Angiography is an imaging technique that uses injected radiopaque contrast agents and x-rays to visualize blood vessels. It can be used to examine arteries and organs in the heart, brain, lungs, kidneys, and extremities. Potential complications of angiography include adverse reactions to the contrast agent like anaphylaxis or nephrotoxicity, as well as procedural risks such as infection, arterial wall damage, thrombosis, embolism, and nerve damage. Careful patient screening and monitoring can help reduce complications, while prompt treatment of any reactions is important.

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