Classification of endoleaks after endovascular aneurysm repair.

Type I (Perigraft ) : (Ia) perigraft flow occurring proximally,
(Ib) perigraft flow occurring distally, and (Ic) perigraft flow around
an iliac artery occlusion device.

 Type II(Branch):Branch arteries back-bleed because of collateral flow. These
endoleaks include (IIa) back-bleeding inferior mesenteric artery
and (IIb) back-bleeding lumbar artery.

Type III :Flow persists between the segments of a modular graft and
include (IIIa) leaks between iliac limbs or an iliac limb and main
body component and (IIIb) leaks between main body components.

Type IV(Porosity) :Flow is present through endograft material (graft porosity).

 Type V(Endotension) :(V), Persistent or recurrent pressurization of the
aortic aneurysm exists in the absence of demonstrable endoleak.

References
Eliason JL, Upchurch GR Jr. Endovascular abdominal aortic aneurysm
repair. Circulation. 2008;117:1738–1744.

Choosing medicine as a profession is metaphor as medicine itself

https://youtu.be/Eg_GwMr4IpY

Left pulmonary artery hypoplasia is associated with Tetralogy of Fallot's

Large patent doctus arteriosus supporting blood supply to left lung

A large collateral from descending thoracic aorta supporting left lung blood supply 

Diminutive pulmonary artery due to hypoplasia with narrowed left pulmonary artery  

IN.PACT Admiral Mechanism of Action

http://www.peripheral.medtronicendovascular.com/videos/inpact-admiral-mechanism-long/index.htm?TB_iframe=true&height=400&width=560

Aortic arch anatomy variations in human

The aortic arch can be characterized into three types based on the vertical distance from the origin of the innominate artery to the top of the arch
Type A-. A type 1 arch has a distance that is less than one times the diameter of the left common carotid artery (CCA). A type 2 arch originates from one to two CCA diameters from the top of the arch, and a type 3 arch originates more than 2 CA diameters from the top of the arch
Type B and C -Left common carotid artery from innominate artery
 Type D-True bovine arch
Type E-Arteria lusoria

Anthropometric measurements showing distance of different vascular beds from the radial artery

Cardiac resynchronization therapy

Before CRT -
1. AHA criteria for CRT indication -OK
2. Coronary Angiogram to rule out ischemic left ventricular dysfunction [CAG/SPECT/CMRI]
4. Coronary sinus angiogram in AP/RAO/LAO view to find suitable coronary vein tributary to place the left ventricular lead and antecubetal vein angiogram to rule anomalous venous system on the day
1.2
 On the day of CRT
1. Keep coronary angiogram on screen of AP view
2. TPI in place through transfemoral
3. Scrub
4. Left infraclavicular local anaesthesia
5. Insert 3 short guide wire into IVC
          6. Introduce 10Fr coronary sinus sheath
7. Repeat coronary sinus venogram to find suitable LV tributary if already       documented view is not well profiled
LV lead insertion
7. Release one lead for introduce 10Fr sheath for left ventricular lead
8. Take JR -4Fr through 10Fr sheath and enter 10Fr sheath into coronary sinus
9. Advance 4Fr JR into the suitable left coronary sinus tributary [upper most and left most]
10. Remove terumo and JR keeping 10Fr in CS
11. Take reverse barman or 20ml syringe, do a coronary sinus venogram to find a suitable tributary
11. Load PTCA wire into LV lead and shape the tip of PTCA wire by giving double bend
12. Introduce LV lead into a pilable sheath then introduce same into 10Fr
13. Advance PTCA wire into suitable tributary
14. Move the LV lead into the above
15. Check threshold and if ok
16.  Remove the pilable 10Fr and release its hub through sleeve of LV lead and lead screwing end
17. Secure LV lead into pocket using proline 2-0
18. Then introduce RV tin lead
19. Introduce RA appendage lead
20. Test each one for threshold, cough and deep inspiration and diaphragm contraction
21, Connect lead CRT device -top to RAA, MIDDLE-rv and bottom-lv, never forget to check lead connection proper also by their assigned number
22. Most of the procedure like PPI 23. Keep lead loops behind the PG by that you would not cut them on next visit
24. Keep the connecting side to left and top and the trade mark on PG should look anterior
25.  Fix PG to both upper and lower part inside.
26. Complete like PPI
After CRT
-Immediate Chest X-Ray  to rule out pneumothorax
-Watch for pocket hemotoma at earliest
-