Download Angiography and Arteriography

Circulatory and
Cardiovascular Systems
Spring 2013
Circulatory System
2
Blood Vascular System
3
Heart and Great Vessels
4
Cross Section of the Heart
5
Arteries of the Heart
6
Anterior View of Coronary Arteries
7
Anterior View of Coronary Veins
8
Pathologies

Congenital Heart
Diseases
–
–
–
–
–

Murmur
Patent Ductus Arteriosus
Arterial Septal Defects
Ventricular Septal Defects
Teratology of Fallot
Valvular heart disease
– Valvular Stenosis
– Congestive Heart Failure

Degenerative diseases
– CAD
– Atherosclerosis
Myocardial infarction
 Aortic aneurysm
 Pulmonary Embolism

9
Murmur

Murmur- an abnormal
heart sound
– Results from
malformed valves
Patent Ductus Arteriosus
11
Atrial Septal Defect
12
Ventricular Septal Defect
Teratology of Fallot
Coarctation of the Aorta
Valvular Disease
16
Mitral Valvular Stenosis
Mitral Valve Stenosis
Congestive Heart Failure
CHF Radiograph
Coronary Artery Disease
Coronary Artery Disease
Myocardial Infarction
Myocardial Infarction Images
Aortic Aneurysm
Aortic Aneurysm Imaging
Aortogram
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28
AORTOGRAM
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Abdominal Aortoraphy
30
Abdominal Angiography
31
AAA Pre and Post Stent Placement
32
33
Abdominal Stent
34
AAA
35
Pulmonary
Embolism
Pulmonary Embolism Imaging
Angiography
Arteriography and
Aortograms
SPRING 2013
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
40
41
Angiography Team

Radiologist

CIT (Radiologic Technologist)
– Sometimes more than one

Other specialists (if needed)

Nurse

Anesthesiologist (if needed)
42
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
43
Contraindications

Previous severe reaction to contrast

Impaired renal function

Impaired blood clotting factors

Inability to undergo surgical procedure
44
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
45
What is this?
46
47
Angiographic Trays
and Sterile Supplies
48
Other Supplies for Angiography
49
Needles
Vascular access
needles
 Size based on
external diameter of
needle
 Allows for appropriate
Guidewires matching

– So internal diameter
must also be known
50
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

51
Introducer Sheaths

Short catheters used
when multiple
catheters will be used

Placed in lieu of a
catheter
52
Catheters
53
54
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
55
Three Dimensional (3-D)
Intraarterial Angiography
56
What Method is this?
57
Catherization: Selinger Technique
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Selinger Technique Catheters and
Guidewires
59
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
60
Stent Placement

http://images.google.com/imgres?imgurl=http://
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61
Pulmonary Circulation
http://www.youtube.com/watch?v=D3ZDJ
gFDdk0
http://www.youtube.com/w
atch?v=0jznS5psypI
62
Pulmonary Arteriogram
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Celiac Ateriogram

Celian artery carries
blood from stomach to
duodenum, liver, spleen
and pancreas

Approx at level T12
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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
77
Brachial and Axillary Arteriogram
78
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
85
Placing a Stent after Angioplasty
with Balloon
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Intravascular Stents
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Cerebral Angiography
Indications
•
Aneurysms
•
Arteriovenous Malformations
•
Tumors
•
Athersclerotic Lesions
•
Stenotic lesions
Circle of Willis
Circulation Time

Cerebral circulation
Carotid artery to jugular vein (3 seconds)

With contrast
– 4.13 seconds

Certain pathologies shorten or delay time
– AVM’s shorten time
– Arterial vasospasm delays time
Equipment

Bi-plane imaging
– Film
– DSA

Automatic Injector
Carotid Angiogram
Internal Carotid Angiograms
Internal Carotid Angiogram
Vertebral Arteries Angiogram
Vertebral Artery Angiogram
Let’s Review
What is the name of this
Procedure?
What is it done for?
98
What is the name of this
pathology?
99
What part of the body is being imaged?
What is the pathology is this image?
100
101
What is this method callled?
102
A
C
B
103
Venography
2013
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:
–
–
–
–
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
http://www.youtube.com/watch?
v=4aGNqmWOuEo&feature=relat
ed
Transjugular Intrahepatic
Portosystemic Shunt

Intervention for creating
an artificial low-pressure
pathway
– Between portal & hepatic
veins

Hepatic venogram usually
preformed before
placement

US also useful
http://www.youtube.com/watch?v=pGA6KUgq
7AI
139
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