Interventional radiology uses minimally invasive techniques guided by imaging to diagnose and treat medical conditions. Procedures use small incisions or catheters inserted through blood vessels to access internal organs. The Seldinger technique is commonly used, involving insertion of a guidewire and catheter through a needle into the femoral artery. A variety of catheters and guidewires are used depending on the target vessel. Angiography involves injecting contrast dye to visualize vessels. Interventional radiology suites contain specialized equipment like large X-ray tubes and digital image receptors to facilitate complex image-guided procedures.

1. INTERVENTIONAL RADIOLOGY
& ANGIOGRAPHY
DR.RABIA SHAH

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. 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. INTERVENTIONAL RADIOLOGY
Stent placement
Embolization
Thrombolysis
Balloon angioplasty
Atherectomy
Electrophysiology

5. Percutaneous biopsy
Abscess drainage
Percutaneous nephrostomy
Percutaneous Biliary drainage
Radiofrequency ablation

6. ANGIOGRAPHY
The radiologic examination of vessels after the
introduction of a contrast medium.

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. Post mortem injection of mercury salts in
Jan,1896.

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. 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. 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.

14. Site cleaned, area draped, local anesthetic given.
The seldinger needle is introduced into the artery.
When pulsating blood returns, the stylet is
removed.

15. 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.

17. 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.

18. 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.


22. 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.

23. 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.

25. Judkins catheters
Right(lesser curve) & left(greater curve) for right &
left coronary arteries.
Amplatz catheters
Right & left coronary arteries

28. Contrast Media
Initially ionic iodine compounds were used.
Now non ionic contrast media in practice—low
adverse reactions and low physiologic problems.

29. INDICATIONS
Diagnosis & presence of ischemic heart disease.
After revascularization procedures
Congenital heart lesions & anomalies of great
vessels.
Valve disease, myocardial disease & ventricular
function.

30. Atheroma
Aneurysms
Arteriovenous malformations
Arterial ischemia
 Trauma

31. Patient preparation
Explain procedure & risk to the patient.
History & physical examination.
Lab tests.
Consent
Pre procedure I/V fluids.
Medication to relieve anxiety.

32. 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.

33. Contra-indications
Contrast allergy
Impaired renal function
Blood- clotting disorders
Anti coagulant medication
Unstable cardio pulmonary/ neurological status

34. 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

35. INTERVENTIONAL RADIOLOGY SUITE
Specifically designed to accommodate the quantity of
equipment needed & the large number of people
involved in the procedure.

36. 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 .

37. EQUIPMENTS
The X-ray apparatus for interventional radiology is
more massive,flexible,expensive & advanced.
More heat load and serial images.

39. 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.

40. 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.

41. Power rating of 80kW—for rapid sequence serial
radiography.
Anode heat capacity of 1 MHU—to accommodate
heat load.

42. Generators
High frequency and high voltage generators
Three phase,12 pulse power.

43. 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.

44. 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).

45. THANKS