INTERVETIONAL

RADIOLOGY
Presentation by;
DDAMULIRA DEO
AINEMBABAZI GIFT RIHANNAH
Objectives
1. Describe the measures used to provide
radiation protection for patients and
personnel during interventional radiology.
2. Discuss the advantages that nonionic (water-
soluble) contrast media offer over ionic
contrast media.
3. Identify the risks of arteriography.
INTRODUCTION
The rapid development of vascular imaging
and aggressive therapeutic intervention
through vessels has resulted in rooms and
equipment designed especially for
interventional radiologic procedures.
Interventional therapeutic procedures that are
conducted in and through vessels are;
Angioplasty, thrombolysis, embolization,
vascular stents, and biopsy.
Types of interventional procedures
ANGIOGRAPHY
 Began in the 1930s with angiography. Needles
and contrast media were used to enter and high
light an artery.
Definition.
Refers to the opacification of vessels through
injection of contrast media.
Or
Refers to the many ways of imaging contrast-filled
vessels.
Types of angiography
 Trans brachial selective coronary angiography.
Is the entering select coronary arteries
through an artery of the arm.
 Transfemoral angiography. Is the entering an
artery in the thigh of selective visceral, heart,
and head arteries.
Basic principles
Arterial Access.
• Here a catheter is used
• The seldinger needle is an 18-gauge hollow
needle with a stylet.
• After the seldinger needle is inserted in the
femoral artery and pulsating arterial blood
returns, the sylet is removed
• A guide wire then is inserted through the
needle into the arterial lumen.
Conti…
• With the guide wire is the vessel, the seldinger
needle is removed and a catheter is threaded
onto the guide wire.
• Under fluoroscopic view, the catheter then is
advanced along the guide wire.
• In angiography, the common femoral artery is
most often used for arterial access.
Conti…
• The common femoral artery can be palpated
by locating the pulse in the groin below the
inguinal ligament, which passes between the
symphysis pubis and the anterior superior
illiac spine.
Guide wires.
• After the catheter is in place, the guide wire
allows the radiologist to position the catheter
within the vascular network.
• Guide wires are fabricated of stainless steel
and contain an inner core wire that is tapered
at the end to a soft, flexible tip.
• The core wire prevents loss of sections of the
wire if it breaks.
Conti…
• The trailing end of the guide wire is stiff and
allows the guide wire to be pushed and twisted
so the catheter can be positioned in the chosed
vessels.
• Guide wires allow the safe introduction of the
catheter into the vessel.
• Conventional guide wires are 145cm long
• Catheters overlying the guide wire are usually
100cm long or less.
Conti…
Conti…
Catheters
• Similar to guide wires, catheters are designed
in many different shapes and sizes
• Usually, catheter diameter is categorized in
French (Fr) sizes, with 3Fr equaling 1mm in
diameter.
• A catheter with side holes help reduce a
possible whiplash effect
Conti…
• The jet effect is minimized with the curve
pigtail, which prevents injury to the vessel.
• After the catheter is introduced into the
vessels, the guide wire is removed.
• The catheter then must be flushed immediately
to prevent clotting of blood with in the
catheter.
• Heparinized saline generally is used to flush
catheters.
Conti…
• After catheter placement, a test injection is
performed under fluoroscopy before static
imaging to check that the catheter tip is not
wedged and that it is in correct vessel.
• Injection rates of the automatic power injector
are gauged by the test flow speed.
Types of catheters
• Head hunter tip (H1)
• Simmons catheter
• Cobra catheter (C2)
• Pigtail catheter
Contrast media
• Vessels under investigation in angiography are
injected with radiopaque contrast media.
• Initially, ionic iodine compounds were used for
contrast injections, however nonionic contrast
media have largely replaced ionic agents
• Because of their low concentration of ions (low
osmolality), physiologic problems and adverse
reactions are reduced for patients undergoing
angiographic injection with nonionic contrast
media.
Patient preparation and monitoring
• Before angiography is performed, the
radiologist visits the patient to establish
rapport and to explain the procedure and
risks.
• A history and physical examination are
necessary to assess the patient for allergies
and other conditions.
Conti…
• During the procedure, monitoring by
electrocardiography, automatic blood pressure
measurement, and pulse oximetry is
mandatory.
• After the procedure has been performed,
when the catheter is removed, the femoral
puncture site must be manually compressed.
Conti..
• The patient then is instructed to remain
immobile for several hours after the
angiographic procedure has been completed
while vital signs are monitored and the
puncture site inspected.
Risk of Arteriography.
• Continued bleeding at the puncture site
• Blood clot formation
• Guide wire penetrating injury can occur