Transcript interventionalradiologyangiography-140219074619

INTERVENTIONAL RADIOLOGY
& ANGIOGRAPHY
DR. Walid Asaad,
MBBS, MD, DABR,CAQ
Diagnostic &Interventional Radiology
King Abdulaziz University Hospital
INTERVENTIONAL RADIOLOGY
A subspecialty which provides minimally invasive
techniques with the help of imaging modalities to
diagnose or treat a condition.
Minimally invasive
Local anesthesia
Early recovery
 8 out of 10 procedures use skin incisions smaller
than 5 mm.
 9 out of 10 procedures use only local anaesthetic,
sometimes with sedation.
 Up to 8 out of 10 patients go home the same day
INTERVENTIONAL RADIOLOGY
Stent placement
Embolization
Thrombolysis
Balloon angioplasty
Atherectomy
Electrophysiology
 Percutaneous biopsy
 Abscess drainage
 Percutaneous nephrostomy
 Percutaneous Biliary drainage
 Radiofrequency ablation
ANGIOGRAPHY
The radiologic examination of vessels after the
introduction of a contrast medium.
HISTORY
The first angiogram was performed only months
after Roentgen's discovery of X rays.
Which was when?
Two physicians injected mercury salts into an
amputated hand and created an image of the arteries
Post mortem injection of mercury salts in
Jan,1896.
 Interventional radiologic procedures began in
1930s with angiography.
 In early 1960s Mason Jones pioneered
transbrachial selective coronary angiography.
 Later in 1960s transfemoral angiography was
developed.
BASIC PRINCIPLES
Arterial access
In 1953 Seldinger described a method for
catheterization of vessels.
A percutaneous technique for arterial and venous
access.
Femoral artery is most commonly used.
SELDINGER TECHNIQUE
Seldinger needle.
18gauge single use,sterile needle.
2 parts-- a solid inner needle(stylet) & an outer thin
wall needle for smooth passage.
a hub---good instrument balance
winged handle---good control.
 Site cleaned, area draped, local anesthetic given.
 The seldinger needle is introduced into the artery.
 When pulsating blood returns, the stylet is
removed.
 A guide wire is inserted through the needle.
 With guide wire in vessel, needle is removed.
 Catheter is threaded onto the guide wire.
 Under fluoro, the catheter is then advanced and
the guide wire is removed.
GUIDEWIRES
Guide the catheter.
Allow safe introduction of catheter into the vessel.
Made of stainless steel.
Usually about 145cm long
An inner core wire that is tapered at the end to a
soft flexible tip.
 Covered by a coating—teflon, heparin and recently
hydrophilic polymers(glide wires) are used.
 Coating reduces friction, gives strength to GW.
 Tips at the end of GW
 Straight
 J- tipped—prevents subintimal dissection of artery.
CATHETERS
•Many
shapes and sizes.
•diameter
is given in French(Fr)—3Fr=1mm.
•Straight-
end hole only—smaller vessels/minimal
contrast.
•Pigtail-
circular tip with multiple side holes —
larger vessels/ more contrast.
 H1 or Head hunter tip– used for femoral approach
to brachiocephalic vessels.
 Simmons catheter is highly curved --- for sharply
angled vessels--cerebral and visceral angiography.
 C2 or Cobra catheter has angled tip joined to a
gentle curve—celiac, renal & mesenteric arteries.
 Judkins catheters
Right(lesser curve) & left(greater curve) for right &
left coronary arteries.
 Amplatz catheters
Right & left coronary arteries
Contrast Media
Initially ionic iodine compounds were used.
Now non ionic contrast media in practice—low
adverse reactions and low physiologic problems.
INDICATIONS
Diagnosis & presence of ischemic heart disease.
After revascularization procedures
Congenital heart lesions & anomalies of great
vessels.
Valve disease, myocardial disease & ventricular
function.
 Atheroma
 Aneurysms
 Arteriovenous malformations
 Arterial ischemia
 Trauma
Patient preparation
Explain procedure & risk to the patient.
History & physical examination.
Lab tests.
Consent
Pre procedure I/V fluids.
Medication to relieve anxiety.
Monitoring during and after procedure
ECG, Automatic BP measurement & pulse oximetry.
Life saving drugs and equipments.
Immobile for minimum 4hrs after.
Vital signs monitored.
Puncture site inspected.
Contra-indications
Contrast allergy
Impaired renal function
Blood- clotting disorders
Anti coagulant medication
Unstable cardio pulmonary/ neurological status
Risks
Bleeding at puncture site
Thrombus formation
Embolus formation –plaque dislodged from vessel
wall by catheter
Dissection of vessel
Puncture site infection ( contaminated sterile field)
Contrast reaction
INTERVENTIONAL RADIOLOGY SUITE
Specifically designed to accommodate the quantity of
equipment needed & the large number of people
involved in the procedure.
Interventional radiology suite
 Procedure Room
 Room
size- 400-600
square feet
 Easily cleaned
(floors, wall, etc.)
 Outlets needed for
O2, suction.
 At least three means
of access.
 Control Room
 100-150
square feet
 Easy access and
communication to
procedure room
 Operating console
with Computers,
monitors .
EQUIPMENTS
The X-ray apparatus for interventional radiology is
more massive,flexible,expensive & advanced.
More heat load and serial images.
X RAY TUBE
Two ceiling track-mounted X-ray tubes alongwith
an image intensified fluoroscope mounted on C or an
L arm.
A large diameter massive anode disc(15cm
diameter, 5cm thick) to accommodate heat load.
Cathodes designed for magnification & serial
radiography.
 A large focal spot of 1mm for heat load.
 A small focal spot( no more than 0.3mm) is
necessary for spatial resolution of small vessel
magnification.
 Power rating of 80kW—for rapid sequence serial
radiography.
 Anode heat capacity of 1 MHU—to accommodate
heat load.
Generators
High frequency and high voltage generators
Three phase,12 pulse power.
Patient couch
Stationary couch with a floating,tilting or rotating
table top.
Controls for couch positioning are located on side
of table and also on a floor switch.
May also have a computer controlled stepping
capability.
Image receptor
2 different types.
Cinefluorographic camera—now obsolete.
Nowadays Digital image receptors are used with a
television camera pickup tube or a charge-coupled
device(CCD).
THANKS