fundamental angiography

• Vascular angiography (diagnostic)


  Procedure to investigate intracranial vascular lesions

  
• Intracranial vascular lesions investigated

  • Aneurysms
  • AVMs
  • Tumours
  • Atherosclerotic or stenotic lesions

  
• Major arteries of upper chest, neck, arm

  
• Positioning for examination


  1. Supine position

  2. Place suitable support under points of straint

  3. Apply compression bands across the body

  4. Adjust the patient's head to place its midsagittal plane perpendicular to IR
• Imaging program (technique & parameter)

  1. Catheterization via femoral artery

  2. Mask taken and then injection commences

  3. 5-10ml/sec for 1 sec (CM)

  4. 3 images (frames)/sec (AP & LAT arterial phase)

  5. 1 image(frame)/sec for capillaries phase

  6. 1 image (frame)/sec for venous phase
• Cerebral angio images (vertebrobasilar)

  
• Complications


  • Local problems such as haematoma, pseudoaneurysms and arteriovenous fistulae
  • Guide wire and catheter manipulation
  • Side effects of the contrast material on renal function and systemic effects or allergic reactions
  • Infection risk
  • Dissection of vessel
  • Embolus formation
  • Thrombus formation
• Thoracic & abdominal angiography

  Procedure to investigate thoracic and abdominal vascular conditions
• Thoracic aortography


  Procedure to investigate aortic aneurysm, congenital conditions, post-surgical conditions, aortic dissection
• Thoracic aortography guidelines


  1. Lateral projections, move patient's arm superiorly

  2. Increase the lateral SID usually to 152cm

  3. 45° RPO/LPO

  4. CR at the level T7 (visualise the entire thoracic aorta, including prox. brachiocephalic, carotid and subclavian vessels)
• Thoracic aortography CM injection

  1. Using automatic pressure injector

  2. Rate: 25 to 30 mL/sec

  3. Total volume: 50-70mL
• Thoracic aortography imaging program

  1. Imaging simultaneously with injection of the CM

  2. 3 frames/sec for 3-4 sec (early)

  3. 1 frame/sec for 3-5 sec

  4. Exposure at the end of suspended inspiration
• AP thoracic aorta
• Lateral thoracic aorta
• Abdominal aortography


  Procedure to evaluate abdominal aortic aneurysm, occlusion, atherosclerotic disease, tumour vascularity, thrombosis, occlusion, bleeding
• Abdominal aortography guidelines


  1. Simultaneous AP and lateral projection

  2. Lateral projections, move patient's arm superiorly

  3. Collimate the field in lateral projection

  4. CR at L2 to visualise from diaphragm to aortic bifurcation (all abdominal visceral branch)

  5. Lateral projection - to demonstrate the origin of the celiac and SMA
• Abdominal aortography CM injection/imaging program

  1. 25mL/sec

  2. 60 mL total volume of CM

  3. 2-3 frames/sec for 4 second

  4. Followed by 1 frame/sec for additional 4 second

  5. Exposure at the end of suspended inspiration
• Abdominal Aorta Angiography (Aortography)
• Selective abdominal arteriography


  Procedure to investigate specific abdominal arteries
• Types of selective abdominal arteriography

  • Celiac arteriogram
  • Hepatic arteriogram
  • Splenic arteriogram
  • Superior mesenteric arteriogram
  • Inferior mesenteric arteriogram
  • Renal arteriogram
  • Other abdominal arteriograms (spinal, lumbar, adrenal, phrenic)

  
• Celiac arteriogram


  1. Arises from the aorta at the level t12, supplies blood to the stomach and the prox. duodenum, liver, spleen, pancreas

  2. CR to l1

  3. Injection rate: 10ml/SEC for 40 ml

  4. 2 frames/seconds for 5 sec
• Hepatic arteriogram


  1. The common hepatic artery branches from the right side of the celiac artery, supplies blood to the liver, stomach, prox. duodenum and pancreas

  2. Position: upper and right margin of the liver centred to IR

  3. Inj. Rate of CM: 8ml/SEC (40-ml)

  4. 2 frames/sec for 5 second, followed by 1 frames/sec for 5 second

  
• Splenic arteriogram


  1. Splenic artery branches from the left side of the celiac artery, supplies blood to the spleen and pancreas

  2. Splenic artery injection delay demonstrates the portal venous system

  3. Inj. Rate of CM: 8 ml/SEC (40-ml)

  4. 2 frames/sec for 5 second, followed by 1/frames/second for 5 second

  5. Portal vein: 1 frames/sec for 20 second after arterial phase
• Superior mesenteric arteriogram


  1. Arises at about the level of L1 and descends to L5-S1, supplies blood to the small intestine and the ascending and transverse colon

  2. Center the patient to the IR

  3. CR at the L3

  4. 8ml/sec (50-ml)

  5. 2 frames/sec for 5 second, followed by 1/frame/sec for 5 second

  6. To visualise bleeding: 1/frames/sec for 18 second

  
• Inferior mesenteric arteriogram


  1. IMA arises from the left side of aorta at about the level of L3 and descends into the pelvis, supplies blood to the splenix flexure, descending colon and rectosigmoid area

  2. Projection: 15° RAO/LPO

  3. 3 ml/sec (15 ml)

  4. 2 frames/sec for 5 second, followed by 1/frame/sec for 5 second

  5. To visualise bleeding: 1/frames/sec for 18 second

  
• Renal arteriogram


  1. Arises from the right and left side of the aorta between L1 and L2, supplies blood to respective kidney

  2. Check the IVU film/do renal flush arteriogram for the exact location and size of the kidney (Precise collimation)

  3. 25 ml/Sec (40-ml) : Renal flush (Multiple side hole catheter)

  4. 8 ml/Sec (12 ml) For a representative selective injection

  5. 3 frames/sec for 3 second, followed by 1@ 2/frames/sec for 5-10 second (Nephrogram images)
• Positioning for right renal arteriogram

  CR at the level of L2 midway between the center of the spine and the patient's right side

  
• Positioning for left renal arteriogram

  CR at the level of L1 midway between the center of the spine and the patient's left side

  
• Selective IMA


  1. Selective abdominal arteriography

  2. Renal arteriogram

  
• Renal arteriogram


  • Arises from the right and left side of the aorta between L1 and L2
  • Supplies blood to respective kidney
• Renal arteriogram


  1. Check the IVU film/do renal flush arteriogram for the exact location and size of the kidney

  2. Renal flush (25 ml/Sec, 40-ml)

  3. Selective injection (8 ml/Sec, 12 ml)

  4. Nephrogram images (3 frames/sec for 3 second, followed by 1@ 2/frames/sec for 5-10 second)
• Peripheral vascular procedures


  1. Also called peripheral angiography/arteriogram

  2. To see the arteries in the hands, arms, feet, or legs

  3. Find narrowed or blocked areas in one or more of the arteries that supply blood to your legs

  
• Peripheral arterial disease (PAD)


  • Comprises a host of noncoronary arterial syndromes due to various pathophysiological mechanisms resulting in stenosis or aneurysms in various vascular beds
  • Atherosclerosis remains by far the most common cause of this disease process
• In spite of tremendous improvements in noninvasive imaging, catheter-based invasive iodine contrast catheter angiography remains the gold standard for the diagnosis of PAD in patients considered for endovascular intervention
• Peripheral arterial disease (PAD)


  Occurs when atherosclerosis, or hardening of the arteries, causes a buildup of plaque in the blood vessels that carry oxygen and nutrients to all the tissues of the body
• Peripheral angiography


  Involves demonstration of the circulation of the upper and lower extremities

  
• Purposes of arteriography of the extremities

  • Identify embolism
  • Identify aneurysm
  • Identify arterial injury
  • Identify bone and soft tissue lesion
  • Identify atherosclerotic vascular

  
• Deep Vein Thrombosis (DVT)


  • A blood clot in a deep vein of the leg, pelvis, and sometimes arm
  • Occurs when your blood thickens in a clump that becomes solid, forming a clot
• Superficial thrombophlebitis


  An inflammation of a vein just below the surface of the skin, which results from a blood clot
• Arm arterial disease


  • Includes arm claudication, steal syndrome, peripheral vascular disease, upper extremity arterial disease
  • Typically, blockages in your arm arteries occur when blood clots float there from your heart or from an injured artery within your chest