If you don’t want to lie flat, change your path.

2022-06-26 0 By

Mr. Xiang, 67 years old, went to the department of Neurology of Enshi Central Hospital for treatment because of “repeated dizziness for 7 years”.After hospitalization, the neurology team found that There was a possibility of severe stenosis in Mr. Xiang’s cerebral vertebral artery, and suggested him to improve the whole cerebral angiography to further clarify the cause.During the preoperative communication, Mr. Xiang learned that the femoral artery puncture (thigh root) was required for the total cerebral angiography operation through the femoral artery, and the puncture point of the femoral artery should be pressed for more than 6 hours after the operation, and the patient should stay in bed for 24 hours and defecate in bed.Because of the busy affairs at home, he did not want to bother his family to accompany him after the operation.After understanding Mr. Xiang’s appeal, the interventional team of neurology decided to perform total cerebral angiography via radial artery (wrist) in order to eliminate the patient’s concerns and improve the patient’s medical experience to the greatest extent.Since Mr. Xiang’s right radial artery was slender, total cerebral angiography was performed through the left radial artery, and it was found that Mr. Xiang had “moderate or above stenosis at the beginning of V1 segment of right vertebral artery”.After the diagnosis of the cause, the surgical team of the Department of Neurology explained the patient’s condition and surgical method in detail with the patient and his family members. After obtaining consent, the patient was performed with “right vertebral artery V1 segment stent implantation”.After surgery, the patient’s dizziness symptoms were significantly relieved.After the angiography, Mr. Xiang walked out of the operating room immediately and happily said while walking in the ward, “The doctor changed the operation method and chose the operation through the arm artery. The operation was not painful at all. The key was that he did not have to lie flat for 24 hours after the operation.Whole cerebral angiography and cerebrovascular check project has a lot of, including the neck vascular ultrasonography and transcranial doppler (TCD) served, CT angiography (CTA), magnetic resonance angiography (MRA), the blood vessels such as high resolution MR, each have advantages and disadvantages, their common ground is noninvasive examination, but the whole cerebral angiogram is still the current “gold standard” of evaluation of cerebrovascular disease.Total cerebral angiography is a kind of X-ray projection examination technology that directly infuses contrast agent into the blood vessel to develop the cerebral vascular system.The morphological changes of blood vessels, such as running, distribution, displacement, thickness and circulation time, can be understood by angiography.Finally, it is determined whether the lesion is vascular itself or vascular changes caused by lesions in other parts of intracranial, providing a basis for clinical diagnosis and treatment.Total cerebral angiography (DSA) is the most accurate method of cerebrovascular examination at present. It can not only clearly display the vascular images of internal carotid artery, vertebrobasilar artery, intracranial large vessels and cerebral hemisphere, but also measure the blood flow of arteries, so it has been widely used in the examination and treatment of cerebrovascular diseases.What are the disadvantages of DSA via femoral artery? The traditional approach is to perform interventional surgery through femoral artery puncture intubation. In order to prevent hematoma and other complications at the puncture site after surgery, lower limb immobilization and compression at the puncture site should be carried out in bed for more than 6 hours.Femoral artery puncture path is long and not easy to compress hemostasis, resulting in poor tolerance and coordination for patients with lower limb immobilization for a long time after surgery, especially for elderly patients with poor compliance.Advantages of transradial DSA 1. Elastic bandage can be used to compress and stop bleeding after radial artery puncture, shortening the time of patients in the operating room.2. Patients are more considerate, easy to accept cerebrovascular DSA examination before surgery, and comfortable after surgery. The vast majority of patients can walk out of the operating room and move freely in the ward.3. The complications of puncture site were significantly reduced compared with DSA through femoral artery, and there were no other discomfort and complications except slight pain near puncture site of radial artery.4. Especially for patients with strong anticoagulation and anti-platelet aggregation, puncture complications are not easy to occur.5. Transradial artery puncture is easier for obese patients.6. Transradial DSA is relatively easier in patients with type iii aortic arch.Total cerebral angiography via radial artery approach is different from conventional femoral artery approach in that it has the advantages of less injury, less bleeding, short path, low incidence of complications, short or no bed time, etc., which can greatly reduce the occurrence of DVT and PE caused by prolonged immobilization of conventional femoral artery approach.However, the radial artery is smaller than the femoral artery, and it is more difficult for the catheter and guide wire to reach the target vessel, which increases the operation difficulty of the surgeon. Therefore, the interventional doctors need more solid basic skills of anatomy and clinical knowledge.As one of the few departments in enshi Central Hospital that can carry out both radial and femoral artery interventional diagnosis and treatment at the same time, the interventional team alleviates patients’ pain with professional and rigorous techniques, reduces patients’ hospitalization time, reduces hospitalization costs, improves patients’ satisfaction, and tries to make greater contributions to people’s health.Which patients are not suitable for total cerebral angiography ① iodine contrast agent allergy or intolerance;② Allergy to interventional equipment;③ Severe heart, liver and kidney insufficiency;(4) Local infection of puncture site;⑤ Complicated with cerebral hernia.Preoperative preparation for cerebrovascular angiography 1. Complete the examination of electrocardiogram, blood routine, liver and kidney function, electrolyte, coagulation function, infectious diseases, etc.;2. For patients who are awake and able to cooperate, dietary prohibition is generally not required before surgery, and dietary prohibition is required according to the doctor’s advice if (stent placement, etc.) is needed;3. Preoperative special drugs (such as metformin and antiplatelet agglutination drugs) should be taken according to the doctor’s advice.1. Stay in bed: patients undergoing femoral artery puncture should lie supine and keep the lower limb braking and pressing the puncture site for more than 6 hours. The lower limb braking should be removed 12 hours after the operation, and the patient can get out of bed 24 hours later.For patients undergoing radial artery puncture, the operative limb was immobilized until the compression device was removed, and the lifting of heavy objects by the operative limb was reduced after surgery.2. Check the puncture site and the pulsatile at the distal end of the artery on a regular basis after surgery, so as to detect abnormalities in time, usually once every 15 minutes, a total of 4 times, and then every 30 minutes, a total of 2 times, and then every 1 hour, a total of 2 times.Inform the doctor in time if any of the following conditions occur: bleeding at the puncture site or hematoma formation;The puncture site could not be reached by pulsation at the distal end.3. Vital signs monitoring: heart rate and heart rhythm monitoring for 24 hours;Patients with unstable blood pressure should be measured every 15 to 30 minutes until the blood pressure stabilizes and then once an hour.4. Diet: light and easy to digest, low salt, low fat, low cholesterol and high fiber diet should be recommended. Eat less and more meals to avoid oversatiety and keep stool smooth;Drink more water to remove contrast agent.Declaration: The copyright of this article belongs to the original author, if there is a source error or infringement of your legitimate rights and interests, you can contact us through the mailbox, we will promptly deal with.Email address: jpbl@jp.jiupainews.com