INTERVENTIONAL RADIOLOGY

& ANGIOGRAPHY

DR. Walid Asaad,

MBBS, MD, DABR,CAQ
Diagnostic &Interventional Radiology
King Abdulaziz University Hospital
 INTERVENTIONAL RADIOLOGY

A subspecialty which provides minimally invasive

techniques with the help of imaging modalities to
diagnose or treat a condition.
Minimally invasive
Local anesthesia
Early recovery
 8 out of 10 procedures use skin incisions smaller
than 5 mm.

 9 out of 10 procedures use only local anaesthetic,

sometimes with sedation.

 Up to 8 out of 10 patients go home the same day

INTERVENTIONAL RADIOLOGY

Stent placement
Embolization
Thrombolysis
Balloon angioplasty
Atherectomy
Electrophysiology
 Percutaneous biopsy

 Abscess drainage

 Percutaneous nephrostomy

 Percutaneous Biliary drainage

 Radiofrequency ablation
 ANGIOGRAPHY
The radiologic examination of vessels after the
introduction of a contrast medium.
 HISTORY
The first angiogram was performed only months
after Roentgen's discovery of X rays.
Which was when?
Two physicians injected mercury salts into an
amputated hand and created an image of the arteries
Post mortem injection of mercury salts in
Jan,1896.
 Interventional radiologic procedures began in
1930s with angiography.

 In early 1960s Mason Jones pioneered

transbrachial selective coronary angiography.

 Later in 1960s transfemoral angiography was

developed.
 BASIC PRINCIPLES
Arterial access

In 1953 Seldinger described a method for

catheterization of vessels.

A percutaneous technique for arterial and venous

access.

Femoral artery is most commonly used.

 SELDINGER TECHNIQUE
Seldinger needle.

18gauge single use,sterile needle.

2 parts-- a solid inner needle(stylet) & an outer thin

wall needle for smooth passage.

a hub---good instrument balance

winged handle---good control.

 Site cleaned, area draped, local anesthetic given.

 The seldinger needle is introduced into the artery.

 When pulsating blood returns, the stylet is

removed.
 A guide wire is inserted through the needle.

 With guide wire in vessel, needle is removed.

 Catheter is threaded onto the guide wire.

 Under fluoro, the catheter is then advanced and

the guide wire is removed.
GUIDEWIRES
Guide the catheter.

Allow safe introduction of catheter into the vessel.

Made of stainless steel.

Usually about 145cm long

An inner core wire that is tapered at the end to a

soft flexible tip.
 Covered by a coating—teflon, heparin and recently
hydrophilic polymers(glide wires) are used.

 Coating reduces friction, gives strength to GW.

 Tips at the end of GW

 Straight

 J- tipped—prevents subintimal dissection of artery.

CATHETERS
•Many shapes and sizes.

•diameter is given in French(Fr)—3Fr=1mm.

•Straight- end hole only—smaller vessels/minimal

contrast.

•Pigtail-circular tip with multiple side holes —

larger vessels/ more contrast.
 H1 or Head hunter tip– used for femoral approach
to brachiocephalic vessels.

 Simmons catheter is highly curved --- for sharply

angled vessels--cerebral and visceral angiography.

 C2 or Cobra catheter has angled tip joined to a

gentle curve—celiac, renal & mesenteric arteries.
 Judkins catheters
Right(lesser curve) & left(greater curve) for right &
left coronary arteries.

 Amplatz catheters
Right & left coronary arteries
 Contrast Media

Initially ionic iodine compounds were used.

Now non ionic contrast media in practice—low

adverse reactions and low physiologic problems.
 INDICATIONS
Diagnosis & presence of ischemic heart disease.

After revascularization procedures

Congenital heart lesions & anomalies of great

vessels.

Valve disease, myocardial disease & ventricular

function.
 Atheroma

 Aneurysms

 Arteriovenous malformations

 Arterial ischemia

 Trauma
Patient preparation
Explain procedure & risk to the patient.

History & physical examination.

Lab tests.

Consent

Pre procedure I/V fluids.

Medication to relieve anxiety.

 Monitoring during and after procedure
ECG, Automatic BP measurement & pulse oximetry.

Life saving drugs and equipments.

Immobile for minimum 4hrs after.

Vital signs monitored.

Puncture site inspected.

 Contra-indications
Contrast allergy

Impaired renal function

Blood- clotting disorders

Anti coagulant medication

Unstable cardio pulmonary/ neurological status

 Risks
Bleeding at puncture site
Thrombus formation
Embolus formation –plaque dislodged from vessel
wall by catheter
Dissection of vessel
Puncture site infection ( contaminated sterile field)
Contrast reaction
 INTERVENTIONAL RADIOLOGY SUITE

Specifically designed to accommodate the quantity of

equipment needed & the large number of people
involved in the procedure.
 Interventional radiology suite

 Procedure Room  Control Room

 Room size- 400-600  100-150 square feet
square feet  Easy access and
 Easily cleaned communication to
(floors, wall, etc.) procedure room
 Outlets needed for  Operating console
O2, suction. with Computers,
 At least three means monitors .
of access.
 EQUIPMENTS
The X-ray apparatus for interventional radiology is
more massive,flexible,expensive & advanced.

More heat load and serial images.

 X RAY TUBE
Two ceiling track-mounted X-ray tubes alongwith
an image intensified fluoroscope mounted on C or an
L arm.
A large diameter massive anode disc(15cm
diameter, 5cm thick) to accommodate heat load.
Cathodes designed for magnification & serial
radiography.
 A large focal spot of 1mm for heat load.

 A small focal spot( no more than 0.3mm) is

necessary for spatial resolution of small vessel
magnification.
 Power rating of 80kW—for rapid sequence serial
radiography.

 Anode heat capacity of 1 MHU—to accommodate

heat load.
 Generators
High frequency and high voltage generators

Three phase,12 pulse power.

 Patient couch
Stationary couch with a floating,tilting or rotating
table top.

Controls for couch positioning are located on side

of table and also on a floor switch.

May also have a computer controlled stepping

capability.
 Image receptor
2 different types.

Cinefluorographic camera—now obsolete.

Nowadays Digital image receptors are used with a

television camera pickup tube or a charge-coupled
device(CCD).
THANKS