Salvaging Arteries

Thursday was an ass kicker. We've been down one nurse and one tech all week at work, leaving us 33% & 25% low on staffing during one of the busiest weeks this year. The first exam of the day was a bilateral kissing stents in a patients aortic bifurcation. Usually, the tech assists the doc place a stent by loading caths onto the wire, maintaining wire position, prepping inflation devices, etc. During a kissing stent procedure, the doc opens deploys one stent while the tech opens the other. At the same time. At the same speed. At $800 t0 $1200 per stent. Guaranteed to focus your concentration so that everything in your world shrinks down to a radiologist's voice and a fluoroscopy monitor showing the deployment. And getting two people to synchronize their actions perfectly, so that the patient gets an ideal deployment that opens a ninety-five percent closed artery and restores flow to the rest of the leg is a great feeling.

Left, Bilateral high-grade ostial stenosis of common iliac arteries. Middle, Simultaneous dilatation of stenotic lesion with kissing balloon technique. Right, Final result after adjunctive implantation of 2 Palmaz stents (diameter, 9 mm; length, 40 mm).

In a few days, that patient will be able to walk longer and more comfortably than in the past year, and will probably continue to do so for years, rather than having a bypass graft. Bypass grafts often run from the groin to below the knee, and have somewhat limited lives, due to clotting problems. When they do clot, and circulation to the feet is severely compromised, then it's back to our lab, where the clot is attacked with a number of methods, both mechanical and chemical, that can take up seventy-two hours, and carries risks of bleeding, including intracranial.

That was immediately followed by a bilateral renal angiogram, an aortic stent graft (more on those later), a central venous line change, and an exchange of an internal/external biliary drain.

I earned my paycheck for the day.