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فحوصات شعاعية7
فحوصات شعاعية7
lecture 7
PORTAL VENOGRAPHY
By
MSc. Zeyad Tareq Al-Dulaimi
3rd.Stage
2023-2024
PORTAL VENOGRAPHY
Methods
1. Late-phase superior mesenteric angiography
2. Trans-splenic approach (discussed later)
3. Paraumbilical vein catheterization
4. Transjugular transhepatic approach
Indications
1. To demonstrate prior to surgery, the anatomy of the portal system in patients
with portal hypertension
2. To check the patency of a porto systemic anastomosis
Contrast Medium
LOCM 370 mg I mL−1, 50 mL.
Equipment
1. Digital radiography unit
2. Arterial catheter (SMA approach)
3. 10-cm needle (20G) with stilette and outer plastic sheath—e.g. Longdwell
(trans-splenic approach).
Patient Preparation
1. Admission to hospital. A surgeon should be informed in case complications of
procedure .
2. Clotting factors are checked
3. Severe ascites is drained
4. Nil orally for 5 h prior to the procedure
5. Premedication, according to local protocols
Technique
Superior mesenteric angiography
Using standard angiographic technique .
Aftercare
1. Blood pressure and pulse—initially quarter-hourly; subsequently 4-hourly.
2. The patient must remain in hospital overnight.
Complications
Due to the contrast medium
1. Mild: Nausea, vomiting, urticaria.
2. Moderate: Tachycardia, mild bronchospasm, vasovagal reaction, diffuse
erythema.
3. Severe: Seizure, cardiovascular collapse, moderate or severe
bronchospasm, laryngeal oedema, loss of consciousness.
Thank you