Week 13- angio 1 Flashcards
what anatomy are we concerned about when doing a cerebral angio?
COW: vertebral A Basilar A Posterior cerebral A Posterior communicating A Middle cerebral A Internal carotid A Anterior communicating A Anterior cerebral A
indications for a cerebral angiogram
stenosis
aneurysm
AVMs
Tumour
Clots
Stroke
Stenting
Dissections
A-V fistula
Embolism
Thrombosis
cerebral angio contraindications
contrast allergy
internal bleeding in the brain
renal failure
metformin
increased creatinine
thyroid pathology
multi-nodule goitre
prior Nuc Med Thyroid scan
risks/complications of cerebral angios
Large dose of radiation may cause cancer
Allergic reaction to contrast
Nursing mothers should wait at least 24 hours after procedure
Diabetes/kidney disease may compromise kidney function in excreting the contrast
Blood vessel damage from the instruments in the blood vessel
Blood clot may form
Embolism may occur if material is dislodged from the arterial wall
Risk of stroke
Arterial punctures causing a bleed in the brain (haemorrhage)
patient prep for cerebral angio
informed consent
blood tests and medication analysis
NBM 12 hours prior
area site prepared
attired properly (hospital gown etc.)
no deodorsnt/ perfume use
Potentially pre-op CXR
the seven criteria that defines informed consent
- Competence to understand and to decide
- Voluntary decision making
- Disclosure of material information
- Recommendation of a plan
- Comprehension of terms and (4)
- Decision in favour of a plan, and
- Authorization of the plan
cerebral angio pre-imaging procedure
sterile set up contrast ready ECG plates puncture site exposed organisations of catheters/wires ECG and oxygen sat monitor Defib ready
what does the radiographer need to do for the patient during imaging of cerebral vessels
- regular observations of ECG
- record BP and oxygen sats regularly
- regular conversation with patient
cerebral angio post care instructions
- remove catheter
- fem stop on puncture wound if needed
- regular patient observation
- pt instructed not to laugh
- clean up puncture site
- pt to drink lots of fluid
- pt given contact phone number if anything is concerning
- follow up call by staff 24hrs after
what anatomy is covered in a peripheral angio
R subclavian A R + L axillary A L + R brachial A R + L internal thoracic A Abdomiinal A descending thoracic A
what anatomy is covered in a peripheral angio of the arm
superficial palmer arch A R/L radial A R/L ulnar A R/L anterior recurrent A R/L brachial A
what anatomy is covered in a peripheral angio of the legs
R/ L common iliac A Abdominal A L/R common iliac A L/R internal iliac A L/R external iliac A L/R fem A L/R deep fem A L/R popliteal A L/R anterior tibial A L/R posterior tibial A L/R fibula A
indications for a peripheral angio
Stenosis
aneurysm
AVMs
Tumour
Clots
Stroke
Stenting
Dissections
A-V fistula
Embolism
Thrombosis
where is contrast administered in a peripheral angio
carotid/basilar A
where is contrast injected in a cerebral angio?
carotid/basilar
contraindications for a peripheral angio
contrast allergy
internal bleeding in the brain
renal failure
metformin
increased creatinine
thyroid pathology
multi-nodule goitre
prior Nuc Med Thyroid scan
risks/complications of a peripheral angio
Large dose of radiation may cause cancer
Allergic reaction to contrast
Nursing mothers should wait at least 24 hours after procedure
Diabetes/kidney disease may compromise kidney function in excreting the contrast
Blood vessel damage from the instruments in the blood vessel
Blood clot may form
Embolism may occur if material is dislodged from the arterial wall
Risk of stroke
Arterial punctures causing a bleed in the brain (haemorrhage)
Nerve damage
patient prep for peripheral angio
informed consent
bloods and medication analysis
NBM
drink clear liquids
prepare puncture sites
patient attired (gown etc.)
pre-op CXR if necessary
what should happen during a peripheral angio
- regular observations of ECG
- record BP and oxygen sats regularly
- regular conversation with patient
peripheral angio post care iinstructions
- remove catheter
- fem stop on puncture wound if needed
- regular patient observation
- pt instructed not to laugh
- clean up puncture site
- pt to drink lots of fluid
- pt given contact phone number if anything is concerning
- follow up call by staff 24hrs after
what are collateral arteries?
Collateral Arteries is a term used to describe the group of arteries that the body uses to bypass an occlusion.
how do collateral arteries arise?
from a chronic occluding process
how are collateral arteries ‘fed’?
Collateral arteries are fed from the proximal source of the occlusion or nearby arteries
what is angiogenesis
Physiological process through which new blood vessels form from pre-existing vessels
when does angiogenesis become a problem?
Angiogenesis becomes a problem when new blood vessels form to “feed” blood to tumours
how is angiography used to locate angiogenesis when it is feeding a tumour
-Angiography is used to locate the “feeding” vessel and then occlude it to deprive the tumour of blood
how are arteriovenous malformations formed?
AVM’S occur when Angiogenesis development gets out of control or doesn’t develop properly
what is an AVM
abnormal growth pattern of angiogenesis
symptoms of AVMs
- Poor Coordination
- Muscle weakness
- Vertigo
- Numbness
- Gradual increasing pain
- Memory loss
- Prominent vein
- Heart Failure (cardiac AVM)
- Breathlessness (Pulmonary AVM)
Symptoms vary depending on location
do AVMs have capillaries and how does this affect surrounding tissues
AVM’s do not have capillaries, therefore surrounding tissues are deprived of nutrients, and CO2 is not removed from active tissues
what occurs from an AVM (think about the connection to other vessels)
Abnormal connection results in fragile vessels coping with high pressure arterial blood and low pressure venous blood
what happens to the abnormal vessels when AVMs occur
Due to the pressure gradient in the abnormal vessels bleeding can occur. Depending on the location of the haemorrhage, the symptoms can be an annoyance to being fatal
what is the difference between a tumour and an AVM when imaging with contrast?
AVM: will see the venous and arterial system highlighted
Tumour: will see either the arterial OR venous system highlighted
