Arteriography and Angiography PowerPoint Presentation

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Angiography and Arteriography SPRING 2009 FINAL 3-10-09

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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

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Types of Angiographic Procedures

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Angiography Team Radiologist CIT (Radiologic Technologist) Sometimes more than one Other specialists (if needed) Nurse Anesthesiologist (if needed)

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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

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Contraindications Previous severe reaction to contrast Impaired renal function Impaired blood clotting factors Inability to undergo surgical procedure

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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

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What is this?

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Angiographic Trays and Sterile Supplies

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Other Supplies for Angiography

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Needles Vascular access needles Size based on external diameter of needle Allows for appropriate Guidewires matching So internal diameter must also be known

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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

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Introducer Sheaths Short catheters used when multiple catheters will be used Placed in lieu of a catheter

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Catheters

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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

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Three Dimensional (3-D) Intraarterial Angiography

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What Method is this?

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Catherization: Selinger Technique

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Selinger Technique Catheters and Guidewires

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Pre-Procedure PT’s are usually limited to a liquid diet and routine medications Adequate hydration An IV line placed Sedative may be given History taken and vitals taken Informed consent

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Preparing the Patient Room Must be extensively cleaned Equipment checked Room thoroughly stocked Extra supplies as needed

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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

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Post Procedure PTs usually can resume normal activity after 24 hours Most often can go home after 24 hours Because internal bleeding can be life threatening Vitals are monitored Puncture site is monitored for bleeding

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Stent Placement http://images.google.com/imgres?imgurl=http://www.nhlbi.nih.gov/health/dci/images/stent_restenosis.gif&imgrefurl=http://www.nhlbi.nih.gov/health/dci/Diseases/stents/stents_all.html&usg=__xDlbsaX9JhuYbpVojLcz19apr-I=&h=513&w=450&sz=59&hl=en&start=20&tbnid=vWwqaG-RNW7M-M:&tbnh=131&tbnw=115&prev=/images%3Fq%3Dabdominal%2Bstents%26gbv%3D2%26hl%3Den

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Abdominal Arteries

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Abdominal Angiography

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AAA Pre and Post Stent Placement

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Abdominal Stent

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AAA

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Renal Arteriogram

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Lower Limb Arteries

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Leg Atherosclerosis

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Atherosclerosis Left Leg

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Upper Limb Arteries

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Upper Extremity Anatomy

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Brachial and Axillary Arteriogram

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Axillary Arteriogram

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Hand Arteriogram

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Hand Arteriogram with Occlusion

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Circle of Willis

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Neck and Brain Arteries

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Middle Cerebral and Internal Carotid

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DSA showing embolization before and after procedure

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Carotid and Brain

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Carotid Atherosclerosis

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Posterior Vertebral Artery

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Posterior Vertebral Angiogram

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Aneurysms

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Pulmonary Circulation

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Pulmonary Arteriogram

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Lateral RT common Carotid Arteriogram

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Balloon Angioplasty

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Balloon Angioplasty Procedure

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Femoral Artery Angioplasty

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Angioplasty Pre and PostIntracranial

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Placing a Stent after Angioplasty with Balloon

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Intravascular Stents