angiography - vidyarthiplus

32
ANGIOGRAPHY www.Vidyarthiplus.com www.Vidyarthiplus.com

Upload: others

Post on 10-May-2022

8 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: ANGIOGRAPHY - Vidyarthiplus

ANGIOGRAPHY

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 2: ANGIOGRAPHY - Vidyarthiplus

• An angiogram is an X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery (such as the aorta) or a vein (such as the vena cava).

• An angiogram can be used to look at the arteries or veins in the head, arms, legs, chest, back, or belly.

• Common angiograms can look at the arteries near the heart (coronary angiogram), lungs (pulmonary angiogram), brain (cerebral angiogram), head and neck (carotid angiogram), legs or arms (peripheral), and the aorta (aortogram).

• During an angiogram, a thin tube called a catheter is placed into a blood vessel in the groin (femoral artery or vein) or just above the elbow (brachial artery or vein).

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 3: ANGIOGRAPHY - Vidyarthiplus

CATHETER PLACEMENT IN FEMORAL VEIN

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 4: ANGIOGRAPHY - Vidyarthiplus

• For angiography, a thin, soft tube (catheter) is placed in a blood vessel in the groin (such as in the femoral vein).

• First, a doctor numbs the area with a local anesthetic. • Then, a needle is placed into the blood vessel. • A guide wire is put through the needle into the blood vessel

and the needle is removed. • The catheter is slid over the guide wire and moved into the

blood vessel. • The catheter is guided through the blood vessels until the tip

is in the area to be studied.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 5: ANGIOGRAPHY - Vidyarthiplus

• The catheter is guided to the area to be studied. • Then an iodine dye (contrast material) is injected into the

vessel to make the area show clearly on the X-ray pictures. • This method is known as conventional or catheter angiogram. • The angiogram pictures can be made into regular X-ray films

or stored as digital pictures in a computer. • An angiogram can find a bulge in a blood vessel (aneurysm). • It can also show narrowing or a blockage in a blood vessel that

affects blood flow. • An angiogram can show if coronary artery disease is present

and how bad it is.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 6: ANGIOGRAPHY - Vidyarthiplus

• A magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) may be an option instead of an angiogram.

• Each of these tests is less invasive than a standard angiogram. • Some MRA tests and all CTA tests require an injection of dye. • A CTA also involves radiation exposure.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 7: ANGIOGRAPHY - Vidyarthiplus

WHY ANGIOGRAPHY IS DONE

• Heart is a muscular pump whose primary job is to pump blood throughout your body.

• It expands and contracts roughly 70 times per minute. • Approximately 5 liters of blood is pumped into our arteries

every minute. • When we are under physical or mental stress, heart has to

function harder to cope with the increased demand of blood (up to 40 liters per minute).

• Like any other organ heart needs oxygenated blood to function.

• Coronary arteries are the vessels, which supply blood to the heart muscle.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 8: ANGIOGRAPHY - Vidyarthiplus

• They are three in number and run on the surface of heart. • The left main Coronary Artery divides into two branches – • the Left Anterior Descending (LAD) and • Left Circumflex (LCx) Artery. • They supply the blood to the front, left side and back of heart. • The Right Coronary Artery (RCA) supplies blood to the bottom

and right side of heart. • Coronary Artery Disease is narrowing of the coronary vessels

thus affecting supply of blood to the heart. • There are several conditions in which the occurrence of the

coronary artery disease is found to be more common.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 9: ANGIOGRAPHY - Vidyarthiplus

• Some of these conditions are • smoking, • diabetes, • high blood pressure, • hyperlipidemia (increased fat in blood), • obesity, • lack of exercise, • stressful life and • family history of coronary artery disease or simply ageing. • A plaque starts getting deposited in the inner walls of the

coronary arteries leading to partial or full blockage of the arteries.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 10: ANGIOGRAPHY - Vidyarthiplus

• The blood flow does not remain normal and this leads to chest pain (angina).

• If it is not treated promptly, a heart attack (myocardial infarction) may result.

• Incidences of Coronary Artery Disease have become more frequent even in the middle and young age group, more so in Indian subcontinent.

• Cardiologist will diagnose CAD on the basis of symptoms, ECG, stress testing (TMT), exercise thallium scan or stress echocardiography, and finally coronary angiography.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 11: ANGIOGRAPHY - Vidyarthiplus

• Angiography till date remains the gold standard for diagnosis and decision making for further management of the coronary artery disease.

• One determines following information by way of angiography: • Presence, location, severity and the extent of blockages • Angiography is performed under local anesthesia. • Status of weakness of heart muscles after the heart attack. • Measurement of chamber pressures if required. • Status of valve function. • Angiography along with other clinical data will guide the

cardiologist to take the proper decision regarding the final treatment.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 12: ANGIOGRAPHY - Vidyarthiplus

HOW IS IT DONE • Some medications are given to make a patient feel relaxed,

but they remain awake. • Patient will lie on a table that allows special x-rays to be taken

of heart that enable the doctor to see while heart is in motion.

• A local anesthetic is given in the groin or in the wrist to numb the area and to prevent pain when the tube is inserted.

• The doctor will insert the tube through a small incision. • The tube is pushed toward the heart through the blood

vessels. • X-rays are used to follow the position of the tube.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 13: ANGIOGRAPHY - Vidyarthiplus

• Patient does not feel the tube as it passes through blood vessels.

• By twisting the hub (the groin/wrist end) of the tube, the doctor will direct the tip of the tube to precise positions in the heart and its blood vessels.

• The tube hub is attached to a device that measures blood flow and blood pressure in various locations in the heart and blood vessels.

• If a picture of the heart chambers, valves, or heart blood vessels is needed, a special dye is injected through the catheter.

• During this injection, moving x-ray pictures are recorded. • The tube is then withdrawn and pressure applied over the

puncture site until bleeding stops.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 14: ANGIOGRAPHY - Vidyarthiplus

DIGITAL SUBTRACTION ANGIOGRAPHY

• Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment.

• Images are produced using contrast medium by subtracting a 'pre-contrast image' or the mask from later images, once the contrast medium has been introduced into a structure.

• Hence the term 'digital subtraction angiography'.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 15: ANGIOGRAPHY - Vidyarthiplus

APPLICATIONS

• DSA is primarily used to image blood vessels. • It is useful in the diagnosis and treatment of: • Arterial and venous occlusions, • including • carotid artery stenosis, • pulmonary embolisms and • acute limb ischaemia. • Arterial stenosis, which is particularly useful for potential

renal donors in detecting renal artery stenosis. • DSA is the gold standard investigation for renal artery

stenosis. • Cerebral aneurysms

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 16: ANGIOGRAPHY - Vidyarthiplus

DSA AND FLUOROSCOPY • In traditional angiography images are acquired by exposing an

area of interest with time-controlled x-rays while injecting contrast medium into the blood vessels.

• The image obtained would also include all overlying structure besides the blood vessels in this area.

• This is useful for determining anatomical position and variations but unhelpful for visualizing blood vessels accurately.

• In order to remove these distracting structures to see the vessels better, first a mask image is acquired.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 17: ANGIOGRAPHY - Vidyarthiplus

• The mask image is simply an image of the same area before the contrast is administered.

• The radiological equipment used to capture this is usually an image intensifier, which will then keep producing images of the same area at a set rate (1 - 6 frames per second),

• The radiologist controls how much contrast media is injected and for how long.

• Smaller structures require less contrast to fill the vessel than others.

• Images produced appear with a very pale grey background, which produces a high contrast to the blood vessels, which appear a very dark grey.

• The images are all produced in real time by the computer, as the contrast is injected into the blood vessels.

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 18: ANGIOGRAPHY - Vidyarthiplus

• DSA is being used less and less routinely in imaging departments.

• It is being taken over by computed tomography angiography (CTA), which can produce 3D images through a test which is less invasive and stressful for the patient.

• But according to the Australian and New Zealand Association of Neurologists DSA is still the gold standard for arterial imaging

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 19: ANGIOGRAPHY - Vidyarthiplus

Personnel in the Angio Room

• Radiologist/ Specialist • Cardiovascular nurse • 2-3 Radiologic Technologists (CV) • Sometimes Anesthesiologist

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 20: ANGIOGRAPHY - Vidyarthiplus

Angiography/ Interventional/ Cardiovascular

• Procedure Room (Suite) – Room size- 400-600 square feet – Easily cleaned – Why? – Outlets needed for O2, suction, crash cart – 3 means of access to the room (Bushong, p. 374)

• What are they?

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 21: ANGIOGRAPHY - Vidyarthiplus

• Control Room – 100-150 square feet – Easy access and communication to procedure

room – Computers, monitors and un sterile personnel – Storage area- guide wires, catheters and needles

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 22: ANGIOGRAPHY - Vidyarthiplus

Equipment found in all Advanced Procedure Rooms

• X-ray generators • Controls • X-ray Tubes • System to record events of procedure • Automatic Injectors

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 23: ANGIOGRAPHY - Vidyarthiplus

Generator

• 700MA- 1500MA • Short exposure times • Able to generate 80- 100 KW power • Limit motion • Provide max. contrast

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 24: ANGIOGRAPHY - Vidyarthiplus

X-Ray Tube Requirements

• Detail • Withstand high heat- rapid exposure

sequences • Tube rating charts posted • Need max. detail for vessels • Use smallest possible focal spot • Decrease target angle,line focus principle

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 25: ANGIOGRAPHY - Vidyarthiplus

Equipment Requirements

• High heat load tubes w/ rapid cooling – Series imaging, intense heat – SPEED UP THE ANODE RPM

• 1-2 Track mounted tubes • Analog- to- Digital Conversion System • Programmable digital image acquisition

system (rate,sequencing, processing)

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 26: ANGIOGRAPHY - Vidyarthiplus

• Electromagnetic Injectors • Monitoring Equipment- BP & ECG • Island Tables- access from all sides, height

adjustments, floor controls • Tables do not usually tilt

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 27: ANGIOGRAPHY - Vidyarthiplus

Digital Acquisition

• 2 types – 1. Analog-to-Digital

• Radiation-pt-intensifier-light-TV-light to electrical signal- analog-to-digital converter- image processor

– 2. Flat detectors – Charged coupled devices (CCD) computer chip – Direct digital conversion

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 28: ANGIOGRAPHY - Vidyarthiplus

Charge Coupled Device (CCD)

Silicon computer chips • Converts light to digital image • Lower noise • Better contrast • Lower patient dose • Advantage to this type system- images

produced in low light w/o loss of resolution

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 29: ANGIOGRAPHY - Vidyarthiplus

Digital Imaging- Analog VS Digital Concepts

• Analog- image seen after chemical process • Digital- image manipulated by software

– Relates to numbers – Number table called an array – Information changed through use of computer

algorithm

• Advantages of Digital Angiography, p.30

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 30: ANGIOGRAPHY - Vidyarthiplus

Post Procedure Care

• Catheter removed – compression • Bed rest- min 4 hrs/ head up 30 degrees • Vital signs • Extremity watch • Some angiographic procedures: angioplasty,

venography, angiocardiography, lymphography

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 31: ANGIOGRAPHY - Vidyarthiplus

Radiation Protection

• Proximity to patient • Radiation protection devices • Leaded glasses pulled into place • Minimal fluoro use • Collimation • Wear badges and ring monitors

www.Vidyarthiplus.com

www.Vidyarthiplus.com

Page 32: ANGIOGRAPHY - Vidyarthiplus

Risks/ Complications

• Bleeding at puncture site • Thrombus formation • Embolus formation –plaque dislodged • Dissection of vessel • Puncture site infection ( contaminated sterile

field) • Contrast reaction

www.Vidyarthiplus.com

www.Vidyarthiplus.com