Aortography

Modern science does not stand still, offering the consumer all the new techniques and technical solutions designed to facilitate our life. This applies to the field of medicine, where every year there is a new medical device, and physiotherapeutic methods for studying the human body are being developed, for the purpose of detecting irregularities in its functioning. Aortography is one of such innovative methods that allow physicians to examine the condition of the aorta. The essence of manipulation is the supply of contrast fluid in the cavity of the vessel with the parallel conduct of a number of X-ray photographs. The resulting images, after the procedure, remain in the computer's electronic memory, allowing them to work with them repeatedly.

[1], [2], [3], [4]

Indications for abdominal aortography

As it became clear, the study in this article is assigned by the treating doctor in the case of a need to examine the condition of the blood vessels and, in particular, the aorta.

That the doctor has appointed or nominated this research, presence of the indications to carrying out of an abdominal aortography is necessary. To such doctors include:

• Aneurysm (pathological local expansion of the blood vessel) of the aorta.
• Coarctation is a developmental disorder that consists in constricting or completely closing the aortic lumen.
• Suspicion of internal bleeding.
• Congenital heart disease, in which the arterial duct (Botallov duct) does not overgrow in the newborn after it was born.
• Stenosis of the mouth of the blood vessel - a narrowing of the aortic valve passageway, leading to a failure of the norm of blood flow from the left ventricle of the heart to the aorta.
• Pathology in the localization of the aortic arch.
• Pathological changes in the arch of the blood vessel, which lead to a complete blockage of the passageway.
• Dysfunction of the aortic valve.
• Violation of the integrity of the abdominal organs, resulting from trauma or chronic disease.
• Differentialization of the diagnosis of neoplasm of mediastinum and aortic aneurysm.
• Suspicion of a benign or malignant tumor.
• The pathology of the retroperitoneal space.
• The need to clarify the location of negative changes in the aorta in the period of preparation for surgical intervention.

Preparing for aortography

Like many other studies, carrying out this procedure requires the implementation of a number of previous activities. Preparation for aortography consists of several stages.

• The patient is taking blood for the analysis of general parameters and coagulation.
• Testing for the presence of an allergy to iodine is being conducted.
• On the eve of the scheduled examination, before going to sleep, the patient undergoes a cleansing enema, after which he receives one of the sedatives.
• Immediately on the day of examination the patient is forbidden to eat, the procedure is performed on an empty stomach.
• At the location of the blood vessel, through which the contrast liquid is planned to be delivered, the manipulative sister shaves the hairs, cleaning the surface for further work.
• The study is conducted under the influence of anesthesia. Therefore, half an hour before the proposed procedure, the patient undergoes premedication, which is a preparation for anesthesia.
• Local anesthesia is often used, but if the patient's body shows an allergic reaction to a contrast fluid containing iodine, then the medical procedure is under the influence of general anesthesia.
• Before the examination, the patient must remove all metal objects from himself.

Methods of abdominal aortography

Many patients, before passing this or that procedure aspire to learn more about the nature of its conduct, the informative nature of the method and the reliability of the results obtained.

The study of the abdominal region of one of the large vessels is carried out to reveal pathological changes affecting both the aorta itself and the internal organs adjacent to it. It can be a liver, an intestine, a lien, organs of a small basin or kidneys.

The technique of abdominal aortography is simple. An x-ray contrast preparation is given, for this type of examination, in the axillary or femoral artery. This substance is inert and does not harm the body of the patient being examined.

Invasive technique consists of three stages:

• The procedure is carried out in prone position. The patient is fixed to the table, since it must remain stationary during the whole examination. Only in this case it is possible to obtain a high accuracy of the result.
• Initially, the patient is anesthetized. The site of insertion of the catheter is sanitized and a small incision of the desired vessel is made, through which it is gently inserted into the blood vessel. A catheter is a special medical tube made of plastic. It is gradually promoted along the course of the blood vessel. The doctor has the opportunity to follow the entire procedure with the help of X-ray television, which is equipped with the device.
• Upon completion of the introduction, the specialist begins to feed the tube with an X-ray contrast substance, in parallel, a lightning survey takes place, giving a series of X-ray images. During the introduction of the drug, the patient may feel the incoming heat. Contrast fluid is fed into the body two to four times (as needed).
• After the examination, the catheter is carefully removed. The place of its introduction is fixed by a constricting dressing or is clamped in another way. This will stop the bleeding. After a quarter of an hour, a tight sterile bandage is applied to the damaged area.

This method makes it possible to recognize such severe diseases as hypervascular neoplasms in the kidneys, hepatic metastasis, inflammation occurring in the lower parts of the gastrointestinal tract.

There are also non-invasive methods of this study:

• Magnetic resonance angiography allows you to determine the anatomical features and level of functioning of the blood vessel being examined.
• Computer tomography angiography enables the specialist to get a very precise picture of the location and condition of the blood vessel.

Abdominal aortography is mainly performed for the investigation and differentiation of diseases of the kidneys, bladder, intestines, kidneys, spleen and uterus. Abdominal aortography is a rather informative method of recognizing the localization of placenta previa.

This procedure allows you to diagnose the presence of various anomalies, polycystosis, the presence of solitary cysts in the body, recognize pyelonephritis, hypernaroid malignant neoplasms, hydronephrosis and other pathological changes.

Breast aortography

If the treating doctor has a suspicion of a pathological process developing in the patient's body that affects the thoracic part of the aorta, then it becomes necessary to confirm or disprove this assumption. In this case, a thoracic aortography is assigned to a specialist as a patient.

This study allows you to recognize:

• An aneurysm of a blood vessel that develops on the thoracic aorta.
• Development of coarctation in the area of interest.
• Aortic valve dysfunction.
• Other anomalies of its development.

[5], [6], [7]

Aortography of the heart

This procedure is rarely prescribed. Although this technique is relatively simple to use, aortography of the heart by puncture of the cardiac aorta can be a sufficient hazard and can not be offered for widespread use.

The essence of the problem of this procedure is that it is not worthwhile to conduct a study with a small diameter needle, whereas a medical instrument suitable for the study of diameter, due to its wide lumen is not recommended because of the high probability of subsequent development of hemorrhage. This medical term denotes the flow of blood from an injured vessel, a violation of its integrity and the permeability of its walls. The presence of bleeding increases the risk of serious complications, and then the threat of death.

It does not save the choice of the place of input, for carrying out this procedure, - the brachial artery. If the contrast fluid is injected through the blood vessel specified above, before it enters the necessary artery, the coloring drug will have to go a long way. This will not allow us to obtain a picture of the required accuracy. But this technique will save the patient and the doctor from the risk of developing hemorrhage.

It is preferable to carry out aortography of the heart through the carotid artery. The whole procedure is done quickly enough, the substance is injected under high pressure to prevent the X-ray contrast drug from entering the brain. At the time of casting a fluid, a number of images are taken.

This method of research is quite innovative and for today it is produced only in specialized institutions.

[8], [9], [10], [11], [12], [13], [14], [15], [16], [17]

CT aortography

Computer tomography angiography is, in fact, two in one. If there is a need and the patient is assigned to CT aortography, the patient undergoes two procedures in one procedure: traditional scanning of the disturbing site with the help of a computer tomography apparatus, in parallel angiography is performed. As a result, the specialist receives the most complete picture of pathological changes, and the series of images taken is copied, and stored on the hard disk of the computer. The doctor will help, if necessary, use this data repeatedly.

After the end of the procedure, the hands of the treating physician have high accuracy images of the aorta, nearby tissues and internal organs.

The very path of organization and procedure is akin to conventional computer tomography. But the additional thing is that during the scan, a contrast liquid is supplied to a certain artery, after which several x-rays are fixed.

In view of the fact that most often the X-ray contrast preparation is fed into a vein rather than an artery, the procedure of CT aortography is considered less invasive than in the case of only aortography.

The doctor can prescribe this study in the same cases that were indicated and as indications for abdominal aortography. During the examination, the examinee is placed on a special lounger (the patient is on the back) and by means of special mechanisms "bring" a cocoon to the chamber. In it, the human body is penetrated by a ring through X-rays.

Receiving a response, the computer program creates images - sections of various parts of the body. The resulting image is in black and white negative gradation. When the patient enters the contrast medium, the picture becomes more distinct. In this case, the doctor receives the material in a three-dimensional (3D) image.

[18], [19], [20], [21], [22], [23], [24], [25], [26]

MRI aortography

Magnetic resonance angiography is a fairly innovative technique for examining the human body. Combination of two methods - mort aortography - allows a specialist to obtain in one procedure the image of the organ of interest, as well as X-ray photographs of the site.

The essence of the technique lies in the fact that the patient is placed in the magnetic field of the apparatus, while irradiation of his body with radiological waves occurs. The human body in such a situation responds to electromagnetic energy, which is recognized and processed by a computer program.

Magnetic resonance angiography is prescribed when it becomes necessary to obtain a three-dimensional image of blood vessels. In this case, this technique allows you to gather information and obtain results without resorting to radiopaque means. Although if there is a need for a clearer picture, physicians resort to the use of contrast medium.

The advantage of this method is that it proceeds painlessly. At the same time, physicians did not notice any negative influence of the magnetic field on the patient's body.

Aortography on Seldinger

One of the most frequently encountered and applied diagnostic techniques, on the question under consideration, is the aortography of the seldinger. This method of percutaneous catheterization of the femoral artery is carried out using a set of special medical instruments. In this kit you can find:

• Medical needle for puncture.
• Metallic conductor with a soft finish.
• Dilator is a tool for expanding natural or artificially created holes and channels. Especially it is relevant in case of their decrease due to the course of pathological changes in the patient's body.
• The catheter is a medical device, represented by a long thin tube and additional multifaceted nozzles, which allow performing various functions.
• The introducer is a "conductor", a plastic tube, with a built-in hemostatic valve.

Before starting the study, the patient undergoes a standard preparation procedure, which has already been described above. The examination begins with the insertion of the puncture needle into the femoral artery. This allows you to insert into the puncture a special metal conductor (like a string). The needle is removed, and using a "string" a medical catheter is delivered to the arteries through the artery.

To improve the clarity of the image, a contrast liquid is used, the quantitative input of which is calculated by the formula 1 ml per kilogram of body weight of the patient (in some cases 2 ml per kilogram). As the monitoring of this study shows, such volumes do not provoke any complications and do not bring any harm to the patient's body.

Since this manipulation is painful enough, the patient gets anesthesia before starting it. More often the examination is carried out under the action of a local anesthetic (lidocaine or novocain), but under certain conditions and medical indications general anesthesia can be applied.

It should also be noted that aortography on the seldinger can be carried out not only through the femoral aorta, but also through a puncture in the brachial or axillary artery. Decide to change the entry point, the doctor may be due to a blockage of the femoral blood vessel.

This technique is considered basic and is used in the diagnosis of the diseases listed above most often.

[27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40]

Translumbar aortography

If a doctor needs a visual examination of the abdominal aorta, or other large blood vessels that "serve" the pelvic organs and lower limbs of a person, then, often, he resorts to a translumumbar puncture. In the case of blurry pictures and the need for a clearer picture, the physicians resort to using another procedure called a translumbral aortography.

Puncture of the blood vessel is performed by a special medical hollow needle. Introduction occurs from the back of the body. High-level translumbral aortography is also possible, with the insertion of the catheter in the thoracic region at the level of the twelfth vertebral column. When there is a need to examine the operation of the vessels of the legs (over their entire length) or the abdominal area, the transluminal introduction of the needle passes in the region of the second lumbar vertebra.

In carrying out the procedure under consideration, it is very important to fulfill a number of mandatory requirements. One of these is the fact of a phased removal of the needle:

• It is first extracted directly from the aorta.
• And only after a few minutes have elapsed the instrument can be removed from the para-aortic zone.

The gradual removal allows to prevent the formation of hemorrhages and hematomas in the para-aortic region.

This method of research allows you to thoroughly study virtually any part of the arterial bed. The method is highly informative!

Studies of this nature are compulsorily conducted in the conditions of specialized institutions. This makes it possible to reduce the risk of complications to a minimum, and the patient will receive the help of highly qualified medical personnel.

Complications of abdominal aortography

Due to the fact that this examination occurs with the use of a medical instrument that damages the integrity of the skin and tissue structures of the body, with the necessary damage to the blood vessel, there is a possibility of complications.

The most common complications of abdominal aortography are:

• Soreness and swelling at the site of insertion of the catheter.
• Occurrence of bleeding. It can be both internal and external.
• Formation of a hematoma.
• Thrombosis of the blood vessel.
• Arterial embolism (blockage of the lumens of the vessels by the embolus, that is brought with the current of the blood particle).
• Formation of arterial or venous fistula.
• An allergic reaction to the iodine component of the contrast agent is possible.
• The development of an aneurysm at the site of insertion of the catheter.
• There may be a malfunction in the heart rate.
• There is a chance of developing acute renal and / or hepatic insufficiency.
• Perforation of the blood vessel.

[41], [42], [43], [44], [45], [46], [47], [48], [49], [50]

Reviews of abdominal aortography

Due to the availability of the "World Wide Web" to get almost any information about this or that medical research is not very difficult. Becomes the norm and forum discussions on the issue of interest.

Proceeding from this, the person to whom the event in question is assigned, before going through it, may well become familiar with its essence. For any patient it is not difficult to read the article directly about the diagnostic study itself. And as well, reviews about abdominal aortography of those respondents who have already gone through this procedure will not be superfluous.

The reviews themselves are quite contradictory in terms of carrying out the procedure. Some complain of subsequent swelling and significant bruising. But in general, the person does not experience significant negative feelings. There is no doubt that after completing this research, the doctor gets a fairly informative picture of the pathological process taking place in the patient's body, which significantly shortens the time for establishing the diagnosis, and, accordingly, the faster start of treatment.

This method of diagnosis not so long ago appeared to "services" of doctors. Aortography is an innovative technique for examining the aorta and other large blood vessels to identify a developing pathological process that adversely affects the patient's health. At the same time, the use of radiopaque material and appropriate equipment will provide an instant series of clear contrast images that will help a specialist to diagnose the diagnosis more quickly and start the treatment process as soon as possible.