Angiography Lecture Notes PDF

# Angiography - This is an X-ray of the arteries and veins to find blockage or narrowing of the vessels, as well as other problems. - Blood vessels do not show clearly on a normal X-ray, so a special dye needs to be injected into your blood first. - This highlights your blood vessels, allowing your...

# Angiography - This is an X-ray of the arteries and veins to find blockage or narrowing of the vessels, as well as other problems. - Blood vessels do not show clearly on a normal X-ray, so a special dye needs to be injected into your blood first. - This highlights your blood vessels, allowing your doctor to see any problems. - The X-ray images created during angiography are called angiograms. ## Angiogram - With an angiogram test, your provider can diagnose and/or plan treatment for conditions, such as: - Coronary artery disease - Peripheral artery disease - Atherosclerosis - Blood clots - Aneurysm ## Why Angiography is Used - **Atherosclerosis**: narrowing of the arteries, which could mean you're at risk of having a stroke or heart attack. - **Peripheral arterial disease**: reduced blood supply to the leg muscles. - **Brain aneurysm**: a bulge in a blood vessel in your brain - **Angina**: chest pain caused by reduced blood flow to the heart muscles. - **Blood clots or a pulmonary embolism**: a blockage in the artery supplying your lungs. - **Blockage in the blood supply to your kidneys** ## Angiography: Before and After - Two images are provided, showing the difference between angiography before and after a procedure. ## Angiogram - An angiogram is a diagnostic procedure that uses imaging to show your provider how your blood flows through your blood vessels or heart. - An injected contrast material makes it easy to see where blood is moving and where blockages. - Your provider can use X-rays or other types of imaging for your angiogram. - Angiograms are used to diagnose and determine treatment options for Peripheral Arterial Disease (PAD). PAD is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and extremities. - PAD usually affects the arteries in the legs. ## Angiogram - Over time, cholesterol and plaque can harden and narrow the arteries. - This reduces the amount of blood that can flow through them and limits the flow of oxygen-rich blood to your organs and other parts of your body like your legs. - This is why many patients complain about leg pain caused by poor circulation. - This pain can occur with activity (claudication) or while at rest. ## Angiogram - Once the area of plaque has been identified several treatments are an option. - **Atherectomy**: A device that helps to remove or lessen the amount of plaque inside of the artery. - **Angioplasty**: A device with a small balloon on its tip is then inserted through the sheath into the artery in your leg or arm until it reaches the area of plaque(blockage) that needs to be treated. - The balloon is inflated to flatten the plaque against the wall of the artery, opening the artery and restoring blood flow. - **Stent placement**: A stent is a small metal/mesh tube that is inserted into the artery through the sheath then expanded to open the artery in the area of the blockage. All stents are permanent. ## Types of Angiography - There are several different types of angiography, depending on which part of the body is being looked at: - **Coronary angiography**: to check the heart and nearby blood vessels. - **Cerebral angiography**: to check the blood vessels in and around the brain. - **Pulmonary angiography**: to check the blood vessels supplying the lungs. - **Renal angiography**: to check the blood vessels supplying the kidneys ## Preparing for Angiography - You will be: - Asked about your medical history, including if you have any allergies. - Asked about any medicine you're taking – you'll be told if you need to stop taking it before the test. - Having tests to check your general health, including a physical examination and blood test. - Discussing the procedure: - What it involves - What the risks are - What you need to do before the test ## During Angiography - You'll usually be awake, but may be given a medicine called a sedative to help you relax. - You lie on an X-ray table and a small cut (incision) is made over 1 of your arteries. - Local anesthetic is used to numb the area where the cut is made. - A very thin flexible tube (catheter) is inserted into the artery. - The catheter is carefully guided to the area that's being examined (such as the heart). - A dye (contrast medium) is injected into the catheter. - A series of X-rays are taken as the dye flows through your blood vessels. - The test can take between 30 minutes and 2 hours. ## After Angiography - You'll be taken to a recovery ward where you'll be asked to lie still for a few hours to prevent bleeding from the cut. - You'll usually be able to go home the same day, although sometimes you may need to stay in hospital overnight. - While recovering at home: - It's a good idea for someone to stay with you for at least 24 hours in case you have any problems. - Eat and drink as soon as you feel ready to. - The contrast dye leaves your body in your pee, so drinking plenty of water can help flush it out. ## Risks of Angiography - Angiography is generally a safe and painless procedure. - But for a few days or weeks afterwards it's common to have: - Bruising - Soreness - A very small lump or collection of blood near where the cut was made ## Complications - **Possible minor complications include**: - An infection where the cut was made, causing the area to become red, hot, swollen and painful – this may need to be treated with antibiotics. - A mild reaction to the dye, such as an itchy rash – it can usually be controlled with medicine. - **Possible serious complications include**: - Kidney damage due to the dye – this is usually temporary. - A heart attack or stroke, Damage to a blood vessel, causing internal bleeding. - A serious allergic reaction to the dye (anaphylaxis), causing dizziness, breathing difficulties or loss of consciousness. ## What is Venography? - Venography is an x-ray examination that uses an injection of contrast material to show how blood flows through your veins. - Venograms are used to diagnose and determine treatment options for a number of vascular diseases including but not limited to Deep Vein Thrombosis and Ilac Vein Compression. - A special dye is injected that can be seen on an X-ray. ## What is Venography? - A venogram can be done in several ways: - **Ascending venography.** This looks for a DVT and finds out where it is in your vein. - **Descending venography.** This looks at how well your deep vein valves are working. - **Venography of the upper extremities.** This looks for blockages, blood clots, or other vascular problems in your neck and armpits. - **Venacavography.** This looks at your inferior or superior vena cava. ## What are some common uses of the procedure? - Assess the status of a vein or system of veins - Find blood clots within the veins - Assess varicose veins before surgery - Find a vein in good condition to use for a bypass procedure or dialysis access - Help a physician place an IV or a medical device, such as a stent, in a vein guide treatment of diseased veins. ## Venography - There are 5 images provided, showing different procedures: - Fluoro - Contrast injected directly into vein to r/o reflux, occlusions - Ascending venography in upper extremity - Descending and ascending venography in lower extremity - Usually precursor to interventions ## Venography - Two images are provided, showing: - Lower extremity venogram - Phlebography in a patient with deep venous thrombosis ## Risks of a Venogram - Pain or discomfort when the needle is inserted into the vein or if the vein needs to be inserted deeper inside the vein - Reaction to the dye used during the x-ray — this could be in the form of hives, itchiness, redness, soreness, headache, nausea and vomiting - Infection at the needle insertion site - Pulmonary embolism (rare) - Damaged veins from needle insertion ## Technique of Angiography - Nothing is mentioned about the technique. ## Contrast Media - Water-soluble iodinated medium used most commonly - Non ionics cause fewer physiologic side effects and allergic reactions - Non ionics are also less nephrotoxic than ionics - Different concentrations used for various procedures ## Injection Technique - An image is provided, showing a high-pressure injector for radiographic contrast medium. ## Equipment - Digital equipment most commonly employed - Digital subtraction is widely used:Instantly "subtracts” overlying bony structures from images to allow better visualization of contrast-filled vascular structures. - Cinefluorography also still used in cardiac catheterization procedures - Rapid film changers are rarely seen today ## Catheterization - Catheter is a small, flexible tube inserted into the vessel through which contrast is introduced. - **Advantages**: - Less risk of extravasation - Allows selective injections of specific vessels - Flexible patient positioning - Can be safely left in body while images are acquired ## Catheterization - Made of pliable plastic - Allows guide wire to pass through it. - J-shaped, straight tip or pig tails - Common sizes range from 4 French – 7 French ## Seldinger technique - Most widely used method of catheterization - Performed under sterile conditions - Catheters made in a variety or sizes and shapes - Various procedures require different sizes and shapes. - An image is provided, showing the Seldinger technique. ## Seldinger technique - An image is provided, showing the Seldinger technique. - Use a beveled needle with an inner cannula to pierce through the artery - Withdraw needle slowly until you get blood flow ## Seldinger technique - Two images are provided, showing: - The needle’s inner cannula is removed and the guide wire is inserted. - The needle is removed, Apply pressure to reduce hemorrhage and fix the wire. ## Seldinger technique - Two images are provided, showing: - The catheter is slipped over the wire and into the artery. - The guide wire is removed leaving the catheter in the artery. ## Preparation of Examination Room - Prior to patient arrival - Clean and prepare room - Check equipment for proper operation. - Set exposure technique. - Check crash cart for operation and stock. - Obtain sterile procedure tray. - Set nonsterile supplies in convenient location. ## Seldinger technique - Contrast injection/filming - When catheter placed, heparin saline flushed (patency), test injection done. - Postprocedural care/instructions - Study done, remove catheter. (If curved, use guidewire) - Achieve hemostasis (15 minutes) (Angioseal) - Patient on bed rest minimum 4 hours usually 8 hours. - Continual monitoring of vital signs & puncture site. - Increase fluid intake ## Patient discharge - If OP, released after examination - Advise patient to increase fluid intake. - Restrict movement (no steps) 24 hrs. - Immediately report any problems (i.e. fever, pain, bleeding at puncture site, coldness, numbness, tingling in ext) ## Complications - Vasovagal reaction - Stroke - Heart attack - Death - Bleeding at puncture site - Nerve, vessel, or tissue damage - Allergic reaction to contrast ## Angiographic Team - **Members**: - Physician : usually an interventional radiologist - CIT : cardiovascular-interventional technologist - Other specialists: e.g., anesthetist, nurse ## All students will be selected for assignments.