lymphography and venography 2012. venous circulation
TRANSCRIPT
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Lymphography and Venography
2012
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Venous Circulation
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What is Venography?
• Vein study using x-ray and contrast media– Fluoroscopy and still images
• One of the most accurate tests for deep vein thrombosis (DVT)
• Most commonly done in legs for DVT
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Thrombosis and Embolism
• Intravascular clot• Commonly in veins
more than arteries
• 3 factors– Where blood is slow– Change in the wall of
vessels– Change in the blood
itself
• Thrombus that becomes detached from the vessel wall
• Can easily flow to heart causing PE
• Severity depends on location of embolism
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Pulmonary Embolism• Occurs when a clot forms or becomes lodged in the
pulmonary artery
• Most commonly thrombus originates in the lower limbs and migrates
• Can lead to resp distress, heart failure or cardiogenic shock
• Symptoms are acute:– Sudden coughing– SOB– Chest pain
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Pulmonary Emboli (PE)
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Indications• Diagnose deep vein thrombosis
– Prevent pulmonary embolism
• Distinguish blood clots from obstructions in the veins
• Evaluate congenital vein problems
• Assess the functioning of deep leg vein valves
• Identify a vein for arterial bypass grafting
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Risk Factors and Complications
• Previous thrombosis
• Dilution of the contrast dye in the lower limb
• Difficulty accessing the veins due to: – Obesity– Severe swelling (edema) – Inflammation in the cells ( cellulitis )
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Contraindications
• Bleeding disorders
• Allergy to iodine
• CHF
• Severe pulmonary hypertension
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Prior to Procedure
• Fast or drink only clear fluids for four hours before the test
• Thorough PT history obtained
• Informed consent
• If you are nervous about the test, your doctor may give you a sedative.
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During Procedure
• PT will lie on a tilting x-ray table
• Area of interest will be shaved and cleaned
• Local anesthetic
• Catheter will be inserted.– A small incision may be made in that area as well
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Explanation of Procedure: Legs• The catheter is inserted into PT
vein– (usually a vein in the foot)
• Contrast is slowly injected.
• A tight band may be tied around your ankle and upper thigh– or your lower body may be tilted– Fluoro and/or x-ray images taken
• The procedure takes about 30 - 45 minutes
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Post Procedure
• Rest and avoid strenuous activity
• Increase fluid intake
• Stop bleeding with pressure – Call DR if it won’t stop bleeding
• Observe for signs of infection
• PT will be sore for a few days
• Resume normal activity 24 hours after procedure
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Possible Post Procedure Complications
• Infection at the injection site
• Tissue damage
• Phlebitis (inflammation of a vein)
• Allergic reactions to the contrast dye
• Congestive heart failure
• Acute renal insufficiency
• Venous thrombosis in a healthy leg
• Dislodging a clot, perhaps resulting in pulmonary embolus or other complications
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Lower Limb Veins
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Lower Limb Venograms
• To rule out thrombosis of the deep veins of the leg – Deep vein thrombosis (DVT)
• Contrast media injected in superficial veins of the foot with a needle
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Lower Limb Venograms
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DVT
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Inferior Venacavagram
• Primarily to rule out thrombus or occlusion
• Catheter inserted into femoral vein and positioned inside the common iliac vein or inferior aspect of inferior vena cava
• Contrast injected at 20 ml/sec for total of 40ml
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Upper Limb Veins
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Upper Limb Venograms• Most often for thrombosis or occlusion• Contrast injected in a superficial vein in the
elbow or wrist– Using a catheter or needle– 40-80ml at a rate of 1-4ml/sec
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Superior Venacavagram• Primarily done to rule out thrombus or occlusion
• Needle or catheter is introduced into antecubital fossa– Catheter is positioned in the axillary or subclavian vein and
contrast is injected– 30-50ml at 10-15ml/sec
• X-rays should include:– Brachicephalic vein– Subclavian vein– Superior vena cava– RT Atrium
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Superior Venacavagram
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Stenosis on a Superior Venacavogram
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Inferior Venacavagram
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Inferior Venacavagram
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Inferior Vena Cava Filters
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Inferior Vena Cava Filter Placement
• Designed to trap thrombus before causing an embolization
• When anticoagulants are contraindicated this can be used
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Inferior Vena Cava Filter Placement
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Hepatic Venogram
• Performed to rule out stenosis or thrombus of the hepatic veins
• Obtain pressure measurements of the veins inside the liver
• Usually catheter enters jugular vein or upper limb veins
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Hepatic Venogram
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Portal Venogram
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Portal System
http://www.youtube.com/watch?v=4aGNqmWOuEo&feature=related
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Transjugular Intrahepatic Portosystemic Shunt
• Intervention for creating an artificial low-pressure pathway– Between portal & hepatic
veins
• Hepatic venogram usually preformed before placement
• US also useful http://www.youtube.com/watch?v=pGA6KUgq7AI
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Transjugular Intrahepatic Portosystemic Shunt
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Renal Venogram
• Rule out thrombosis of renal vein
• Renal vein catheterized to take blood– Measure the production of renin– Catheter insertion site: femoral vein
• Contrast injected 8ml/sec for 16ml total– 2 images per second for 4 seconds
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Renal Venogram
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Lymphatic System:Green-superficialBlack- deep
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RT AND LT LYMPH DRAINAGE
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LYMPH DRAINAGE
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Lymphography• General term applied to the radiologic examination of:
– Lymph nodes – Lymph Vessels
• Usually done to demonstrate pelvis and abdomen– Injected in foot
• For axillary, clavicular area and upper limbs– Injected in hand
• Checks drainage of lymph nodes
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Pre Procedure
• Obtain PT history
• Obtain PT consent
• Make sure to have all supplies
• Positioning aides and comfort supplies
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Procedure
• Inject blue dye under skin in between toes
• Inject small amount of contrast into the lymph vessels– Show blue tint
• Nodes in pelvis and abdomen are demonstrated with foot injection
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Procedure
• X-rays are usually taken 1 HR after injection– 24 hrs– 48 hrs (if needed)– 72hrs (if needed)
• First hour– Contrast in lymph ducts
• 24 hours – If lymph nodes
• After 24 hours it is indicative of cancer
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Post Procedure
1. Watch for signs of infection Swelling red and warm to touch Accompanied by a fever Contact DR right away
2. Drink lots of water
3. Major swelling in one limb Especially limb injected
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Indications• Check for
metastasis
• Edema in limbs– Obstruction
• Infections
• Rule out cancer
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Contrast
• Oil based – More commonly used– Ethiodal– Lipodal
• Water based Iodine– Less commonly used– Ionic– Non-ionic
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Iliopelvic-aortic Lymphatic System
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Iliopelvic Abdominoaortic Lymph Nodes
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Inguinal Region
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Lymphography
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Upper Limb Lymphography