presentasi_kuliah_angiografi

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Angiographic



ANGIOGRAPHIC PROCEDURES As defined at the beginning of this

chapter, angiography refers to

radiologic imaging of blood vessels

after injection of a contrast medium.



Angiography can be ore

specifica!!y described as fo!!o"s#$Arteriography: iaging of the arteries

$Venography: iaging of the %eins

$Angiocardiography: iaging of the heart andassociated str&ct&res

$Lymphography: iaging of the !yphatic

%esse!s'nodes



(HE ANGIOGRAPH) (EA* # Angiography is perfored by a tea of hea!th

professiona!s, inc!&ding+-a radiologist +or other .&a!ified angiographer-,

+/- a “scrub” nurse or technologist who assists

with sterile and catheterization procedures, and

+0- a radiologic technologist. Depending on thedepartenta! protoco! and the specific sit&ation, an

additiona! physician, n&rse, techno!ogist, and'or

heodynaic techno!ogist a!so ay be a%ai!ab!e to

assist "ith the proced&re1



our vessels are typica!!y considered for

catheteri2ation#

+-feora!,+/- a3i!!ary,

+0- brachia!, and

+4- radia!1

(he femoral artery is the preferred site for an

arteria! p&nct&re beca&se of its si2e and easi!y

accessib!e !ocation



Indications

$ S&spected or 5no"n coronary$ heart disease

$ *yodcardia! infarction

$ S&dden cardio%asc&!ar death

$ 6a!%&!ar heart disease

$ Congenita! heart disease

$ Aortic dissection

$ Pericardia! constriction

$ Cardioyopathy

$ Initia! and fo!!o" &p assessent for

heart transp!ant 7



Contraindications

$ Acti%e GI b!eed

$ Rena! fai!&re

$ Recent stro5e$ 8e%er fro infection

$ E!ectro!yte iba!ance

$ Aneia

$ Short !ife e3pectancy

$ Digita!is into3ication

$ P( ref&sa!

$ Uncontro!!ed

hypertension

$ 9!eeding disorders

$ P&!onary edea

$ Uncontro!!ed %entric&!ar

arrhythias$ Aortic %a!%e endocarditiis

$ A!!ergic to contrast

:



Cop!ications and Ris5s

$ Death

$ *yocardia! infarction

$ Arrhythia

$Heorrhage$ Contrast

$ Heodynaic

$ Perforation

;



Angiographic S&pp!ies

and E.&ipent

$Catheters

$Contrast *edia$Press&re In<ector



Catheters

$ 8or =( cardiac cath

sii!ar to those for

angio

$ R( cath re.&ires

specia!i2ed catheters

$(ypica!!y f!o" directedcatheters

$ >ith anifo!ds

?



Contrast *edia

$ High Oso!ar Ionic

$ Soeties ca&ses ECG changes

$ >ide!y &sed$ Non@ionic

$ Ionic !o" oso!ar

$ Restricted costs ca&ses !iited &se of !o"oso!ar contrast agents1



SE=DINGER (ECHNIUE



ANGIOGRAPHIC (RA)

A steri!e tray contains the basic e.&ipent

necessary for a Se!dinger catheteri2ation of

a feora! artery 9asic steri!e ites inc!&de

the fo!!o"ing#1Heostats

/1Prep sponges and antiseptic so!&tion

01Sca!pe! b!ade

41Syringe and need!e for !oca! anesthetic

B19asins and edicine c&p

71Steri!e drapes and to"e!s:19and@Aids

;1Steri!e iage intensifier co%er



CON(RAINDICA(IONSContraindications for patients to e3perience angiography

inc!&de contrast media allergy! impaired renal function!blood"clotting disorders or ta#ing anticoagulant

medication, and unstable cardiopulmonary$neurologic

status.



POS(PROCEDURA= CARE

After the angiographic proced&re has been cop!eted, the catheter is reo%ed

and copression is app!ied to the p&nct&re site1

(he patient reains on bed rest for a ini& of 4 ho&rs, b&t the head of the

bed'stretcher ay be e!e%ated appro3iate!y 0?1 D&ring this tie, the patient is onitored, and %ita! signs and the periphera!

p&!se dista! to the p&nct&re site are reg&!ar!y chec5ed1

(he e3treity is a!so chec5ed for "arth, co!or, and n&bness to ens&re that

circ&!ation has not been disr&pted1 Ora! f!&ids are gi%en and ana!gesics are

pro%ided if re.&ired1

Patients sho&!d be instr&cted on "hat to do if the p&nct&re site spontaneo&s!ybegins to b!eed# apply pressure and call for help.



AU(O*A(IC E=EC(RO*ECHANICA= CON(RAS( *EDIU* INEC(OR

As contrast edia is in<ected into the circ&!atory syste, it is di!&ted by b!ood1 (he

contrast ateria! &st be in<ected "ith s&fficient press&re to o%ercoe the

patients systeic arteria! press&re and to aintain a bo!&s to inii2e di!&tion"ith b!ood1 (o aintain the f!o" rates necessary for angiography, an a&toatic

e!ectroechanica! in<ector is &sed1 (he f!o" rate is affected by any %ariab!es,

s&ch as the %iscosity of the contrast edi&, the !ength and diaeter of the

catheter, and in<ection press&re1 Depending on these %ariab!es and the %esse! to

be in<ected, the desired f!o" rate can be se!ected before in<ection1



ANGIOCARDIOGRAPH)

P&rpose

Angiocardiography refers specifica!!y to radio!ogic iaging of the heart and

associated structures. %oronary arteriography typica!!y is perfored at the

sae tie to %is&a!i2e the coronary arteries.%ardiac catheterization is a ore genera! ter that is &sed to describe p!acing a

catheter in the heartF it inc!&des st&dies in addition to radio!ogic iaging ones, s&ch

as obtaining b!ood sap!es to eas&re o3ygen sat&ration +o3ietry- and eas&ring

heodynaic press&res and gradients1 Specia!i2ed physio!ogic onitoring

e.&ipent is re.&ired for these sensiti%e eas&reents1 8or the p&rposes of this

te3t, the foc&s "i!! be on the iaging aspect of cardiac catheteri2ation1

Patho!ogic Indications

$Coronary artery disease and angina

$*yocardia! infarct$6a!%&!ar disease

$Atypica! chest pain

$Congenita! heart anoa!y

$Other heart and aorta patho!ogy



Catheteri2ation

As for other angiogras, the feora! artery is the preferred site for catheteri2ation1

(he catheter is ad%anced to the aorta and a!ong its !ength into the !eft %entric!e for the

left ventriculogram. A pigtai! catheter is &sed beca&se a !arge %o!&e of contrast

edia "i!! be in<ected1 8or the coronary arteriogra, the catheter is changed and the

coronary artery is se!ectedF both right and !eft coronary arteries are ro&tine!y

e3ained1 Specia!!y shaped catheters are designed to fit each of the coronary

arteries1

After in<ection of contrast edia into the coronary arteries, the catheter is iediate!y

reo%ed to pre%ent occ!&ding the %esse!1

Access to the right side of the heart is obtained by catheteri2ing the feora! %ein andad%ancing the catheter thro&gh the %eno&s str&ct&res &nti! the right side of the heart

is reached1



Anci!!ary E.&ipent

and S&pp!ies

$Physio!ogic E.&ipent

$Other e.&ipent



Physio!ogic E.&ipent

$ E.&ipent to onitor

$ ECG

$ Heodynaic press&res

$ 6ita! signs to

$ record P( f&nction

/



Other E.&ipent

$ Crash cart

$ O3ygen and s&ction

$ Defibri!!ator

$ (eporary pacea5er $ P&!se o3ieter

$ 9!ood press&re c&ff

$ E.&ipent to perfor cardiac o&tp&tst&dies

$ Acti%ated c!otting tie +AC(- e.&ipent

//



Catheteri2ation

*ethodsand (echni.&es



Pre@Catheteri2ation Care

$ Infored consent obtained

$ P( history

$ Physica! e3a

$ Ro thora3$ 9!ood "or5

$ ECG

$ Echocardiogra

$ E3ercise stress test

$ N&c!ear *edicine cardiac perf&sionst&dies

/4



Pre@Catheteri2ation Care

$ I6 started$ Sedation and na&sea

$ Nothing to eat 4@7 ho&rs before proced&re

$ Records of proced&re

$ P( heodynaic data$ 8!&oro ties

$ *edications adinistered

$ S&pp!ies &sed

$ Other pertinent inforation

/B



Catheter Introd&ction

$ Prepare catheter introd&ctionsite "ith aseptic techni.&e$ Sha%ed and c!eaned

$ Can be at feora! +ostcoon-, brachia!, radia!,a3i!!ary, <&g&!ar and

s&bc!a%ian areas

$ Se!inger techni.&e &sed

/7



Se!inger (echni.&e

/:

Need!e "ith cann&!a

inserted

Need!e "ithdra"n

&nti! there is b!ood f!o"

Inner cann&!a reo%ed

g&ide"ire inserted

Need!e reo%ed

Catheter o%er g&ide"ire G&ide"ire reo%ed

!ea%ing catheter in

artery



Data Co!!ection

$ Physio!ogic data &n&s&a!!y co!!ected

$ Heodynaic paraeters

$ Inc!&des b!ood press&re

$ Cardiac o&tp&t

$ 6asc&!ar press&res +inside o&tsidethe heart-

$ ECG

$ O3ietry readings

$ Cardiac o&tp&t$ 9!ood sap!es to eas&re o3ygen

sat&rations !e%e!s in %ario&s parts of theheart

/;



Catheri2ation St&dies

and Proced&res

$ Ad&!ts

$Chi!dren



9asic Diagnostic

St&dies of the6asc&!ar Syste for

Ad&!ts



Cath of the =( side of the heart#

ADU=(S$ Catheter introd&ced into

the radia!, brachia! or

feora! artery to the

ascending aorta

$ Aortic root angio is

perfored to doc&ent

copetence of the aortic

%a!%e

0



Aorta Root Angiography

$ Nora! eans bac5"ardf!o" of the contrast ediainto the =( %entric!ed&ring in<ection

$ Atria! o3ietry and b!oodpress&re "ithin aorta areeas&red

$ (hen ad%anced into the=( %entric!e

0/



=( 6entric&!ography

$ Pro%ides info on %a!%&!arcopetence

$ Inter%entric&!ar septa!integrity

$ Efficiency of the p&pingaction of =( %entric!e

$ Press&re eas&reentsare ade

$ >hen systo!ic +=(

%entric!e- does not atchsysto!ic +aorta-@ co&!dean aortic stenosis

00



Coronary Angiography

$ A!!o"s the e3tent of intracoronary stenosis to be

e%a!&ated

04




0B




07

Nora! =( coronary Artery

=( coronary

artery



Cath of the R( side

of the heart#

ADU=(S

0:



Cath of the R( side of the

heart#

ADU=(S

$ Press&re eas&reents

$ Used to deterine %a!%&!ar heartdisease

$ Congesti%e heart fai!&re

$ P&!onary hypertension

$ Cardioyopathies

0;



E3ercise Heodynaics

$ 8or e%a!&ation of %a!%&!ar disease$ >hen fatig&e and dyspnea are present

$ Si&!taneo&s catheri2ation is doneand press&re eas&reents of R( =( heart is ta5en$ At rest$ >ith e3ertion

$ Catheter is p!aced in#$ An artery +feora! or brachia!-$ 6ein +feora! or basi!ic-

0



9asic Diagnostic St&diesof the 6asc&!ar Syste for

Chi!dren$ 8or e%a!&ation of specific heodynaic

data

$ Se!ected aspects of cardiac f&nction

$ Congenita! heart defects

$ *ethods are different according to age

and si2e of the heart

4?



Ad%anced Diagnostic St&dies of the

6asc&!ar Syste for Ad&!ts

Chi!dren$ 9iopsy catheter "ithbioptoe tip isinserted into <&g&!aror feora! %ein intoR( %entric!e

$ a"s are opened andany biopsies areta5en

4



9ioptoe 9iopsies

$ Used to onitorcardiac transp!ants fortiss&e re<ection

$ And to differentiatebet"een %ario&stypes of

cardioyopathies

4/



St&dies of the Cond&ction

Syste for Ad&!ts Chi!dren

40

*&!ipo!ar catheters are inserted in$High R( atri& near sin&s node$ Atrio%entric&!ar ape3$Coronary sin&s



St&dies of the Cond&ction

Syste for Ad&!ts Chi!dren

$ Soeties 0 introd&cer sheaths are p!aced in one %ein

$ 8eora!

$ Interna! <&g&!ar %ein

$ S&bc!a%ian %ein

$ Cathodes ser%e a d&a! f&nction

$ Record e!ectrica! signa!s

$ Pace the heart

44



Inter%entiona! Proced&res

of the 6asc&!ar Syste#

Ad&!ts• Percutaneous Transluminal Coronary

Angioplasty (PTCA) • Also known as balloon angioplasty

• Employs balloon to dilate thecoronary artery stenosis

• The placement of the catheter isplaced much in the same way asstandard coronary angiography

4B



P(CA cont

$ Specia! steerab!e P(CA

g&ide"ire is &sed1

$ G&ide"ire is ad%anced to

stenotic area thro&gh the

ba!!oon catheter

$ 9a!!oon is p&shed

thro&gh to the stenotic

area

$ 9a!!oon is inf!ated and

copresses fatty

deposits

47



P(CA cont

$ 8o!!o"ed byarteriography to a5es&re it b!ood is f!o"ing

$ (his ay be donerepeated ties toass&re a3i&di!atation

$ Restenosis occ&rs in0?@B? of patients

4:



P(CA

4;



P(CA "ith Stent p!aceent

$ Sii!ar to P(CA a!one

e3cept a stent is

p!aced

$ Restenosis is !o"erfor ptJs "ho do this

rather than

con%entiona!

angiop!asty a!one

4



P(CA "ith Stenting

B?



P(CA "ith Stent P!aceent

B



Atherectoy$ Atherectoy de%ices

reo%e the fatty deposit

or throb&s ateria!"ithin artery

$ Directiona! coronary

atherectoy de%icesha%ing a specia!i2ed

c&tting de%ice to sha%e

o&t the p!a.&e

$ (here is a specia! nose

cone that co!!ect the free

f!oating partic!es

B/



Perc&taneo&s trans!&ina!

coronary rotationa! atherectoy$ (he tip is a footba!! shape

and is ebedded "ith

diaond partic!es

$ Specia! tor.&e g&ide"ire

bet"een 7?,???@/??,??? rp

$ (he p!a.&e is p&!%eri2ed

into partic!es the si2e of

R9CJs and reo%ed bythe retic&!oendothia!

syste

B0



Inter%entiona! Proced&res of the

6asc&!ar Syste# Chi!dren$ 9a!!oon Septostoy to

en!arge a patent foraeno%a!e or pree3isting atria!septa! defect

$ (his a!!o"s i3ing of R(and =( b!ood$ Res&!ting in ipro%ed

arteria! o3ygenation

$ 9a!!oon is passed thro&ghatria! septa! opening into the=( atri&, inf!ated "ithcontrast and p&!!ed bac5thro&gh the orifice$ Ca&ses sept& to tear

B4



9a!!oon Septostoy "ith

(ransepta! Syste Approach

$ >hen there is not a

pree3isting ho!e in the

atria! sept&

$ (ransepta! approach is

&sed

$ Catheter "ith 5nife is

ep!oyed into =( atri&

b!ade is opened and p&!!edbac5 thro&gh R( atri&

$ (hen ba!!oon septostoy

ay be perfored to open

the ho!e oreBB

f



Inter%entiona! Proced&res of the

Cond&ction Syste# Ad&!ts

Chi!dren

$ Antiarrhythic

de%ices$ Pacea5ers

$ Ip!antab!e

cardio%erter

defibri!!ators

B7



CKR "ith Pacea5er

B:



Post Catheteri2ation Care

$ 8ir press&re is app!ied to p&nct&resite for B@0? in&tes

$ >o&nd sites are c!eaned and dressed$ (he patient "i!! be obser%ed in

reco%ery for 4@; ho&rs$ (he insertion site "i!! be chec5ed

fre.&ent!y for signs of b!eeding1$ *edications and discharge instr&ctions

are gi%en$ =ots of f!&id sho&!d be ta5en in$ 6ita! signs sho&!d be onitored for /4

ho&rs

B;



Cardiac Catheteri2ation

(rends



(rends

$ 6asc&!ar brachytherapy@ techni.&e "here

radiation is de!i%ered to an area of a

pre%io&s!y stented artery &sing

endo%asc&!ar techni.&es

$ Dr&g e!&ting stents@ dr&g coated stents&sed for treatent of CAD to red&ce

restenosis

7?



*RI

$ Is becoing ore sophisticated and ha%ing greater

detai! and reso!&tion

$ A!!o"s for is to be &sed ore often for the cardio%asc&!arsyste

$ *RA is no" ab!e to assess anoa!ies in the coronaryarteries

$ And identify ca!cifications in the coronary arteries and

bypass grafts

7



E!ectron 9ea C(

$ Can detect heart disease at it ear!iest and

ost treatab!e stages

$ *eas&res the ao&nt of coronary

ca!ci&,

$ E!ectron 9ea angiography is a sip!e

and nonin%asi%e techni.&e that &ses I6

contrast edia in<ection

$ Effecti%e for %is&a!i2ation of great

%esse!s, carotid arteries and periphera!%asc&!at&re

7/



(han5 yo&111 >ith !o%e Dr1 *ario

presentasi_kuliah_angiografi

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