how to manage vascular disease cp - dr sahal fatah

8/10/2019 How to Manage Vascular Disease Cp - Dr Sahal Fatah

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How To Manage Vascular Surgery in Semarang

Sahal FatahDiponegoro University

KARIADI HOSPITAL


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20141929 1960

Era of diagnostics

Cardiac and vascular diagnostic

procedures were rapidly developed

(Table 1.1)

Era of therapeutics

Development of interventional

modalities such as embolectomy,

angioplasty, and atherectomy(Table 1.2)

Evolution of Endovascular Therapy: Diagnostics and

Therapeutics Thomas J. Fogarty and Amitava Biswas

Endovascular therapy is the manipulation ofpathology by an intraluminal approach

Historyof endovascular therapy can be dividedinto two 30-year periods.


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Evolutionof Endovascular

Diagnostics and Therapeutics

Evolution of Endovascular Therapy:

Diagnostics and Therapeutics

Thomas J. Fogarty and Amitava Biswas


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Era of Diagnostics

(19291959)

The surgeon Renaldo Dos Santos,

breakthrough applied to the extremities and to

develop arteriography and aortography

Forssmann should be possible to insert a

catheter into the right side of the heart through a

venous channel and thereby:

monitor cardiac pressures obtain blood for analysis, and

administer therapeutic agents


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Renaldo Dos Santos, MD,

Pioneer surgeonand original

developer of diagnostic arterial

visualization techniques and

technologies

Werner Forssmann, MD,

Physician credited with developing

endovascular diagnostics by

demonstrating cardiac assessment

using catheter


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Werner Forssmann inserting acatheter into his antecubital vein

1956 Nobel Prize in Medicine
http://en.wikipedia.org/wiki/Nobel_Prize_in_Medicinehttp://en.wikipedia.org/wiki/Nobel_Prize_in_Medicine


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Sven Ivar Seldinger

A radiologist from Sweden. He

introduced technique to obtain safe

access to blood vessels and other

hollow organs

Andr Frdric Cournand

A Surgeonswho is known for cardio

catheterizationNobel Prize in Physiology or Medicine

the Anders Retzius Silver Medal of theSwedish Society for Internal Medicine
http://en.wikipedia.org/wiki/Nobel_Prize_in_Physiology_or_Medicinehttp://en.wikipedia.org/wiki/Nobel_Prize_in_Physiology_or_Medicine


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Era of Therapeutics

(19601990)

Embolec tomyFogarty The earliest disease

entity to be approached intraluminally was

embolic occlusion.

Balloon Angiop lasty

Dotter/Grntzig useda balloon catheter made by Fogarty to

expansion of the balloon caused an increase

in the lumen diameter (iliac stenosis). AtherectomySimpsondeveloped the idea

of mechanically removing atheroma from

vessels lumen (atherectomy).


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Charles Theodore Dotter

RadiologistThe Father of

Intervention. Described angioplasty

in 1964

Dr. Thomas J. Fogarty

An American CardioVascular surgeon

inventor of the embolectomy catheter

for removing an embolus, or blood clot


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Andreas Roland Grntzig

A German Cardiologist who first

developed successful balloon

angioplasty for expanding lumens of

narrowed arteries

Julio Palmaz

Doctor of vascular radiology. He

got the idea for his stent after

listening to a lecture by Gruentzig

at a conference in New Orleans in

1978.


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Juan C. Parodi, MD,

Vascular surgeon and designer

who advanced the clinical

techniques and applications for the

transluminally placed endovascular

endograft

John B. Simpson, MD,

Cardiologist and innovator

of catheter-mediated techniques for

treating coronary artery

atherosclerosis


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Future Developments

The users of the new technology are often

shared by multiple specialties. In the

endovascular field we have :

Cardiologists Cardiothoracic and Vascular Surgeons

Vascular surgeons

Interventional radiologists

All threating the same diseases and pathology withthe same or different techniques and instruments.


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Indonesia

Indonesia has only one vascular surgery

program in Jakarta.

and had two cardiovascular thoracic surgery

program in Jakarta and Surabaya.

240 Millionof population


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Live


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Endovascular is the

responsibility of the

Cardiothoracic and Vascular Surgeon

Vascular Surgeon

Cardiologist

Radiologist

DO NOT BLAME EACH OTHERS


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Endovascular therapy is a multidisciplinary

field

involving contributions from surgeons,

cardiologists

radiologists, physicists, and engineers.


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Indication of Endovascular

CHRONIC LIMB ISCHEMIA : Arteriografi, PTA Stent graft ACUTE LOWER LIMB ISCHEMIA : Thrombolysis , Thromboembolectomy

CAROTID AND VERTEBRAL DISEASE : Angioplasty and stenting

VISCERAL ARTERY OCCLUSIVE DISEASE : Angioplasty and Stenting

THORACIC and ABDOMINAL AORTA : ANEURYSMS AND DISSECTIONS

VISCERAL AND PERIPHERAL ANEURYSMS : Endovascular grafting

VASCULAR MALFORMATIONS : Embolization, coiling

VASCULAR TRAUMA : Arteriografi, Embolization

VENOUS DISEASE : IVC filter, Venoplasty, stenting

ARTERIOVENOUS ACCESS


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Advantages and Disadvantages

Endovascular

Advantages

Less invasive

Less hospital length of stay Less morbidity and mortality

Disadvantages More expensive

Indonesia


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Indonesia

Hospitals TEVAR and EVAR*

Peripheral

endovascular

diagnostic and

treatment **RSPJN Harapan Kita Jakarta Cardiologist

Thoracic Cardio-Vascular

RSUPN Cipto

Mangunkusumo Jakarta

Vascular Surgery

Cardiovascular Consultan

RSUP dr Kariadi Semarang Thoracic Cardio-Vascular

Surgery

Intervention Radiology

RSUD dr Soetomo Surabaya Cardiologist

Intervention Radiology

RSUD Sanglah Denpasar Thoracic Cardio-Vascular

Surgery

RSUD Dr. Moewardi Solo Thoracic Cardio-VascularSurgery

RSUD Dr. Zainal Abidin

Aceh

Thoracic Cardio-Vascular

Surgery

* Thoracic-Abdominal Aneurism and Dissecting

** Arteriography, PTA, Stenting


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Taiwan

Vascular surgery only gained recognition as a specialty inthe mid-2000s, when the Taiwan Society for Vascular

Surgery was established.

Prior to this endovascular work was largely in the hands of

cardiologists.

There has been a significant volume of carotid and

vertebral angioplasty and stenting done by the Division of

Cardiology at the National University of Taiwan Hospital.

EVAR development was late in Taiwan due to government

regulations mandating a FDA-type trial before any devicescan be registered for use.


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Vascular surgery practiceis mainly confined to

two university hospitals

and the rest are performedby general surgeons.

Affordable health care

for all citizens are provided

but expensive devices

were not included;

i.e. endografts and stents.

In general, peripheral endovascular surgery is still notpopular due to reluctance of the patients to undergo

intervention and to pay for expensive devices. Endovascular stent graft remained at this time largely

in the hands of surgeons, working in operating roomsetting either individually or in cooperation withradiologists.

Hong Kong


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Thailand

Endovascular surgery has also proliferated

significantly in Thailand in the last few years.

Initially supported and reimbursed by the

government, covering 80% of device costs, there has

been a rapid growth of endovascular stent grafts, butat significant expenses to the government

Malaysia

EVAR and other endovascular surgery is limited to avery few private vascular surgeons who have the

facilities and the patients to afford the devices.

Currently this remains a very small market.

how to manage vascular disease cp - dr sahal fatah

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