Summary
In the years since the introduction of outpatient cardiac catheterization and coronary angiography, the indications for the use of these procedures have expanded rapidly with advancements in surgical and endovascular procedures. The safety of outpatient coronary angiography has been well established, comparing very favorably with that of inpatient procedures. At present, a variety of different outpatient facilities exist. Catheterization laboratories may adjoint a hospital or be free-standing; the safety and success of procedures performed in mobile cardiac catheterization laboratories has also been described.
There are a variety of access techniques for cardiac catheterization in use today, and there are many types and sizes of catheters available. Miniaturization of equipment has reduced complications and allowed early ambulation and discharge from outpatient laboratories. In addition, the development and refinement of catheters and techniques for achieving hemostasis may allow further reductions in patient stay and complications. The complication rates of outpatient cardiac catheterization and coronary angiography are, in fact, quite low — in some cases, lower complication rates are seen in the outpatient population than in the inpatient population. Although this is certainly related in part to the fact that outpatients generally have more stable disease, it is clear that careful equipment choices, proper technique, and adequate monitoring have contributed to the success of these important outpatient procedures.
Zusammenfassung
Die ambulante Koronarangiographie hat sich aufgrund der Fortschritte in der Herzchirurgie und in der interventionellen Kardiologie schnell verbreitet. Die Sicherheit der ambulanten Koronarangiographie ist dokumentiert, die Risiken liegen im Bereich der stationär durchgeführten Koronarangiographie. Zur Zeit gibt es unterschiedliche Konzepte: Katheterlabors sind entweder einem Krankenhaus angeschlossen oder unabhängig hiervon installiert. Darüber hinaus wurde über die Sicherheit und Erfolgsrate von mobilen Herzkatheterlabors berichtet.
Heute werden unterschiedliche arterielle Zugänge gewählt, dementsprechend gibt es viele unterschiedliche Arten und Größen von Herzkathetern. Die Miniaturisierung der Ausrüstung hat zu einer Reduktion der Komplikationsraten geführt und gestattet eine frühe Mobilisierung bzw. Entlassung aus ambulanten Katheterlabors. Zusätzlich hat die Entwicklung und Verbesserung von Techniken zur raschen Hämostase eine weitere Verminderung der Patientenaufenthaltsdauer und eventuell auch der Komplikationen gebracht. Die Komplikationsrate ambulanter Koronarangiographien ist in der Tat sehr niedrig. Gelegentlich werden auch bei ambulant durchgeführten Herzkatheteruntersuchungen geringere Komplikationsraten beschrieben als bei einem stationären Krankengut. Obwohl dies sicher zum Teil darauf zurückzuführen ist, daß die ambulant durchgeführten Herzkatheteruntersuchungen bei stabileren Patienten durchgeführt werden, hat die sorgfältige Auswahl des Kathetermaterials, die geeignete Technik und das adäquate Monitoring zum Erfolg der wichtigen ambulanten Koronarangiographien beigetragen.
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Heuser, R.R. Outpatient coronary angiography: Indications, safety, and complication rates. Herz 23, 21–26 (1998). https://doi.org/10.1007/BF03043008
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DOI: https://doi.org/10.1007/BF03043008