冠脉造影的规范操作归纳.ppt

* The trick of doing a proper groin stick is to fully understand the anatomy of femoral artery and its branches and also always use fluoroscopy if you are not sure. * Puncture Anatomical difficulties Selective catheterization of coronary ostia Support with guide catheter Learning curve * Patient selection: Any patient with dual arterial supply and palpable pulse. Obese ,elderly and patients with PVD Patients with bleeding risk ( lytic, on coumadin, GP2b/3a) Patient to avoid Shock Raynaud’s, Buerger’s disease Small artery even with normal Allen test * . * Brachial artery divides proximal to the elbow in 20%. Basilic vein lies in the medial. Medial nerve courses anteralateral to medial in the right. * In this particular case ,a 100 cm diagnostic catheter can not reach the coronary ostium. Therefore brachial approach was taken and MP catheter were used * Disadvantage * * The left Judkins guide is designed for coronary angiography with its primary (90) ,secondary (180) and tertiary (35) curves fitting the aortic root anatomy so it can engage the LM ostium without much manipulation .It knows where to go unless thwarted by the operator. Because of the 90 bend at its tip, it does not make perfect coaxial alignment. Furthermore ,in inexperienced hands ,the LM ostium can still be easily engaged by the guide due to its preshaped configuration. On many occasions, even when secondary curve does not sit well on the opposite aortic wall or coronary sinus, diagnostic angiography can still be performed satisfactorily while there is no adequate support for advancement of interventional hardware. * If the tip does not reach the ostium or below it , the guide is too small. If the tip lies above the ostium, or the loop can not be opened ,the guide is too large. When the RCA ostium is very high, than the AL may be used to engage the RCA. For arteries that lies in the middle portion of the right sinus or lower, a AR with much smaller hook must be used. The guide is advanced into the