Capítulo 1384: 【1384】Hanging
Not just during puncture, try to avoid mistakes by delivering the Guidewire under fluoroscopy rather than blindly inserting it. If the Guidewire is again sent to the wrong location at this time, it can only be a special situation.
Is there something obstructing the vessel? Arterial occlusion usually occurs in the lower limbs and is unlikely to occur in the upper limbs. Doctors will administer heparin, an interventional surgery requires dual antiplatelet therapy, and what doctors fear most is massive bleeding during the transportation of the Guidewire. If the patient is tense, vascular spasms can also indicate Guidewire jamming, for which doctors routinely administer verapamil and nitroglycerin to slightly relieve such symptoms.
The probability of either occurring is low. Jin Tianyu believes this. The reason can only return to the possibility of the Guidewire mistakenly entering a branch. Whether or not the Guidewire has taken the wrong branch cannot be fully perceived from just a planar fluoroscopy.
“When you sent it in, how much resistance did you face? Was it significant?” Jin Tianyu asked Doctor Fang again to determine if the Guidewire had indeed erroneously entered a branch earlier.
Everyone in the control room was listening for the answer.
When inserted into a branch, resistance will increase. Branches have smaller diameters compared to the main trunk, and adept doctors can feel this subtle sensation. Hence, Doctor Fang’s precise answer is crucial.
Doctor Fang struggled to answer while recalling, “I didn’t feel much resistance earlier. If there was, I definitely wouldn’t have forced it through.”
Gently sent, encountering no significant resistance along the way, indicates the path taken is correct. How could it suddenly be wrong? Doctor Fang couldn’t understand. The Guidewire should have smoothly slid into the major pathway, which should have been easy. How could the Guidewire go into the side road without the doctor’s forceful push? Besides, he did not see the Guidewire entering a branch in the fluoroscopy image.
“Why don’t you try it yourself?” Doctor Fang, unable to pinpoint the issue, suggested to Jin Tianyu to try and verify.
Jin Tianyu remained still, evidently weighing the pros and cons.
Doctor Fang had previously been jammed at this spot; if he were to try again, he must first understand the cause before proceeding, otherwise, it would be useless and just increase risk. It was fortunate that the Guidewire was retracted just now, but if it jams again, it may not be as fortunate and successful to retract it.
“It’s precarious,” Li Chengyuan, anxious, looked at the people in the operating room and said to Fu Xinheng, “It’s hard to tell if they have reached the brachial artery. The journey to the axillary artery, subclavian artery to the aortic arch is even harder.”
The Guidewire travels from the radial artery to the cardiac artery, passing through the brachial artery, axillary artery, subclavian artery, to reach the aortic arch and finally arrive at the base of the aortic sinus. This is when the contrast agent confirms the blocked segment of the coronary artery, and if necessary, a stent is placed.
The lower section of the brachial artery is formed by the convergence of the ulnar artery and radial artery; simultaneously, it is a trunk artery, meaning it gives off other vessels like the deep brachial artery, superior ulnar collateral artery, and inferior ulnar collateral artery, among others.
The cardiovascular system of the human body is an extremely complex and vast project; blood vessels are a crucial component of the cardiovascular system. They are distributed throughout the body, interwoven and intertwined, and everyone’s vascular map may be different.
Doctors can only learn the common parts of human physical structure in medical knowledge; the small differences must be analyzed and controlled by clinicians according to individual case studies. In this case, the blood vessel parts seem extremely challenging, and it is difficult for doctors to grasp instantly.
The time for an emergency patient means life, and doctors cannot ponder slowly but must quickly resolve or make decisions.