Transcript Comparison of Treatment Techniques for Blocked Arteries

Comparison of Surgical
Treatments for Blocked Arteries
By-Pass Surgery with Heart-Lung Machine
By-Pass Surgery using Off-Pump Technique
Angioplasty with Stent
Coronary Circulation
http://www.heartpoint.com/cathtell.html
Blockages In Arteries
http://www.brucemindich.com/Overview_of_cad.htm
The By-Pass: using another vessel to by-pass the
blockage and restore flow.
• Anastomosis: “An anastomosis is
a surgical connection between
two structures. It most commonly
refers to a connection which is
created between tubular
structures, such as blood vessels
or loops of intestine.”
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http://www.nlm.nih.gov/medlineplus/ency/article/00223
1.htm
What vessels are used for the by-pass?
1. Saphenous Vein from the Leg
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Relatively easy to locate and remove
Long segments can be divided to
provide multiple grafts.
Long segments can be used to reach
blockages on the back of the
heart.
Endoscopic technology can be used
to remove the vein with small
incisions.
Can usually be sewn to the coronary
artery without difficulty.
Good size match for coronary
arteries.
May not be usable in patients with
severe vascular disease
http://www.ctsa.com/html/cabg_2002.html Last update - 9/04/02. Page by kas@ctsa.
What vessels are used for the by-pass?
2. Internal Mammary Arteries
Two different mammary arteries
(left and right chest); both can be
used.
• Stay open longer than most
saphenous vein grafts. Do not develop
atherosclerotic disease.
• So durable that surgeons try to use
one on every patient, if possible.
• Too short to reach some blockages
on the back of the heart.
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http://www.ctsa.com/html/cabg_2002.html Last update - 9/04/02. Page by kas@ctsa.
What vessels are used for the by-pass?
3. Radial Arteries
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Radial Artery from the lower arm.
Longer and wider than the mammary
arteries.
Thicker than the mammary artery easier to sew.
Taken from the non-dominant arm
(ie, from the left arm if you are righthanded.)
93% of these grafts are still open after
1 year.
Longer term results
are under study.
http://www.ctsa.com/html/cabg_2002.html Last update - 9/04/02. Page by kas@ctsa.
By-Pass Surgery (heart-lung)
“The heart-lung bypass machine
takes over the work of the heart and lungs
during bypass and other open-heart
procedures so the heart can be still while
the surgeon works. It also is frequently
used to cool the patient’s body
temperature, reducing oxygen
requirements and protecting the heart and
other organs.
During total cardiopulmonary
bypass, all blood is diverted from the heart
by inserting big cannulas, or tubes, in the
right atrium, the collecting chamber of the
heart, and the aorta, a major artery, that
moves blood out of the heart into the
body. This enables a bloodless field that’s
important for surgeries such as replacing
the mitral valve that lets blood into the left
ventricle, the ejection chamber of the
heart.”
1.
Anesthesia
2. Harvest graft vessel
3.
Open Sternum
4. Retract Ribcage
5. Cut Open Pericardial Sac
6. Attach to Heart Lung Machine
7.
Attach Graft to Blocked Artery
8. Attach Graft to Aorta or Branch of Aorta
9. Restore Flow of Blood to Heart
10. Remove Heart Lung Machine
Dr. Kwabena Mawulawde, cardiothoracic surgeon at the
Medical College of Georgia
11. Stabilize Heart
http://www.mcg.edu/news/2002NewsRel/mawulawde.html
12. Close.
By-Pass Surgery, Off-Pump
1.
Anesthesia
2.
Harvest graft vessel
3.
Open Sternum
4.
Retract Ribcage
5.
Cut Open Pericardial Sac
6.
Stabilize Heart with Apparatus
7.
Attach Graft to Blocked Artery
8.
Attach Graft to Aorta or Branch of
Aorta
9.
Remove Stabilizer
10.
Close.
Angioplasty with Stent
1. The person is awake during the procedure.
2. Stent implantation :
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The stent is introduced into the blood
vessel on a balloon catheter.
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The doctor maneuvers the balloon
catheter to the blocked area of the artery
and inflates the balloon.
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The inflation of the balloon causes the
stent to expand, pressing it against the
vessel wall.
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The balloon is deflated and withdrawn.
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The stent stays in place permanently,
holding the vessel open and improving the
flow of blood.
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The doctor may choose to further expand
the stent with a balloon catheter similar to
that used in an angioplasty procedure.
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The stent will hold the artery open,
allowing blood to flow freely as in a
healthy vessel.
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New cells and tissue will slowly grow over
the stent eventually covering the inner
surface.
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© 2004, Guidant Corporation. All rights reserved
Where is the catheter inserted?
1. Groin/Femoral Approach
Catheter introduction into the groin requires a small incision to be made on the
inside of your upper thigh so an introducer sheath (short tube) can be inserted into
your femoral artery. Next, your doctor will insert a guiding catheter (long, flexible
tube) into the introducer sheath and advance it through the aorta to where the
coronary arteries branch off to the heart.
2. Arm/Brachial Approach
Catheter introduction into the arm requires that a small incision be made on the
inside of your elbow after local anesthesia has been given. The guiding catheter is
then inserted directly into the artery through the small incision and advanced to
where the coronary arteries branch off to the heart.
3. Transradial Approach
Catheter introduction into the wrist requires that a small incision be made on the
inside of your wrist after local anesthesia has been given. The guiding catheter is
then inserted directly into the artery through the small incision and advanced to
where the coronary arteries branch off to the heart
© 2004, Guidant Corporation. All rights reserved