Angiography and Angiography and ArteriographyArteriography

SPRING 2009 SPRING 2009

FINALFINAL

3-10-093-10-09

AngiographyAngiography

Is the general term that Is the general term that describes the radiologic describes the radiologic examination of vascular examination of vascular

structures within the body structures within the body after the introduction of an after the introduction of an

iodinated contrast medium or iodinated contrast medium or gasgas

Types of Angiographic Types of Angiographic ProceduresProcedures

Angiography TeamAngiography Team

RadiologistRadiologist

CIT (Radiologic Technologist)CIT (Radiologic Technologist)– Sometimes more than oneSometimes more than one

Other specialists (if needed)Other specialists (if needed)

Nurse Nurse

Anesthesiologist (if needed)Anesthesiologist (if needed)

IndicationsIndications

Verify the presence of Verify the presence of tumorstumors– Blood supply to tumorsBlood supply to tumors

Internal bleedingInternal bleeding– Possible anemiaPossible anemia

StenosisStenosis

– Can be caused form Can be caused form atherosclerosisatherosclerosis

OcclusionsOcclusions– ClotsClots– ThrombusThrombus– EmbolusEmbolus

AneurysmsAneurysms

Heart diseaseHeart disease

ContraindicationsContraindications

Previous severe reaction to contrast Previous severe reaction to contrast

Impaired renal functionImpaired renal function

Impaired blood clotting factorsImpaired blood clotting factors

Inability to undergo surgical Inability to undergo surgical procedureprocedure

Contrast MediaContrast Media

Iodinated contrast media is usedIodinated contrast media is used– Can produce nausea & an Can produce nausea & an

uncomfortable burning sensationuncomfortable burning sensation

– Allergic reactionsAllergic reactions Severe: anaphylactic shockSevere: anaphylactic shock

– Shock, rapid shallow breathing, high pulse rate & Shock, rapid shallow breathing, high pulse rate & ALOCALOC

Mild: Hives or slight difficulty breathingMild: Hives or slight difficulty breathing

What is this?What is this?

Angiographic Trays Angiographic Trays and Sterile Suppliesand Sterile Supplies

Other Supplies for Other Supplies for AngiographyAngiography

NeedlesNeedles

Vascular access Vascular access needlesneedles

Size based on Size based on external diameter of external diameter of needleneedle

Allows for Allows for appropriate appropriate Guidewires Guidewires matchingmatching– So internal diameter So internal diameter

must also be knownmust also be known

GuidewiresGuidewires Used as a platform Used as a platform

over which a catheter over which a catheter is to be advancedis to be advanced

Once positioned Once positioned guidewire is fixed and guidewire is fixed and catheter is advanced catheter is advanced until it meets the tip until it meets the tip of the guidwireof the guidwire

Mostly constructed on Mostly constructed on stainless steel & stainless steel & coated with Tefloncoated with Teflon

Introducer SheathsIntroducer Sheaths

Short catheters Short catheters used when multiple used when multiple catheters will be catheters will be usedused

Placed in lieu of a Placed in lieu of a cathetercatheter

CathetersCatheters

DSA DSA

A subtraction mask is A subtraction mask is taken before contrast taken before contrast injectedinjected

Each of digitized Each of digitized image is from the image is from the maskmask

Images acquired Images acquired formform– 1 image every 2-3 sec1 image every 2-3 sec– Up to 30 images per Up to 30 images per

secsec

Three Dimensional (3-D) Three Dimensional (3-D) Intraarterial AngiographyIntraarterial Angiography

What Method is this?What Method is this?

Catherization: Selinger Catherization: Selinger TechniqueTechnique

Selinger Technique Catheters Selinger Technique Catheters and Guidewiresand Guidewires

Pre-ProcedurePre-Procedure PT’s are usually limited to a liquid diet and PT’s are usually limited to a liquid diet and

routine medicationsroutine medications

Adequate hydrationAdequate hydration

An IV line placedAn IV line placed– Sedative may be givenSedative may be given

History taken and vitals takenHistory taken and vitals taken

Informed consentInformed consent

Preparing the Patient RoomPreparing the Patient Room

Must be extensively cleanedMust be extensively cleaned

Equipment checkedEquipment checked

Room thoroughly stockedRoom thoroughly stocked

Extra supplies as neededExtra supplies as needed

Radiation ProtectionRadiation Protection

PT is protected by no less than 2.5 PT is protected by no less than 2.5 mm of Aluminummm of Aluminum

Beam restrictionBeam restriction Avoidance of repeat exposureAvoidance of repeat exposure Cardinal rulesCardinal rules

– Time Time – DistanceDistance– ShieldingShielding

Post ProcedurePost Procedure

PTs usually can resume normal PTs usually can resume normal activity after 24 hoursactivity after 24 hours

Most often can go home after 24 hoursMost often can go home after 24 hours– Because internal bleeding can be life Because internal bleeding can be life

threateningthreatening Vitals are monitoredVitals are monitored Puncture site is monitored for bleedingPuncture site is monitored for bleeding

Stent PlacementStent Placement

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Abdominal ArteriesAbdominal Arteries

Abdominal AngiographyAbdominal Angiography

AAA Pre and Post Stent AAA Pre and Post Stent PlacementPlacement

Abdominal StentAbdominal Stent

AAAAAA

Renal ArteriogramRenal Arteriogram

Lower Limb ArteriesLower Limb Arteries

Leg AtherosclerosisLeg Atherosclerosis

Atherosclerosis Left LegAtherosclerosis Left Leg

Upper Limb ArteriesUpper Limb Arteries

Upper Extremity AnatomyUpper Extremity Anatomy

Brachial and Axillary Brachial and Axillary ArteriogramArteriogram

Axillary ArteriogramAxillary Arteriogram

Hand ArteriogramHand Arteriogram

Hand Arteriogram with Hand Arteriogram with OcclusionOcclusion

Circle of WillisCircle of Willis

Neck and Brain ArteriesNeck and Brain Arteries

Middle Cerebral Middle Cerebral and Internal Carotidand Internal Carotid

DSA showing embolization DSA showing embolization before and after procedurebefore and after procedure

Carotid and BrainCarotid and Brain

Carotid AtherosclerosisCarotid Atherosclerosis

Posterior Vertebral ArteryPosterior Vertebral Artery

Posterior Vertebral Posterior Vertebral AngiogramAngiogram

AneurysmsAneurysms

Pulmonary CirculationPulmonary Circulation

Pulmonary ArteriogramPulmonary Arteriogram

Lateral RT common Carotid Lateral RT common Carotid ArteriogramArteriogram

Balloon AngioplastyBalloon Angioplasty

Balloon Angioplasty Balloon Angioplasty ProcedureProcedure

Femoral Artery AngioplastyFemoral Artery Angioplasty

Angioplasty Pre and PostAngioplasty Pre and PostIntracranialIntracranial

Placing a Stent after Placing a Stent after Angioplasty with BalloonAngioplasty with Balloon

Intravascular StentsIntravascular Stents