Cardiac catheterization and angiography, in general, are still primary imaging modalities for the treatment of a variety of cardiovascular diseases. Technological advancements incorporated into fluoroscopic equipment have improved its design, mobility, imaging quality and efficiency. At Jackson Memorial Hospital in Miami, Florida, interventional cardiologist Cesar Mendoza, MD, FACC, stated that these were the qualities they were looking for when deciding to upgrade their equipment, and the Ziehm Vision RFD Hybrid Edition CMOSline flat panel motorized C-arm was the one that best fit their expectations.
“After having a bit more than 1 year of experience with a motorized C-arm, we are very satisfied with its performance. It has helped to streamline the daily cath lab patient flow, especially the one corresponding to our Heart Failure/Transplant service. Alleviating the caseload (20-25 cases per week) of this busy service in our hospital was a remarkable achievement,” said Dr. Mendoza. “Recognizing its value, we use this room for pre- and post-transplant right heart catheterizations, left heart catheterizations, coronary angiography, and myocardial biopsies. In addition, the electrophysiology team uses it for implantation of devices, and the interventional cardiology team for performing diagnostic and simple percutaneous coronary interventions.”
In this particular lab, the performance of more complex interventional procedures is limited by room size rather than by the capability of the Ziehm C-arm. Dr. Mendoza noted, “Imaging quality provided by Ziehm’s CMOS technology is as comparable as the one provided by the other fixed equipment available in our other rooms. Anecdotally, the first case done with the Ziehm C-arm was an emergent procedure performed in a patient with a large inferior ST-segment elevation myocardial infarction and cardiogenic shock. He required a complex intervention of the right coronary artery, including distal bifurcation stenting and hemodynamic support with an intra-aortic balloon pump. The motorized C-arm performed very well, demonstrating its capacity as a reliable backup when an emergency ensues. Its simplicity of use, optimal imaging quality, and versatility are encouraging features. From my own experience, I have no doubt of its real utility as a great asset for any cath lab.”
On the west coast of California, The Bay Area Vein and Vascular Center, an office-based laboratory (OBL) in Burlingame, recently replaced their older C-arm with the new motorized Ziehm Vision RFD 31 CMOSline and have been extremely pleased with its performance. The main advantages include exceptional image quality with reduced radiation for their patients, staff and interventionists. The C-arm is used mostly for lower extremity endovascular reconstruction, fistulagrams, placement and removal of tunneled catheter, ports and inferior vena cava (IVC) filters, deep venous reconstruction, and carotid and cerebral angiography. Dr. Raju Gandhi, Founder and Medical Director, Bay Area Vein and Vascular, stated, “The versatility of having the motorized C-arm along with a floating table has maximized our workflow during and between procedures. The level of efficiency is superior to the fixed units that we use at our hospitals. The support we have received from installation and maintenance over the past 6 years has been exemplary. We could not be more pleased with our recent acquisition and invite those who may be interested to visit our office-based laboratory.”
The doctors at Midwest Institute for Minimally Invasive Therapies (MIMIT) Health in Chicago, Illinois use the Ziehm Vision RFD C-arm in complicated arterial interventions in the lower extremities all the way down to the foot. The C-arm is also used in additional procedures such as transradial mesenteric procedures, spine procedures, and interventional oncology procedures. The Ziehm C-arm provides the capability to complete the entire gamut of procedures traditionally done in a hospital setting.
Dr. Paramjit “Romi” Chopra, Founder, President and CEO, stated that the Ziehm Vision RFD Hybrid Edition has helped increase their caseload and allows them to use the system the entire day due to its reliability and its water-cooled technology. Advanced Active Cooling (AAC) is a unique liquid cooling system that significantly boosts performance. AAC constantly maintains an ideal operational temperature, preventing the generator from overheating. “The Ziehm C-arm has also allowed us to become very efficient, as it’s well integrated into our network. It is a fixed lab on wheels and has definitely added value to our practice” said Dr. Chopra.
Advantages of the Ziehm Vision RFD Hybrid Edition flat-panel detector include lowered dose, larger field of view, and a 30 x 30 flat-panel detector for excellent anatomical detail. High image resolution and sharp contrast allow the visualization of small vessels. The flat-panel square format extends the field of view offered by conventional image intensifiers, which enables significantly more information to be captured in each x-ray image.
“The workflow with the Ziehm C-arm has been excellent. For example, the vascular package is a one-button DSA and RSA, making it very simple to use. I can use it at the same time as performing a procedure and I can use it with tableside joystick controls, which is helpful. With the Ziehm Vision RFD Hybrid Edition, we have the same advantages as a fixed system, while being in a small outpatient or mobile lab. We have been able to accomplish everything we were able to do with a fixed system with the use of this unit,” said Dr. Chopra.