Angiography

Conventional radiographs do not produce images of arteries, veins, and lymphatic vessels, since they absorb X-rays in the same way as the surrounding tissues. The exception is the arteries and veins of the lungs, which appear as branching dark stripes against the background of light pulmonary fields. In addition, in patients with atherosclerosis, mainly in the elderly and senile, there is a deposition of lime in the walls of the vessels, and these calcareous plaques are clearly visible on the images.

Angiography is an X-ray examination of blood vessels performed using contrast agents.

For artificial contrasting, a solution of an organic iodine compound intended for this purpose is introduced into the blood and lymphatic system. Depending on which part of the vascular system is being contrasted, a distinction is made between arteriography, venography (phlebography) and lymphography.

Angiography is performed only after a general clinical examination and only in cases where non-invasive methods fail to diagnose the disease and it is assumed that, based on the picture of the vessels or the study of blood flow, it is possible to identify damage to the vessels themselves or their changes in diseases of other organs. However, it should be remembered that angiography is an invasive study associated with the possibility of complications and with a fairly significant radiation load.

Angiography is used to study hemodynamics and identify vascular pathology itself, diagnose damage and malformations of organs, and identify inflammatory, dystrophic, and tumor lesions that cause dysfunction and morphology of blood vessels. Angiography is a necessary step in endovascular surgeries.

Contraindications to angiography include extremely severe condition of the patient, acute infectious, inflammatory and mental diseases, severe cardiac, hepatic and renal failure, and hypersensitivity to iodine preparations.

The possibility of idiosyncrasy to iodine is determined during the patient's questioning before the examination, as well as by conducting a sensitivity test to the iodine preparation that is going to be used. For this, the patient is given 1-2 ml of contrast agent intravenously. Signs of an allergic reaction include headache, nausea, skin itching, urticaria, conjunctivitis, rhinitis, and heart rhythm disturbances.

Before the examination, the doctor must explain to the patient the necessity and nature of the procedure and obtain his consent to perform it. Tranquilizers are prescribed the evening before the angiography. Breakfast is cancelled in the morning. Hair is shaved in the puncture area. Premedication (antihistamines, tranquilizers, analgesics) is performed 30 minutes before the examination.

Arteriography is performed by puncturing the vessel or by catheterizing it. Puncture is used to examine the carotid arteries, arteries and veins of the lower extremities, the abdominal aorta and its large branches. However, the main method of angiography at present is, of course, catheterization of the vessel, which is performed according to the method developed by the Swedish doctor Seldinger.

The favorite place for catheterization is the femoral artery. The patient is placed on his back. The surgical field is processed and delimited with sterile sheets. The pulsating femoral artery is palpated. After local paravasal anesthesia with 0.5% novocaine solution, a 0.3-0.4 cm long skin incision is made. A narrow passage to the artery is made from it using blunt force. A special needle with a wide lumen is inserted into the made passage at a slight angle. It pierces the wall of the artery, after which the piercing stylet is removed. By pulling the needle, its end is localized in the lumen of the artery. At this point, a strong stream of blood appears from the needle pavilion. A metal conductor is inserted into the artery through the needle, which is then advanced into the internal and common iliac arteries and the aorta to the selected level. The needle is removed, and a radiopaque catheter is inserted through the conductor to the required point of the arterial system. Its progress is monitored on the display. After removing the conductor, the free (outer) end of the catheter is connected to the adapter and the catheter is immediately washed with isotonic sodium chloride solution with heparin.

All manipulations during angiography are carried out under the control of X-ray television. Participants in catheterization work in protective aprons, over which sterile gowns are put on. During the angiography, the patient's condition is constantly monitored.

A contrast agent is injected under pressure into the artery being examined using an automatic syringe (injector) through a catheter. At the same time, high-speed X-ray imaging begins. Its program - the number and time of images - is set on the control panel of the device. The images are immediately developed. Once the examination is successful, the catheter is removed. The puncture site is pressed for 8-10 minutes to stop bleeding. A pressure bandage is applied to the puncture site for 24 hours. The patient is prescribed bed rest for the same period. After 24 hours, the bandage is replaced with an aseptic adhesive. The patient's condition is constantly monitored by the attending physician. Measuring body temperature and examining the surgical site are mandatory.

The most common complication of angiography is the development of a hematoma in the catheterization area, where swelling occurs. It is treated conservatively. A severe, but fortunately rare complication is thromboembolism of a peripheral artery, the occurrence of which is indicated by limb ischemia.

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