Angiography and Arteriography
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Transcript Angiography and Arteriography
Angiography
Arteriography
Aortograms
and Venography
SPRING 2011
FINAL
Angiography
Is the general term that describes
the radiologic examination of
vascular structures within the
body after the introduction of an
iodinated contrast medium or gas
Types of Angiographic Procedures
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Angiography Team
Radiologist
CIT (Radiologic Technologist)
– Sometimes more than one
Other specialists (if needed)
Nurse
Anesthesiologist (if needed)
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Indications
Verify the presence of
tumors
– Clots
– Thrombus
– Embolus
– Blood supply to tumors
Internal bleeding
– Possible anemia
Occlusions
Aneurysms
Heart disease
Stenosis
– Can be caused form
atherosclerosis
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Contraindications
Previous severe reaction to contrast
Impaired renal function
Impaired blood clotting factors
Inability to undergo surgical procedure
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Contrast Media
Iodinated contrast media is used
– Can produce nausea & an uncomfortable
burning sensation
– Allergic reactions
Severe: anaphylactic shock
– Shock, rapid shallow breathing, high pulse rate & ALOC
Mild: Hives or slight difficulty breathing
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What is this?
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Angiographic Trays
and Sterile Supplies
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Other Supplies for Angiography
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Needles
Vascular access
needles
Size based on
external diameter of
needle
Allows for appropriate
Guidewires matching
– So internal diameter
must also be known
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Guidewires
Used as a platform
over which a catheter
is to be advanced
Once positioned
guidewire is fixed and
catheter is advanced
until it meets the tip
of the guidwire
Mostly constructed on
stainless steel &
coated with Teflon
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Introducer Sheaths
Short catheters used
when multiple
catheters will be used
Placed in lieu of a
catheter
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Catheters
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DSA
A subtraction mask is
taken before contrast
injected
Each of digitized
image is from the
mask
Images acquired form
– 1 image every 2-3 sec
– Up to 30 images per
sec
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Three Dimensional (3-D)
Intraarterial Angiography
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What Method is this?
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Catherization: Selinger Technique
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Selinger Technique Catheters and
Guidewires
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Pre-Procedure
PT’s are usually limited to a liquid diet and routine
medications
Adequate hydration
An IV line placed
– Sedative may be given
History taken and vitals taken
Informed consent
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Preparing the Patient Room
Must be extensively cleaned
Equipment checked
Room thoroughly stocked
Extra supplies as needed
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Radiation Protection
PT is protected by no less than 2.5 mm of
Aluminum
Beam restriction
Avoidance of repeat exposure
Cardinal rules
– Time
– Distance
– Shielding
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Post Procedure
PTs usually can resume normal activity
after 24 hours
Most often can go home after 24 hours
– Because internal bleeding can be life
threatening
Vitals are monitored
Puncture site is monitored for bleeding
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Stent Placement
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Aortogram
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AORTOGRAM
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Abdominal Aortoraphy
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Abdominal Angiography
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AAA Pre and Post Stent Placement
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Abdominal Stent
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AAA
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Pulmonary Circulation
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Pulmonary Arteriogram
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Celiac Ateriogram
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Hepatic Arteriogram
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Splenic Arteriorgram
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Renal Arteriogram
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renal
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Lower Limb Arteries
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Leg Atherosclerosis
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Atherosclerosis Left Leg
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Upper Limb Arteries
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Upper Extremity Anatomy
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Brachial and Axillary Arteriogram
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Axillary Arteriogram
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Hand Arteriogram
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Hand Arteriogram with Occlusion
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Balloon Angioplasty
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Balloon Angioplasty Procedure
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Femoral Artery Angioplasty
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Placing a Stent after Angioplasty
with Balloon
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Intravascular Stents
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Let’s Review
B
C
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What is the name of this
Procedure?
What is it done for?
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What is the name of this
pathology?
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What part of the body is being imaged?
What is the pathology is this image?
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What is this method callled?
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A
C
B
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Venography
Venous
Circulation
What is Venography?
Vein study using x-ray and contrast media
– Fluoroscopy and still images
One of the most accurate tests for deep
vein thrombosis (DVT)
Most commonly done in legs for DVT
Thrombosis and Embolism
Intravascular clot
Commonly in veins
more than arteries
3 factors
– Where blood is slow
– Change in the wall of
vessels
– Change in the blood
itself
Thrombus that
becomes detached
from the vessel wall
Can easily flow to
heart causing PE
Severity depends on
location of embolism
Pulmonary Embolism
Occurs when a clot forms or becomes lodged in the
pulmonary artery
Most commonly thrombus originates in the lower limbs
and migrates
Can lead to resp distress, heart failure or cardiogenic
shock
Symptoms are acute:
– Sudden coughing
– SOB
– Chest pain
Pulmonary Emboli (PE)
Indications
Diagnose deep vein thrombosis
–
Prevent pulmonary embolism
Distinguish blood clots from
obstructions in the veins
Evaluate congenital vein
problems
Assess the functioning of deep
leg vein valves
Identify a vein for arterial
bypass grafting
Risk Factors and Complications
Previous thrombosis
Dilution of the contrast dye in the lower
limb
Difficulty accessing the veins due to:
– Obesity
– Severe swelling (edema)
– Inflammation in the cells ( cellulitis )
Contraindications
Bleeding disorders
Allergy to iodine
CHF
Severe pulmonary hypertension
Prior to Procedure
Fast or drink only clear fluids for four hours
before the test
Thorough PT history obtained
Informed consent
If you are nervous about the test, your doctor
may give you a sedative.
During Procedure
PT will lie on a tilting x-ray table
Area of interest will be
shaved and cleaned
Local anesthetic
Catheter will be inserted.
– A small incision may be
made in that area as well
Explanation of Procedure: Legs
The catheter is inserted into
PT vein
–
(usually a vein in the foot)
Contrast is slowly injected.
A tight band may be tied
around your ankle and upper
thigh
– or your lower body may be
tilted
– Fluoro and/or x-ray images
taken
The procedure takes about 30
- 45 minutes
Post Procedure
Rest and avoid strenuous activity
Increase fluid intake
Stop bleeding with pressure
– Call DR if it won’t stop bleeding
Observe for signs of infection
PT will be sore for a few days
Resume normal activity 24 hours after procedure
Possible Post Procedure Complications
Infection at the injection
site
Tissue damage
Phlebitis (inflammation of
a vein)
Allergic reactions to the
contrast dye
Congestive heart failure
Acute renal insufficiency
Venous thrombosis in a
healthy leg
Dislodging a clot, perhaps
resulting in pulmonary
embolus or other
complications
Lower Limb Veins
Lower Limb Venograms
To rule out thrombosis of the deep veins
of the leg
– Deep vein thrombosis (DVT)
Contrast media injected in superficial veins
of the foot with a needle
Lower Limb
Venograms
DVT
Inferior Venacavagram
Primarily to rule out thrombus or occlusion
Catheter inserted into femoral vein and
positioned inside the common iliac vein or
inferior aspect of inferior vena cava
Contrast injected at 20 ml/sec for total of
40ml
Upper Limb Veins
Upper Limb Venograms
Most often for thrombosis or occlusion
Contrast injected in a superficial vein in
the elbow or wrist
– Using a catheter or needle
– 40-80ml at a rate of 1-4ml/sec
Superior Venacavagram
Primarily done to rule out thrombus or occlusion
Needle or catheter is introduced into antecubital
fossa
– Catheter is positioned in the axillary or subclavian
vein and contrast is injected
– 30-50ml at 10-15ml/sec
X-rays should include:
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–
–
–
Brachicephalic vein
Subclavian vein
Superior vena cava
RT Atrium
Superior Venacavagram
Stenosis on a Superior
Venacavogram
Inferior Venacavagram
Inferior Venacavagram
Inferior Vena Cava Filters
Inferior Vena Cava Filter Placement
Designed to trap
thrombus before
causing an
embolization
When anticoagulants
are contraindicated
this can be used
Inferior Vena Cava Filter Placement
Hepatic Venogram
Performed to rule out stenosis or
thrombus of the hepatic veins
Obtain pressure measurements of the
veins inside the liver
Usually catheter enters jugular vein or
upper limb veins
Hepatic Venogram
Portal Venogram
Portal System
Transjugular Intrahepatic
Portosystemic Shunt
Intervention for creating
an artificial low-pressure
pathway
– Between portal & hepatic
veins
Hepatic venogram usually
preformed b before
placement
US also useful
Transjugular Intrahepatic
Portosystemic Shunt
Renal Venogram
Rule out thrombosis of renal vein
Renal vein catheterized to take blood
– Measure the production of renin
– Catheter insertion site: femoral vein
Contrast injected 8ml/sec for 16ml total
– 2 images per second for 4 seconds
Renal Venogram