Cardiovascular Interventions

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

the skin: Clinical considerations and potential medico-legal

[63] Beathard G. "Arteriovenous grafts stenosis and thrombosis" in Interventional Nephrology. China: The McGraw-Hill Companies Inc.; 2012.

[64] Beathard G. Venous angioplasty. In: Interventional Nephrology. China: The McGraw-Hill Companies Inc.; 2012.

[65] NKF. KDOQI clinical practice guidelines for vascular access.

2006;**48**(Suppl 1):S248-S272

American Journal of Kidney Diseases.

[66] Ahya S, Windus D, Vesely T, et al. Flow in hemodialysis grafts after angioplasty. Kidney International.

2010;**23**(5):540-542

p. 179

p. 199

ramifications. Seminars in Dialysis.

**202**

**Chapter 12**

Techniques

more specialized and rapidly progressive field.

*Imran Khalil*

**1. Introduction**

vascular operator.

**205**

**Abstract**

Coronary Artery Intervention

The topic of coronary artery intervention techniques is very complex. This chapter's goal is to discuss basic to complex techniques summarized to help coronary operators at all levels to understand the practical aspects of daily coronary interventions using a noncomplex approach. With the revolution of percutaneous cardiovascular and valvular interventions, more patients with complex coronary lesions are treated with percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery. Thus, mastering all approaches, techniques of PCI, being comfortable with performing high risk PCIs, and using hemodynamic support devices have become very important. While the basics of coronary interventions have not changed, equipment innovation has a very rapid pace with almost daily additions to the arsenal of coronary interventions, in particular, stent development. Stent therapy for coronary interventions especially in acute coronary syndrome is a proven concept. This created a race to develop a perfect stent that allows for physiological healing of the coronaries and avoid their use in long-term issues. With each addition to the equipment collection comes a learning curve on both technical and clinical evidence aspects, all which make coronary intervention a

**Keywords:** percutaneous coronary interventions, techniques, complex, high risk, equipment, radial approach, bifurcations stenting, coronary guidewires, coronary

For daily planned procedures, there are several approaches for coronary interventions. In reality and especially an emergency situation, any kind of arterial approach that can reach the coronary tree can be used as long as emergency percu-

This chapter is focusing on PCI technical aspects and high-risk interventions. Reader is redirected to other resources that focus on performing diagnostic left

guide catheters, left main, venous graft interventions, instent restenosis

taneous coronary interventions could be successfully and safely performed. These common approaches include radial right and left, ulnar right and left, distal radial right and left, femoral, and brachial. Carotid, axillary approaches might be necessary in the right clinical presentation. For each approach, operators need to be familiar with the limitations, advantages, disadvantages, access and closure techniques, potential complications, and their management. Knowledge of arterial and venous anatomy and its possible anomalies are basic requirements of any
