Interventional radiology & angiography


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Interventional radiology & angiography

  2. 2. INTERVENTIONAL RADIOLOGY A subspecialty which provides minimally invasive techniques with the help of imaging modalities to diagnose or treat a condition. Minimally invasive Local anesthesia Early recovery
  3. 3. 8 out of 10 procedures use skin incisions smaller than 5 mm. 9 out of 10 procedures use only local anaesthetic, sometimes with sedation. Up to 8 out of 10 patients go home the same day
  4. 4. INTERVENTIONAL RADIOLOGY Stent placement Embolization Thrombolysis Balloon angioplasty Atherectomy Electrophysiology
  5. 5. Percutaneous biopsy Abscess drainage Percutaneous nephrostomy Percutaneous Biliary drainage Radiofrequency ablation
  6. 6. ANGIOGRAPHY The radiologic examination of vessels after the introduction of a contrast medium.
  7. 7. HISTORY The first angiogram was performed only months after Roentgen's discovery of X rays. Which was when? Two physicians injected mercury salts into an amputated hand and created an image of the arteries
  8. 8. Post mortem injection of mercury salts in Jan,1896.
  9. 9. Interventional radiologic procedures began in 1930s with angiography. In early 1960s Mason Jones pioneered transbrachial selective coronary angiography. Later in 1960s transfemoral angiography was developed.
  10. 10. BASIC PRINCIPLES Arterial access In 1953 Seldinger described a method for catheterization of vessels. A percutaneous technique for arterial and venous access. Femoral artery is most commonly used.
  11. 11. SELDINGER TECHNIQUE Seldinger needle. 18gauge single use,sterile needle. 2 parts-- a solid inner needle(stylet) & an outer thin wall needle for smooth passage. a hub---good instrument balance winged handle---good control.
  12. 12. Site cleaned, area draped, local anesthetic given. The seldinger needle is introduced into the artery. When pulsating blood returns, the stylet is removed.
  13. 13. A guide wire is inserted through the needle. With guide wire in vessel, needle is removed. Catheter is threaded onto the guide wire. Under fluoro, the catheter is then advanced and the guide wire is removed.
  14. 14. GUIDEWIRES Guide the catheter. Allow safe introduction of catheter into the vessel. Made of stainless steel. Usually about 145cm long An inner core wire that is tapered at the end to a soft flexible tip.
  15. 15. Covered by a coating—teflon, heparin and recently hydrophilic polymers(glide wires) are used. Coating reduces friction, gives strength to GW. Tips at the end of GW Straight  J- tipped—prevents subintimal dissection of artery. 
  16. 16. CATHETERS •Many shapes and sizes. •diameter is given in French(Fr)—3Fr=1mm. •Straight- end hole only—smaller vessels/minimal contrast. •Pigtail- circular tip with multiple side holes — larger vessels/ more contrast.
  17. 17. H1 or Head hunter tip– used for femoral approach to brachiocephalic vessels. Simmons catheter is highly curved --- for sharply angled vessels--cerebral and visceral angiography. C2 or Cobra catheter has angled tip joined to a gentle curve—celiac, renal & mesenteric arteries.
  18. 18. Judkins catheters Right(lesser curve) & left(greater curve) for right & left coronary arteries. Amplatz catheters Right & left coronary arteries
  19. 19. Contrast Media Initially ionic iodine compounds were used. Now non ionic contrast media in practice—low adverse reactions and low physiologic problems.
  20. 20. INDICATIONS Diagnosis & presence of ischemic heart disease. After revascularization procedures Congenital heart lesions & anomalies of great vessels. Valve disease, myocardial disease & ventricular function.
  21. 21. Atheroma Aneurysms Arteriovenous malformations Arterial ischemia  Trauma
  22. 22. Patient preparation Explain procedure & risk to the patient. History & physical examination. Lab tests. Consent Pre procedure I/V fluids. Medication to relieve anxiety.
  23. 23. Monitoring during and after procedure ECG, Automatic BP measurement & pulse oximetry. Life saving drugs and equipments. Immobile for minimum 4hrs after. Vital signs monitored. Puncture site inspected.
  24. 24. Contra-indications Contrast allergy Impaired renal function Blood- clotting disorders Anti coagulant medication Unstable cardio pulmonary/ neurological status
  25. 25. Risks Bleeding at puncture site Thrombus formation Embolus formation –plaque dislodged from vessel wall by catheter Dissection of vessel Puncture site infection ( contaminated sterile field) Contrast reaction
  26. 26. INTERVENTIONAL RADIOLOGY SUITE Specifically designed to accommodate the quantity of equipment needed & the large number of people involved in the procedure.
  27. 27. Interventional radiology suite Procedure Room  Room size- 400-600 square feet  Easily cleaned (floors, wall, etc.)  Outlets needed for O2, suction.  At least three means of access. Control Room  100-150 square feet  Easy access and communication to procedure room  Operating console with Computers, monitors .
  28. 28. EQUIPMENTS The X-ray apparatus for interventional radiology is more massive,flexible,expensive & advanced. More heat load and serial images.
  29. 29. X RAY TUBE Two ceiling track-mounted X-ray tubes alongwith an image intensified fluoroscope mounted on C or an L arm. A large diameter massive anode disc(15cm diameter, 5cm thick) to accommodate heat load. Cathodes designed for magnification & serial radiography.
  30. 30. A large focal spot of 1mm for heat load. A small focal spot( no more than 0.3mm) is necessary for spatial resolution of small vessel magnification.
  31. 31. Power rating of 80kW—for rapid sequence serial radiography. Anode heat capacity of 1 MHU—to accommodate heat load.
  32. 32. Generators High frequency and high voltage generators Three phase,12 pulse power.
  33. 33. Patient couch Stationary couch with a floating,tilting or rotating table top. Controls for couch positioning are located on side of table and also on a floor switch. May also have a computer controlled stepping capability.
  34. 34. Image receptor 2 different types. Cinefluorographic camera—now obsolete. Nowadays Digital image receptors are used with a television camera pickup tube or a charge-coupled device(CCD).
  35. 35. THANKS