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Up, Up and Away: The Potential for Drug- Eluting Balloons for the Treatment of Lower Extremity Peripheral Artery Disease
Vol. XXXIV No. 2
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
PAGE 63
2016 SVN National Conference Oral/Poster Abstracts Abstract 1 What Do They Do In That Hybrid Room? Sharon Brooks, BSN, RN, CNOR, CVN, Norton Audubon Hospital, Louisville, KY The Hybrid operating room is an operating room in which both interventional procedures and surgical operations can be performed. The term ‘‘hybrid’’ is used because the rooms are the combination of the newest real time radiologic imaging in the aseptic environment of the operating room. The Hybrid room meets the needs of health care facilities for increased patient safety, improved surgical techniques and better cost efficiency demands, by combining minimally invasive and interventional technologies with medical imaging and communications in one room. The Hybrid room and the procedures performed in them, are sometimes confusing to vascular nurses and patients. Understanding what is involved in the those procedures is helpful, so those nurses who will care for patients pre and post operatively, have a complete understanding of the procedure being performed. Surgery is a specialty in and of itself. Patients having a vascular procedure in the Hybrid room, many times are under conscious sedation, and remain awake. Understanding how the procedure will be done, relieves anxiety, and the patients tolerate the procedures much better. Educating staff allows them to provide an accurate explanation to the patients. Working together as a team, the Vascular Surgeons, their staff and the staff from the Hybrid operating room are able to provide not only an environment of awareness to the patient but a safer experience that will result in a better outcome.
Abstract 2 Up, Up and Away: The Potential for Drug- Eluting Balloons for the Treatment of Lower Extremity Peripheral Artery Disease Debra Kohlman-Trigoboff, RN, MS, ACNP-BC, Duke University Medical Center, Durham, NC Endovascular treatment of peripheral arterial disease of the lower extremities is associated with a high rate of restenosis. One of the major causes of restenosis after percutaneous peripheral interventions such as stenting or angioplasty is neo-intimal hyperplasia. The multiple endovascular modalities for the treatment of peripheral arterial lesions evolved from coronary interventions. However, peripheral arterial lesions can be more challenging than coronary arterial lesions since lower extremity
1062-0303/$36.00 http://dx.doi.org/10.1016/j.jvn.2016.04.005
arterial disease can occur in long segments, are frequently multi-level and have lower flow rates. Additionally, treatment of arterial lesions crossing joint spaces is difficult. Drug eluting stents (DES) are coated with an immunosuppressive and anti-proliferative drug that provides direct delivery of the drug to the arterial stenosis to suppress neo-intimal hyperplasia. However, drug eluting stents are often avoided in joint space arteries since they may kink or twist with joint flexure. Drug eluting balloons (DEB) are coated with an immunosuppressive drug that, when inflated, can also deliver this drug directly to the arterial stenosis. Drug eluting balloons have been shown to be superior when compared to plain old balloon angioplasty. Thus, drug eluting balloons may be the best endovascular option for the treatment of stenosis and restenosis of peripheral arterial lesions, especially those which cross joint spaces.
Abstract 3 Vascular Access Complications in Percutaneous Endovascular Procedures Kathleen Rich, PhD, RN, CCNS, CCRN-CSC, CNN, IU Health La Porte Hospital, La Porte, IN Peripheral artery disease (PAD) is frequently defined as the extracoronary manifestation of atherosclerosis. Advances in technology along with patient preferences have resulted in a shift from open surgical repair of PAD lesions to percutaneous catheter-based endovascular procedures such as balloon angioplasty, atherectomy and stents. Since 1995, there has been a ten-fold increase in these peripheral endovascular interventions. Obtaining vascular access in preparation for performing endovascular procedures is considered one of the most important components. Appropriate entry into the circulation is integral to the safety and success of the planned intervention. The preferred method of vascular access is the common femoral artery. However depending upon the location of the lesion and operator preference, other access site options may include the superficial femoral, brachial, radial, popliteal and pedal arteries. The incidence of vascular access site complications (VASC) ranges from 1% to 11% of all procedures. These complications include: hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, arteriovenous fistula formation and infection. VASC are associated with increased morbidity, mortality and costs. Common risk factors for and predictors of VASC include age, diabetes, female gender, body mass index, uncontrolled hypertension, medications, sheath size, arterial puncture location, hemostatic method and vessel calcification. Nursing goals in caring for a patient post percutaneous intervention include maintenance of hemostasis at the access puncture site and assessing for VASC. Knowledge of VACS signs and symptoms along with immediate treatment strategies provides the nurse with the ability to proactively lessen the
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
PAGE 63
2016 SVN National Conference Oral/Poster Abstracts Abstract 1 What Do They Do In That Hybrid Room? Sharon Brooks, BSN, RN, CNOR, CVN, Norton Audubon Hospital, Louisville, KY The Hybrid operating room is an operating room in which both interventional procedures and surgical operations can be performed. The term ‘‘hybrid’’ is used because the rooms are the combination of the newest real time radiologic imaging in the aseptic environment of the operating room. The Hybrid room meets the needs of health care facilities for increased patient safety, improved surgical techniques and better cost efficiency demands, by combining minimally invasive and interventional technologies with medical imaging and communications in one room. The Hybrid room and the procedures performed in them, are sometimes confusing to vascular nurses and patients. Understanding what is involved in the those procedures is helpful, so those nurses who will care for patients pre and post operatively, have a complete understanding of the procedure being performed. Surgery is a specialty in and of itself. Patients having a vascular procedure in the Hybrid room, many times are under conscious sedation, and remain awake. Understanding how the procedure will be done, relieves anxiety, and the patients tolerate the procedures much better. Educating staff allows them to provide an accurate explanation to the patients. Working together as a team, the Vascular Surgeons, their staff and the staff from the Hybrid operating room are able to provide not only an environment of awareness to the patient but a safer experience that will result in a better outcome.
Abstract 2 Up, Up and Away: The Potential for Drug- Eluting Balloons for the Treatment of Lower Extremity Peripheral Artery Disease Debra Kohlman-Trigoboff, RN, MS, ACNP-BC, Duke University Medical Center, Durham, NC Endovascular treatment of peripheral arterial disease of the lower extremities is associated with a high rate of restenosis. One of the major causes of restenosis after percutaneous peripheral interventions such as stenting or angioplasty is neo-intimal hyperplasia. The multiple endovascular modalities for the treatment of peripheral arterial lesions evolved from coronary interventions. However, peripheral arterial lesions can be more challenging than coronary arterial lesions since lower extremity
1062-0303/$36.00 http://dx.doi.org/10.1016/j.jvn.2016.04.005
arterial disease can occur in long segments, are frequently multi-level and have lower flow rates. Additionally, treatment of arterial lesions crossing joint spaces is difficult. Drug eluting stents (DES) are coated with an immunosuppressive and anti-proliferative drug that provides direct delivery of the drug to the arterial stenosis to suppress neo-intimal hyperplasia. However, drug eluting stents are often avoided in joint space arteries since they may kink or twist with joint flexure. Drug eluting balloons (DEB) are coated with an immunosuppressive drug that, when inflated, can also deliver this drug directly to the arterial stenosis. Drug eluting balloons have been shown to be superior when compared to plain old balloon angioplasty. Thus, drug eluting balloons may be the best endovascular option for the treatment of stenosis and restenosis of peripheral arterial lesions, especially those which cross joint spaces.
Abstract 3 Vascular Access Complications in Percutaneous Endovascular Procedures Kathleen Rich, PhD, RN, CCNS, CCRN-CSC, CNN, IU Health La Porte Hospital, La Porte, IN Peripheral artery disease (PAD) is frequently defined as the extracoronary manifestation of atherosclerosis. Advances in technology along with patient preferences have resulted in a shift from open surgical repair of PAD lesions to percutaneous catheter-based endovascular procedures such as balloon angioplasty, atherectomy and stents. Since 1995, there has been a ten-fold increase in these peripheral endovascular interventions. Obtaining vascular access in preparation for performing endovascular procedures is considered one of the most important components. Appropriate entry into the circulation is integral to the safety and success of the planned intervention. The preferred method of vascular access is the common femoral artery. However depending upon the location of the lesion and operator preference, other access site options may include the superficial femoral, brachial, radial, popliteal and pedal arteries. The incidence of vascular access site complications (VASC) ranges from 1% to 11% of all procedures. These complications include: hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, arteriovenous fistula formation and infection. VASC are associated with increased morbidity, mortality and costs. Common risk factors for and predictors of VASC include age, diabetes, female gender, body mass index, uncontrolled hypertension, medications, sheath size, arterial puncture location, hemostatic method and vessel calcification. Nursing goals in caring for a patient post percutaneous intervention include maintenance of hemostasis at the access puncture site and assessing for VASC. Knowledge of VACS signs and symptoms along with immediate treatment strategies provides the nurse with the ability to proactively lessen the