Patients suffering from diseases of the heart and blood vessels undergo regular clinical trials. Primary diagnosis allows you to differentiate the pathology and make the correct diagnosis, and examinations in dynamics help to clarify the state of the body during therapy and are a preventive measure for the development of complications. An often used method for examining diseases of the cardiovascular system is angiography. What is diagnostically important is the manipulation and how it is carried out, is considered in the article.
general information
It took more than 30 years to realize the idea of angiography since the physiologist Bekhterev voiced his thought: “If there are solutions that do not let X-rays pass, then you can fill the vessels and take photographs with such liquids.” In order for manipulation to become widespread and effective in use, four more decades were needed.
Patients who are prescribed the procedure are interested in: "Angiography - what is it?" This is a method for diagnosing the condition and patency of blood vessels, which is carried out using radiopaque substances. The procedure allows you to evaluate the following indicators:
- blood flow rate;
- location of blood vessels;
- the presence of congenital malformations;
- narrowing;
- formation of roundabout blood flow paths;
- the state of the vessels that feed the tumor.
Where is the procedure performed?
Diagnostic centers (narrow or wide profile) and hospitals are equipped with special facilities for angiography.
All conditions of asepsis are met here. In the premises there is the necessary equipment:
- angiograph - a device having an x-ray unit for assessing the state of blood vessels (arteries, veins, capillaries, lymphatic vessels);
- speedy x-ray camera;
- apparatus whose job is to conduct x-ray multishot and video recording.
In highly specialized diagnostic institutions, CT angiography is performed. This procedure allows you to get a clearer picture of the state of the vessels (in detail), which means that it requires the use of the latest advanced devices.
Research principles
A radiopaque substance, which is a derivative of iodine, is injected into that blood vessel that needs to be examined and studied. This is done through catheterization or puncture. If the vessel is located at a short distance under the skin, then the solution is injected into it using a syringe (puncture).
Catheterization is used for deeper arteries or veins. In the projection of the test vessel, local anesthesia is done. After cutting the skin and subcutaneous adipose tissue, the test vessel is found, an introducer is inserted into it (a thin plastic tube about 10 cm long). Other instruments and a catheter are moved through the introducer, so as not to accidentally damage the walls of the vessels. A contrast agent is introduced through the catheter.
After the solution enters the vessel, it spreads through the system. First, the arteries and veins are filled, then the arterioles, venules and capillaries. At this time, using the X-ray apparatus , several shots or a short video shoot are taken.
An angiography of arteries or veins (results of the study) is recorded on a digital medium, which allows you to show the manipulation data to other specialists.
Where is it used?
Examination of the condition and patency of blood vessels is used in such areas of medicine as:
- vascular surgery - before surgery, the doctor clarifies the location and structure of the operated areas;
- oncology - the area of the primary region and metastases is examined at the time of construction of their capillary network;
- pulmonology - allows you to evaluate the vascular network of the lungs, as well as determine the localization of bleeding;
- phlebology - specialists determine the presence of narrowing, the appearance of aneurysms, the formation of blood clots, vascular lesions with atherosclerosis, congenital anomalies;
- neurology - angiography of the vessels of the brain shows the presence of aneurysms, hemorrhages, constrictions, tumor processes.
If it is necessary to examine all the vessels of a certain area, then this procedure is called general angiography. In the case of assessing the condition of individual vessels, such a study is called selective.
Brain angiography
To conduct an examination, a radiopaque substance is administered by catheterization of one of such arteries, such as:
- right femoral;
- humeral;
- ulnar;
- subclavian.
The catheter is advanced along the system of blood vessels to the area where the branch of the test vessel is located. A solution is injected into its lumen. Immediately take a series of shots from the side and front of the head. If it is necessary to study more distant structures, a second portion of the substance is introduced. Again follows a series of shots in the necessary projections. The entered tools are deleted, and the diagnosis is considered complete.
Angiography of the brain requires the use of local anesthesia to anesthetize the place where the catheterization is performed. While the catheter is being advanced throughout the body, the patient does not feel discomfort. With the introduction of the solution, a taste of metal in the mouth may appear, hyperemia of the skin of the face, a feeling of spilled heat. The phenomena disappear after a few minutes.
Indications for examination of brain vessels
A number of pathological conditions requiring diagnosis (to clarify the details, MRI angiography is performed):
- aneurysm - an expansion of the vessel, which can lead to hemorrhage;
- angioma - a vascular tumor;
- ischemic stroke - the doctor assesses the need for thrombolysis;
- hemorrhagic stroke - the source of hemorrhage is determined;
- vascular malformation - the doctor assesses the level of pathology and the source of bleeding;
- TBI - allows you to determine the consequences of an injury;
- hematoma - a specialist evaluates localization and size;
- tumor - determine the size, location, condition of the supply vessels.
Angiography of the heart vessels
Coronary angiography - what is it? This is a method for examining heart vessels. Catheterize the femoral or radial artery and catheter to the aorta. The radiopaque solution is injected alternately into the right and left coronary arteries. A series of shots is taken instantly.
The patient may complain of the appearance of symptoms with the introduction of the drug, such as:
- fever in the face;
- arrhythmia;
- dizziness;
- nausea, vomiting;
- cough.
Indications for conducting are considered heart attack, coronary heart disease, cardiosclerosis, anomalies of the heart vessels of a congenital nature.
Examination of the vessels of the limbs
Angiography of the extremities involves the process of examining the condition of the arteries and veins of the arms and legs. Diagnosis of the upper extremities is carried out by introducing a radiopaque substance into the brachial artery. For the lower extremities, into the abdominal aorta or femoral artery, depending on the level at which diagnosis is needed. To study the vessels of the foot and lower leg, a puncture of the posterior tibial artery is performed. With the introduction of the solution, the patient may feel a rush of heat in the legs.
Indications for research:
- atherosclerosis of the lower extremities;
- obliterating endarteritis;
- thrombosis, thrombophlebitis;
- thromboembolism;
- damage accompanied by rupture of blood vessels;
- stratified aneurysm;
- evaluation of the effectiveness of treatment.
Diagnostic preparation
Be sure to clarify the lack of individual hypersensitivity to iodine and its derivatives. If the patient has a pregnancy, x-rays are not used. In this case, MR angiography is preferred.
For two weeks exclude alcoholic beverages, for a week - anticoagulants ("Heparin", "Warfarin", "Aspirin"). A few days before the diagnosis, a number of studies are carried out, such as:
- clinical tests of blood and urine, coagulogram, biochemistry;
- ECG and ultrasound of the heart;
- fluorography of the lungs;
- determination of blood group and Rh factor;
- screening for infections (HIV, hepatitis, syphilis).
On the eve of angiography, a test for radiopaque substance is performed. 0.1 ml of solution is injected into a vein. In the event of the appearance of urticaria, allergic rhinitis, conjunctivitis, arrhythmias, the drug is prohibited to use.
In the evening before the procedure, a cleansing enema, hygiene procedures are performed. The specialist prescribes sedatives, which allow the patient to relax and rest. In the morning, the subject should not eat or drink, before the manipulation, the bladder must be emptied.
The nuances of preparation
There are a number of pathological conditions that require a longer and more thorough approach in preparation for a procedure such as angiography. What should patients do so that the diagnosis goes smoothly?
With high blood pressure it must be stabilized. For this purpose, use "Nifedipine", "Dibazole", "Raunatin" or any other antihypertensive drug that is in continuous therapy of the patient.
In the presence of cardiac arrhythmias, Panangin or potassium chloride is administered. As prescribed by the doctor, cardiac glycosides are used. For coronary heart disease or cardiac pain, Nitroglycerin, Erinit, Sustak are used.
Kidney diseases require saturation of the body with water. The radiopaque material used will act less as an irritant and will be excreted faster in the urine.
If there are chronic sources of infection (sinusitis, bronchitis), a specialist prescribes antibacterial drugs or sulfonamides 2 weeks before the study.
Contraindications to angiography
The diagnostic procedure is not performed when there is a threat to the condition and health of the patient. This occurs in conditions such as:
- acute inflammatory diseases;
- psychical deviations;
- renal failure;
- decompensated heart failure;
- allergy to iodine and its derivatives;
- diseases accompanied by bleeding disorders;
- pregnancy.
Angiography is an effective and widely used method for studying the vascular system, which has many advantages over other diagnostic procedures.