Imaging used in vascular surgery

Question 1

What imaging is uses in vascular surgery?

Answer 1

• Ultrasound
• CT angiogram
• MR angiogram
• Digital Subtraction angiogram

Question 2

What is the role of vascular imaging?

Answer 2

• Confirm diagnosis - Used in vascular patients if there is difference in symptoms and what is found in examination
• Plan treatment
• Surveilance - Monitor a particular condition overtime
• Follow up

Question 3

What is the advantages of imaging in ultrasound?

Answer 3

• Safe
• Low cost
• Best for imaging - good for dynamic real time assesment of blood flow
• Quick

Question 4

What are the indications of ultrasound

Answer 4

• Percutaneous access - Use of needle.
• Access diameters of blood vessel - check how big the blood vessels are, get an idea of someones vein
• Access Atheroclerosis - Check appearance of plaque, colour doppler can check degree of narrowing
• Access dynamic blood flow of veins. - Check which sections of the vein are affected
• Diagnosis +/- treatment of pseudoaneurysm
• Graft surveillance - if operation is done to patient ultrasound is used to check the patient afterwards.

Question 5

What are the disadvantages of ultrasound?

Answer 5

• Operator dependant - the way the hold and move the probe is dependant for how the image turns out
• Image quality may be limited

Question 6

What are the advanatges of CT?

Answer 6

• Widely available, 24/7
• Quick scan to perform
• Provides useful information about blood vessels, surrounding structures. (Precise anatomical details), diagnosis range of vascular patholgies, may show incidental or alternative diagnosis.

Question 7

What is CT used for?

Answer 7

• used in bleeding patients
• Stenosis or occlusion
• Anatomical abnormalities - anyerusm and disection

Question 8

What are the diadvantages of CT?

Answer 8

• Artefact - obliterates what is seen in surround vessels and tissue. Such as metal obstruction in patient
• Over estimation of calcification - may appear worse than it is
• Poor differntiation of disease in crural vessles - difficult to differentiate between vessles

Question 9

What are the advantages of MRI?

Answer 9

Luminal flow is highlited within vessels - crural vessels

Question 10

What are the disadvantages of MRI?

Answer 10

• Not suitable for patients with metal work
• Not readily available
• Patients can find very claustrophobic
• Not suitable for patients with poor renal function

Question 11

What are the advanatges of DSA?

Answer 11

Angiolpasty can be followed up with the sent. Treatment is done in the same sitting

Question 12

What are the disadvantages of DSA?

Answer 12

• Invasive - pseudoanyerusm, bleeding, dissection and distal embolism
• Contrast - allergic reactions, nephropathy
• Ionising radiation - skin reaction or theoretical risk of cancer
• Patient position - Include need to lie still with legs up in bed. Need to be able to tolerate this.