angio practical

8/6/2019 Angio Practical

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Angiography practical


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Patient preparation:

` The pt should be in- patient in the hospital` lab test should be done:

creatinine , KFT ,PT (Prothrombin time ),PTT(Partialthromboplastin time ), INR( international normalize

ratio)

` The pt should be good hydrated

` If general anesthesia the pt should be fast

` Check the history of allergy` Stop the anti-coagulant, DM for 3 days pre & post the

examination


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` Equipment used in the angiogram room:

C arm ( image intensifier) , multi monitors , automatic

injector (150 ml ) , why ??

1- fixed rate 2- high pressure 3-radiation protection


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` Puncture site

femoral artery :

1- straight 2- middle 3- superficial 4- large size

5- above the head of femur easy for compression .


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` Use the seldinger technique :

1. Insert the needle 45 toward the head

2. Insert the wire sheeth

3. Draw needle wire fixed

4. Dilation ( dilator + sheeth)

5. Draw wire and dilator

6. Sheeth fixed has two open

7. Guide wire and catheters are inserted


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` 3 types of images :

1.flush : for aorta ( large vessels )

use pigtail catheter or side hole catheter

ex: flush aortogram

pigtail catheter above the renal arteries (abdominal

aorta , celiac trunk ,SMA ,renal arteries , IMA

2. Selective :

from abdominal aorta to celiac trunk3. Super selective :

from celiac trunk to splenic artery


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Vascular angiogram :

A. Diagnostic (cerebral vascular structures)

a. 4 Vessel angiogram

` Right and left vertebral arteries

` Right and left common carotid arteries

b. Venogram

B. Therapeutic

a. Aneurysm embolisation

b. AVM embolisation

c. Angioplasty

d. Stenting


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Angiography

` Type of contrast procedures :

` 1- vascular procedure

` ex : L.L Angio

` 2- non- vascular procedure

` Ex: nephrostomy , PCNL


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Indications

A. Cerebrovascular diseaseB. Carotid artery disease

C. Cerebral thrombosis

D. Cerebral embolism

E. Cerebral haemorrhageF. Aneurysm

G. AVM

H. Congenital malformation

I. Primary neoplasmJ. Trauma

K. Presurgical evaluation

L. Postsurgical evaluation


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Contraindications

A. CM sensitivity

B. Advanced arteriosclerosis

C. Severe illness

D. Severe hypertension

E. Advanced age


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PROCEDURE


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4 Vessels mean 2 common carotid & 2 vertebral art.

- Flush at the beginning of aortic arch

AP and LAO 30

CM:25-30ml

RATE: 20-25 ml /sec

- Common carotid artery :

External carotid artery and internal carotid artery .

internal carotid artery : anterior cerebral artery and middlecerebral artery ( , RAO or LAO 45 and lateral, AP cephalic 30(town view) )


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Normal arch angiogram..


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- vertebral Rise from subclavian arteries and

: only injection in one side is enough because the

communication between right and left vertebral

arteries in basilar artery which divides into two

posterior cerebral arteries


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Anatomy contd


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Cerebral AngiographyShowing Arterial Phase,

Capillary Phase, and

Venous Phase of

Circulation


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Neuroangiography Interventions

A. Decreasing blood flow` Aneurysm

` AVM

` Tumour


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A. Decreasing Blood Flow

` Clipping

` Aneurysms

` Plugging the hole

` Insertion of thrombogenic coils (aneurysms)

` Filling with glue (AVM)

` onyx (superglue)


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Cerebral Aneurysm Clipping

Aneurysm Clip


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Guglielmi Detachable Coils

(Aneurysm Occlusion)


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Superglue Embolisation (Tumour)

Pre Embolization Post Embolization


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B. Increasing Blood Flow

1. Balloon Angioplasty

` Carotid artery stenosis

2. Stent insertion

` Carotid

3. Pharmacologic agents

` Papaverine


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Balloon Angioplasty and Stent Insertion

Stenosis

After balloon

angioplasty &

insertion of

stent


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Lower limb angiogram

` Indications:a. Evaluation of the extent of aneurysm formation or atherocclusive

disease

b. Evaluation of bleeding from trauma or tumor

c. Antigrade versus retrograde

` Risks: embolization due to therapeutic procedures


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` Flush aortogramRt nd Lt common iliac arteries

CM : 20-25 ml

Rate : 15-20 ml / sec

For pelvic : AP , LAO for right side and RAO for left side

External iliac arteries( EIA)to common femoralartery(CFA)

15-20 ml with 10-15 ml /secThe common femoral artery divides into superficial and

deep femoral arteries

LAO 15 for left side and RAO 15 for right one


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` The superficial femoral artery branches into poplitealartery (AP VIEW )

` The popliteal artery branches into anterior tibial artery

, and tibioperonial trunk which divides into posteriortibial and peronial arteries


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After care

` Firm pressure over puncture site for 15min.

` Patient moved back to bed for 6 hrs.

` Puncture site must not be bent: legstraight

` Patient to ward

` BP/resp/puncture site obs` hr for 2 hrs

` Hourly for 4 hours

` The pt should drink fluids

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