Introductory note
The department of invasive and interventional cardiovascular diagnostics and therapy is profiled as a department focused on the needs of patients while adhering to the highest ethical and professional health care standards. High quality of health care services is ensured through introducing new medical and information technologies, implementing standardized procedures and protocols, as well as cooperation with other departments of ICVD Dedinje. Records of performed diagnostic and interventional procedures are continuously kept. Work plans for the following period are made annually based on the analysis of the condition of equipment, personnel and other factors. Professional staff, spatial organization, safety of patients and employees, as well as professional training and continuing education of employees are taken into consideration when planning the improvement of work and patient safety. The goals set are monitored through the analysis of achievement performed at the end of the year, and annual reports are made according to them.
HISTORY
The department of Invasive and Interventional Cardiovascular Diagnostics and Therapy started working at the end of 1977, when the Clinic for Cardiovascular Surgery “Dedinje” was founded (reorganized in 1995 into the Institute for Cardiovascular Diseases “Dedinje” – ICVDD), as a special organizational unit in ICVDD. The head of this Department was Dr Zoran Đurišić, a radiologist, whose work was supported by Dr. Sreten Grujičić, a radiologist and chief of medicine Dr. Petar Pejčić, cardiologist. Aorthography and selective angiography, as well as coronary angiography and cardiac catheterization were introduced and performed on two Siemens X-ray machines. The first coronary angiography was performed on October 4 th , 1977, whereas the first coronary artery balloon dilatation (PTCA) was performed in December, 1981. In March 1980, Grujičić/Đurišić performed the first PTA in the femoral popliteal region and the first balloon dilatation (PTRA) of the renal artery.
ABOUT THE CLINIC – SCOPE OF WORK
he Department of Invasive and Interventional Cardiovascular Diagnostics and Therapy, within the ICVD Dedinje, provides diagnostics and interventional treatment of patients suffering from cardiovascular disorders. In addition to classic radiography, non-invasive diagnostics also includes MDCT (multidetector scanner) examinations: CT coronary angiography, heart CT scan in giving the diagnosis of valvular heart diseases and myocardial and pericardial diseases, CT aortography of the entire aorta, CT arteriography of limbs, CT angiography of the blood vessels of the neck and intracanal segment, CT of large systemic veins. In addition to blood vessels, CT examinations of the chest, abdomen and small pelvis are performed. More than 5,000 CT examinations are performed annually, of which about 800 are CT coronary angiographies. As a part of invasive diagnostics, about 700 endovascular procedures are performed on arterial blood vessels, of which about 50 procedures on the aorta affected by aneurysms and dissections (TEVAR, EVAR), about 200 dilatations with stents on carotid arteries as well as other interventions on limb arteries, on the renal arteries and other blood vessels. Rotational atherectomy is performed in cases of recanalizations of occluded leg arteries. Special attention is paid to planning the development of new technologies in the treatment of aortic arch dissections and aneurysms, the placement of TEVAR stents with prior bypassing on the carotid arteries and the use of new specially designed stent grafts. The continuation and further development of renal denervation (RDN) in treating resistant arterial hypertension is foreseen.
ORGANIZATIONAL STRUCTURE
The Department for Invasive and Interventional Cardiovascular Diagnostics and Therapy operates as a special organizational unit within the ICVDD. This department consists of: This department consists of:
LIST OF PROCEDURES
The Department of Invasive and Interventional Cardiovascular Diagnostics and Therapy provides non-invasive, invasive and interventional diagnostic procedures. ICVDD offers the following types of CT scans:
- CT angiography (view of the arteries of the neck and brain, the entire thoracic aorta and abdominal aorta with branches, arteries of the upper and lower limbs),
- CT of coronary arteries – imaging of arteries of the heart,
- Calcium score – assessment of the extent of calcification of the arteries of the heart,
- CT of the heart cavities – assessment of the heart cavities and the quality of the heart muscle CT of the endocranium with and without contrast – imaging of the brain parenchyma with and/or without contrast medium,
- ЦТ прегледи грудног коша, трбуха, мале карлице и коштаног система.
Before the CT scan, the blood pressure is measured, and a cannula is inserted into the cubital vein of the left arm, which is used to inject iodine contrast medium (100 ml) through an automatic injector. Immediately before being sent to the CT room, patients are given a sedative if necessary. Parenteral premedication Synopen amp. 20 mg i.v., Ranitidine amr. 50mg i.v., methylprednisolone amp. 40mg i.v. is administered half an hour before the intervention in case of patients who are allergic to iodine.
Peripheral vascular interventions – PTA dilatations (percutaneous transluminal angioplasty) are performed on the arterial and venous systems. They can be performed in an angio room or a hybrid surgical room. These procedures are performed under local anesthesia. These procedures usually require puncturing the femoral or cubital and radial arteries. After the puncture using a special needle, a valve introducer is placed into the blood vessel via a wire guide. The valve is washed out with physiological solution while administering heparin from 60 to 100 IU/Kg. A catheter guide is then placed over the wire guide, to continue further with the procedure. In case of artery narrowing, dilatation is performed using balloons and stenting, with stents of specific diameter and length. Before stenting, the patient receives Andol – Aspirin 100mg and Clopidogrel. PTA of brachiocephalic arteries is an endovascular treatment of stenosis occurring in the carotid, vertebral, subclavian arteries and brachiocephalic trunk. During carotid artery stenting, distal protection is used in the form of special umbrella-filters to prevent distal embolization and occurrence of neurological complications. Renal artery PTA is an endovascular treatment of stenotic lesions in the renal arteries in case of arterial hypertension and impaired renal function. PTA of the arteries of the lower limbs is an intervention with dilatation, balloon and stent placement for artery narrowing at different levels, if pain appears in the legs during walking or while resting (critical ischemia). In case of severe calcifications in the arteries, in the above-knee and below-knee segment, calcium plate removal can be performed prior to PTA, with a special catheter system – rotational atherectomy (cutting and aspiration of plaque particles in the blood vessel). In case of blood vessel dilation (aneurysms), procedures performed involve the placement of stents covered with a canvas (stent graft): TEVAR (thoracic aortic aneurysm) and EVAR (abdominal aortic aneurysm). These interventions are performed under local, epidural or general anesthesia. The femoral artery is usually surgically dissected, which can be performed by puncture if there are not many calcifications. The stent graft is packed in a system that opens up as a type of self-releasing stent, and if necessary, balloon postdilatation can be performed. In case of congenital or newly developed AV fistulas (artery-vein communication), interventions performed include the installation of wire spirals used to close the communication (embolization).
MOST SIGNIFICANT RESULTS
- The first coronary angiography was performed on October 4 th , 1977 whereas the first percutaneous angioplasty of the coronary artery (PCI) was performed in December, 1981 (Đurišić, Grujičić, Pejčić).
- In March, 1980, Grujičić/Đurišić performed the first PTA of the femoral popliteal region and the first balloon dilatation (PTRA) of the renal artery.
- The first intracoronary thrombolysis and mechanical coronary recanalization in acute myocardial infarction was performed for the first time on a mobile X-ray machine by Dr. Uroš Babić, in 1983.
- In October of the following year, 1984, the first balloon dilatation of the stenotic pulmonary valve (Grujičić/U.Babić/Đurišić) was performed, and in 1985 stenotic mitral valve was dilated for the first time (percutaneous mitral valvuloplasty: retrograde transarterial technique with two balloons, transseptal approach) (U.Babić/Grujičić).
- In October 1986, Grujičić/Đurišić applied for the first time the method of dilatation of the stenosed aortic valve using a balloon catheter. During 1989, the ducus Bottali and ASD (U.Babić/Grujičić) were closed.
- The first coronary stent implantation (NIR stent Boston Sc.) was performed in August, 1996 (Sagić/Mirić).
- The first percutaneous intervention with carotid stent implantation (Sagić/Antonić) was performed in 2002.
- During 2003, the first dilatation was performed with stent implantation in aortic coarctation (Antonić/Sagić) and for the first time in the country TEVAR, endovascular stent graft implantation was performed to treat thoracic aortic aneurysm (Sagić/Antonić/Radak).
- In 2005, the ICVDD successfully performed the first in the world, implantation of a PARACHUTE (PercutAneus Bentricular RestorAtionin Chronic Heart failUre PaTiEnts) umbrella in the left ventricle (treatment of aneurysm of the apex of the ventricle) (Sagić/Antonić).
- In mid-2007, 64 multidetector scanner was installed in the ICVDD. This Institute was among the first in Europe to introduce MDCT angiography as the basic angiographic method, instead of the conventional one (Ž. Antonić).
- The first renal denervation – RDN (treatment of resistant hypertension) in the country (Antonić / Sagić) was performed in 2008.
- The TAVI program (percutaneous treatment of aortic valve stenosis) commenced in 2015 and continued in 2018 (Boljević, Sagić) with 30 patients.
- The first rotational atherectomies of the leg arteries were performed in 2019 (Antonić, Petrović, Kovačević, Sagić).
EMPLOYEES
Head of Department – Prof. dr Dragan Sagić, specialist in radiology, subspecialist in interventional radiology
CONTACT DETAILS
Switchboard operator: 011 360 1700
Manager’s office: 011 360 1642,
Room for X-ray technician: 011 360 1678,
Medical doctors’ room (CT): 011 360 1732,
Angio room: 011 360 1788, 011 360 1789,
CT 011 360 1732
