radiology

1. Complications of Contrasts &
Angiography

2. Angiography
“It is an imaging technique used to visualize the
lumen of blood vessels and organs of the body by
means of injecting a radio opaque agent into the
blood vessels followed by images taken using x-ray
based techniques”

3. ANGIOGRAPHY PERFORMED IN…..
 Heart--( coronary angiography)
 Brain --(cerebral angiography)
 Lungs --(pulmonary angiography)
 Kidneys --(renal angiography)
 Arms or legs --(extremity angiography)

4. INDICATIONS
 Congenital arterial anomalies
 Aneurysms
 Stenosis
 Thrombosis
 Arteritis
 Trauma
 Embolus
 AV fistulas
 Hemorrhage
 Masses/tumors

5. The Angiography Procedure
 A catheter is inserted through a small cut and into
one of the arteries, usually in the groin . A radiologist
then guides the catheter into the area that needs to
be examined. The contrast medium is injected
through the catheter and into the blood vessel. A
series of X-rays is then taken.
 Anesthesia

8. COMPLICATIONS OF
CONTRASTS

9. Contrast Media
 Contrast media is primarily divided into two
categories:
 high osmolar contrast media (HOCM)
 low osmolar contrast media (LOCM)
• Most non-ionic agents are placed into the LOCM category
while all ionic agents are in the HOCM category.

10. Mechanisms of Contrast Reactions
ANAPHYLACSIS
 Anaphylactic reactions are the immediate type of
hypersensitivity that result from interaction of antigens
with specific antibodies bound to mast cells and
basophils.
 They involve the release of vasoactive
bronchoconstrictive substances such as: Histamine,
Leukotrienes
 Occur within 30 minutes
 60% within 5 minutes
 94% within 20 minutes
 Respiratory decompensation: 40% of deaths

11. Anaphylactic Reaction

12. Mechanism
CHEMOTOXICITY
 Chemotoxic effects are related to does and chemical
nature of agent (osmolality, viscosity, hydrophilicity,
etc.)
 More likely in debilitated or unstable patients

13. MAJOR RISK FACTORS
 Allergy(asthma)extremes of age
 Cardiovascular disease
 Previous history

14. MINOR RISK FACTORS
 DIABETES MELLITUS
 DEHYDRATION
 IMPAIRED RENAL FUNCTION
 HAEMOGLOBINOPATHIES
 B BLOCKERS
 INTERLEUKIN 2 THERAPY

15. MILD REACTIONS
 Sneezing
 Mild urticaria
 Nausea
 Mild pallor
 Sweating
 Mild urticaria
 Arm pain
 Tachycardia/bradycardia

16. INTERMEDIATE REACTIONS
 Widespread urticaria
 Bronchospasm
 Laryngospasm
 Angioneurotic edema
 Moderate hypotension
 Faintness
 Headache
 Severe vomiting
 Rigors
 Dysnoea
 Chest/abdominal pain

17. SEVERE REACTIONS
 Cardiopulmonary collapse
 Severe hypotension
 Pulmonary edema
 Edema of glottis
 Bronchospasm
 Laryngospasm
 MI
 Arrhythmias
 Loss of consciousness

18. NEPHROTOXICITY
 Oliguric renal failure(severe form)
 Direct toxic effect
 Vasoconstriction
 Cast formation in tubules leading to obstruction

19. IODISM
 Interference of free iodine present in contrast with
iodine function tests of thyroid----hyperthyroidism

20. Management of Contrast Reactions
 Reassurance
 Emergency drugs
 I/V fluid administration
 Oxygen administration
 Vagal reaction(hypotension
+bradycardia)>epinephrine
 Anaphylactoid reaction(hypotension
+tachycardia)>atropine

22. COMPLICATIONS OF
ANGIOGRAPHY

23. INFECTION
 Improper sterilization techniques
ARTERIAL WALL DAMAGE
 Directly by needle/catheter puncture.
 Subintimal injection

24. THROMBOSIS
 Trauma to arterial wall
 Subintimal injection of contrast
 Prolonged cathterization:3000 units of
heparin(systemic heparinization)

25. ALLERGY
 Urticaria
 Sneezing
 Coughing
 Severe form: cardiopulmonary collapse
 Severe reaction:dexamethsone10-20mg iv
 Edema of glottis: epinephrine 0.5 mg, Subcut/ im
 Antihistamine

26. HYPOTENSION
 Release of chemical mediaters
 Patient having atheromatous stenosis---high risk
 Hemiplegia---carotid thrombosis

27. CATHETER CLOT EMBOLUS
Clot formation at the catheter tip
Stripped off as catheter is withdrawn
Serves as a focus for thrombosis

28. CHOLESTEROL EMBOLIZATION
 Atheromatous disease
 Cholesterol crystalsdislodged into circulation

29. AIR EMBOLUS:
 When syringe points upward or horizontally.
HAEMATOMAS AND FALSE ANEURYSMS:
 Application of firm pressure at the puncture site
 Hypertensive's are highly susceptible.
 Anticoagulant drugs must be stopped

30. NERVE DAMAGE
NERVE PALSIES:
 Femoral nerve palsy
 Brachial plexus damage during transaxillary
catheterization.
 Caused by direct puncture or by hematoma
compression

31. VITAL ORGAN DAMAGE
 Cortical blindness—vertebral angiography
 Paraplegia: Artery of Adamkewicz, supplies the
cord from T8 downwards.
 Tetraplegia: excess contrast in deep cervical artery
 Ventricular fibrillation, MI.

32. THANK YOU