Angiography practical

Patient preparation:
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The pt should be in- patient in the hospital lab test should be done: creatinine , KFT ,PT (Prothrombin time ),PTT(Partial thromboplastin 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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` 1. 2. 3. 4. 5. 6. 7.

Use the seldinger technique : Insert the needle 45 toward the head Insert the wire sheeth Draw needle wire fixed Dilation ( dilator + sheeth) Draw wire and dilator Sheeth fixed has two open Guide wire and catheters are inserted

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 trunk 3. Super selective : from celiac trunk to splenic artery
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Vascular angiogram :
A.
a.
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Diagnostic (cerebral vascular structures)
4 Vessel angiogram
Right and left vertebral arteries Right and left common carotid arteries

b.

Venogram

B.
a. b. c. d.

Therapeutic
Aneurysm embolisation AVM embolisation Angioplasty Stenting

Angiography
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Type of contrast procedures : 1- vascular procedure ex : L.L Angio 2- non- vascular procedure Ex: nephrostomy , PCNL

Indications
A. B. C. D. E. F. G. H. I. J. K. L.

Cerebrovascular disease Carotid artery disease Cerebral thrombosis Cerebral embolism Cerebral haemorrhage Aneurysm AVM Congenital malformation Primary neoplasm Trauma Presurgical evaluation Postsurgical evaluation

Contraindications
A. B. C. D. E.

CM sensitivity Advanced arteriosclerosis Severe illness Severe hypertension Advanced age

PROCEDURE

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

Normal arch angiogram..

- 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

Anatomy cont d

Cerebral Angiography Showing Arterial Phase, Capillary Phase, and Venous Phase of Circulation

Neuroangiography Interventions
A.
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Decreasing blood flow
Aneurysm AVM Tumour

A. Decreasing Blood Flow
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Clipping
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Aneurysms

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Plugging the hole
Insertion of thrombogenic coils (aneurysms) Filling with glue (AVM)
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onyx (superglue)

Cerebral Aneurysm Clipping

Aneurysm

Clip

Guglielmi Detachable Coils (Aneurysm Occlusion)

Superglue Embolisation (Tumour)

Pre Embolization

Post Embolization

B. Increasing Blood Flow
1.
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Balloon Angioplasty
Carotid artery stenosis

2.
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Stent insertion
Carotid

3.
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Pharmacologic agents
Papaverine

Balloon Angioplasty and Stent Insertion

After balloon angioplasty & insertion of stent Stenosis

Vasospasm and Papaverine

Pre

Post

Lower limb angiogram
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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

Flush aortogram Rt 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 femoral artery(CFA) 15-20 ml with 10-15 ml /sec The 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 popliteal artery (AP VIEW ) The popliteal artery branches into anterior tibial artery , and tibioperonial trunk which divides into posterior tibial and peronial arteries

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Subtracted Images Mask Images

After care
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Firm pressure over puncture site for 15 min. Patient moved back to bed for 6 hrs.
Puncture site must not be bent: leg straight

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Patient to ward
BP/resp/puncture site obs
¼ hr for 2 hrs ` Hourly for 4 hours The pt should drink fluids
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