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Interventional Basics
How do we perform an angiographic
procedure?
Dr. ABEER FAWZY EL-SOBKY
MASTER of RADIOLOGY
Types of angiography
Conventional
angiography
Digital
subtraction
The bony
skeleton is
subtracted
CT
angiography
Vascular 2007
MR
angiography
Index
Technique
of
angiography
on the procedure
Technologist Responsibilities
Prepare Room/ consent forms
Provide radiographic positioning / Dr Assistance
Knowledge of exam, anatomy, pathology
Prepare sterile tray, prep patient
Knowledge of catheters and guide wires
Know sterile technique/ safe clean up
Monitor ECG + pressure
Patient care skills and pharmacology
Angiography/ Interventional/
Cardiovascular
Procedure Room
(Suite)
Control Room
sequences
Use smallest possible focal spot
Equipment Requirements
High heat load tubes w/ rapid cooling
system
PACS
Electromagnetic Injectors
Monitoring Equipment- BP & ECG
Island Tables- access from all sides,
process
Digital- image manipulated by software
Digital Subtraction
Angiography (DSA)
Computer subtracts out all anatomy
( clots, constrictions)
Electromechanical Injector
Used in Angio, CT, MRI
Overcome arterial pressure + maintains
bolus
Maintains flow rate
Flow rate affected by
Viscosity
Length + diameter catheter
Injection pressure
Vessel selected
Seldinger Technique
Method for catheterization of vessels
Developed 1950s still popular today
Percutaneous (through the skin)
Selection based on
strong pulse w/
absence of disease
Site cleaned, area
draped, local given
cm
Removal of Needle- guide wire in position
Threading of catheter to area of Interest- fluoro
used
Removal of guide wire- catheter remains in
place
SELDINGER TECHNIQUE
lock)
Baseplate
transparent tubing
Guidewires
Guide catheter for placement in vessel
Guide wire diameter be large enough so blood
Straight
J- tipped
GUIDEWIRES
CATHETERS
Straight- end hole only
Pigtail- circular tip w/ multiple side
holes to reduce whiplash and control
contrast
Sidewinder- curved to facilitate vessel
selection
Cobra- variation in curvature to facilitate
selection of vessels
CATHETERS
Interventional Imaging
Procedures
Intervene w/ disease, provide
therapeutic outcome
Purpose/ benefits
Preparation to procedure
Anti coagulants- what do these do?
Consent form
NPO 8 hours
Lab tests to test kidney function?
applied
Bed rest- min 4 hrs/ head elevated 30
degrees
Vital signs
Extremity watch
Radiation Protection
> radiation dose to angio team- fluoro
Proximity to patient
Radiation protection devices
Leaded glasses pulled into place
Minimal fluoro use as possible
Collimation
Angio personnel wear badges and ring
monitors
Contra Indications
Contrast allergy
Impaired renal function
Blood- clotting disorders
Anti coagulant medication
Unstable cardio pulmonary/ neurological
status
Risks/ Complications
Bleeding at puncture site
Thrombus formation
Embolus formation plaque dislodged