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Angiography I
Angiography refers to the radiographic
examination of vessels after injection of a
contrast medium. Because of the relative
densities of the soft tissues of the body, contrast
medium must be added to visualize the
circulatory system.
The circulatory system consists of the cardiovascular
and lymphatic components. The cardiovascular portion
includes the heart, blood, and vessels that transport the
blood.
The lymphatic element of the circulatory system is
composed of a clear, watery fluid called lymph, along with
lymphatic vessels and lymphatic nodes. The
cardiovascular and lymphatic components differ in their
function and method of transporting their respective fluids
within the vessels.
The cardiovascular, or blood circulatory, division may be
divided further into the cardio (circulation within the heart)
and vascular (blood vessel) components.
The vascular or vessel component is divided into the
pulmonary (heart to lungs and back) and the general, or
systemic, systems (throughout the body)
Functions of the cardiovascular system include
the following:
1.Transportation of oxygen, nutrients, hormones, and
chemicals necessary for normal body activity
2.Removal of waste products through the kidneys and lungs
3.Maintenance of body temperature and water and electrolyte
balance. These functions are performed by the following
blood components: red blood cells, white blood cells, and
platelets suspended in plasma
Blood Components:
Red blood cells, or erythrocytes, are produced in the red
marrow of certain bones and transport oxygen by the protein
hemoglobin to body tissues.
White blood cells, or leukocytes, are formed in bone
marrow and lymph tissue and defend the body against
infection and disease. Platelets, also originating from bone
marrow, repair tears in blood vessel walls and promote blood
clotting.
Plasma, the liquid portion of the blood, consists of 92% water
and about 7% plasma protein and salts, nutrients, and
oxygen.
Arteries
Vessels that transport oxygenated blood from the heart to
tissues are called arteries. Arteries that originate directly
from the heart are large, but they subdivide and decrease
in size as they extend from the heart to various parts of the
body. The smaller arteries are termed arterioles. As the
blood travels through the arterioles, it enters the tissues
through the smallest subdivision of these vessels, known
as capillaries
Veins
The deoxygenated blood returns to the heart
through the venous system. The venous
system extends from venous capillaries to
venules to veins, increasing in size as it nears
the heart.
The elements of the blood vessel circuit (veins, venules,
capillaries, arterioles, and arteries), which supply blood to the
lungs and back, make up the pulmonary circulation
component of the cardiovascular system.
As previously noted, arteries generally carry oxygenated blood
away from the heart to the capillaries. Exceptions to this are the
pulmonary arteries, which carry deoxygenated blood to the
lungs that has been returned to the heart through the superior
and inferior venae cavae.
The superior and inferior venae cavae (singular, vena cava)
empty the returning deoxygenated blood into the right atrium
of the heart.
The heart pumps this deoxygenated blood from the right
ventricle through the pulmonary arteries to the lungs, where
oxygen and carbon dioxide are exchanged through the small
air sacs or alveoli of the lungs. The oxygenated blood then
returns through the pulmonary veins to the left atrium of the
heart
The heart itself is divided into four chambers: the right
and left atria and the right and left ventricles. Each
chamber functions to receive and/or pump blood. The
blood circulation is a closed system by which
unoxygenated blood enters the right atrium from all
parts of the body, is reoxygenated in the lungs, and is
returned to the body by the left ventricle.
Blood returning to the heart enters the right atrium
through the superior and inferior venae cavae. Blood
in the superior vena cava originates from the head,
chest, and upper limbs. The inferior vena cava serves
to deliver blood into the right atrium from the abdomen
and lower limbs
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CORONARY ARTERIES
The coronary arteries are the vessels that deliver blood to
the heart muscle. The two coronary arteries are called
the right and the left. Both coronary arteries originate from
the aortic bulb.
The right coronary artery arises from the right (anterior)
sinuses of the aortic bulb, and the left coronary artery
originates from the left (posterior) aortic bulb sinus. The
right coronary artery supplies much of the right atrium
and the right ventricle of the heart.
The left coronary artery supplies blood to both ventricles
and the left atrium of the heart. Many interconnections or
anastomoses exist between the left and right coronary
arteries. Blood returns to the right atrium of the heart via
the coronary veins
The coronary sinus system
returns blood to the right atrium
for recirculation. The coronary
sinus is a large vein on the
posterior side of the heart
between the atria and
ventricles.
BLOOD SUPPLY TO THE BRAIN
The brain is supplied with blood by major arteries of the
systemic circulation. The four major arteries that supply
the brain are as follows :
1.Right common carotid artery
2.Left common carotid artery
3.Right vertebral artery
4.Left vertebral artery
BRANCHES OF THE AORTIC
ARCH
The aorta is the major artery
leaving the left ventricle of the
heart. Three major branches arise
from the arch of the aorta and
include the following:
1.Brachiocephalic artery
2.Left common carotid artery
3.Left subclavian artery
INTERNAL CAROTID ARTERY
Each internal carotid artery ascends to enter the
carotid canal in the petrous portion of the temporal
bone. Within the petrous pyramid, the artery curves
forward and medially. Before supplying the cerebral
hemispheres, each internal carotid artery passes
through a collection of venous channels around the
sella turcica. Each internal carotid artery passes
through the dura mater, medial to each anterior clinoid
process, to bifurcate into the cerebral branches.
The S-shaped portion of each internal carotid artery is
termed the carotid siphon and is studied carefully by
the radiologist.
GREAT VEINS OF THE NECK
The three pairs of major veins that drain
the head, face, and neck region shown in
include the following:
1.Right and left internal jugular veins
2.Right and left external jugular veins
3.Right and left vertebral veins
THORACIC ARTERIES
The aorta and pulmonary
arteries are the major
arteries located within the
chest. The pulmonary
arteries supply the lungs
with deoxygenated blood
The aorta extends from the
heart to about the fourth lumbar
vertebra and is divided into
thoracic and abdominal
sections. The thoracic section
is subdivided into the following
four segments
1.Aortic bulb (root)
2.Ascending aorta
3.Aortic arch
4.Descending aorta
ABDOMINAL ARTERIES
The abdominal aorta is the continuation of the thoracic aorta.
The abdominal aorta is anterior to the vertebrae and extends
from the diaphragm to approximately L4, where it bifurcates
into the right and left common iliac arteries. Five major
branches of the abdominal aorta exist that are of greatest
interest in angiography. Any one of these branches may be
selectively catheterized for study of a specific organ.
Blood is returned from structures below the diaphragm
(the trunk and lower limbs) to the right atrium of the
heart by the inferior vena cava. Several
radiographically important tributaries to the inferior vena
cava exist. These veins include the right and left
common iliacs, internal iliacs, external iliacs, renal
veins and the hepatic portal system .The iliac veins
drain the pelvic area and lower limbs, and the renal
veins return blood from the kidneys.
The hepatic portal system includes all veins that drain
blood from the abdominal digestive tract and from the
spleen, colon, and small intestine. From these organs, this
blood is conveyed to the liver through the hepatic portal
vein. While in the liver, this blood is “filtered” and is returned
to the inferior vena cava by the hepatic veins. Several major
tributaries to the hepatic veins exist . The splenic vein is a
large vein with its own tributaries, which return blood from
the spleen
UPPER LIMB ARTERIES
The arterial circulation of the upper limb
is generally considered to begin at the
subclavian artery. The origin of the
subclavian artery differs from the right
side to the left side. On the right side, the
subclavian arises from the
brachiocephalic artery, whereas the left
subclavian originates directly from the
aortic arch.
The arterial circulation of the lower limb
begins at the external iliac artery and
ends at the veins of the foot The first
artery to enter the lower limb is the
common femoral artery. The common
femoral artery divides into the femoral
and deep femoral arteries. The femoral
artery extends down the leg and becomes
the popliteal artery at the level of the
knee. Major branches of the popliteal are
the anterior tibial and posterior tibial
arteries
LYMPH DRAINAGE
The lymphatic system serves to
drain interstitial fluid (fluid in the
spaces between the cells) and
return it to the venous system.
The fluid from the left side of
the body, the lower limbs,
pelvis, and abdomen enters
the venous system by the
thoracic duct (largest lymph
vessel in the body), which
drains into the left subclavian
vein near its junction with the
left jugular vein
FUNCTIONS
Functions of the lymphatic portion of the
circulatory system are as follows:
1.Fights disease by producing lymphocytes and
macrophages
2.Returns proteins and other substances to the
blood
3.Filters the lymph in the lymph nodes
4.Transfers fats from the intestine to the thoracic
duct and hence to the blood
ANGIOGRAPHIC PROCEDURES
Overview
As defined at the beginning of this chapter, angiography
refers to radiologic imaging of blood vessels after injection
of a contrast medium. To visualize these low-contrast
structures, contrast media is injected by a catheter that is
placed in the vessel of interest. Positive contrast media are
more commonly used, but there are instances when use of
negative contrast media is indicated. Highly specialized
imaging equipment is required for these procedures.
Angiography can be more specifically described as follows:
•Arteriography: imaging of the arteries
•Venography: imaging of the veins
•Angiocardiography: imaging of the heart and associated
structures
•Lymphography: imaging of the lymphatic vessels/nodes