Limb Angiography Flashcards
Upper Limb Arteriography
Clinical Indications and contraindications
Clinical indications
traumatic injury
bypass graft planning
atherosclerotic disease
acute limb ischemia
vascular anomalies
Contraindications
Patient history of severe or
anaphylactic reaction to iodinated
contrast
Patients with renal disease (eGFR <
50mL/min)
Severe anemia
Approaches for Upper Limb Arteriography
Femoral artery site for selective injection into the subclavian or axillary artery
Direct Branchial Artery
Devices or equipment to be used for upper limb angiography
Catheter (Headhunter, a sidewinder Ducor
catheter)
Needles and Guidewires
Local Anaesthetic (10 ml. 1% lidocaine)
Fluoroscopy Machine
Contrast Media for upper limb Angiography
Low osmolality contrast material
- Isopaque Cerebral
- Hexabrix
- Telebrix
Complications after/during Procedure
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
After care for upper limb Angiography
The patient is advised not to bend the limb for 24hours.
Patient must remain at least several hours in hospital and, particularly for the first two hours, is watched closely for any evidence of bleeding or other complications
Lower Limb Arteriography
Clinical Indications
Chronic Ischemia (intermittent claudication, rest pain and ulceration)
Acute Ischemia
Peripheral Arterial Disease
Lower Limb Arteriography
Contraindications
Patient history of severe or anaphylactic reaction to iodinated contrast
Patients with renal disease (eGFR < 50mL/min)
Severe anemia
Lower Limb Arteriography
Approaches
Use a femoral route.
Lowe Limb Arteriography
Devices/Equipment to be used
Catheter: pigtail or straight
Syringe and needle
Fluoroscopy Machine
Local anesthetic
Guidewire
LLA Contrast Media
Use iso-osmolar contrast in
patients with critical ischaemia.
This reduces the
pain/ heat associated with
contrast injection.
Before the arteriogram takes place the patient will need to
have a blood test
The patient will be asked about his/her medications and if
he/she has allergies.
The patient will be asked to undress and put on a hospital
gown.
The patient lies down to the fluoroscopy table.
The femoral region of the symptomatic leg is cleansed and the
sterile drapes are applied.
Using aseptic technique, local anesthesia is infiltrated at the
puncture site.
After puncture of artery, stylet of needle is removed and the
needle hub is depressed so it runs parallel to the skin.
A guidewire is introduced through the needle and advanced
gently along artery using fluoroscopy.
1
LLA
Complications during/after procedure
Hemorrhage
Artery dissection
Bleeding and infection at the puncture site
Arterial thrombus
Guidewire breakage
Pseudoaneuryms
Allergic reaction to contrast media
LLA
After Care
The catheter is pulled back, removed and manual pressure is applied to the femoral artery at the puncture site.
A firm dressing is applied to the puncture site.
The patient is advised not to bend the limb for 24 hours.
Patient must remain at least several hours in hospital and, particularly for the first two hours, is watched closely for any evidence of bleeding or other complications.
Upper Limb Venography
Clinical Indications
Contraindications
Approaches/Methods
Clinical Indications
- Edema
- To demonstrate the site of venous occlusion or stenosis
- Superior vena cava obstruction
- Congenital abnormality of
the venous system
Contraindications
- Contrast media allergy
- Impaired renal function
- Severe anemia
Approaches/Methods
The contrast medium is injected through a needle or catheter into a superficial vein at the elbow or wrist.
