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Slide 1 - Circulatory and Cardiovascular Systems Spring 2013
Slide 2 - 2 Circulatory System
Slide 3 - 3 Blood Vascular System
Slide 4 - 4 Heart and Great Vessels
Slide 5 - 5 Cross Section of the Heart
Slide 6 - 6 Arteries of the Heart
Slide 7 - 7 Anterior View of Coronary Arteries
Slide 8 - 8 Anterior View of Coronary Veins
Slide 9 - 9 Pathologies Congenital Heart Diseases Murmur Patent Ductus Arteriosus Arterial Septal Defects Ventricular Septal Defects Teratology of Fallot Valvular heart disease Valvular Stenosis Congestive Heart Failure Degenerative diseases CAD Atherosclerosis Myocardial infarction Aortic aneurysm Pulmonary Embolism
Slide 10 - Murmur Murmur- an abnormal heart sound Results from malformed valves
Slide 11 - Patent Ductus Arteriosus 11
Slide 12 - Atrial Septal Defect 12
Slide 13 - Ventricular Septal Defect
Slide 14 - Teratology of Fallot
Slide 15 - Coarctation of the Aorta
Slide 16 - Valvular Disease 16
Slide 17 - Mitral Valvular Stenosis
Slide 18 - Mitral Valve Stenosis
Slide 19 - Congestive Heart Failure
Slide 20 - CHF Radiograph
Slide 21 - Coronary Artery Disease
Slide 22 - Coronary Artery Disease
Slide 23 - Myocardial Infarction
Slide 24 - Myocardial Infarction Images
Slide 25 - Aortic Aneurysm
Slide 26 - Aortic Aneurysm Imaging
Slide 27 - 27 Aortogram
Slide 28 - 28
Slide 29 - 29 AORTOGRAM
Slide 30 - 30 Abdominal Aortoraphy
Slide 31 - 31 Abdominal Angiography
Slide 32 - 32 AAA Pre and Post Stent Placement
Slide 33 - 33
Slide 34 - 34 Abdominal Stent
Slide 35 - 35 AAA
Slide 36 - Pulmonary Embolism
Slide 37 - Pulmonary Embolism Imaging
Slide 38 - Angiography Arteriography and Aortograms SPRING 2013
Slide 39 - Angiography Is the general term that describes the radiologic examination of vascular structures within the body after the introduction of an iodinated contrast medium or gas
Slide 40 - 40 Types of Angiographic Procedures
Slide 41 - 41
Slide 42 - 42 Angiography Team Radiologist CIT (Radiologic Technologist) Sometimes more than one Other specialists (if needed) Nurse Anesthesiologist (if needed)
Slide 43 - 43 Indications Verify the presence of tumors Blood supply to tumors Internal bleeding Possible anemia Stenosis Can be caused form atherosclerosis Occlusions Clots Thrombus Embolus Aneurysms Heart disease
Slide 44 - 44 Contraindications Previous severe reaction to contrast Impaired renal function Impaired blood clotting factors Inability to undergo surgical procedure
Slide 45 - 45 Contrast Media Iodinated contrast media is used Can produce nausea & an uncomfortable burning sensation Allergic reactions Severe: anaphylactic shock Shock, rapid shallow breathing, high pulse rate & ALOC Mild: Hives or slight difficulty breathing
Slide 46 - 46 What is this?
Slide 47 - 47
Slide 48 - 48 Angiographic Trays and Sterile Supplies
Slide 49 - 49 Other Supplies for Angiography
Slide 50 - 50 Needles Vascular access needles Size based on external diameter of needle Allows for appropriate Guidewires matching So internal diameter must also be known
Slide 51 - 51 Guidewires Used as a platform over which a catheter is to be advanced Once positioned guidewire is fixed and catheter is advanced until it meets the tip of the guidwire Mostly constructed on stainless steel & coated with Teflon
Slide 52 - 52 Introducer Sheaths Short catheters used when multiple catheters will be used Placed in lieu of a catheter
Slide 53 - 53 Catheters
Slide 54 - 54
Slide 55 - 55 DSA A subtraction mask is taken before contrast injected Each of digitized image is from the mask Images acquired form 1 image every 2-3 sec Up to 30 images per sec
Slide 56 - 56 Three Dimensional (3-D) Intraarterial Angiography
Slide 57 - 57 What Method is this?
Slide 58 - 58 Catherization: Selinger Technique
Slide 59 - 59 Selinger Technique Catheters and Guidewires
Slide 60 - 60 Radiation Protection PT is protected by no less than 2.5 mm of Aluminum Beam restriction Avoidance of repeat exposure Cardinal rules Time Distance Shielding
Slide 61 - 61 Stent Placement
Slide 62 - 62 Pulmonary Circulation
Slide 63 - 63 Pulmonary Arteriogram
Slide 64 - Celiac Ateriogram Celian artery carries blood from stomach to duodenum, liver, spleen and pancreas Approx at level T12 64
Slide 65 - Hepatic Arteriogram 65
Slide 66 - Splenic Arteriorgram 66
Slide 67 - 67 Renal Arteriogram
Slide 68 - 68 renal
Slide 69 - 69
Slide 70 - 70
Slide 71 - 71
Slide 72 - 72 Lower Limb Arteries
Slide 73 - 73
Slide 74 - 74 Leg Atherosclerosis
Slide 75 - 75 Atherosclerosis Left Leg
Slide 76 - 76 Upper Limb Arteries
Slide 77 - 77 Upper Extremity Anatomy
Slide 78 - 78 Brachial and Axillary Arteriogram
Slide 79 - 79 Hand Arteriogram
Slide 80 - 80 Hand Arteriogram with Occlusion
Slide 81 - 81
Slide 82 - 82 Balloon Angioplasty
Slide 83 - 83
Slide 84 - 84 Balloon Angioplasty Procedure
Slide 85 - 85 Femoral Artery Angioplasty
Slide 86 - 86 Placing a Stent after Angioplasty with Balloon
Slide 87 - 87 Intravascular Stents
Slide 88 - Cerebral Angiography Indications Aneurysms Arteriovenous Malformations Tumors Athersclerotic Lesions Stenotic lesions
Slide 89 - Circle of Willis
Slide 90 - Circulation Time Cerebral circulation Carotid artery to jugular vein (3 seconds) With contrast 4.13 seconds Certain pathologies shorten or delay time AVM’s shorten time Arterial vasospasm delays time
Slide 91 - Equipment Bi-plane imaging Film DSA Automatic Injector
Slide 92 - Carotid Angiogram
Slide 93 - Internal Carotid Angiograms
Slide 94 - Internal Carotid Angiogram
Slide 95 - Vertebral Arteries Angiogram
Slide 96 - Vertebral Artery Angiogram
Slide 97 - Let’s Review
Slide 98 - 98 What is the name of this Procedure?What is it done for?
Slide 99 - 99 What is the name of this pathology?
Slide 100 - 100 What part of the body is being imaged?What is the pathology is this image?
Slide 101 - 101
Slide 102 - 102 What is this method callled?
Slide 103 - 103 A B C
Slide 104 - Venography 2013
Slide 105 - Venous Circulation
Slide 106 - What is Venography? Vein study using x-ray and contrast media Fluoroscopy and still images One of the most accurate tests for deep vein thrombosis (DVT) Most commonly done in legs for DVT
Slide 107 - Thrombosis and Embolism Intravascular clot Commonly in veins more than arteries 3 factors Where blood is slow Change in the wall of vessels Change in the blood itself Thrombus that becomes detached from the vessel wall Can easily flow to heart causing PE Severity depends on location of embolism
Slide 108 - Pulmonary Embolism Occurs when a clot forms or becomes lodged in the pulmonary artery Most commonly thrombus originates in the lower limbs and migrates Can lead to resp distress, heart failure or cardiogenic shock Symptoms are acute: Sudden coughing SOB Chest pain
Slide 109 - Pulmonary Emboli (PE)
Slide 110 - Indications Diagnose deep vein thrombosis Prevent pulmonary embolism Distinguish blood clots from obstructions in the veins Evaluate congenital vein problems Assess the functioning of deep leg vein valves Identify a vein for arterial bypass grafting
Slide 111 - Risk Factors and Complications Previous thrombosis Dilution of the contrast dye in the lower limb Difficulty accessing the veins due to: Obesity Severe swelling (edema) Inflammation in the cells ( cellulitis )
Slide 112 - Contraindications Bleeding disorders Allergy to iodine CHF Severe pulmonary hypertension
Slide 113 - Prior to Procedure Fast or drink only clear fluids for four hours before the test Thorough PT history obtained Informed consent If you are nervous about the test, your doctor may give you a sedative.
Slide 114 - During Procedure PT will lie on a tilting x-ray table Area of interest will be shaved and cleaned Local anesthetic Catheter will be inserted. A small incision may be made in that area as well
Slide 115 - Explanation of Procedure: Legs The catheter is inserted into PT vein (usually a vein in the foot) Contrast is slowly injected. A tight band may be tied around your ankle and upper thigh or your lower body may be tilted Fluoro and/or x-ray images taken The procedure takes about 30 - 45 minutes
Slide 116 - Post Procedure Rest and avoid strenuous activity Increase fluid intake Stop bleeding with pressure Call DR if it won’t stop bleeding Observe for signs of infection PT will be sore for a few days Resume normal activity 24 hours after procedure
Slide 117 - Possible Post Procedure Complications Infection at the injection site Tissue damage Phlebitis (inflammation of a vein) Allergic reactions to the contrast dye Congestive heart failure Acute renal insufficiency Venous thrombosis in a healthy leg Dislodging a clot, perhaps resulting in pulmonary embolus or other complications
Slide 118 - Lower Limb Veins
Slide 119 - Lower Limb Venograms To rule out thrombosis of the deep veins of the leg Deep vein thrombosis (DVT) Contrast media injected in superficial veins of the foot with a needle
Slide 120 - Lower Limb Venograms
Slide 121 - DVT
Slide 122 - Inferior Venacavagram Primarily to rule out thrombus or occlusion Catheter inserted into femoral vein and positioned inside the common iliac vein or inferior aspect of inferior vena cava Contrast injected at 20 ml/sec for total of 40ml
Slide 123 - Upper Limb Veins
Slide 124 - Upper Limb Venograms Most often for thrombosis or occlusion Contrast injected in a superficial vein in the elbow or wrist Using a catheter or needle 40-80ml at a rate of 1-4ml/sec
Slide 125 - Superior Venacavagram Primarily done to rule out thrombus or occlusion Needle or catheter is introduced into antecubital fossa Catheter is positioned in the axillary or subclavian vein and contrast is injected 30-50ml at 10-15ml/sec X-rays should include: Brachicephalic vein Subclavian vein Superior vena cava RT Atrium
Slide 126 - Superior Venacavagram
Slide 127 - Stenosis on a Superior Venacavogram
Slide 128 - Inferior Venacavagram
Slide 129 - Inferior Venacavagram
Slide 130 - Inferior Vena Cava Filters
Slide 131 - Inferior Vena Cava Filter Placement Designed to trap thrombus before causing an embolization When anticoagulants are contraindicated this can be used
Slide 132 - Inferior Vena Cava Filter Placement
Slide 133 - ppt slide no 133 content not found
Slide 134 - Hepatic Venogram Performed to rule out stenosis or thrombus of the hepatic veins Obtain pressure measurements of the veins inside the liver Usually catheter enters jugular vein or upper limb veins
Slide 135 - Hepatic Venogram
Slide 136 - Portal Venogram
Slide 137 - Portal System
Slide 138 - Transjugular Intrahepatic Portosystemic Shunt Intervention for creating an artificial low-pressure pathway Between portal & hepatic veins Hepatic venogram usually preformed before placement US also useful
Slide 139 - 139
Slide 140 - Transjugular Intrahepatic Portosystemic Shunt
Slide 141 - Renal Venogram Rule out thrombosis of renal vein Renal vein catheterized to take blood Measure the production of renin Catheter insertion site: femoral vein Contrast injected 8ml/sec for 16ml total 2 images per second for 4 seconds
Slide 142 - Renal Venogram