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Brainiac Breakdown
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Welcome to Brainiac Breakdown, the ultimate channel for all types of medical and surgical education! Whether you're a student, a professional, or simply curious about the fascinating world of healthcare, we've got you covered. Our mission is to break down complex medical concepts and surgical procedures into easy-to-understand, engaging content. With in-depth explanations, step-by-step tutorials, and expert insights, Brainiac Breakdown will help you level up your knowledge, boost your skills, and stay ahead in the ever-evolving field of medicine. Join us on this journey to master the brain and body, one breakdown at a time!
Transcript
00:00The treatment of peripheral arterial disease endovascularly has been an existential leap
00:04in the treatment of atherosclerotic disease with a minimally invasive technique,
00:09but there's a lot of finesse involved with the procedure, especially if you have relatively
00:14advanced disease. And this is a picture of a diseased vessel. It's got a large atherosclerotic
00:19plaque in the middle, which prevents the vessel from opening and closing. And if that gets bad
00:24enough, you clot off the center and block the blood flow to whatever end organ this vessel
00:28is delivering blood to. To treat the vessel, we have to put a wire down through the center,
00:34hopefully through the center of the vessel. That's called intraluminal. Very important to
00:38stay intraluminal. And we can use our angiographic picture to assist us in that endeavor. And what
00:44we do is we take a picture. This is a wide open vessel, so it's easy to see. We kind of take a
00:49negative of that angiographic picture and we use that as a background to guide our wire right down
00:55through the center of that vessel, which you can see right here going straight down the center. That,
00:59again, is intraluminal. It allows us many options. We can do a balloon angioplasty and treat the vessel
01:05that way. We can actually go in and use a atherctomy device where we shave down the inside of the vessel.
01:12My patients call this the roto-router, but it's a way to open up the vessel without leaving anything
01:17behind. If all else fails, you can always put a stent in a metallic framework to hold the vessel open,
01:22but try not to do that if we can avoid it. The other option, subintimal, is basically the
01:28wire goes underneath of the lumen, subintimal, and it goes through that muscular layer. And
01:34unfortunately, if you do that, your options are extremely limited. All you can really do
01:39in that particular scenario is put a stent in to keep the vessel open. And personally,
01:45I prefer not to leave a stent because it is a foreign body and the body itself can react to the
01:51stent material over time. So preferentially like to perform an atherctomy or something
01:56where nothing is left behind. That requires a little finesse and actually guiding the wire
02:02down through the center of the vessel.