Angiographic

Thoracalis
Dimas Prakoso, S.Tr.Rad, M.Tr.Kes
Pendahuluan
Angiografi mengacu pada pencitraan radiologi pembuluh darah dengan
menggunakan media kontras. Untuk memperlihatkan struktur yang memiliki
kontras rendah , kontras media diinjeksikan dengan sebuah kateter pada
pembuluh darah yang diinginkan. Yang biasa digunakan adalah kontras media
positif , tetapi jika membutuhkan kontras media negatif, juga harus disediakan.
Pada pemeriksaan ini diperlukan Peralatan yang canggih.

Angiography can be more specifically described as

follows:
● Arteriography: imaging of the arteries
● Venography: imaging of the veins
● Angiocardiography: imaging of the heart and associated structures
● Lymphography: imaging of the lymphatic vessels/nodes
 The Angiography Team
Angiography is performed by a team of health
professionals, including (1) a radiologist (or
other qualified angiographer), (2) a “scrub”
nurse or technologist who assists with sterile
and catheterization procedures, and (3) a
radiologic technologist. Depending on the
departmental protocol and the specific
situation, an additional physician, nurse,
technologist, and/or hemodynamic technologist
also may be available to assist with the
procedure.
 Consent &
Preprocedural Care
• A medical history should be obtained before the
procedure is begun. This should
• include questions intended to assess The patient's
ability to tolerate the contrast injection (e.g., allergy
history, cardiac/pulmonary status, renal function)
• The patient also will be interviewed regarding
medication history and symptoms. Medication
history is important because some medications are
anticoagulants and will cause excessive bleeding
during and after the procedure
• Knowing the medication history is also important
when one is selecting the premedication
• The explanation will include possible risks and
complications of the procedure, so that the patient
is fully informed before signing the consent
 Consent &
Preprocedural Care
• Solid food is withheld for approximately 8 hours before
the procedure to reduce the risk for aspiration
• making sure that the patient is well hydrated is
• important to reduce the risk for contrast-induced renal
damage
• Premedication usually is given to patients before the
procedure to help them relax
• The patient may be made more comfortable on the table
by placing a sponge under the knees to reduce strain on
the back
• Vital signs are obtained and recorded, and pulse in the
extremity distal to the selected puncture site is checked
• The puncture site is shaved, cleaned, and draped
• Continual communication and monitoring of the patient
by the technologist and the rest of the angiography team
will greatly alleviate patient discomfort and fear.
Vessel Access for
Contrast Media Injection
To visualize the vessel(s) of interest, a catheter
must be introduced into the patient’s
vasculature, through which the contrast media
will be injected. A commonly used method for
catheterization is the Seldinger technique. This
technique was developed by Dr. Sven Seldinger
in the 1950s and remains popular today. It is a
percutaneous (through the skin) technique that
can be used for arterial or venous access.
 Vessels
Four vessels are typically considered for catheterization: (1)
femoral, (2) axillary, (3) brachial, and (4) radial. The
angiographer will make the selection based on the strong
presence of a pulse and the absence of vessel disease. The
femoral artery is the preferred site for an arterial puncture
because of its size and easily accessible location. It is
punctured just inferior to the inguinal ligament. If a femoral
artery puncture is contraindicated because of previous
surgical grafts, the presence of an aneurysm, or occlusive
vascular disease, the axillary, brachial, or radial artery may
be selected. The femoral vein would be the vessel of choice
for venous access.
Seldinger technique
 Angiographic Tray
A sterile tray contains the basic equipment
necessary for a Seldinger catheterization
of a femoral artery Basic sterile items
include the following:
1.Hemostats
2.Prep sponges and antiseptic solution
3.Scalpel blade
4.Syringe and needle for local anesthetic
5.Basins and medicine cup
6.Sterile drapes and towels
7.Band-Aids
8.Sterile image intensifier cover
Contraindications
Contraindications for patients to experience angiography include contrast
media allergy, impaired renal function, blood-clotting disorders or taking
anticoagulant medication, and unstable cardiopulmonary/neurologic status.

Risk/Complications
Angiographic procedures are not performed without always involving some
level of risk for the patient. Some of the most common risks and complications
include the following:
▪ Bleeding at the puncture site: this usually can be controlled by applying
compression
▪ Thrombus formation: a blood clot may form in a vessel and disrupt the flow
to distal parts
Risk/Complications
▪ Embolus formation: a piece of plaque may be dislodged from a vessel wall
by the catheter. A stroke or other vessel occlusion may result
▪ Dissection of a vessel: the catheter may tear the intima of a vessel
▪ Infection of puncture site: this is caused by contamination of the sterile
field
▪ Contrast media reaction: this may be mild, moderate, or severe
 Postprocedural Care
After the angiographic procedure has been completed, the
catheter is removed and compression is applied to the
puncture site. The patient remains on bed rest for a
minimum of 4 hours, but the head of the bed/stretcher
may be elevated approximately 30°. During this time, the
patient is monitored, and vital signs and the peripheral
pulse distal to the puncture site are regularly checked. The
extremity is also checked for warmth, color, and numbness
to ensure that circulation has not been disrupted. Oral
fluids are given and analgesics are provided if required.
Patients should be instructed on what to do if the
puncture site spontaneously begins to bleed: apply
pressure and call for help.
 Automatic Injector
As contrast media is injected into the circulatory system,
it is diluted by blood. The contrast material must be
injected with sufficient pressure to overcome the patient's
systemic arterial pressure and to maintain a bolus to
minimize dilution with blood. To maintain the flow rates
necessary for angiography, an automatic
electromechanical injector is used. The flow rate is
affected by many variables, such as the viscosity of the
contrast medium, the length and diameter of the catheter,
and injection pressure. Depending on these variables and
the vessel to be injected, the desired flow rate can be
selected before injection.
 Thoracic Angiography

Purpose
Thoracic angiography demonstrates the contour and
integrity of the thoracic vasculature. Thoracic
aortography is an angiographic study of the
ascending aorta, the arch, the descending portion of
the thoracic aorta, and the major branches.
Pulmonary arteriography is an angiographic study of
the pulmonary vessels that usually is done to
investigate for pulmonary embolus. As was
mentioned earlier, pulmonary angiography is
performed infrequently because of the availability of
alternative modalities.
Pathologic Indications
Pathologic indications for thoracic and pulmonary angiography
include the following:
▪ Aneurysms

▪ Congenital abnormalities
▪ Vessel stenosis

▪ Embolus
▪ Trauma
Catheterization
The preferred puncture site for a thoracic aortogram is the femoral artery. The
catheter is advanced to the desired location in the thoracic aorta. Selective
procedures may be performed with the use of specially designed catheters to
access the vessel of interest.

Because of the location of the pulmonary artery, the femoral vein is the
preferred site for catheter insertion. The catheter is advanced along the venous
structures, into the inferior vena cava, through the right atrium of the heart into
the right ventricle, and into the pulmonary artery. Typically, both pulmonary
arteries are examined.
 Angiocardiography
Purpose
Angiocardiography refers specifically to radiologic
imaging of the heart and associated structures. Coronary
arteriography typically is performed at the same time to
visualize the coronary arteries. Cardiac catheterization is
a more general term that is used to describe placing a
catheter in the heart; it includes studies in addition to
radiologic imaging ones, such as obtaining blood samples
to measure oxygen saturation (oximetry) and measuring
hemodynamic pressures and gradients. Specialized
physiologic monitoring equipment is required for these
sensitive measurements. For the purposes of this text,
the focus will be on the imaging aspect of cardiac
catheterization.
Pathologic Indications
▪ Coronary artery disease and angina
▪ Myocardial infarct
▪ Valvular disease
▪ Atypical chest pain
▪ Congenital heart anomaly
▪ Other heart and aorta pathology
Catheterization
As for other angiograms, the femoral artery is the preferred site for
catheterization. The catheter is advanced to the aorta and along its length into
the left ventricle for the left ventriculogram. A pigtail catheter is used because a
large volume of contrast media will be injected. For the coronary arteriogram,
the catheter is changed and the coronary artery is selected; both right and left
coronary arteries are routinely examined. Specially shaped catheters are
designed to fit each of the coronary arteries. After injection of contrast media
into the coronary arteries, the catheter is immediately removed to prevent
occluding the vessel. Access to the right side of the heart is obtained by
catheterizing the femoral vein and advancing the catheter through the venous
structures until the right side of the heart is reached.
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