Thoracic and Abdominal Angiography PDF

30/10/2024 Thoracic Angiography Thoracic &  Thoracic Aorthogram Pulmonary Arteriogram Abdominal...

30/10/2024 Thoracic Angiography Thoracic &  Thoracic Aorthogram Pulmonary Arteriogram Abdominal  Angiography ARIF FADDILAH BIN MOHD NOOR Pathologic Indications THORACIC ANGIOGRAPHY Pathologic indications for thoracic and pulmonary angiography include the following: Purpose Aneurysms Thoracic angiography demonstrates the contour and Congenital abnormalities integrity of the thoracic vasculature. Thoracic aortography Vessel stenosis is an angiographic study of the ascending aorta, the arch, Embolus the descending portion of the thoracic aorta, and the major Trauma branches. Pulmonary arteriography is an angiographic study of the Catheterization pulmonary vessels that usually is done to investigate for The preferred puncture site for a thoracic aortogram is the pulmonary embolus. As was mentioned earlier, pulmonary femoral artery. The catheter is advanced to the desired angiography is performed infrequently because of the location in the thoracic aorta. Selective procedures may be availability of alternative modalities. performed with the use of specially designed catheters to access the vessel of interest. 1  30/10/2024 Thoracic Aorthogram  procedure to test for defects and functional problems in aorta using contrast and catheter. Indications  aneurysm, a ballooning-out of the aorta  aortic dissection, when bleeding occurs in the walls of the aorta  aortic regurgitation or aortic stenosis, when blood returns back to the ventricle  congenital heart defects, such as double aortic arch  inflammation of the aorta, also called Takayasu’s arteritis  injury to the aorta from trauma or other problems  peripheral artery disease  recurring chest pain  Pre-mapping for others angiographic procedure.  to evaluate congenital or postsurgical conditions. 2  30/10/2024 Contraindications 9 Possible complications  Previous severe reaction to contrast  allergic reaction to the dye  Impaired renal function  blockage of the artery  blood clots  bruising  Impaired blood clotting factors or taking anticoagulant medication  heart attack  infection  injury to the aorta  Inability to undergo surgical procedure, unstable cardiopulmonary/neurologic status.  irregular heart rhythms  kidney damage  stroke  tear in the artery Contrast Media 11 Equipment Iodinated contrast media is used  Single or biplane digital subtraction angiography  Can produce nausea & an uncomfortable burning apparatus, with a C-arm allowing unlimited sensation imaging planes, high quality fluoroscopy, and preferably a road mapping facility.  Allergic reactions  Automatic Injector.  Severe: anaphylactic shock  Shock, rapid shallow breathing, high pulse  immobilization device. rate & ALOC  Mild: Hives or slight difficulty breathing 3  30/10/2024 Automatic Power Injector Control panel injector  To maintain the flow rates necessary for angiography Preparation Syringe Kit A  Admitted a day before to the ward.  Fast for 8 hours. A. syringe150mls.  LMP/ history of allergies. B. Coiled high B  CT/PT, BT checked. pressure  HIV/AIDS. connecting tubes  Shaving of puncture site. C. Fill tube.  Full explanation of procedure. C  Informed consent obtained.  Premed: pherngan & pethidine 4  30/10/2024 During Procedure After the Procedure  Apply pressure on puncture site  Patient is comfortable. till bleeding stops.  Communicate with patient.  Check for hemorrhage.  BP and pulse hourly for 4 hours.  Observe patient continuously. 4 hourly for 24 hours. VASCULAR ACCESS seldinger technique  femoral and brachial arteries. 5  30/10/2024 A set of equipment to perform Needles 21 the Seldinger technique  Vascular access needles  Size based on external diameter of needle  Allows for appropriate Guidewires matching  So internal diameter must also be known Tools PT position 1) Supine  A: Pigtail catheter. B: Angled pigtail catheter. C: Cobra catheter. D: J- tipped guidewire. E: Straight (Bentson) guidewire. F: An 18-gauge needle for vessel puncture. 6  30/10/2024 Image Acquisition Technique 1. Contrast Concentration: 370  anteroposterior (AP) or posteroanterior  (PA)  Rate : 23 to 35 mL/sec  Volume: 50 to 70 mL.  lateral projections  CR directed perpendicular to T7 2, Catheter : pigtail catheter *recommended biplane fluoro machine 3. Film rate15f/sec 4. Injector pressure : 300psi 5. ROI included. 27 28 7  30/10/2024 29 Vessels demonstrated Pulmonary Arteriogram 32  Thoracic aorta  Proximal brachiocephalic  Proximal carotid 8  30/10/2024 Purpose 34  Evaluationof pulmonary embolic disease Use a catheter that has side-holes, such as a pigtail, to decrease the risk of damaging the vasculature Use a soft-tipped or tip-deflecting wire (eg, Reuter tip-deflecting wire, Cook, Inc. Bloomington, IN) and protect the tissues from a regular-tip wire. 35 Pulmonary Circulation 36 9  30/10/2024 Because of the location of the pulmonary artery, the femoral vein is the preferred Technique site for catheter insertion. The catheter is advanced along the venous structures, into the inferior vena cava, through the right atrium of the heart into the right ventricle, and into the pulmonary artery. Typically, both pulmonary arteries are examined.  Simultaneous PA and oblique projections recommended  Injection rate 25 mL/sec for 50 mL total volume  Film rate 1. Two to four images/sec for 4 seconds 2. Then slows to one/sec for 4 seconds 39 Images demonstrated  Pulmonary arteries  Left atrium  Left ventricle  Thoracic aorta Digital subtraction Right femoral vein Tip of catheter in angiography approach with the St. the main image shows the Charles catheter tip in pulmonary artery. pigtail catheter in the right atrium the main left pulmonary artery. 10  30/10/2024 Abdominal Angiography Indication 1. Abdominal Aothogram  Abdominal aortic aneurysm 2. Selective Abdominal  Occlusion Angiography  Atherosclerotic disease Abdominal Aortography 44 43 11  30/10/2024 Tools  A: Pigtail catheter. B: Angled pigtail catheter. C: Cobra catheter. D: J- tipped guidewire. E: Straight (Bentson) guidewire. F: An 18-gauge needle for vessel puncture. PT position Image Acquisition 1) Supine  AP/PA *recommended biplane fluoro machine Seldinger technique is apply 12  30/10/2024 Technique Vessels demonstrated – PA 1. Contrast  Abdominal aorta from diaphragm to bifurcation  Concentration: 370  Renal artery origins  Rate : 23 to 35 mL/sec  Aortic bifurcation  Volume: 50 to 70 mL.  Course and general condition of visceral branches 2, Catheter : pigtail catheter  Vessels demonstrated – lateral  Origin of celiac artery 3. Film rate :15f/sec  Origin of superior mesenteric artery 4. Injector pressure : 300psi 5. ROI included.  Renal Arteriogram Selective Abdominal  Celiac Arteriogram Superior Mesenteric Arteriogram Angiography   Inferior Mesenteric Arteriogram 13  30/10/2024 Indication Abdominal Angiography 54  Visualize tumor vascularity  Rule out atherosclerotic disease  Thrombosis  Occlusion  Bleeding Selective angiographic studies require the use of specially shaped catheters to access the vessel of interest. Common selective studies performed include the celiac artery, the renal arteries, and the superior and inferior mesenteric arteries, which are Indications selected when a GI bleed is investigated. A superselective study involves selecting a branch of a vessel. A common example of this is selection of the hepatic or splenic artery; these are two of the branches of the celiac artery. Catheterization for venacavography is obtained by a femoral vein puncture. The catheter then is advanced to the desired level. 1. Renal artery stenosis 2. Renal tumour prior to embolization or rarely for diagnosis 3. Kidney donor 4. Haematuria of unknown cause. 14  30/10/2024 Contrast media Selective renal artery injection LOCM 300,  Anterio-posterior & oblique views (visualization of renal 10 ml at 5ml/s, or by hand injection. artery origins) Right: RAO 10ο-20ο, LAO 10ο Flush aortic - LOCM 370, 50 ml at 12 ml/s.   Left: LAO 0ο-15ο  Selective angiography of renal arteries  Shaped sheaths  Guiding catheters (Soft tip Omni, Cobra 2, Simmons, RDC etc)  Support guide-wire within aorta  Trans-lesional gradient (catheter, pressure wire) Renal Arteriogram 59 60 15  30/10/2024 61 RENAL ARTERY STENOSIS Celiac Arteriogram Superior Mesenteric Arteriogram 16  30/10/2024 Inferior Mesenteric Arteriogram THANKS 17