2003). "The birth, early years, and future of
interventional radiology". J Vasc Interv Radiol 14 (7): 841–853. PMID
12847192.
3.^ Biographic sketch of Andreas Gruentzig. http://www.ptca.org/archive/bios/gruentzig.html
4.^ "Angioplasty". http://professionalradiology.com/angioplasty.php. Retrieved 2010-04-06.
5.^ "The Facts on Angioplasty". http://bodyandhealth.canada.com/channel_condition_info_details.asp?disease_id=8&channel_id=10&relation_id=10865. Retrieved 2010-04-06.
6.^ "What Are the Risks of Coronary Angioplasty?". http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_Risks.html. Retrieved 2010-04-06.
7.^ "Risks And Possible Complications". http://www.mayoclinic.com/health/angioplasty/MY00352/DSECTION=risks. Retrieved 2010-04-06.
8.^ "PTCA or Balloon Angioplasty". http://www.heartsite.com/html/ptca.html. Retrieved 2010-04-06.
9.^ a b Kolata, Gina. "New Heart Studies Question the Value Of Opening
Arteries" The New York Times, March 21, 2004. Retrieved January 29, 2011.
10.^ "What should I expect after my procedure?". http://professionalradiology.com/angioplasty.php. Retrieved 2010-04-06.
11.^ "After the operation". http://bodyandhealth.canada.com/channel_condition_info_details.asp?disease_id=8&channel_id=10&relation_id=10865. Retrieved 2010-04-06.
12.^ "Angioplasty Recovery". http://www.angioplastysurgery.net/recovery.php. Retrieved 2010-04-06.
13.^ Boden W. E., O'Rourke R. A. et al. (2007). "Optimal medical therapy
with or without PCI for stable coronary disease". N Engl J Med 356 (15):
1503–16. doi:10.1056/NEJMoa070829. PMID 17387127.
14.^ Zubkov IuN, Nikiforov BM, Shustin VA (Sep-Oct 1983). "1st attempt at
dilating spastic cerebral arteries in the acute stage of rupture of arterial
aneurysms". Zh Vopr Neirokhir Im N N Burdenko 5 (5): 17–23. PMID 6228084.
15.^ Zubkov YN, Nikiforov BM, Shustin VA (Sep-Oct 1984). "Balloon catheter
technique for dilatation of constricted cerebral arteries after aneurysmal
SAH". Acta Neurochir (Wien) 70 (1-2): 65–79. doi:10.1007/BF01406044. PMID
6234754. |
|
