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HEAPHY 1 & 2 CASE RACE 1 – DIAG Rowena OLIVER Sat 31 st Aug 2013 Session 3 / CR1-6 13:26 – 13:30 OTAGO / SOUTHLAND ABSTRACT A case of a 81 year old female.

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Presentation on theme: "HEAPHY 1 & 2 CASE RACE 1 – DIAG Rowena OLIVER Sat 31 st Aug 2013 Session 3 / CR1-6 13:26 – 13:30 OTAGO / SOUTHLAND ABSTRACT A case of a 81 year old female."— Presentation transcript:

1 HEAPHY 1 & 2 CASE RACE 1 – DIAG Rowena OLIVER Sat 31 st Aug 2013 Session 3 / CR1-6 13:26 – 13:30 OTAGO / SOUTHLAND ABSTRACT A case of a 81 year old female previous history of Coronary artery disease with CABG. presenting with chest pain and troponins raise. Send to Cath Lab for coronary and grafts angiography to determine cause of chest pain. What could go wrong with a routine procedure?

2 THINGS ALWAYS GET WORSE BEFORE THEY GET BETTER ROWENA OLIVER NDIMDI STAFF MRT DUNEDIN RADIOLOGY DUNEDIN HOSPITAL

3 PATIENT HISTORY  81year old female  Previous history of:  unstable angina  10 years post Coronary Artery Bypass Graft surgery (C.A.B.G) - 3 vessel grafts  Presented with prolonged chest pain.  Transferred from: Southland Hospital to Dunedin Hospital.  Referral for Cardiac Angiography

4 PATIENT PREPARATION Informed consent was given. -Procedure benefits of Cardiac Angiography - Diagnosis - Stents -Alternatives and risk including but not limited to: - Heart attack - Death - Stoke - Lost of limb - Vessel injury - Contrast reaction - Bleeding - Infection - Open heart surgery - Renal failure

5 Left Internal Mammary Artery (LIMA) Graft to Left Anterior Descending Artery (LAD) Left Internal Mammary Artery (LIMA)Left Anterior Descending Artery (LAD)

6 Catheter Kink in Origin of Left Radial Artery to Brachial Artery CATHETER KINK

7 Right Femoral Artery Approach to Left Subclavian Artery LIMA CATHETER Guiding Catheter

8 Right Femoral Artery approach to Left Subclavian Artery with Goose Neck Snaring of LIMA Catheter VERTEBRAL ARTERY CAROTID SHEATH LIMA CATHETER SNARE

9 LIMA Catheter Snared and Removal CAROTID SHEATH LIMA CATHETER SNARED

10 martyink.com 23/07/2013

11 Antegrade and Retrograde Imaging VERTEBRAL ARTERY DISSECTION FLAP OCCLUSION

12 Ballooning & Positioning of Stent in Subclavian Artery 8mm x 4cm BALLOON8mm x 4cm STENT

13 Deployment of Stent Partly Deploy Stent

14 Post Stent Deployment VERTEBRAL ARTERY LIMA 50% Stenosis

15 onwardstate.com 27/07/2013

16 Perforation and Extravasation Post Previous Perforation Extravasated Contrast

17 Post Covered Stents of Radial-Brachial Arteries gefaesszentrum-bochum.com- 26/07/2013 COVERED STENT

18 ACKNOWLEDGEMENTS The Anonymous Professor of Cardiology & Cardiology, Radiology Team Dunedin Hospital

19


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