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Angiography
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Angiography is the examination of the blood vessels using x-rays following the injection of a radiopaque substance
Global Management of Concomitant Peripheral Vascular and Coronary Artery Diseases: The Role of the Invasive Cardiologist
Background. Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global management of patients with known coronary artery disease (CAD). We sought to retrospectively evaluate the role of the invasive cardiologist in the diagnosis and management of clinical relevance significant subclavian artery stenosis (SAS) and abdominal vessel stenosis or aneurysm (AVA) diagnosed by coincident peripheral angiography in patients undergoing coronary angiography in whom CAD is detected. Methods. Medical records of consecutive patients underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients underwent coincident diagnostic abdominal aorta angiography to evaluate abdominal vessels or subclavian angiography on the basis of clinical and angiographic criteria were analyzed. Results. During the study period, 724 consecutive patients (535 males, mean age 68.1± 11 years) were enrolled (Table 2). A significant atherosclerotic disease of at least one arterial segment was observed in 198 patients (27.3%). Angiographically significant SAS was observed in 18/220 patients (8.1%) undergoing concomitant subclavian artery angiography and candidates to coronary surgery using the internal mammary artery. AVA was reported in 180 (35.7%) of 504 consecutive patients; renal artery stenosis was found in 13.1% of cases (66 patients), aortoiliac artery disease in 13.7% (69 patients), and aortic aneurismal disease in 8.9% (45 patients). Logistic regression analyses revealed >3-vessel CAD (odds ratio[OR] 9.917 , p=0.002), age >60 years old (OR 3.817, p=0.036), >3 risk factors (OR 2.8, p=0.048) as independent predictors of SAS and AVA. Conclusion. The role of the invasive cardiologist and coincident peripheral angiography in the management of patients with multivessel CAD and concomitant PVD seems not to be trivial due to the high prevalence of PVD in aged patients with multivessel CAD. It suggests t
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Diagnostic Angiography of Specific Vascular Territories
The most common variant location for gonadal artery origins is the renal arteries (20%), followed by the adrenal, lumbar, or even iliac arteries. In a small percentage of patients, the lower anterior spinal artery (artery of Adamkiewicz) will arise from the L1 or L2 lumbar artery. If the accessory renal artery is of similar caliber to the main renal artery, thus supplying a large portion of the renal blood supply, revascularization of the stenosed accessory renal arteries can be justified.
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Inaccurate Ultrasound Assessment of Internal Carotid Disease in Patients with Carotid Artery Disease and Aortic Valve Stenosis Candidates to Endovascular Carotid Stenting and Cardiac Surgery
Purpose. The association of internal carotid artery disease (ICAD) with aortic valve stenosis (AVS) constitutes a very high-risk clinical occurrence in which combined surgery may increase the operative risks. Therefore, carotid stenting before or after cardiac surgery may be a valuable option. Unfortunately, in patients with aortic valve stenosis (AVS), the evaluation of carotid arteries by Doppler ultrasound (DUS) may be inaccurate. The present retrospective study is aimed to evaluate the pitfalls of DUS and the role of carotid angiography in evaluating ICAD in patients with AVS. Methods. We analyzed the clinical, hemodynamic and angiographic findings of 200 patients with moderate to severe AVS (5.5% of 3600 patients undewent cardiac catheterization, mean age 68.5 ± 10.6 years) investigated in our institution over the past 2 years. Patients with moderate to severe AVS, candidates for open cardiac surgery, underwent carotid ultrasonography to assess ICAD and complete left and right catheterization with coronary artery angiography. In case of doubtful carotid artery sonography, the patients also underwent carotid artery angiography at the time of complete cardiac catheterization before confirming the indication to carotid stenting or combined surgery. Results. Seventy patients with moderate to severe AVS and doubtful carotid ultrasonography underwent coincident carotid angiography. The use of suboptimal Doppler ultrasonographic examinations are related to the anatomical or difficult evaluation of Doppler flow due to hemodynamic influences of aortic valve stenosis. On carotid angiography, 20 patients (28.5%, male/female: 8/12, mean age 72.1 + 5.1 years) were diagnosed with critical stenosis of one (16 patients) or both (4 patients) internal carotid arteries. In 5 patients, a significant ICAD was not diagnosed by DUS, whereas in 7 patients the stenosis was underestimated by DUS (mean luminal narrowing 58 + 12.7% versus 76.7 + 19.3%, p<0.03), and in the other 8, DUS overestimated ICA
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Image Guidance of Percutaneous Coronary and Structural Heart Disease Interventions Using a Computed Tomography and Fluoroscopy Integration
Standard angiography (SA) of the coronary vasculature and heart structures is limited by its two-dimensional (2-D) projection of complex three-dimensional (3-D) structures. The use of angiography and fluoroscopy results in imaging artifacts and procedural limitations that makes some interventions difficult. The introduction of 3-D imaging technologies paves the way to a more precise and thorough evaluation of complex structures. Computerized tomographic angiography (CTA) and X-ray based innovative 3-D reconstruction fusion software are major advances in cardiovascular imaging. These imaging techniques provide a 3-D vessel representation and enable the subsequent analysis of 3-D properties with important clinical implications. This review will focus on novel X-ray/CT image fusion techniques that allow for guidance of percutaneous coronary and structural heart disease interventions off- and online.
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Diagnosis and Non-Surgical Management of Mesenteric Ischemia
Diagnosis and Non-Surgical Management of Mesenteric Ischemia Feature: Diagnosis and Non-Surgical Management of Mesenteric Ischemia - Jaffar Ali Raza, MD, Michael Miller, MD, ?Robert S. Dieter, MD, RVT, ?? Acute mesenteric ischemia (AMI) is further subdivided into occlusive and nonocclusive mesenteric ischemia. 52 Patients with peritoneal signs and documented thrombosis with mesenteric ischemia, infarction, bowel ischemia and bowel infarction require laparotomy for possible thrombectomy and ...
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Brachiocephalic and Vertebral Arteriography: Technical Considerations
4). This will maximize the visualization of bilateral common carotid artery, bilateral vertebral artery, as well as carotid bifurcations. Usually the tip of the selective catheter goes into the innominate or the left subclavian artery during the manipulation of the catheter in the arch to gain access to the left common carotid artery. 14). Vertebral Catheterization Evaluation of the vertebral artery may be necessary for vertebrobasilar insufficiency or assessing collateral circulation in ...
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Multidetector Computerized Tomography for the Evaluation of Crebrovascular Disease: A Case Study
The study identified several relevant findings, including an aberrant origin of the left vertebral artery from the aortic arch (Figure 1a) with moderate to severe origin stenosis (Figure 1b); right internal carotid artery occlusion (Figure 2a); 60% stenosis of the left internal carotid artery (Figure 3a) and severe basilar artery stenosis (Figure 4a). The angiogram confirmed right internal carotid artery occlusion (Figure 2b), left internal carotid stenosis (Figure 3b) and severe long ...
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Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insufficiency in Patients wth Peripheral Arterial Disease
Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insufficiency in Patients wth Peripheral Arterial Disease Feature: Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insufficiency in Patients wth Peripheral Arterial Disease - David E. Allie, MD, Chris J. Herbert, RT, RCIS, and Craig M. Walker, MD It is currently estimated that in the United ...
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Perforation of External Carotid Artery Branch Arteries during Endoluminal Carotid Revascularization Procedures: Consequences and Management
The purpose of this article is to describe several inadvertent perforations of external carotid artery branches that occurred in our laboratory during planned carotid artery stenting procedures. When known, the mechanism of the perforation is described. The treatment of these complications is discussed, along with a more general discussion of potential embolic materials. Perforation of branch arteries within the external carotid artery territory during planned carotid revascularization is an uncommon but potentially life-threatening complication. This complication can occur as a result of wire or catheter placement into these vessels. Early recognition of the perforation, prompt treatment of the bleeding, and control of the patient?s airway are necessary to avoid a potentially catastrophic outcome.
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Use of a Disposable Radiation Protective Table for Reducing Operator Radiation Exposure during Cardiovascular Angiographic Procedures
Background: The purpose of this study was to determine the effectiveness of a side shield radiation protection method designed to decrease the scatter radiation exposure experienced by operators during cardiac catheterization procedures. Methods and Results: The study included 50 patients undergoing diagnostic cardiac catheterization. Scatter radiation exposure was measured directly with silicone diode dosimeters. Radiation doses were measured outside of protective lead draping worn by the operators at the abdominal and thyroid levels. The mean fluoroscopy times were similar between the control group, 1.86 (± 1.27) minutes and the protected group, 2.47 (± 1.90) minutes. The number of recorded cine angiographic runs was also the same at 10.36 (± 2.86) and 10.29 (± 2.35), respectively. The mean waist exposures utilizing the radiation protection method were reduced by 54%, p < .007 and the mean thyroid exposure were reduced by 8%, p = non significant. Conclusions: The use of this radiation protection method can lead to significantly lower scatter radiation exposure experienced by operators during radiation-based fluoroscopic procedures. Use of this type of shielding should be considered as an additional method in keeping with the as low as reasonably achievable (ALARA) concept for reducing occupational radiation exposure by healthcare workers.
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