Angio and Interv Procedures

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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Procedures

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

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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

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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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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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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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Documents

Angio and Interv Procedures