Many of us, after hearing the word "surgery", are used to thinking that there will be an association series, understandable for everyone – anesthesia, scalpel and blood. However, in medicine there is such a specialization as an endovascular surgeon – a doctor who performs operations without a knife and … which is the most surprising – without anesthesia.
On the day before the professional holiday of doctors – radiologists, I was fortunate to get acquainted with the X-ray diagnostic methods in the treatment and treatment of the Republican Hospital No. 2 – Emergency Aid Center. The acting head of the department Konstantin LUGINOV told about the methods and functions of x-ray surgery.
– Konstantin Konstantinovich, please tell us, in the treatment of which diseases is X-ray surgery used?
– In general, X-ray surgery is used in almost all areas of medicine. In our hospital, the main work focuses on providing emergency medical care to patients with vascular pathology. But besides, we perform non-vascular diagnostic and therapeutic treatments. With intravascular X-ray surgery, cardiovascular diseases are performed: myocardial infarction, coronary heart disease, and the treatment of acute cerebral circulatory disorders – strokes.
– How was the x-ray treatment performed?
– All operations are performed without incisions and anesthesia, intravascular access. Special tools with a diameter of not more than a few millimeters are used, which by puncturing the skin in the circulatory system can be carried to any part of the body. By using X-rays to obtain images of vessels and organs, this method allows the surgeon to perform intra-body treatments without skin incision, using only the same puncture method that, for example, is performed by intravenous injection.
In the case of an acute coronary syndrome (any group of clinical signs and symptoms that suspect myocardial infarction or unstable angina), the most common is access through the radial artery: on the wrist, to the place where everyone is used to find the pulse, a special needle is inserted, then the introducer is a hemostatic valve tool that prevents blood from flowing back into the arterial lumen. Access via the femoral artery is also available.
Thanks to the installed introducer, all other instruments are already working: catheter and guide, straight to the heart. All instrument movements are monitored under fluoroscopic guidance. Then, the coronary arteries are selectively catheterized: the catheter is inserted into the coronary artery, the contrast medium is injected, which allows visualization of the coronary artery, and its changes are detected at this stage. It may be a narrowing or the worst for the patient – complete closure when the artery is completely closed, blood does not flow. Therefore, the area of the myocardium in which there is no blood flow is affected and a heart attack develops. The sooner the patient comes to us, the sooner the revascularization will be carried out – the restoration of blood flow.
In the case of rupture of the brain aneurysm, in X-ray surgery there is such a method of treatment – embolisation of the aneurysm. The microcell is inserted into the aneurysm cavity, and through it into the aneurysm itself, a twisted micro-jet is wound, which after insertion into the aneurysm fills it tightly, cutting it away from the bloodstream. This method is an alternative to neurosurgical intervention, open surgery.
With ischemic stroke (cerebral artery thrombosis) – the microcell is also installed by access to the vessels, through it a special stent passes, which catches the thrombus, and the stent is removed along with the clot. In this way, blood flow is also restored.
– Why do not anesthesia be used in such operations?
– There are no nerve endings in the vessels themselves, the patient will not feel pain. In most cases, to perform endovascular (intravascularlya) the intervention does not require anesthesia, only the local anesthesia is performed at the puncture point of the vessel, as well as the day before and before the operation itself, the patient receives sedatives (sedatives) drugs. No need for anesthesia is a great advantage of X-ray surgery – it allows even patients with severe coexisting diseases and it will be difficult for them to undergo anesthesia and / or traditional surgical treatment.
– And the X-rays during the operation given continuously?
– No, according to periods, only for controlling the holding of the instrument, during manipulation, inflating the balloon in the stenosis zone, stent implantation, etc. During the operation the doctor is in a special protective apron and a "collar" of rubberized lead. The weight of such a "uniform" is at least 6 kilograms.
– What difficulties do you encounter in the work of an X-ray surgeon?
– In some patients, due to anatomical features, age, the vessels are very coiled, prone to contractions. This slightly increases the time of surgery, but I would not call it a difficulty for an x-ray surgeon. All doctors in our department are highly qualified, have high professionalism and extensive, significant professional experience – we will deal with any dishes and save every patient.
– How many patients are treated every year in the ward?
– During 10 months of 2018, more than 1000 patients underwent coronary angiography, an X-ray contrast test method, which is the most accurate and the most reliable method for diagnosing coronary heart disease, which allows to precisely determine the nature, location and extent of the coronary artery. Of these, 600 patients underwent stenting of coronary arteries. In addition, over 500 extravascular procedures were performed.
– Will the X-ray operation be applied in other areas in the near future to replace the open operation?
– I think that it is still impossible to completely replace open operations. However, due to the rapid development of new technologies and progress in general, X-ray surgery has a very big future.
– Thank you for the interview, Konstantin Konstantinovich, and I heartily congratulate you on your professional leave, I wish you good health and great success!
– Thank you! Congratulations to all my colleagues, I wish you good health and innovation in your work!
Source: Journal "Health of Yakutia"