PROCEDURES AND SURGERIES

 


DIAGNOSTIC INTERVENTION

CT Angiography
Computed Tomography Angiography images the heart using (usually) a 64 slice machine to create a vivid, detailed, three dimension image of the heart and its arteries, valves and cavities to allow the diagnosis of many of the same conditions as a traditional coronary angiogram. While a CTA is non-invasive, it does involve radiation exposure and contrast dye.

CT Calcium Count
Computer Tomography is used to determine the concentration of calcium in the plaque in the coronaries. Calcium in the coronary arteries is a sign of coronary artery disease (CAD).

 

 

INVASIVE


Pacemaker

When patient has slow heart beat or heart block with symptoms then pacemaker is warranted. 

 

Transesophageal Echocardiogram and Bubble Study
Similar to a transthoracic echocardiogram, it images the heart movement and function, but a tube is fed down the throat via the esophagus so as to permit a closer look at the heart, unobstructed by the ribcage and the lungs. This test is often used as a second step when a PFO (Patent Foramen Ovale) is suspected. In those cases saline bubbles are injected and the patient bears down (valsalva) so that the migration of bubbles can observed if a PFO is present. This diagnostic technique is also used to look for blood clots in the left atrial appendage that could put a patient and risk for stroke (Anderson-Fabry Disease, AFD).

Coronary Angiogram or Coronary Catherization
The artery, most commonly the femoral artery, is cannulated via a 2mm incision using a plastic catheter. Iodine dye is used as a contrast material which is injected while the flow of the dye is visualized using fluoroscopy to take x-ray images.

Intravascular Ultrasound
Known by the acronym IVUS, this diagnostic procedure involves a miniature ultrasound probe fed through the catheter in place for a Coronary Catheterization in order to visualize the inside of the heart’s blood vessels. This method allows another more accurate means for approximating the degree of blockage or stenosis in order to determine the appropriateness of revascularization. Plaque volume may differ significantly between angiographic images and IVUS images. Additionally, IVUS may be used to verify the deployment of a stent to reduce the occurrence of thrombosis due to incomplete expansion.

Carotid Angiogram
Similar to a coronary angiogram, this procedure images the arteries in the neck that provide the brain’s blood supply via a catheter (usually) via groin access and using fluoroscopy to take x-ray images. This procedure is sometimes referred to as Cerebral Angiography since the cerebral and vertebral vessels are imaged. This is a very important test that can help determine the probability of the risk of stroke or TIA (Transient Ischemic Attack).

Renal Angiogram
This procedure is also called renal arteriography and allows imaging of the renal arteries to determine if there is any blockage or plaque. By visualizing the renal arteries, the cardiologist can determine if a renal stent is indicated. In some cases, narrowing of the renal arteries is the sole cause of hypertension and therefore stenting of this plaque may eliminate or reduce the need for anti-hypertensive medication(s).

 

 


 

INTERVENTIONAL

Angioplasty/PTCA Percutaneous Transluminal Coronary Angioplasty

This is the revascularization of the lumen or artery in a region of narrowing due to plaque or atherosclerosis. First developed by Andreas Grünzig in Switzerland, a small balloon is inserted into the artery over a wire from (usually) the femoral artery in the groin area. The balloon is inflated at pressures over 1 atm. for a period of seconds to dilate the affected region of the artery to it’s original diameter.

 

Cardiac Stent
A stent is a tiny metal scaffold or mesh that is used to re-open or revascularize an artery. Stents can be bare metal or coated in with a medicine that helps reduce the occurrence of restenosis - the rebuilding of plaque in the artery causing the reoccurrence of reduced or blockage of blood flow. The latter type of stent is known by the acronym of DES: Drug Eluting Stent. The stent is moved into place via a wire through the catheter that was inserted in the (usually) groin. The stent is then deployed by the inflation of the balloon upon which the stent sits. The balloon is inflated sufficiently to open the artery to (approximately) its original diameter - if achievable. The placement of a stent is a permanent placement. The decision to place a stent is based on the observations made during the angiogram or cardiac catheterization and, if used, IVUS. In general stents are placed if the artery is obstructed by 70% or greater. Restenosis is the recurrent narrowing due to the rebuilding of plaque or scar tissue in the artery.


Peripheral Intervention (Carotid, Renal, Arms, and Legs)

Dr Jost is highly specialized in peripheral artery stenting which includes peripheral artery procedures in the leg such as atherectomy which utilizes high tech devices. In addition to specializing in iliac vessel, reconstruction of femoral artery vessel popliteal aneurysm and small vessel atherectomy below the knee. Some type of stents include: Coronary stenting, carotid stenting, cerebral stenting, subclavian artery stenting, mesenteric/celiac artery stenting, renal artery stenting and all leg interventions which include patients with non-healing wounds or ulcers.

 

Endoluminal Graft Repair of AAA
An aneurysm of the abdominal aorta (AAA) is a life-threatening condition. There are two methods of repair: Conventional Open Repair (COR) and Endoluminal graft repair (ELG). The latter is done by a cardiologist and is less invasive than the COR technique. Patients undergoing ELG usually leave after an overnight stay. Access for the repair is via the groin and femoral artery. A catheter is used as a guide for a graft to be fed to the correct position within the aneurysm. As with all interventional procedures, the operator’s skill and experience are critical to the success of this repair.