1. Chapter 25 Circulatory System Blood -Vascular

2. Two Systems of Circulatory System
Both carry oxygen and nutrients to tissues in continuous, endless uni-direction
Both transport waste products to organs of excretion
Skin
Lungs
Liver
kidneys

3. 2 Circulatory Systems cont’d
Blood-Vascular System- major portion- transports blood
Lymphatic System- minor portion - collects fluid from tissue spaces, filters through lymph system

4. Bloodvascular System
Lymphatic System

5. Blood-Vascular System
Heart has 2 circulation routes
Systemic
Pulmonary
Both carry oxygenated blood to organs and tissues

6. Pulmonary, systemic, and portal circulation
red = oxygenated blue = deoxygenated purple -nutrient-rich

7. Systemic Circulation
Pumps blood to organs

8. Pulmonary Circulation
Takes returning blood to lungs to exchange carbon dioxide for oxygen
Carries oxygenated blood from lungs to heart
Only veins in post-fetal human body carrying oxygenated (red) blood

9. Portal System
Pathway of venous drainage from abdominal organs through liver before returning to inferior vena cava
Liver has 2 blood supplies!

10. Anatomy: Heart 4chambers – Myocardium - muscular wall of heart
2 atria- upper, receiving chambers
2 ventricles- lower, distributing chambers
Myocardium - muscular wall of heart
Endocardium - inner lining of heart
Epicardium - thin membrane that covers heart
Pericardial sac double-walled outermost covering of heart

11. Heart Valves Right atrioventricular (AV) valve or tricuspid valve
controls opening between right atrium and ventricle
Left AV valve or mitral valve
controls opening between left atrium and ventricle

12. Great Vessels of Heart Deoxygenated/Oxygenated Blood Flow
Pulmonary artery
Aorta
Vena Cava
Inferior and Superior portions
Pulmonary Vein

13. Anatomy: Heart
Right side of heart- handles venous, or deoxygenated blood
Left side of heart- handles arterial, or oxygenated blood

14. Coronary arteries supply blood to myocardium (muscular wall of heart)
Right Coronary artery
Left Coronary artery
Coronary sinus
Great cardiac vein

15. Myocardial infarction (MI)
Commonly known as a heart attack
interruption of blood supply to part of heart, causing some heart cells to die
Most commonly due to occlusion (blockage) of a coronary artery

16. CABG (Coronary Artery Bypass Graft)
Surgery called revascularization to improve blood flow to heart in people with severe coronary artery disease (CAD)
Occurs coronary arteries become blocked due to buildup (plaque) on inside of blood vessels.
If severe, chest pain (angina), shortness of breath, possible heartattack and death
healthy artery or vein grafted, to blocked
artery bypassing blocked portion New passage routes oxygen-rich blood around the blockage to heart muscle
Up to 4 major blocked coronary arteries can be bypassed during 1 surgery.
Collateral veins will take over role previously performed by piece removed.

17. Blood -Vascular System Radiological Studies
Slide 17

18. Various Radiologic Studies
Angiography - exam of vascular structures - contrast medium
Arteriography - exam of arteries -contrast injection
Venography - of veins - contrast injection

19. Indications Claudication - leg pain and cramping
Stenosis - narrowing of vessel
Occlusion -blockage of a vessel
Aneurysm -weakened area of artery
“ballooned”
Suspected tumors
Anatomic variances

20. Contrast dye is injected
Automatic injector is most commonly used
Manual injection is done rarely
Injectors are programmed to coincide with imaging sequence
Rapid film changers are rarely seen

21. Equipment Digital equipment
Digital subtraction -instantly “subtracts” overlying bony structures
better visualization of contrast-filled vascular structures
Cinefluorography still used in cardiac catheterization procedures

22. Equipment

23. Catheterization
Catheter - small, flexible tube inserted into vessel through which contrast is introduced
Femoral artery most common introduction site
Radial
Brachial
Axillary
Jugular
Subclavian

24. Femoral Catheter Introduction

29. Complications! Bleeding at puncture site Allergic reaction to contrast
Nerve, vessel, or tissue damage
Stroke
Heart attack
Death

30. Angiographic Team Physician – usually an interventional radiologist
CIT -cardiovascular-interventional technologist
Anesthetist, nurse, etc

31. Procedures Aortography Pulmonary arteriography
Thoracic
Abdominal
Pulmonary arteriography
Abdominal visceral arteriography

32. Thoracic Aortography Rule out aortic aneurysm
Evaluate congenital or postsurgical conditions
Evaluate aortic dissection
Biplane imaging - PA and lateral obtained with one contrast injection

33. Abdominal Aortography
To Detect
Abdominal aortic aneurysm
Occlusion
Atherosclerotic disease

34. Cerebral Angiography

35. Cerebral Angiography To investigate: Aneurysms
AVM (Arteriovenous malformation)
Tumors
Atherosclerosis
Stenosis

36. Arteriogram of Hand

37. Circle of Willis
Arrangement of brain's arteries creating redundancies in cerebral circulation
If one part of circle becomes blocked or narrowed blood flow -other blood vessels can often preserve cerebral perfusion well enough to avoid loss of blood supply (ischemia)
The

38. Interventional Radiology

39. Balloon Angioplasty
Used to dilate strictures in venous structures, ureters, and GI tract

40. Inferior Vena Cava Filter
Trap emboli to prevent pulmonary embolism resulting from deep vein thrombosis of lower limbs
Delivered via a catheter - assume functional shape as released

41. Vena Cava Filter

42. Foreign object removal
Stones and other occlusive objects can be retrieved via a special catheter with snare at the end

43. Cardiac Catheterization
Minor surgical procedure involving introduction of special catheters into heart, great vessels, and coronary arteries

44. Catheter placement in heart

45. Specialized Equipment

46. Specialized Equipment

47. Venography

48. Indications For Venography
Deep vein thrombosis: Formation of blood clot inside blood vessel
When blood vessel injured
body forms blood clot to prevent loss of blood
If too much clotting & clot breaks free
travels in bloodstream – blocks blood vessel - obstructs circulation (embolism)
If goes to lungs - can rupture pulmonary artery, causing death

49. Other Indications for Venography
Venous obstruction
Recurrent varicose veins
Swollen legs of unknown etiology
Varicose ulcers
Venous malformations

50. Central Venography 2 studies Superior venacavogram
Inferior venacavogram
Purpose
Rule out existence of thrombus or occlusion of central veins

51. Central Venography
Superior venacavogram performed by accessing axillary or subclavian vein
Inferior venacavogram performed by accessing femoral vein and placing catheter in common iliac vein or inferior aspect of inferior vena cava

52. Peripheral Venography
Examines superficial and deep veins of extremities
Less common today-replaced by advances in ultrasound

53. Anatomy Superficial veins Deep veins Dorsal venous arch
Small saphenous vein
Great saphenous vein
Deep veins
Anterior tibial
Posterior tibial
Peroneal
Popliteal
External iliac
Internal iliac
Femoral vein

54. Procedure Patient is supine on table Injection area cleansed
IV started in dorsum of foot or hand
Tourniquets applied
Injection started
Radiographs obtained

55. Indications For Upper Limb Venography
Edema of arm or hand
Venous obstruction
Suspected thrombosis

56. Lower-Limb Venogram
AP of entire extremity
Lateral of entire extremity

57. The End