Angiography

1. HARVIN NELSON A

2.  It is the study of the blood vessels by injection
of a contrast medium into the vessel.
 Direct injection of contrast
 Injection of the contrast catheter insitu(catheter
Angiogram)

3.  1.Primary vascular desease like
 (a)Vasco-occlusive desease
 (b)Vasospatic disease
 (c) Aneurysms
 (d) AVMArteriovenous Malformation
 (e) AVFArteriovenous Fistula
2.Vascularity assesment of a tumor
3.Investicating source of heamorrhage
4.Congenital vascular condition(Ex: abnormal origin of vessels )
5.Pre-operative definition of vascular anatomy
6.Percutaneous interventional vascular procedure

4.  Bleeding tendencies
 Thrombogenic tendency
 Skin infection or Swelling at site of entry
 Abnormal renal function
 Hepatic Failure
 History of allergy
 Pregnancy
 Residual barium from previous studies

5.  Careful history and clinical examination
 Informed consent
 Patient should be well hydrated
 Fasting 4 hours prior to procedure
 Shave and clean the arterial puncture site
 Check pulse chart,HBsAg and HIV
 Xylocaine sensitivity test
 The patient is on warfarin, it should be
stopped 4-6 days before procedure

6.  Any history of drug intake
 History of diabetes mellitus
 History of coronary heart disease
 PTT 1.2 x control is acceptable

7.  1% to 2% Xylocaine without adrenaline is used
 After intradermal and subcutaneous infiltration,
needle is advanced at 45deg angle to the skin
surface ,with the femoral artery fixed with 3
fingers ,3-4ml is infiltrated medial to the artery.
 Note: Not to injected in femoral vessels, by
aspirating prior to the injection.
 Then 3-4ml of Xylocaine is injected lateral to the
artery.
 This large quantity of local anesthesia helps in
stabilizing the artery and to minimize local
vasospasm.

8.  For femoral artery
 Feel the inguinal ligament
 Feel the artery and fix it with three fingers of
left hand below the inguinal ligaments.
 Inject the local anaesthesia agent at the site
of the puncture as described above.
 Make the hole in skin using a thick needle 21/2
cm (1 inch) below the inguinal ligament or
give a stab incision.

9. 1. Due to local Anaesthesia
 (A) Allergic
 (B)Toxic- due to injection in the vein

10. 2.Due to contrast media:
 (A) Allergic and idiosyncratic reaction are much
less common with intra arterial injection than
with intravenous injection.
 (B) Feeling of warmth localized to the region
supplied by the injected artery.
 (C)Pain may follow injection of contrast material
into the vessel.
 (D) Chemo toxic effect: If contrast media
containing pure sodium ions is used ,the
changes of these reaction are high.Meglumine
salts are less toxic.

11. 3. Due to technique:
 (a) Haemorrahage/ haematoma formation at
puncture site
 (b) sub intimal dissection
 (c) Infection at puncture site
 (e) Damage to local structure

12. 4.Distant completion:
 (a) Peripheral embolism can result from
atherosclerotic plaque damage or dislodgement
of a thrombus formed at puncture site.
 (b) Air embolism can prevented by:
 Ensuring that all tabs and connectors are tight
 Always sucking back when a new syringes is
connected
 Ensuring that all bubbles are excluded from the
syringes before injecting.
(c) Cotton fiber embolus occurs when syringes are filled
from bowls containing cotton swabs.

15. Femoral Artery: Most common and prefered
route of entry
Axillary artery: Site of entry, in case of femoral
are not palpable.
Brachial: Midarm is prefered for the
catheterization.
Direct carotid: Percutaneous entry into the
common carotid artery is done at lower
border of the thyroid cartillage.

16. DirectVertebral: Only historical now.The vertebral
artery was punctured by a special needle which
had only a side hole without any end hole.
Radial Artery:TheAdvantage is that if the artery is
thrombosed the limb still survives because of the
palmar and dorsal arches.4F or smaller caliber
catheters have to be used.
Popliteal Artery:This artery is punctured in the
popliteal fossa and has been used primarily for
angiography.

17.  Coronary angiography
 Cerebral angiography
 Peripheral angiography (arm or leg)
 Visceral angiography(the abdominal organs, or
viscera)
 Pulmonary angiography (lungs)
 Lymphangiography (lymph vessels)
 Aortography (looking at the aorta, the major
artery from the heart)
 Retinal angiography
 Magnetic Resonance Angiography (MRI study of
the blood vessels)

18.  Shows no of coronary arteries blocked by fatty
plaque accumulations (atherosclerosis)
 Pinpoint the area of blockages located in the
blood vessels
 Indicate the extent ( %) of blockages
 Also eliminates the need for surgery. If surgery
remains necessary, it can be performed more
accurately.
 It presents a very detailed, clear and accurate
picture of the blood vessels.This is especially
helpful when a surgical procedure is being
considered.

19.  Bleeding, pain, or swelling where the catheter
was inserted
 Rarely, severe allergic reactions can occur,
especially among people who have had
previous allergic reactions to the contrast
dye.
 Infrequently, a patient with CHF may
experience shortness of breath or fluid
overload due to poor pumping action of heart

20.  Most angiography performed is non-invasive.
This means that no instruments are inserted
into the body.You will have a scan, which will
be examined by an X-ray Doctor (Radiologist)
who is an expert in vascular conditions and
diagnosis. In Sheffield we use two types of
non-invasive angiography.These are
Magnetic Resonance Angiography (MRA) and
ComputedTomography Angiography (CTA).

21.  (a) Heart and arc of aorta:
 20-25ml/sec
 Total volume 30-40ml in heart and 40-80ml in arc
(b) Abdominal aorta:
▪ 15-20ml/sec (with occlusive disease)
▪ 20-25ml/sec (without occlusive disease)
▪ Total volume: 40-80ml.
(c) Infrarenal segment:
80-10ml/sec
Total volume 40ml
In step motion angios the volume increase to 80-100ml.

22. (d)Innominate:
 8-10ml/sec
 Total volume 20ml
(e) Other Arteries:
 (1) Carotids: 10ml rapidly with hand
 (2)Internal carotid: 8ml rapidly with hand
 (3)Vertebral: 6ml rapidly with hand
 (4) External carotid: 5ml rapidly with hand
 (5)Coeliac axis: 6-8ml/s (total 40ml)
 (6)S.M.A: 6-8ml/s (total 40ml)
 (7)I.M.A: 4ml/sec (total 20ml)
 (8)Renal:8-10ml rapid injection with hand.
 (9) Femoral: 20-40ml (hand injection with static serial),
50ml (6-8ml/sec in step motion angio)


23.  Although the test is non invasive a small tube
called a cannula is inserted into the vein of
the hand or arm to allow access to vein. This
is because an injection of contrast medium (a
special dye) may be required for certain tests.

24.  Invasive or Conventional angiography is
sometimes needed. This test used to be
commonly performed; however with the
improved non-invasive scans it is now rarely
used.
 It is sometimes needed during endovascular
treatments for the arteries (such as an
angioplasty or stent).
 Separate booklets are available about these
kinds of endovascular treatments.
 It may also be used if you are unsuitable for non
invasive angiography.

25.  MRA is a type of scan which uses powerful magnets,
radio waves and computers to generate images of the
body.To get the best views of the blood vessels, it is
usually necessary to give some contrast medium into
your vein at the time of the scan.
 The scanner is a large tube which you lay inside on a
scan table.The table moves through the scanner to
take images of your body. You will need to lie as still
as possible.The scanner is quite noisy, so you will be
given a set of headphones and will be offered some
music to listen to.

26.  Some people feel claustrophobic in the scanner, but
most manage with little or no problem. The
radiographers (specialist technicians who perform the
scans) are always available to help and give
reassurance if required.The scan usually takes about
15 - 20 minutes, and can be done as an outpatient
investigation.
 An advantage of MRA is that it doesn't use x-rays,
which may be important if you are younger or if you
require multiple follow-up scans for your condition.
This means that you are not being exposed to
radiation which can be dangerous if you need lots of
tests.

27.  As MRA scans use strong magnets, many
people are not suitable to have this test. You
must not have this test if you have a heart
pacemaker. If you have any metal device or
retained metal fragment inside your body
you must make sure that you have tell the
doctor looking after you.

28.  A CT scanner looks similar to an MRI scanner, but the
'tunnel' you pass in to for the scan is much shorter (the
scanner looks like a doughnut).You also pass in and
out of the scanner far more quickly than MRA and so
it can be better for people who are quite
claustrophobic. Usually this scan takes no more than
5 - 10 minutes, and it can be performed as an
outpatient. CTA uses X-rays to get the pictures
required and it is necessary to give contrast medium
to 'light up' the blood vessels.This type of scan is
useful for people who are unable to have an MRA.

29.  Conventional angiography used to be the
'gold standard' test but due to improvement
in MRA and CTA it is now performed much
less. It is an invasive test so there are more
risks associated with it than the non invasive
tests. We still need to use conventional
angiography as not everybody is suitable for
these other tests.

30.  It is used to provide blood vessel 'roadmaps'
using X-rays during endovascular treatments.
It is still a very important diagnostic test in
certain circumstances, and the radiologist
may feel it is the best test for your particular
circumstances.

38.  Bed rest
 Keep the puncture part with out moving for
atleast 6-8 hours
 Watch for any recurrence of bleeding
 Peripheral pulses should be monitored /vitals
monitored.
 Hydrate the patient well.
 Deterioration of renal function should be
watched for.

39.  It is an imaging test that uses x-rays to
pinpoint the location and severity of any
narrowing or blockages within the coronary
arteries
 Shows number of blockages
 Indicates % of blockages
 Pinpoint the area of blockages located in the
blood vessels