PICA Stroke, Brainstem strokes|ASA,Plavix|45|Male
PICA Stroke, Brainstem strokes|ASA,Plavix|45|Male
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Okay, so let's go back to the case. So I knew the patient needed the same procedure.

I don't know why that happened, I'm so sorry. But that was about, I did the left iliac, let me go back. If I may. So, oh shit. I'm so sorry.

(audience laughing) I'm not paying attention, I'm so sorry. Okay so as you can see, I'm putting the stamp on the left side, doing the ballon angioplasty at 9:05. And here is the balloon angioplasty, and I keep asking the CRNA how's everything going,

that is a habit I have, I cannot just stop asking how is everything going. And they keep saying "everything is perfect, everything goes great." After I finish the second balloon angioplasty, how is the patient doing?

They reply, I'm not making it up, was patient is loving it. Okay. So I just proceeded with the case. So about 9:14 hours that day, suddenly the CRNA stands up with a very confused face.

By the way, he had been in the room for about 10 minutes for a bathroom break. He's the one who said everything is fine, patient is loving it. And suddenly at 9:14 he stands up and starts hitting the monitor like that.

And I said "what are you doing?" He says "can someone check the leads?" The blood pressure just plummeted. I have no blood pressure. And I said "what are you talking about? Are you okay?"

I mean, I said "the monitor is perfect. Is everything okay?" No, not everything was okay. This is what happened after that situation. I got your attention now, right? (audience laughing)

Guess what the CRNA was doing. Was texting while we were doing the case. Because he came to the IR to cover for somebody for 10 minutes and during these 10 minutes he couldn't put aside the text. He was making plans to have lunch.

I'm not making it up. So this is my complication, don't take it the wrong way. I am the one who was doing the case. But what was the complication? That it took seven minutes for him to realize there was a problem.

When the patient practically caught it on the table because I had exsanguinated. The patient was under general, so no pain. No defense mechanism. And the patient just bled out. So, what I did was put a balloon,

and then bring fortunately have the big sheathe, have the change the sheathe. and then what I did was to place a cover the stent. I knew exactly where the rupture was. You can see all the contrast accumulated. The patient at this moment practically had no pressure.

This is immediate outcome. So I did the angio right after putting the cover the stent. It's perfectly sealed, almost nothing. But now it's obvious that the right iliac is so significant that it's blocking off this flow.

So the anesthesiologist is fighting with me, we need to bring the lady to the OR. The surgeon telling me you have to fix this right side. Both sides of my brain fighting, what do I do? And I sided with the surgeon. And I said we need to fix this first.

So this is what we did. We brought the, put the stents in place. And then finally this was the outcome after the procedure. So the patient now had flow on the right, and the iliac had thoroughly strong.

I opened up the flow again, found out there was this blockage here and most of the transition from the external to the CFA. So, what did I do? I did, pulled the sheathe down as much as I could, and treated that with just a balloon angioplasty.

And this is at 9:34. So thirty minutes after the complication had occurred. So what happened to this lady? She does well the next 24, 36 hours after the procedure. She required four units of blood.

She went into full hypovolemic shock. Had to stay in ICU several days. The first 24 hours were so, I mean, the family was devastated because the patient had some degree of hypoxic brain injury. Actually she recuperated.

But the next day, the patient had a foot drop. Complete foot drop. She required fasciotomies all over the left left. And eventually she required, within the next 24 hours, a right to left fem-pop bypass. Fem-fem bypass.

Not fem-pop, and fem-fem bypass. The patient was finally stabilized and she was discharged home after surgery. I saw her once after this event in the clinic, and the patient continues to have... The patient of course doesn't want to have

anything else done to her, but she survived. And actually she is alive to the present time.

We did improve our communication.

Actually one of the things that grew out of this that wasn't part of our initial plan was this IR team email distribution list. So on this distribution list are all the interventional radiologists, our schedulers, our team leads, the supervisors and myself.

What this is is a way for anyone in the team to communicate with the people who are coordinating for the day, especially the radiology resident, to prep for the next day's cases. So the example that I have here is what our fellow, our resident would send out the night before.

Has the name of the patient, what we're doing, what the order is. If there's any previous imaging it'll be referenced here as well. On the bottom you can see we also do CT interventions as well.

Our IR doctors cover those cases as well. So that'll actually bring the CT images into the email and include what number it is, what slice it is, so that everyone's on the same page. CT is also on this so they're able to know what lesion are we going after,

especially if there's multiple lesions that affects positioning. So this has been really helpful and it was not something that we had discussed doing at the beginning or during our pilot.

So we move forward and talk about women's health. I mentioned FreedomfromFibroids.com. This is a patient-focused website,

and just like the Interventional Initiative a lot of this is driven digitally as we recognize that that's a platform that a lot of your community is reaching out to you to understand stories from not only other patients in their community but also getting more

of that health literacy. So this is a patient-focused website also driven at that level to help them understand what uterine fibroids are and the range of treatment options available to them, especially uterine fibroid embolization as a minimally invasive therapy.

On that website we have things like a list of questions for a patient to go take to their primary care physician, to their OB/GYN, ask their doctor is UV right for me? We also have whiteboard videos on there. These are all things that you can have accessible within your practice.

You can download many of these to help education patients on again the simple terminology, what is a fibroid, and then hear about other patients that have gone through the painful experience of uterine fibroids and what outcomes they found, what they found helpful, and the important role

that interventional radiology plays within their care.

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