A subspecialty which provides minimally invasive
techniques with the help of imaging modalities to
diagnose or treat a condition.
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
The radiologic examination of vessels after the
introduction of a contrast medium.
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
Post mortem injection of mercury salts in
Interventional radiologic procedures began in
1930s with angiography.
In early 1960s Mason Jones pioneered
transbrachial selective coronary angiography.
Later in 1960s transfemoral angiography was
In 1953 Seldinger described a method for
catheterization of vessels.
A percutaneous technique for arterial and venous
Femoral artery is most commonly used.
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.
Site cleaned, area draped, local anesthetic given.
The seldinger needle is introduced into the artery.
When pulsating blood returns, the stylet is
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.
Guide the catheter.
Allow safe introduction of catheter into the
Made of stainless steel.
Usually about 145cm long
An inner core wire that is tapered at the end to a
soft flexible tip.
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
J- tipped—prevents subintimal dissection of artery.
shapes and sizes.
is given in French(Fr)—3Fr=1mm.
end hole only—smaller vessels/minimal
circular tip with multiple side holes —
larger vessels/ more contrast.
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.
Right(lesser curve) & left(greater curve) for right &
left coronary arteries.
Right & left coronary arteries
Initially ionic iodine compounds were used.
Now non ionic contrast media in practice—low
adverse reactions and low physiologic problems.
Diagnosis & presence of ischemic heart disease.
After revascularization procedures
Congenital heart lesions & anomalies of great
Valve disease, myocardial disease & ventricular
Explain procedure & risk to the patient.
History & physical examination.
Pre procedure I/V fluids.
Medication to relieve anxiety.
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.
Impaired renal function
Blood- clotting disorders
Anti coagulant medication
Unstable cardio pulmonary/ neurological status
Bleeding at puncture site
Embolus formation –plaque dislodged from vessel
wall by catheter
Dissection of vessel
Puncture site infection ( contaminated sterile field)
INTERVENTIONAL RADIOLOGY SUITE
Specifically designed to accommodate the quantity of
equipment needed & the large number of people
involved in the procedure.
Interventional radiology suite
(floors, wall, etc.)
Outlets needed for
At least three means
Easy access and
The X-ray apparatus for interventional radiology is
more massive,flexible,expensive & advanced.
More heat load and serial images.
X RAY TUBE
Two ceiling track-mounted X-ray tubes alongwith
an image intensified fluoroscope mounted on C or an
A large diameter massive anode disc(15cm
diameter, 5cm thick) to accommodate heat load.
Cathodes designed for magnification & serial
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
Power rating of 80kW—for rapid sequence serial
Anode heat capacity of 1 MHU—to accommodate
High frequency and high voltage generators
Three phase,12 pulse power.
Stationary couch with a floating,tilting or rotating
Controls for couch positioning are located on side
of table and also on a floor switch.
May also have a computer controlled stepping
2 different types.
Cinefluorographic camera—now obsolete.
Nowadays Digital image receptors are used with a
television camera pickup tube or a charge-coupled