Angiography

The usual radiographs do not produce an image of the arteries, veins and lymph vessels, as they absorb X-rays in the same way as the surrounding tissues. An exception are arteries and lung veins, which appear as branching dark strips against the background of light pulmonary fields. In addition, in patients with atherosclerosis, mainly elderly and senile, deposits of lime in the walls of the vessels are observed, and these calcareous plaques are clearly visible in the pictures.

Angiography - X-ray examination of blood vessels, produced with the use of contrast agents.

For artificial contrasting, a solution of the organic iodine compound intended for this purpose is injected into the blood and lymphatic channels. Depending on what part of the vascular system is contrasted, distinguish arteriography, venography (phlebography) and lymphography.

Angiography is performed only after a general clinical examination and only in cases when it is not possible to diagnose the disease with the help of non-invasive methods and it is supposed that on the basis of a picture of the vessels or the study of blood flow it is possible to detect the damage of the vessels themselves or their changes in diseases of other organs. However, it should be remembered that angiography is an invasive study associated with the possibility of complications and with a rather significant radiation load.

Angiography is used to study hemodynamics and identify proper vascular pathology, diagnose injuries and malformations of organs, recognize inflammatory, dystrophic and tumor lesions that cause impairment of vascular function and morphology. Angiography is a necessary stage in the conduct of endovascular operations.

Contraindications to angiography are extremely serious condition of the patient, acute infectious, inflammatory and mental diseases, severe cardiac, hepatic and renal insufficiency, increased sensitivity to iodine preparations.

The possibility of idiosyncrasy to iodine is clarified during the interview of the patient prior to the study, and also by conducting a sample for the sensitivity to the iodide drug that is going to be used. To do this, the patient is injected intravenously with 1-2 ml of contrast medium. Symptoms of an allergic reaction include headache, nausea, pruritus, hives, conjunctivitis, rhinitis, and heart rhythm disturbances.

Before the examination, the doctor should explain to the patient the necessity and nature of the procedure and obtain his consent to conduct it. In the evening on the eve of angiography, tranquilizers are prescribed. In the morning they cancel breakfast. In the field of a puncture shave hair. 30 minutes prior to the study, premedication is performed (antihistamines, tranquilizers, analgesics).

Arteriography is performed by puncture the vessel or its catheterization. Puncture is used in the study of carotid arteries, arteries and veins of the lower extremities, the abdominal aorta and its large branches. However, the main method of angiography at present is, of course, the catheterization of the vessel, which is performed according to the procedure developed by the Swedish doctor Sel'dinger.

A favorite place for catheterization is the area of the femoral artery. The patient is placed on his back. The operating field is treated and delimited with sterile sheets. A throbbing femoral artery is probed. After local paravasal anesthesia, a 0.5% solution of novocaine makes a cut of the skin 0.3-0.4 cm long. From this, a narrow path to the artery is inserted through a blunt path. In the move, with a slight inclination, a special needle with a wide opening is inserted. It is pierced by the wall of the artery, after which the stitching stylus is removed. Pulling the needle, localize its end in the lumen of the artery. At this moment a strong stream of blood appears from the pavilion of the needle. A metal conductor is inserted through the needle into the artery, which is then advanced to the internal and general iliac artery and aorta to the selected level. The needle is removed, and a radiopaque catheter is inserted into the necessary point of the arterial system along the conductor. His progress is observed on the display. After removing the conductor, the free (external) end of the catheter is connected to the adapter and the catheter is immediately washed with an isotonic sodium chloride solution with heparin.

All manipulations in angiography are carried out under the control of X-ray television. Participants in the catheterization work in protective aprons, on top of which are put on sterile gowns. During the angiography, the patient is constantly monitored.

Through the catheter, a contrast agent is injected into the test artery with an automatic syringe (injector) under pressure. At the same time, high-speed x-ray photography begins. Her program - the number and time of taking pictures - is installed on the device's control panel. Pictures immediately show. Convinced of the success of the study, the catheter is removed. The puncture site is pressed for 8 to 10 minutes to stop bleeding. On the puncture area for a day, a pressure bandage is applied. Patient for the same period prescribed bed rest. After a day, the bandage is replaced with an aseptic sticker. The patient is constantly monitored by the attending physician. Obligatory measurement of body temperature and inspection of the site of surgery.

The most common complication of angiography is the development of a hematoma in the area of catheterization, where a swelling appears. She is treated conservatively. A serious, but fortunately, rare complication is the thromboembolism of the peripheral artery, which is indicated by ischemia of the extremity.

[1], [2], [3], [4], [5]