| Invasive tests and procedures Invasive tests and procedures are most often conducted in the hospital because they involve surgical incisions and the insertion of medical equipment into your body. The CVA physicians have specialized training for such procedures. If we need to get a better image of your heart than we can get through noninvasive testing and your medical history suggests it would the best course of action, we may order a coronary angiogram. The angiogram allows us to actually see the arteries of your heart and determine whether there are blockages that need to be treated. An angiogram is a cardiac catheterization, a procedure during which a thin, plastic tube called a catheter is inserted into your body through an incision in your arm or groin. Using an X-ray, the catheter is guided to the arteries of your heart. During the procedure, the physician injects a special dye that shows up on the X-ray, giving your doctor invaluable information about any arterial blockages. Normally, we schedule angiograms as an elective procedure at
the hospital. You may be admitted the night before to receive
IV fluids so your body can safely accept the special dye, but
you will able to
return home that day as long as no additional procedure is needed.
If we’re concerned about your immediate welfare during your visit
to Cardiovascular Associates, we may directly admit you to the
hospital for an angiogram. Percutaneous coronary intervention (PCI) Percutaneous coronary intervention (PCI) is a medical technique
to open clogged or blocked arteries in order to allow blood to
flow freely again. Like coronary angiograms, PCI procedures
are cardiac catheterizations in which a catheter is inserted
into your body
through
an incision in your arm or groin. The catheter is guided to the
arteries of your heart using an X-ray. Balloon angioplasty is a common PCI procedure. Once the catheter
reaches its destination in your blood vessel, the interventional
cardiologist inflates a small balloon that has been placed at its
end. The expanded balloon compresses the material that’s been
causing the blockage against your arterial walls and opens up the
vessel.
The balloon
is then deflated
and the catheter is removed. In coronary stenting, a mesh-like scaffold, or stent, is placed
over a balloon and guided via catheter to a narrowed artery.
When the interventional
cardiologist inflates the balloon, the stent expands and
props open the
arterial walls. The deflated balloon and catheter are removed,
but the stent stays in your artery permanently. For several months
to a
year, you will be prescribed a drug called Plavix which allows
your body to safely accept the stent. When a hard plaque called atheroma is dangerously blocking any
of your your peripheral arteries, you will be admitted to the
hospital for a peripheral atherectomy. During this procedure,
a catheter with
a blade attached is inserted into your body. A motor will activate
the blade and shave off the plaque while safely storing the debris
inside a small chamber. The chamber is emptied of debris when
the catheter is removed, and then the catheter may be reinserted
to chip off atheroma
from another area. This restores normal blood flow back through the
previously blocked area. Intravascular ultrasound (IVUS) To get information about potential trouble spots inside your heart and blood vessels, intravascular ultrasound (IVUS) is sometimes used to supplement a coronary angiogram. It offers more detailed information when clarifaction of the angiogram is needed. An IVUS catheter, which is guided into your blood vessels the same
as other PCI procedures, has an ultrasound camera on its tip. It emits
and reads reflected sound waves to create an image of the inside of
your artery that is displayed in real time on a monitor for your doctors
to analyze. This may help us determine if stenting is necessary. A thrombectomy may be performed to remove a thrombus, or blood clot, that is dangerously blocking an artery. It may be performed prior to other PCI procedures to make them safer. During a thrombectomy, a catheter will be inserted into your body
and guided to the clot. Then, a pump will expel a saline solution
under high pressure to break it up. The jets also create a vacuum
in the artery that further weakens the thrombus and safely sucks the
clot pieces through the catheter and out of your body. Another type
of thrombectomy catheter uses negative pressure to remove the clot. Transesophageal echocardiogram (TEE) In some clinical situations, we need a better view of your heart
than we can get in a normal echocardiogram taken through your chest
wall. We would then perform a transesophageal echocardiogram (TEE),
which takes the ultrasound image from the inside your esophagus,
or throat. A special camera is inserted through your mouth and down
the
esophagus, which rests directly behind your heart, to take the
image. You’ll be admitted to the hospital the same day as the
TEE and sent home a few hours after the procedure. Pacemakers and implantable cardioverter-defibrillators (ICD) are devices surgically implanted in your body to treat abnormal heart rhythms. The ICDs deliver small shocks to stimulate your heart back into a normal state when they detect life-threatening rhythmic irregularities. A pacemaker ensures that your heart rate does not drop below a pre-set level. Once a device is implanted, you will need it for the rest of your life, and you will be able to feel the device’s battery through your skin. The procedure requires a minimum overnight stay in the hospital
and then follow-up visits to the pacemaker/ICD clinic at Cardiovascular
Associates. The device will also need its generator changed periodically,
normally every five years or so, depending on your clinical situation. Peripheral artery angiogram/intervention Symptoms of leg or buttock pain when walking or high blood pressure that’s difficult to treat could mean that you have peripheral arterial disease (PAD). PAD is a condition where clogged arteries do not allow enough blood to make its way to your limbs, kidneys, or brain. If peripheral arterial disease is suspected, we first conduct noninvasive procedures such as an ankle-brachial index test or an arterial ultrasound. If we detect abnormalities, we electively admit you to the hospital for a peripheral angiogram. Similar to a coronary angiogram, in this procedure we insert a catheter into your body and inject a dye to determine trouble spots. PAD can be treated with balloon angioplasty, stenting, or an
atherectomy. Endovenous Laser Therapy (EVLT) Endovenous Laser Therapy (EVLT) is a minimally invasive procedure for treating varicose veins that is performed in our offices rather than in a hospital setting. Aside from being unsightly, varicose veins can cause pain, fatigue, and heaviness in your legs. EVLT is the most advanced and effective treatment for varicose
veins available today. During the procedure, your physician inserts
a thin, narrow fiber through a small puncture in your leg and
guides it up the blood vessel using ultrasound imaging. Laser
energy is delivered
through the fiber as it is slowly withdrawn, closing up the vein.
You only need local anesthesia for EVLT. It takes less than an
hour, and
you ’re able to walk immediately once it’s through. |
Percutaneous coronary intervention Transesophageal echocardiogram Peripheral artery angiogram/intervention |
