RESUMO
Recently the importance of post procedure bleeding contributing to both short-term and long-term mortality has lead to a renewed interest in transradial coronary interventions in the United States. It has been long known that the incidence of access site bleeding is dramatically decreased by transradial access but the procedure is only used in 1% of coronary interventions in the United States, far below the rest of the world. In India, Japan and some European centers 50% of interventions are transradial. To extend this benefit of lower incidence of access site complications, we started using a transradial approach for peripheral interventions for the lower extremities, renal and subclavian arteries. By experience, we realized that in many cases the radial approach makes the procedure actually simpler. Also, in many instances, the transradial approach allows discharge of the patient on the same day. In this paper, we describe our approach to lower extremity, renal and subclavian interventional procedures.
Assuntos
Cateterismo Periférico/métodos , Doenças Vasculares Periféricas/terapia , Artéria Radial , Obstrução da Artéria Renal/terapia , Angioplastia com Balão , Humanos , Extremidade Inferior/irrigação sanguínea , Artéria SubcláviaRESUMO
Fifty-one patients with human immunodeficiency virus infection and acute coronary syndromes were identified. Nearly all patients (98%) had traditional coronary risk factors. Revascularization procedures were performed safely with low in-hospital mortality.
Assuntos
Doença das Coronárias/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Doença Aguda , Cateterismo Cardíaco/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Comorbidade , Doença das Coronárias/diagnóstico , Doença das Coronárias/cirurgia , Feminino , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Estudos Retrospectivos , SíndromeRESUMO
We present the case of a patient with severe symptomatic pulmonary hypertension due to rheumatic mitral valve disease who was refractory to traditional therapies, including prostacyclin. Therapy with continuous nesiritide infusion resulted in significant and sustained decreases in pulmonary vascular resistance, an improvement in renal function, and the maintenance of euvolemia.
Assuntos
Hipertensão Pulmonar/tratamento farmacológico , Natriuréticos/uso terapêutico , Peptídeo Natriurético Encefálico/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Bilateral stenting of the common iliac arteries via the radial access route, in the same setting, is presented in this case report. Radial access limits bleeding complications, avoids the crossover technique and allows same-day discharge.