THE CIRCULATORY SYSTEM Vascular and Cardiac Interventions

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THE CIRCULATORY SYSTEM Vascular and Cardiac
Interventions
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2 Systems differ in function/
transportation of fluids
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• Functions
• Transport nutrients and Oxygen
• Remove waste
• Maintain temp, water and electrolytes
• Components- RBC, WBC, Platlets, Plasma, H2O

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Blood Vessel Structure

• Tunica Intima (interna)
• Lining blood vessel
• Tunica Media
• Support for vessel
• Tunica Adventitia (externa)
• Responsible for strength of vessel

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• Capillary bed- arteries and veins connected here
• Where diffusion of materials take place across
  walls of small vessels

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Systemic Circulation

• Arteries- carry blood away from heart (O2)
• Strong pulse (heart phases)
• Vessels decrease in size to tissues
• Veins- blood returns to heart (deoxygenated)
• Vessels increase in size towards the heart
• Gradients

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Blood flow through the Heart

• SVC/IVC-
• RT AtriumTricuspid Valve
• RT Ventricle-Pulmonary ArteriesLUNGSPulmonary
  Veins- LT Atrium-Mitral Valve
• Left Ventricle-Ascending Aorta
• (Snopek p. 205)

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Cardiac Cycle

• Repeats 75x/ minute
• Consists of 3 phases
• Atrial contraction (systole)
• Ventricular contraction (systole)
• Complete rest (diastole)

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Blood flow of Coronary Arteries

• ORIGINATE FROM AORTIC BULB
• LEFT CORONARY ARTERY
• Feed anterior and posterior portions of heart
• RIGHT CORONARY ARTERY ( RCA)
• Supplies blood to Rt Atrium/ Rt Ventricle

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• Sinoatrial Node and Atrioventricular node
• AKA pacemaker of the heart

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• Blood Supply to the Brain
• RT LT Common Carotid ( Bifrucate at C-4)
• RT LT Vertebral Artery
• Branches off Aortic Arch
• 1.Brachiocephalic( Innominate) Artery
• Right common Carotid Artery
• Right Subclavian artery
• 2. Lt Common Carotid Artery
• 3. Left Subclavian Artery

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• Abdominal Aorta - Diaphragm to L-4
• Bifurcates into RT and LT Common Iliac Arteries-
  about L-4, L-5
• Then into Internal and External Iliac Arteries

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BRANCHES OFF ABDOMINAL AORTA (p. 356 Snopek)

• CELIAC TRUNK ( 3 branches arteries off aorta)
• Gastric, Hepatic and Splenic
• SMA
• Renal
• IMA

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VEINS

• Inferior Vena Cava
• Common Iliac
• Femoral
• Great Saphenous
• Anterior Tibial
• Seen in Venograms
• Bontrager, p 709

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VENOGRAMS pp 272-276

• 2/3 bodys blood supply sits in venous system
• Flow to heart controlled by what?
• Valves to prevent?
• DVT-
• Varicose veins-
• Replaced by modality that uses echoes or sound
  waves what modality?

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LYMPHANGIOGRAPHY

• Drains interstitial fluid and returns it to
  venous system
• Fluid from left side of body, lower limbs,
  pelvis and abdomen enter veins from thoracic duct
• Upper right, upper limb, head and neck drain into
  veins by right lymph duct

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Terms

• Lymphatic System-
• Lymph -
• Lymph nodes-
• No pump muscle massage and artery pulsation to
  move fluid

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Lymphatic Procedure

• Required a cut down to vessels
• Blue dye -Isolated lymph capillaries
• Oil based contrast
• Vessels cannulated, pressure injector
• Slow injection- 45 min
• Imagesleg, pelvis, abdomen, thorax (about 2
  hours)
• Patient returned 24-48 hours for same films
  Lymph nodes
• Now CT, US, Nuc Med used

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Coronary Arteriography

• What it visualizes Coronary arteries
• Indications Chest Pain pre-op Evaluation
• Pathologies Occlusion of Coronary
  Arteries
• Optimal time of injection diastole

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Some History

• 1976 Wallace interventional radiology term
• 1964 Dotter and Judkins opened stenosis vessel
• 1974 Gruntzig developed double-lumen balloon
• Improved vessel widening
• Reduced trauma at puncture site

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Divisions of Vascular Interventional Procedures

• Reduce or stop blood flow
• Increase blood flow
• Removal of Foreign bodies
• other

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BLOOD FLOW

• DECREASE
• Embolization- Gelform, coils
• Balloon Occlusion- Balloon
• Intravascular Infusion of Vasoconstrictors
• Intravascular Electrocoagulation

• INCREASE
• Percutaneous Transluminal Angioplasty (PTA)
• Vascular Stent Placement
• Intravascular Thrombolysis
• Intra- Arterial Infusion of Vasodilators

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Percutaneous Transluminal Angioplasty

• PTA
• Non surgical procedure
• Repair or reshape lumen w/ Balloon inflation
• Improve blood flow
• Create smooth inner wall
• After dilation, post angiogram done
• Antithrombic medication given for some timeWHY?

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TO PREVENT RE-STENOSIS

• Laser assisted balloon angioplasty
• Artherectomy
• High speed burr, plaque pulverized and eliminated
  by body
• Extraction- slow speed burr w/ vacuum
• Stent placement
• Delivered,expanded and left in place

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• Intravascular Thrombolysis
• Substances break up clots
• Removal of FB
• Accidental breakage of guidewires and catheters
• Inserted and FB brought to area where easily
  removed

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• Other Category
• TIPS-
• shunts in portal system decreases pressure in
  portal system liver
• IVC Filter (below renal veins)
• Prevents or reduces pulmonary embolus
• Filter traps emboli or DVT

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Cardiac Interventions

• Hemodynamic Studies
• Improvement of Blood to Myocardium
• Valve performance Improvement
• Extraction Techniques
• Electrophysiologic procedures
• PTCA-
• http//www.simbionix.com/ANGIO_Mentor/ANGIO_Module
  s_Coronary.html

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TERMS

• Valvuloplasty
• Ablation therapy
• Biopsy
• Intra-aortic balloon placement
• Pericardiocentesis
• Cardiac Tamponade
• Cardioversion