1. Angiography and Arteriography SPRING 2009 FINAL3-10-09

2. Angiography Is the general term that describes the radiologic examination of vascular structures within the body after the introduction of an iodinated contrast medium or gas

3. Types of Angiographic Procedures

5. Angiography Team Radiologist Radiologist CIT (Radiologic Technologist) CIT (Radiologic Technologist) –Sometimes more than one Other specialists (if needed) Other specialists (if needed) Nurse Nurse Anesthesiologist (if needed) Anesthesiologist (if needed)

6. Indications Verify the presence of tumors Verify the presence of tumors –Blood supply to tumors Internal bleeding Internal bleeding –Possible anemia Stenosis Stenosis –Can be caused form atherosclerosis Occlusions Occlusions –Clots –Thrombus –Embolus Aneurysms Aneurysms Heart disease Heart disease

7. Contraindications Previous severe reaction to contrast Previous severe reaction to contrast Impaired renal function Impaired renal function Impaired blood clotting factors Impaired blood clotting factors Inability to undergo surgical procedure Inability to undergo surgical procedure

8. Contrast Media Iodinated contrast media is used Iodinated contrast media is used –Can produce nausea & an uncomfortable burning sensation –Allergic reactions  Severe: anaphylactic shock –Shock, rapid shallow breathing, high pulse rate & ALOC  Mild: Hives or slight difficulty breathing

9. What is this?

11. Angiographic Trays and Sterile Supplies

12. Other Supplies for Angiography

13. Needles Vascular access needles Vascular access needles Size based on external diameter of needle Size based on external diameter of needle Allows for appropriate Guidewires matching Allows for appropriate Guidewires matching –So internal diameter must also be known

14. Guidewires Used as a platform over which a catheter is to be advanced Used as a platform over which a catheter is to be advanced Once positioned guidewire is fixed and catheter is advanced until it meets the tip of the guidwire Once positioned guidewire is fixed and catheter is advanced until it meets the tip of the guidwire Mostly constructed on stainless steel & coated with Teflon Mostly constructed on stainless steel & coated with Teflon

15. Introducer Sheaths Short catheters used when multiple catheters will be used Short catheters used when multiple catheters will be used Placed in lieu of a catheter Placed in lieu of a catheter

16. Catheters

18. DSA A subtraction mask is taken before contrast injected A subtraction mask is taken before contrast injected Each of digitized image is from the mask Each of digitized image is from the mask Images acquired form Images acquired form –1 image every 2-3 sec –Up to 30 images per sec

19. Three Dimensional (3-D) Intraarterial Angiography

20. What Method is this?

21. Catherization: Selinger Technique

22. Selinger Technique Catheters and Guidewires

23. Pre-Procedure PT’s are usually limited to a liquid diet and routine medications PT’s are usually limited to a liquid diet and routine medications Adequate hydration Adequate hydration An IV line placed An IV line placed –Sedative may be given History taken and vitals taken History taken and vitals taken Informed consent Informed consent

24. Preparing the Patient Room Must be extensively cleaned Must be extensively cleaned Equipment checked Equipment checked Room thoroughly stocked Room thoroughly stocked Extra supplies as needed Extra supplies as needed

25. Radiation Protection PT is protected by no less than 2.5 mm of Aluminum PT is protected by no less than 2.5 mm of Aluminum Beam restriction Beam restriction Avoidance of repeat exposure Avoidance of repeat exposure Cardinal rules Cardinal rules –Time –Distance –Shielding

26. Post Procedure PTs usually can resume normal activity after 24 hours PTs usually can resume normal activity after 24 hours Most often can go home after 24 hours Most often can go home after 24 hours –Because internal bleeding can be life threatening Vitals are monitored Vitals are monitored Puncture site is monitored for bleeding Puncture site is monitored for bleeding

27. Stent Placement http://images.google.com/imgres?imgurl=http:// www.nhlbi.nih.gov/health/dci/images/stent_rest enosis.gif&imgrefurl=http://www.nhlbi.nih.gov/h ealth/dci/Diseases/stents/stents_all.html&usg=_ _xDlbsaX9JhuYbpVojLcz19apr- I=&h=513&w=450&sz=59&hl=en&start=20&tb nid=vWwqaG-RNW7M- M:&tbnh=131&tbnw=115&prev=/images%3Fq %3Dabdominal%2Bstents%26gbv%3D2%26hl %3Den http://images.google.com/imgres?imgurl=http:// www.nhlbi.nih.gov/health/dci/images/stent_rest enosis.gif&imgrefurl=http://www.nhlbi.nih.gov/h ealth/dci/Diseases/stents/stents_all.html&usg=_ _xDlbsaX9JhuYbpVojLcz19apr- I=&h=513&w=450&sz=59&hl=en&start=20&tb nid=vWwqaG-RNW7M- M:&tbnh=131&tbnw=115&prev=/images%3Fq %3Dabdominal%2Bstents%26gbv%3D2%26hl %3Den

28. Abdominal Arteries

29. Abdominal Angiography

30. AAA Pre and Post Stent Placement

32. Abdominal Stent

33. AAA

34. Renal Arteriogram

35. Lower Limb Arteries

37. Leg Atherosclerosis

38. Atherosclerosis Left Leg

39. Upper Limb Arteries

40. Upper Extremity Anatomy

41. Brachial and Axillary Arteriogram

42. Axillary Arteriogram

43. Hand Arteriogram

44. Hand Arteriogram with Occlusion

46. Circle of Willis

47. Neck and Brain Arteries

48. Middle Cerebral and Internal Carotid

49. DSA showing embolization before and after procedure

50. Carotid and Brain

51. Carotid Atherosclerosis

52. Posterior Vertebral Artery

53. Posterior Vertebral Angiogram

54. Aneurysms

55. Pulmonary Circulation

56. Pulmonary Arteriogram

57. Lateral RT common Carotid Arteriogram

58. Balloon Angioplasty

60. Balloon Angioplasty Procedure

61. Femoral Artery Angioplasty

62. Angioplasty Pre and Post Intracranial

63. Placing a Stent after Angioplasty with Balloon

64. Intravascular Stents