LIMB ANGIO Flashcards
What are the clinical indications of upper limb arteriography?
- traumatic injury
- bypass graft planning
- atherosclerotic disease
- acute limb ischemia
- vascular anomalies
What are the contraindications of upper limb arteriography?
- Patient history of severe or anaphylactic reaction to iodinated
contrast - Patients with renal disease (eGFR <
50mL/min) - Severe anemia
Approaches of upper limb arteriography?
-femoral artery site
- direct brachial artery
devices/equipment to be used in upper limb arteriography
- Catheter (Headhunter, a sidewinder Ducor catheter)
- Needles and Guidewires
- Local Anaesthetic (10 ml. 1% lidocaine)
- Fluoroscopy Machine
Contrast media used in upper limb arteriography
Low osmolality contrast material
- Isopaque Cerebral
- Hexabrix
- Telebrix 30
Procedure for upper limb arteriography
- Patients shouldn’t be dehydrated but food withheld for 6-10 hrs before the exam
- Patient will take a blood test
- Ask the patient allergies and medications
- Undress and put a hospital gown
- Apply local anesthesia
- Position hand flat on a padded arm board in an anatomic position
- Introduce catheter in transfemoral approach
- Administer heparin
- For the left subclavian artery, simply turn the tip of the catheter to the left, craniolateral with respect to the aortic arch.
- For the right subclavian artery, the catheter has to be advanced into the ascending aorta.
- contrast dye is injected into the catheter and take some X-ray scans.
- The injection varies from 3 or 4 ml/sec through a catheter positioned
distally to 10 ml/sec through a proximally positioned catheter.
During the direct brachial angio, where will be the incision made?
antecubital fossa
Complications during/after upper limb arteriography
- Involuntary movement on the part of the arterial injection of the contrast media
- Complications caused by the neurotoxic effect of contrast media
- Bleeding at the puncture site
- injury of the intima
- a pseudo-aneurysm or - A-V fistula at the puncture site
- thrombosis
- impaired circulation
Clinical indications of lower limb arteriography
- Chronic Ischemia (intermittent claudication, rest pain and ulceration)
- Acute Ischemia
- Peripheral Arterial Disease
Contraindications of lower limb arteriography
- Patient history of severe or anaphylactic reaction to iodinated contrast
- Patients with renal disease (eGFR < 50mL/min)
- Severe anemia
approach of lower limb arteriography
femoral
DEVICES/EQUIPMENTS TO BE USED IN LOWER LIMB ARTERIOGRAPHY
- Catheter: pigtail or straight
- Syringe and needle
- Fluoroscopy Machine
- Local anesthetic
- Guidewire
Contrast media used in lower limb arteriography
Use iso-osmolar contrast in
patients with critical ischemia. This reduces the pain/ heat associated with contrast injection
Complications in lower limb arteriography
- Hemorrhage
- Artery dissection
- Bleeding and infection at the puncture site
- Arterial thrombus
- Guidewire breakage
- Pseudoaneuryms
- Allergic reaction to contrast media
clinical indications during upper limb venography
- Edema
- demonstrate the site of venous occlusion or stenosis
- Superior vena cava obstruction
- Congenital abnormality of the venous system