Roentgen of vessels (arteries)

Radiation angiology and radiation vascular surgery have grown into a vast discipline, developing at the intersection of medical radiology and surgery. The successes of this discipline are related to four factors:

1. Radiation examination is available to all arteries, all veins and venous sinuses, all lymphatic ways;
2. for the study of the vascular system, all radiation methods can be used: X-ray, radionuclide, magnetic resonance, ultrasound, and this makes it possible to compare their data, in which they mutually complement each other;
3. ray methods provide a conjugate study of the morphology of blood vessels and blood flow in them;
4. under the control of radial methods, various therapeutic manipulations on vessels can be performed (X-ray and endovascular interventions). They represent an alternative to surgical operations in a number of pathological conditions of the vessels.

Thoracic aorta

On the radiographs, the shade of the ascending aorta, its arcs and the beginning of the descending part are well distinguished. In the nadklapannom department, its caliber reaches 4 cm, and then gradually decreases, making an average of 2.5 cm in the descending part. The length of the ascending part varies from 8 to 11 cm, and the length of the arch of the aorta varies from 5 to 6 cm. The upper point of the arc on the roentgenogram is 2 - 3 cm below the jugular breaststroke. The shadow of the aorta is intense, uniform, its contours are even.

Ultrasound examination makes it possible to assess the thickness of the aortic wall (normal 0.2-0.3 cm), the speed and nature of the blood movement in it. CT allows you to see not only the aorta, but also the sphenoidal trunk, the left common carotid artery and the left subclavian artery, as well as the right common carotid and subclavian arteries, both brachiocephalic veins, both hollow veins, internal jugular veins leaving its arc. The possibilities of CT in the visualization of the aorta have significantly expanded with the introduction into medical practice of spiral computer tomographs. On these devices, a three-dimensional reconstruction of the image of the aorta and its large branches became available. Particularly notable are the possibilities of MRI.

Atherosclerotic lesions of the aorta in routine clinical practice can be assumed already on the basis of the results of a review X-ray study. Atherosclerosis of the aorta is indicated by its enlargement and elongation, clearly visible on the chest radiograph. The upper pole of the arch of the aorta is located at the level of the jugular notch, and the duvet itself is strongly curved to the left. The elongated aorta forms bends, also clearly visible on radiographs. The bends of the descending part of the aorta can squeeze and push back the esophagus, which is determined by its artificial contrasting. Lime deposits are often detected in the walls of the aorta.

X-ray is a reliable means of detecting an aneurysm of the ascending aorta. Aneurysm has the appearance of a round, oval or irregular shape, inseparable from the aorta. Sonography is important in the diagnosis of aortic aneurysm. With the help of CT and MRI it is possible to clarify its relationship with surrounding organs, the condition of the aneurysm wall, including the possibility of exfoliating aneurysm, to establish thrombosis of the aneurysmal sac. With even more detail, all these signs are determined in conditions of artificial contrasting of the aorta - aortography.

However, aortography is especially needed to study the brachiocephalic trunk and brachiocephalic branches of the aorta in order to diagnose, in general, vascular anomalies that are common in this area, as well as occlusive lesions, i.e. Vasoconstriction due to arteritis or atherosclerosis.

Abdominal aorta and arteries of extremities

On ordinary radiographs, the abdominal aorta and the arteries of the extremities do not give an image. They can be seen only when lime is deposited in their walls, so the main value in the study of this part of the vascular system is sonography and Doppler mapping. Important diagnostic information is obtained with CT and MRI. In some cases, preference is given to the invasive technique - aortography.

On sonograms, a direct image of the abdominal aorta and large arteries is achieved. They can be used to judge the position, shape and shape of the aorta, the thickness of its walls, the size of the lumen, the presence in it of atheromatous plaques and thrombi, and detachment of the intima. Local narrowing and expansion of the vessel are clearly visible. Important importance is given to sonographies when examining patients with an aneurysm of the abdominal aorta. With this method, it is easy to determine the diameter of the aneurysm, which is of decisive prognostic value. So, aneurysms with a diameter of more than 4 cm are an indication for surgical treatment, since at such sizes of an aneurysm the probability of its rupture increases. Similar morphological data can be obtained with the help of other non-invasive techniques - CT and MRI.

MRT in recent years has taken a firm place in the examination of patients with peripheral vascular disease. Modern mid-field and especially high-field tomographs make it possible to obtain a non-invasive image of the vascular bed of all parts of the body, up to medium-sized vessels, and the use of contrast agents opened the way for MRI to visualize rather small arteries - up to 5-6 caliber and volumetric reconstruction of the vascular bed (MR angiography).

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

Angioscintigraphy

A definite value in the diagnosis of lesions of arterial vessels is their radionuclide imaging - angioscintigraphy.

The technique is non-invasive, can be used in outpatient settings in outpatients, and causes a low radiation load. In general, this method can be used as screening for the selection of patients for invasive studies, such as, for example, X-ray angiography.

[6], [7]

Aortography

A crucial role in assessing the condition of the abdominal aorta and ileum-femoral segments, especially when planning surgical or X-ray endovascular intervention, is played by aortography.

The study is performed by transluminal puncture of the aorta or its catheterization by a retrograde route from the peripheral artery (most often femur). In any case, it is necessary to obtain an image of the entire abdominal aorta, pelvic arteries and both lower extremities, since the classical sites of atherosclerotic lesion are the aortic bifurcation region, ileal vessels, femoral arteries, the region of the adductor channel (middle and distal parts of the thigh).

The shadow of the normal aorta has the form of a band gradually tapering downward, located anterior to the spine and somewhat to the left of the midline of the body. At the level of the renal arteries, there is a physiological decrease in the aortic lumen. The distal diameter of the aorta in an adult is an average of 1.7 cm. A number of branches extend to the abdominal organs from the aorta. At the lower end of the body, the LV aorta is divided into common iliac arteries. Those in turn are divided into external and internal iliac arteries. The first directly pass into the femoral arteries.

Like the abdominal aorta, and its large branches in a healthy person have clear and even outlines. Their caliber gradually decreases in the distal direction. Atherosclerosis initially causes rectification of the vessel and its moderate expansion, but as the sclerosis increases, a tortuous vessel arises, the unevenness, the waviness of its outlines, the unevenness of the lumen, the flaws of the contour in the sites of atherosclerotic plaques. In the case of aortoarteritis, narrowing of the vessel predominates with relatively smooth contours of it. Before the narrowed section, the vessel is enlarged. In connection with the violation of blood flow in occlusive lesions, the development of the collateral network of vessels is revealed, which also clearly appears on arteriograms and in magnetic resonance angiography. Disorders of blood flow in the arteries are demonstratively determined in dopplerography with color mapping. When a thrombus is found in the artery, the question of thrombectomy with the use of a hydrodynamic catheter and subsequent installation of a stent coated with polytetrafluoroethylene is considered.

[8], [9], [10]