.Transradial Angioplasty : Our Experience
BK Goyal, R Kawar, BC Kalmath, A Sharma, V Vikranth, P Manokar
Background : Transradial angioplasty has emerged as a good alternative to the transfemoral route for percutaneous interventions. We decided to conduct a safety and feasibility study to evaluate transradial angioplasty in our setup.
Methods : We evaluated 80 consecutive patients who underwent angioplasty through the radial route over a period of one year 2004-2005 for feasibility and safety of transradial intervention.
Results : The average of the patients was 50.6 years. There were 60 males (75%) and 20 females (25%). The choice of hand of approach was similar with right hand chosen in 44 (55%) patients and left hand in the remaining 36 (45%), Unstable angina 16 patients (20%) acute myocardial infarction (PAMI) 6 patients (7.5%), Post Infarction Angina 15 patients (18.75%), asymptomatic high risk 7 patients (8.75%). A total of 100 vessels were tackled through the transradial approach, the vessel distribution being were LAD (n=50), LCX (n=30), RCA (n=20). Patients with single vessel disease were 60 patients (75%), double vessel disease 18 patients (22.5%) and triple vessel disease 2 patients (2.5%). A total of 104 lesions were tackled, two lesions had plain balloon angioplasty done while the remaining lesions were stented with non drug eluting stents (n=70) and drug eluting stents (n=32). The use of GP II b/III a inhibitors was limited to 15 patients (18.75%), abciximab (n=1), eptifibatide (n=3) tirofiban (n=11). There was no deaths in the angioplasty patients but one patient had a MACE (Acute Stent Thrombosis). There were 5 cases (6.25%) of failure to complete the procedure i.e. it required a cross over to femoral route to complete the procedure. The causes of failure were Access site failure (n=3) (3.75%), inability to place guide satisfactorily (n=1) (1.25%) and inability to cross lesion (n=1) (1.25%).
Conclusion : Transradial angioplasty is a safe and feasible alternative to transfemoral approach for percutaneous coronary interventions.
Abstracts of Papers Presented at the 137th Research Meeting of the Medical Research Centre of Bombay Hospital Trust on Monday 13th March 2006
(Convener Dr. HL Dhar)
1. Pregnancy with Chronic Hypertension
Anita Kamat, PB Paidhunghat, Nitin Paidhunghat, Jolly Achnani, B Rudhita
A unique case of 29 year old primigravida admitted with 4 months amenorrhoea with high blood pressure on T Aldomet (500) qds and T Depin (R) 20 bd. All routine investigations were carried out along with renal artery doppler which showed normal levels.
Nephrology opinion was taken and she was diagnosed as chronic hypertension. She was started on T. Nicardia, T aldomet and T Lobate and gradually all doses had to be increased to control the BP though it was persistently high diastolic keeping between 110-130 mmHg. Patient was on to Tocolytic, placentotrophic drugs and was monitored by urine, blood and USG guidance.
Pregnancy was successfully carried on till 29 weeks of gestation without any major foetal or maternal morbidity or mortality.
Patient had to be delivered by caesarean section in view of nonreactive NST. Baby’s weight is 840 gm. Baby is doing well in NICU. Post operative mother’s blood pressure was under control with high doses of antihypertension mainly T. Lobate (100) 3-3-3 and T. Thiazide 12.5 od.
2. Vesicovaginal Fistula - Complication of a Difficult Vaginal Hysterectomy - Managed by Cystoscopic Chemical Cauterisation
Jolly Achnani, PB Paidhunghat, Nitin Paidhunghat, SW Thatte, Charu Chaudhary,
Forty five year old PARA 2 living 2 with previous 1 forcep and 1 LSCS had undergone vaginal hysterectomy for fibroid uterus. Accidental intraoperative bladder injury was repaired in 3 layers.
On day 8th of surgery, patient was diagnosed to have vesicovaginal fistula. She was discharged with Foley’s catheter and called for follow up after 6 weeks when it was found that after removal of catheter leak persisted she was called for cystoscopy judgement with 6 weeks.
When cystoscopy showed pinpoint opening and vaginally no opening was visible. It was decided to try unique procedure and No. 8 trench catheter was threaded from cystoscopic opening to vaginal opening and delicate silver nitrate was injected along with retrieving the catheter from vagina to bladder.
Post operative catheter was put and patient is now healed.
3. Role of Vaginal Hysterectomy with Bilateral Salphingoophorectomy in case of Adenocarcinoma of Endometrium in High Risk Patient
Deepak Bhenki, PB Paidhunghat, SR Goyal, Nitin Paidhunghat, Heena M, Anita Kamat
To study role of vaginal hysterectomy (VH) with bilateral salphingoophorectomy (BSO) in case of carcinoma endometrium in high risk patients.
This is retro and prospective on going study of 10 patients having stage 1 adenocarcinoma of endometrium of these patients present mean age 56.4 years, 30% nulligravida, 50% hypertensive, 30% diabetic, 20% diabetic with hypertensive, 50% hypothyroid, one patient had undergone CABG. All these patients were obese with mean BMI 33.92. All these patients underwent VH + BSO care taken not to open endometrial cavity to avoid spillage of malignant cells. There was no single intraoperative and postoperative major complication on deaths. All patients were given adjuvant therapy with proven 10 mg life long. One patient was given radiotherapy.
Patient discharged on day 4th surgery postoperative follow up of these patients showed no morbidity or mortality.
VH with BSO is good modality of treatment in case of adenocarcinoma endometrium in high risk patients.
4. An Unusual Case of Spontaneous Uterine Rupture at 23 Weeks Gestation
Preeti Kantak, Nikhil Chitnis, Sarita Bhalerao, Ajit Virkud
Spontaneous uterine rupture is a rare entity - the reported incidence being 1 in 8000 in 50000 deliveries. The appropriate treatment depends upon factors such as parity, extent of the defect and magnitude of bleeding. A 35 years old 4th gravida with previous 3 full term normal deliveries presented to us at 23 weeks gestation with signs and symptoms suggestive of uterine rupture. An obstetric hysterectomy was done with an uneventful post operative period.
As it was a full thickness rupture it resulted in marked vaginal bleeding, intrauterine fetal death and clinically hard uterus. On the basis of factors such as parity, extent of the defect and magnitude of bleeding we took the right decision to proceed with an obstetric hysterectomy. We believe that we could save the mother in this case due to early diagnosis, continuous clinical assessment and promt surgical intervention.