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8/3/2019 Angio and Interv Procedures
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Click to edit Master subtitle style
5/3/12
Angiography andInterventional
Procedures
Presented By:
Dr. Mohammed A.Musa
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Procedures Course Objectives: Describe the essential equipment
necessary for angio & interventionalprocedures.
Explain patient preparation for thevarious angio & interventionalprocedures.
Explain principles of asepsis andinfection control utilized in the
angiographic/interventional suite.
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Procedures Course Objectives: Discuss diagnostic and interventional
techniques as related to pathology.
Describe vascular interventionalprocedures.
State non-vascular interventionalprocedures.
Describe the role of medical imaging
technologist in the operation theatre.
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Procedures Evaluate radiographs for technical quality,
anatomy, physiology, and pathology.
Determine the various alternativemodalities of vascular imaging.
Apply radiation safety for differentprocedures.
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Procedures Definition of angiography is:
The radiographic examinations of thevessels after injection of a contrastmedium.
Contrast agent is injected by a catheterthat is placed in the vessel of the interest.
Positive contrast agent are more
commonly used, but there are instanceswhen use of ne ative contrast a ent is
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Procedures Highly specialized imaging equipment is
required for these procedures.
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Procedures Angiography can be more specifically
described as follows:
Arteriography:
Imaging of the arteries
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Procedures
Venography: Imaging of the veins
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Procedures Angiocardiography:
Imaging of the heart and associatedstructures.
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Lymphography: Imaging of the lymphatic vessels/nodes.
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Procedures Angiography is performed on the patientby a team of health professionals
Including:-
Radiologists
Are doctors that are specially trained tointerpret the angiogram, They will
write a report on the examination that
will be sent back to the specialist that
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Procedures According to departmental protocoland the specific situation, an
additional physician, nurse ortechnologist may be also available to
assist with the procedure.
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Procedures Vessels acess for contrast media injection:
To visualize the vessel(s) of interest acatheter must be introduced into thepatients vasculature, through which thecontrast agent will be injected.
The common method of catheterizationused is Seldinger Technique.
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Procedures Vessels access for contrast mediainjection:
To visualize the vessel(s) of interest acatheter must be introduced to the patientvasculature through which the contrastmedia will be injected.
A common method of catheterization isthe seldinger technique, developed by DR.Sven Seldinger in the 1950s.
Three vessels are typically considered for
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Procedures The preferred vessel for arterial puncture
is:
FEMORAL ARTERY
Why?
Because of the : Size
Easily accessible location.
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Procedures Angiographic Imaging Equipment
Angiographic room is equipped for alltypes of angiographic and interventionalprocedures and has a wide variety ofneedles, catheters, and guidewires close
at hand.
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Procedures Specialized X-ray tubes, with high heat
load capacity and rapid cooling to meetthe need for high mA.
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Procedures If the X rays system selected isappropriate for the procedures to becarried out in the catheterization
laboratory.
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Procedures This technique requires high fluoroscopictube currents with the benefit of reducingpatient exposure to radiation while
improving image contrast.
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Procedures The introduction of additional filtration inthe X ray beam (commonly copper filters)reduce the number of low energy photons
and as consequence, saves skin dose forthe patients
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Procedures Radiation-freeCollimation.
Manipulation ofdiaphragms in LastImage Hold.
No fluoroscopy
required.
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Procedures Pre-procedural patient care All patients must be admitted into wards
for pre-procedure preparation.
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Procedures. The risks of the procedure must be fully
explained to the patients / or theirrelatives.
. Obtain signed consent for all angiographicprocedures.
. In patients with significant allergy history,give prophylactic steroid cover.
.
Patients should empty their bladder priorto the attendance of the a ointment.
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Procedures Seldinger Technique:
Its percutaneous technique that can beused for arterial or venous access.
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Procedures Seldinger Technique (Step-By- Step) Step 1 (insertion of needle)
The needle with an inner canula is placedin a small incision and advanced
so that it punctures walls of the vessel.
Step2 (Placement of needle in lumen ofvessel)
Placement of needle in lumen of vessel is
achieved by removing the inner canula
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Procedures After the guide wire is in position, the
needle is removed by withdrawing it overthat portion of the guide wire remainingoutside the patient.
Step5 (Threading of catheter to area of
interest)
The catheter is then threading over theguide wire and advanced to the area of
interest under fluoroscopic control
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Procedures Other Techniques for vessel access Cut down: which require minor surgical
procedure to expose the vessel of interest
Trans-lumbar approach: which requires thepatient to be placed in a prone position and along needle be passed through the abdomenat the level fT12 or L2 into the aorta.
The catheters have different shapes at thedistal end to permit easy access to thevessel of interest, the radiographer mustbe familiar with the types, radiopacity,
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Angiography Tray
The angiography tray should include thefollowing basic sterile items for a
Seldinger catheterization of vessel(s):-
Hemostats
Prep sponges and antiseptic solution
Scalpel blade Syringe and needle for local anesthesia
Basins and medicine cup
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Procedures Contrast Media The contrast media of choice is water-
soluble, nonionic iodinated substancebecause of its low Osmolarity and thereduced risk of allergic reactions.
The amount required will depend on the
vessel under examination.
As for all procedures that use contrastmedia, emergency equipment and drugs
should be available
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Procedures Indications Common indications for angiograms
includes
1. Rule out vascular abnormality, e.g.:-
- Aneurysms
- AVMs - Stenosis / Occlusions
- Tumors
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Procedures2. Pre-operative assessment, e.g.:- - Renal donors
- Liver donors / recipients - Tumor
3. For immobilization, e.g.:-
- Intracranial aneurysms
- Ruptured hepatocellular carcinoma
- Haemoptysis
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Procedures4. For angioplasty / stenting5. For thrombolytic therapy5
6. For treatment of hepatocellular carcinoma7. For radio surgery AVM localization
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Procedures Complications Bleeding at the puncture site: This can be
controlled by applying compression.
Thrombus formation: This may form in avessel and disrupt the flow to distal part.
Embolus formation: This is a plaque maybe dislodged from vessel wall by thecatheter.
Dissection of a vessel: this occurs by thecatheter which ma tear the intima of a
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Procedures Suggested post-angio orders (Aftercare)
1. Vital signs every 15 min. x 4 then ...every 1 hr. x 4
2. Check femoral area, axillarly area orbrachial area for bleeding with vital signs
every 15 min. x 4 then every 1 hr. x 4.
3. Strict bed rest x 20 hours.
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Procedures Angiographic Imaging Equipment 1. Angiographic Room
An angiographic room is equipped for alltypes of angiographic and interventionalprocedures.
It is larger than conventional radiographicroom and has outlets for oxygen andsuction, and emergency medicalequipment must be nearby.
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Procedures2. Equipment Requirements An angiographic unit generally
requires the following:-
An island table that provide access to thepatient from all sides with four-way floatingcapability, adjustable height and tilting
mechanism.
Large field of view image intensifier digitalfluoroscopy and acquisition in a C-arm
configuration.
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Procedures Specialized x-ray tube(s) with high heat
load capacity with rapid cooling to meetthe need of high MA.
Electromechanically injector for delivery ofcontrast media.
Physiological monitoring equipment thatallow monitoring of the patient venous andarterial pressure and ECG.
Ima e archivin method linked to a laser
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Procedures Digital Acquisition:- The radiation passes through the patient
and is detected by the image intensifier.
the image intensifier converts the x-rayenergy to light.
the light energy is transmitted to atelevision system that convert the light toelectric signal
the electric signal is transmitted to ananalo to di ital converter and di itized
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Procedures Radiation Protection A potential risk exists for increased
radiation dose to the members of the
angiography team because of the use offluoroscopy during the procedure, and forthat certain precautions must be taken
such as:- The use of radiation protection devices
such as lead aprons, thyroid shields, and
lead glasses is essential.
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Procedures Digital subtraction angiography (DSA) One advantage of digital technology is the
ability to perform DSA which replaces the
older photographic method of imagesubtraction.
With digital technology, a highly
sophisticated computer subtracts certainanatomic structures so that the resultantimage demonstrates only the vessel(s) of
interest containing contrast media
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Procedures A subtracted image appears as a reversed
image and may visualize diagnostic
information not apparent on aconventional non subtracted image.
Because the images are digital and are
stored a number of post processingoptions can be obtained to move or modifythe images such as:-
Remasking which allow the ability to improve
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Click to edit Master subtitle style
5/3/12
Angiography andInterventional
Procedures
Presented By:
Dr. Mohammed A.Musa
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Procedures Basic Angiographic procedures Cerebral Angiography
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Procedures
Purpose
Cerebral angiography is a Radiologic study ofthe brain blood vessels. The purpose of theprocedure is to provide a road map whichenable to localize and diagnose pathology orother anomalies of the brain.
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Procedures
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Procedures Indications: Vascular Stenosis
Aneurysms Trauma
Arteriovenous malformation
Neoplastic diseases
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Procedures Puncture Site
Femoral artery
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Procedures Catheter Location The femoral approach is preferred for the
catheter insertion. The catheter is
advanced to the aortic arch and the vesselto be imaged is selected.
Vessels commonly selected for cerebral
angiography include the common carotidarteries, internal carotid arteries, externalcarotid arteries, and the vertebral arteries.
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Procedures Contrast Agent A. Omnipaque 300
B.Amount 5-10 cc depending onwhich vessel is being examined
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Procedures Imaging:- Biplane equipment is preferred for cerebral
angiography
Imaging sequence should include allphases of the circulation
arterial phase
capillary phase
venous phase
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Procedures
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Procedures
Lateral ICA arteriogram.
Vascular malformation (AVM)
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Click to edit Master subtitle style
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Angiography andInterventional
Procedures
Presented By:
Dr. Mohammed A.Musa
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Procedures Thoracic Angiography Purpose:
Thoracic angiography is the study of theascending aorta, the arch the descendingportion of the thoracic aorta, and the majorbranches.
Pulmonary Arteriography is the study ofpulmonary vessels.
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Procedures
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Procedures
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Procedures Some Indications Aneurysms
Congenital abnormality Vessel Stenosis
Embolus Trauma
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Procedures
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Procedures Puncture site
Femoral artery
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Procedures Catheter location The catheter is advanced to the selected
location into the thoracic aorta
Selective procedures are performed byusing special design catheters to accessthe vessel of interest.
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Procedures Contrast agent - Omnipaque 300
- Average amount is 30-50 cc forthoracic angiography
- Average amount is 25-35 cc forselective pulmonary angiography
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