Doppler Ultrasound

The blood vessel that Dr. Eltahawy was concerned about was thin and looked as though it would collapse in on itself. First, Dr. Eltahawy tried a balloon catheter. At the top of the catheter was a small balloon that could inflate to maintain a shape or structure of a blood vessel. However, because the blood vessel was so thin, the balloon catheter was not very effective. Instead, Dr. Eltahawy installed a stent. A stent is a wire mesh tube. It is placed in a blood vessel permanently to maintain the shape of the vessel and to allow for the free flow of blood. Throughout this entire independent study, I realize that shadowing in the medical field is less about learning about medicine and more about discovering about whether becoming a doctor is the right step. This independent study has been a step in the right

Unfortunately, “VTE comprised of DVT and/or PE represent a serious public health challenge, affecting up to 600,000 Americans annually. The consequences can be deadly; VTE has been identified as the most common cause of preventable mortality in hospitalized patients, accounting for up to 10% of hospital deaths” (Shermock et al., 2013, p. 1) It is imperative that all patients admitted to the ICU should be assessed for VTE. The assessment should be done frequently. It is important to assess both subjective and objective data. Past medical history is very important. It is essential to find out if the patient has any predisposition to a VTE including any trauma to veins, any varicosities, obesity, COPD, HF. Certain medications can also put a patient at risk for VTE such as oral contraceptives, hormone therapy, tamoxifen, or raloxifene. Also, any recent surgeries such as orthopedic, gynecologic, gastric, or urologic and past surgeries involving veins or a central venous catheter can put a patient at risk. Objective data includes fear, anxiety, and pain. Monitor vital signs frequently. Check the integumentary system for symmetry; taut, shiny, warm skin, erythematous, tender to palpation. Not every patient

1). Chest X-ray was normal. Initial laboratory studies were remarkable for white blood cells count of 12.1K, a creatine kinase MB fraction of < 3 mm was associated with significant reductions in restenosis and the rate of target vessel revascularization19. In SES-SMART trial patients were randomly assigned to receive a Sirolimus-eluting or bare-metal stent in small coronary artery. Sirolimus stent was associated with significant reductions in the rates of angiographic restenosis (primary outcome), target lesion revascularization and MI at 8 months20. The composite clinical endpoint ( death, non-fatal MI, ischemia- driven target lesion revascularization, and cerebrovascular accidents) was significantly lower with the sirolimus-eluting stent21. In the TAXUS V trial, in the subset of patients with small coronary arteries, the paclitaxel stent was associated with significant reductions in angiographic restenosis and target lesion revascularization at nine months compared to bare metal stents22. Although DES improves target lesion revascularization rates compared to bare-metal stents in small vessels, the absolute rates are still higher in small vessels than large

A coronary angiography provides information about the hearts blood pressure and functioning. This procedure can identify whether the coronary arteries are blocked or narrowing. A tube/camera is passed through an artery in the groin or arm; it is guided using x-rays up to the heart. A coronary angiogram is a safe procedure, but there are some small side affect. You may feel a slightly strange sensation when the dye is put down the catheter, a small amount of bleeding when the catheter is removed, a bruise in your groin or arm.

When I tell a person that I want to pursue a degree in Diagnostic Medical Ultrasound their first thought is babies. Which I don’t blame them because that is the part of ultrasound we are exposed most too. But ultrasound is so much more than just seeing an unborn baby. There are so many amazing things that ultrasounds can do. DMU is an imaging technique used to visualize the tissue structures/internal organs of the body by recording the returning reflections of ultrasonic waves with the purpose of pathology diagnosis. There are two names it goes by, ultrasound and sonography. These two terms are often used interchangeably. Ultrasound uses sound and acoustics to produce images that are then reflected back in real time.

This type of procedure is performed in a hospital or outpatient setting under the supervision of a certified Interventional Radiologist. Commonly performed procedures can include the treatment of varicose veins, deep vein thrombosis (DVT), pulmonary embolism, IVC filter placement, abdominal aortic aneurysm (AAA), etc. This type of modern imaging has greatly decreased the amount of invasive surgeries as well as limits the cost for patients. With this procedure, imaging such as x-ray, CT, or ultrasound are used to guide the doctor through minor incisions into the body.

This past Friday in the cardiac catheterization lab I began my day with continuing the work that I was previously assigned to do last week where I collected the data of patient's Cardiothoracic surgery. I continued to familiarize myself with the different types of Cardiothoracic surgery procedures, however, the specific reports I was working with, they are called TAVR report (Transcatheter Aortic Valve Replacement). I later learned and was explained to, the TAVR multiple procedures and its causes, which is aortic stenosis. As for the procedures, a valve needs to be placed in the heart and each procedure delivers it a different way. The three ways the valve can be placed in the heart is through the heart's femoral artery (the transfemoral approach),

Comparing the data found in the Palliative Nursing textbook and those found in the articles researched, there are both similarities in description and etiologies identified by the disease but there are variances in the treatment plan for initial management of SVCO. All sources confirmed the use of CT scans as the primary diagnostic tool used to identify SVCO, followed up by the use of MRI. One source identified the use of a portable ultrasound for emergency department patients. Detailed by Birch et al., 2014, those patient were found to have a thrombolytic cause of the obstruction. The ultrasound was used as a primary tool for diagnosis in these cases. In, comparison Coyle et al., 2015 still reports using CT or MRI for screening of thrombolytic causes for SVCO. Older data indicates more frequent use of chemotherapy and radiation therapy but newer data demonstrates a greater use of stent placement as the initial treatment for SVCO. Research data, Leung et al., 2015, detailed that the initial treatment once SVCO is identified should be surgical stenting of the obstruction. This method was recommended because it provided rapid and effective relief of symptoms in patients. According to Leung et al., 2015, it was found that 95% of patients revealed overall symptom relief with stenting as the initial treatment of SVCO. There was only a reoccurrence of SVCO in 11% of patients. Labarca et al, 2014, reaffirms the stance for surgical intervention of stent placement as initial

This is where the research gets very interesting. The truth of the matter is there are two methods to discuss. The first method is commonly known as the “blind” method where the catheter line is threaded by feel through a vein the arm and into the superior vena cava of the heart. The second method is accomplished using ultrasound technology to guide the catheter up through the arm and into the heart chamber.

Catheter angiography can accurately evaluate aortic pararenal patency. This is especially important when placing engrafts at the iliac bifurcation site. CTA is more sensitive to assessing endoleaks occurring after EVAR procedures, but digit subtraction angiography (DSA) is more accurate in classifying endoleaks. This is possible because the direction of flow in or out of the aneurysm site can be evaluated via DSA. Catheter angiography plays a role in imaging intraoperative EVAR patients for endoleak classification and for post-operative re-intervention (Francois et al., 2012). Figure 5 illustrates an arteriogram taken in preparation for an EVAR procedure, while Figure 6 was taken after the EVAR procedure was

[7] However, diabetes still remains a major risk factor for restenosis after both bare-metal stents and DESs. [10] Diabetes mellitus is regarded as a proinflammatory and prothrombotic condition, and patients with diabetes mellitus are more frequently resistant to aspirin and clopidogrel than those without diabetes mellitus. [2] The minimum necessary duration of DAPT may be longer in diabetic than in nondiabetic patients. [2] Among diabetic patients, target vessel failure occurred more frequently with 6-month DAPT than with 12-month DAPT. [2] Prolonged DAPT for >6 months might be needed to prevent late stent thrombosis because of delayed vascular healing and inflammatory reaction after implantation of drug-eluting stents.

A few of stents are the Leo, Enterprise, and the Solitaire AB Stent. Leo stents are retrievable but they are prone to shift when they are in mid release state (Cui, Y., Xu, H., Liu, H., & Wang, Y. (2015). Enterprise stents can only be recovered once, and it’s only when they haven’t been released over 70 percent. The Solitaire AB Stent can be recovered a number of times. This is the main advantage of the Solitaire AB stent over other stents. The release technique is also different with the Solitaire AB stent. The stent is released from distal end and only after the position is determined; it also has a single open end which is different than the Leo and

50 percent of patients with severe aortic stenosis wouldn’t serve the nominal two year life expectancy in respect to those with Aortic valve replacement[28]. Hence, emphasis on the study of aortic stenosis and its progression is of decisive significance [23].

The stent will be placed where it can be expanded to hold the artery open. Some stents are designed to simply keep the artery held open. Other stents used are drug-eluting stents. These stents are coated with pharmacologic agents that work to prevent restenosis of the artery.

appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler