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Chapter 25Chapter 25

Circulatory SystemCirculatory System

Blood -VascularBlood -Vascular

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Two SystemsTwo Systems of Circulatory of Circulatory SystemSystem

Both carry oxygen and nutrients to Both carry oxygen and nutrients to tissues in continuous, endless uni-tissues in continuous, endless uni-directiondirection

Both transport waste products to organs of excretionSkinLungsLiverkidneys

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2 Circulatory Systems 2 Circulatory Systems cont’dcont’d

Blood-Vascular System- Blood-Vascular System- major major portion- transports bloodportion- transports blood

Lymphatic System- Lymphatic System- minor minor portion - collects fluid from portion - collects fluid from tissue spaces, filters through tissue spaces, filters through lymph systemlymph system

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Bloodvascular System

Lymphatic System

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Blood-Vascular SystemBlood-Vascular System

Heart has 2 Heart has 2 circulation routescirculation routes SystemicSystemic PulmonaryPulmonary

Both carry Both carry oxygenated oxygenated bloodblood to organs and to organs and tissuestissues

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Pulmonary, systemic, and portal circulation

red = oxygenated blue = deoxygenated purple -nutrient-rich

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Systemic Systemic CirculationCirculation

Pumps blood to Pumps blood to organsorgans

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Pulmonary CirculationPulmonary Circulation

Takes returning Takes returning bloodblood to to lungs to exchange carbon lungs to exchange carbon dioxide for oxygendioxide for oxygen

Carries Carries oxygenated oxygenated bloodblood from lungs to from lungs to heartheart

Only veinsOnly veins in post-fetal in post-fetal human body carrying human body carrying oxygenated (red) bloodoxygenated (red) blood

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Portal SystemPortal System

Pathway of venous Pathway of venous drainage from drainage from abdominal organs abdominal organs through liver before through liver before returning to inferior returning to inferior vena cavavena cava

Liver has 2 blood Liver has 2 blood supplies!supplies!

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Anatomy: HeartAnatomy: Heart

4chambers –4chambers – 2 atria- upper, receiving chambers2 atria- upper, receiving chambers 2 ventricles- lower, distributing chambers2 ventricles- lower, distributing chambers

Myocardium - muscular wall of heartMyocardium - muscular wall of heart Endocardium - inner lining of heartEndocardium - inner lining of heart Epicardium - thin membrane that Epicardium - thin membrane that

covers heartcovers heart Pericardial sac double-walled Pericardial sac double-walled

outermost covering of heartoutermost covering of heart

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Heart ValvesHeart Valves Right Right

atrioventricular (AV)atrioventricular (AV) valve or valve or tricuspid tricuspid valve valve controls opening controls opening

between right atrium between right atrium and ventricleand ventricle

Left AV valve or Left AV valve or mitral valvemitral valve controls opening controls opening

between left atrium between left atrium and ventricleand ventricle

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Great Vessels of Great Vessels of Heart Heart DeoxygenatedDeoxygenated//OxygenatedOxygenated

Blood FlowBlood Flow

Pulmonary arteryPulmonary artery AortaAorta Vena CavaVena Cava

Inferior and Inferior and Superior portionsSuperior portions

Pulmonary VeinPulmonary Vein

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Anatomy: HeartAnatomy: Heart

Right side of heart-Right side of heart- handles venous, or handles venous, or deoxygenated deoxygenated bloodblood

Left side of heart-Left side of heart- handles arterial, or handles arterial, or oxygenated bloodoxygenated blood

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Coronary arteriesCoronary arteries supply supply blood to blood to myocardiummyocardium (muscular wall of heart)(muscular wall of heart)

Right Coronary artery Left Coronary artery

Great cardiac vein

Coronary sinus

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Myocardial infarctionMyocardial infarction ( (MIMI)) Commonly known Commonly known

as a as a heart attackheart attack

interruption of blood interruption of blood supply to part of supply to part of heart, causing some heart, causing some heart cells to dieheart cells to die

Most commonly due Most commonly due to occlusion to occlusion (blockage) of a (blockage) of a coronary arterycoronary artery

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CABG (CABG (Coronary Artery Bypass Graft)

Surgery called revascularization to improve blood flow to heart in people with severe coronary artery disease (CAD)

Occurs coronary arteries become blocked due to buildup (plaque) on inside of blood vessels.

If severe, chest pain (angina), shortness of breath, possible heartattack and death

healthy artery or vein grafted, to blocked

artery bypassing blocked portion New passage routes oxygen-rich blood around the blockage to heart muscle

Up to 4 major blocked coronary arteries can be bypassed during 1 surgery.

Collateral veins will take over role previously performed by piece removed.

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Blood -Vascular SystemBlood -Vascular System Radiological StudiesRadiological Studies

Slide 17

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Various Radiologic Various Radiologic StudiesStudies

AngiographyAngiography - exam of vascular - exam of vascular structures - contrast mediumstructures - contrast medium

ArteriographyArteriography - exam of arteries - - exam of arteries -contrast injectioncontrast injection

VenographyVenography - of veins - contrast - of veins - contrast injectioninjection

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IndicationsIndications

Claudication - leg pain and cramping

Stenosis - narrowing of vessel

Occlusion -blockage of a vessel

Aneurysm -weakened area of artery “ballooned”

Suspected tumors Anatomic variances

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Contrast dye is injected Contrast dye is injected

Automatic injector is most commonly Automatic injector is most commonly usedused Manual injection is done rarelyManual injection is done rarely

Injectors are programmed to coincide Injectors are programmed to coincide with imaging sequencewith imaging sequence

Rapid film changers are rarely seenRapid film changers are rarely seen

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EquipmentEquipment Digital equipmentDigital equipment Digital subtractionDigital subtraction - -

instantly “subtracts” instantly “subtracts” overlying bony overlying bony structuresstructures better visualization better visualization

of contrast-filled of contrast-filled vascular structuresvascular structures

CinefluorographyCinefluorography still used in cardiac still used in cardiac catheterization catheterization proceduresprocedures

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EquipmentEquipment

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CatheterizationCatheterization

CatheterCatheter - - small, flexible tube small, flexible tube inserted into vessel through which inserted into vessel through which contrast is introducedcontrast is introduced

Femoral artery most commonFemoral artery most common introduction siteintroduction site Radial Radial BrachialBrachial AxillaryAxillary Jugular Jugular Subclavian Subclavian

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Femoral Catheter Femoral Catheter IntroductionIntroduction

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Complications!Complications! Bleeding at Bleeding at

puncture sitepuncture site Allergic reaction Allergic reaction

to contrastto contrast Nerve, vessel, or Nerve, vessel, or

tissue damagetissue damage StrokeStroke Heart attackHeart attack DeathDeath

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Angiographic TeamAngiographic Team

PhysicianPhysician – usually an – usually an interventional radiologistinterventional radiologist

CITCIT -cardiovascular-interventional -cardiovascular-interventional technologisttechnologist

Anesthetist, nurseAnesthetist, nurse, etc, etc

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ProceduresProcedures

AortographyAortography ThoracicThoracic AbdominalAbdominal

Pulmonary arteriographyPulmonary arteriography

Abdominal visceral Abdominal visceral arteriographyarteriography

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Thoracic AortographyThoracic Aortography Rule out aortic Rule out aortic

aneurysmaneurysm Evaluate congenital or Evaluate congenital or

postsurgical conditionspostsurgical conditions Evaluate aortic Evaluate aortic

dissectiondissection

Biplane imaging - PA Biplane imaging - PA and lateral obtained and lateral obtained with one contrast with one contrast injectioninjection

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Abdominal AortographyAbdominal Aortography

To DetectTo Detect Abdominal aortic Abdominal aortic

aneurysmaneurysm

Occlusion Occlusion

Atherosclerotic Atherosclerotic diseasedisease

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Cerebral AngiographyCerebral Angiography

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Cerebral AngiographyCerebral Angiography

To investigate:To investigate:

AneurysmsAneurysms AVM AVM

((Arteriovenous Arteriovenous malformation)malformation)

TumorsTumors Atherosclerosis Atherosclerosis StenosisStenosis

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Arteriogram of HandArteriogram of Hand

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Circle of WillisCircle of Willis Arrangement of

brain's arteries creating redundancies in cerebral circulation

If one part of circle becomes blocked or narrowed blood flow -other blood vessels can often preserve cerebral perfusion well enough to avoid loss of blood supply (ischemia)

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Interventional Interventional RadiologyRadiology

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Balloon AngioplastyBalloon Angioplasty

Used to dilate Used to dilate strictures in strictures in venous venous structures, structures, ureters, and ureters, and GI tractGI tract

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Inferior Vena Cava FilterInferior Vena Cava Filter Trap emboli to Trap emboli to

prevent pulmonary prevent pulmonary embolism resulting embolism resulting from deep vein from deep vein thrombosis of thrombosis of lower limbs lower limbs

Delivered via a Delivered via a catheter - assume catheter - assume functional shape as functional shape as releasedreleased

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Vena Cava FilterVena Cava Filter

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Stones and other Stones and other occlusive objects occlusive objects can be retrieved can be retrieved via a special via a special catheter with catheter with snare at the endsnare at the end

Foreign object Foreign object removalremoval

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Cardiac CatheterizationCardiac Catheterization

Minor surgical Minor surgical procedure procedure involving involving introduction of introduction of special catheters special catheters into heart, great into heart, great vessels, and vessels, and coronary coronary arteriesarteries

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Catheter placement in Catheter placement in heartheart

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Specialized EquipmentSpecialized Equipment

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Specialized EquipmentSpecialized Equipment

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VenographyVenography

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IndicationsIndications For For VenographyVenography

Deep vein thrombosis: Deep vein thrombosis: Formation of Formation of blood clot inside blood vesselblood clot inside blood vessel

When blood vessel injuredWhen blood vessel injured body forms blood clot to prevent loss of body forms blood clot to prevent loss of

bloodblood

If too much clotting & clot breaks freeIf too much clotting & clot breaks free travelstravels in bloodstream – blocks blood vessel in bloodstream – blocks blood vessel

- obstructs circulation - obstructs circulation (embolism)(embolism)If goes toIf goes to lungslungs - can rupture pulmonary - can rupture pulmonary

artery, causing artery, causing deathdeath

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Other IndicationsOther Indications for for VenographyVenography

Venous obstruction Venous obstruction

Recurrent varicose veinsRecurrent varicose veins

Swollen legs of unknown etiologySwollen legs of unknown etiology

Varicose ulcersVaricose ulcers

Venous malformationsVenous malformations

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CentralCentral Venography Venography

2 studies2 studies

Superior venacavogramSuperior venacavogram Inferior venacavogramInferior venacavogram

PurposePurpose Rule out existence of thrombus or Rule out existence of thrombus or

occlusion of central veinsocclusion of central veins

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Central VenographyCentral Venography

Superior venacavogramSuperior venacavogram performed performed by accessing axillary or subclavian by accessing axillary or subclavian veinvein

Inferior venacavogramInferior venacavogram performed performed by accessing femoral vein and placing by accessing femoral vein and placing catheter in common iliac vein or catheter in common iliac vein or inferior aspect of inferior vena cavainferior aspect of inferior vena cava

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Peripheral VenographyPeripheral Venography

Examines superficial and deep Examines superficial and deep veins of extremitiesveins of extremities

Less common today-replaced by Less common today-replaced by advances in ultrasoundadvances in ultrasound

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AnatomyAnatomy Superficial Superficial

veinsveins Dorsal venous archDorsal venous arch Small saphenous veinSmall saphenous vein Great saphenous veinGreat saphenous vein

Deep veinsDeep veins Anterior tibialAnterior tibial Posterior tibialPosterior tibial Peroneal Peroneal PoplitealPopliteal External iliacExternal iliac Internal iliacInternal iliac Femoral veinFemoral vein

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ProcedureProcedure

Patient is supine on tablePatient is supine on table Injection area cleansedInjection area cleansed IV started in dorsum of foot or IV started in dorsum of foot or

handhand Tourniquets appliedTourniquets applied Injection startedInjection started Radiographs obtainedRadiographs obtained

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Indications For Upper Limb Indications For Upper Limb VenographyVenography

Edema of arm or Edema of arm or handhand

Venous obstructionVenous obstruction Suspected Suspected

thrombosisthrombosis

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AP of entire AP of entire extremityextremity

Lateral of entire Lateral of entire extremityextremity

Lower-Limb Venogram

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The EndThe End