Aortography is an X-ray examination of the thoracic or abdominal aorta and its vascular branches after preliminary catheterization and filling with contrast. It is indicated for suspected aortic valve insufficiency, aneurysm, atherosclerosis, occlusion of the aorta and its main branches, for the diagnosis of a number of pathologies of the abdominal and thoracic cavity. Aortography is mandatory before the upcoming endovascular surgery on the arteries. It can be performed transfemorally (through puncture of the femoral artery), transvenously (through venesection of the ulnar, jugular or femoral vein), translumbally (paranephral – through puncture of the aorta in the lumbar region).
Indications for abdominal aortography
As it has already become clear, the study considered in this article is prescribed by the attending doctor if there is a need to examine the condition of blood vessels and, in particular, the aorta.
In order for the doctor to prescribe this study, it is necessary to have an indication for abdominal aortography. Such doctors include:
- Aneurysm (pathological local dilation of a blood vessel site) of the aorta.
- Coarctation is a malformation consisting in narrowing or complete closure of the aortic lumen.
- Suspected internal bleeding.
- Congenital heart disease, in which the ductus arteriosus (Botall’s duct) does not overgrow in a newborn after its birth.
- Stenosis of the mouth of the blood vessel – narrowing of the passage section of the aortic valve, 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 arc of the blood vessel, which lead to complete blockage of the passage lumen.
- Dysfunction of the aortic valve.
- Violation of the integrity of the abdominal organs resulting from injury or chronic disease.
- Defferentialization of the diagnosis of mediastinal neoplasms and aortic aneurysms.
- Suspected presence of a benign or malignant tumor.
- Pathology of retroperitoneal space.
- The need to clarify the location of negative changes in the aorta during the preparation for surgery.
Preparation for aortography
Like many other studies, this procedure requires the implementation of a number of previous measures. Preparation for aortography consists of several stages.
- The patient’s blood is taken for analysis of general parameters and clotting.
- Testing for the presence of an allergy to iodine is carried out.
- On the eve of the scheduled examination, before going to bed, the patient undergoes a cleansing enema, after which he receives one of the sedatives.
- On the day of the 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 fluid is planned to be supplied, the manipulation nurse shaves the hairs, cleaning the surface for further work.
- The study is performed under the influence of anesthesia. Therefore, half an hour before the intended procedure, the patient undergoes premedication, which is preparation for anesthesia.
- Local anesthesia is used more often, but if the patient’s body shows an allergic reaction to a contrast fluid containing iodine, then the medical procedure takes place 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 undergoing a particular procedure, seek to learn more about the essence of its implementation, the informative nature of the method and the reliability of the results obtained.
The study in question of the abdominal region of one of the large vessels is performed to identify pathological changes affecting both the aorta itself and the internal organs adjacent to it. It can be the liver, intestines, spleen, pelvic organs or kidneys.
The technique of abdominal aortography is simple. The X-ray contrast preparation is fed, with this type of study, into the axillary or femoral artery. This substance is inert and does not harm the body of the examined patient.
The invasive technique consists of three stages:
- The procedure is performed in a lying position. The patient is fixed to the table, since he must be motionless during the entire examination. Only in this case it is possible to obtain high accuracy of the result.
- Initially, the patient receives anesthesia. The catheter insertion site is sanitized and a small incision is made of the desired vessel, through which it is carefully inserted into the blood vessel. A catheter is a special medical tube made of plastic. It is smoothly promoted along the course of the blood vessel. The doctor has the opportunity to monitor the entire procedure with the help of X-ray television, which the device is equipped with.
- Upon completion of the introduction, the specialist begins to supply an X-ray contrast substance through the tube, a lightning-fast shooting takes place in parallel, giving a series of X-rays. During the administration of the drug, the patient may feel the incoming heat. Contrast fluid is supplied to the body two to four times (as needed).
- After the end of the examination, the catheter is carefully removed. The place of its introduction is fixed with a tightening bandage or 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 the study in question:
- Magnetic resonance angiography allows you to determine the anatomical features and the level of functioning of the examined blood vessel.
- Computed tomography angiography allows a specialist to get a very clear and accurate picture of the location and condition of a blood vessel.
Abdominal aortography is mainly performed for the study and differentiation of diseases of the kidneys, bladder, intestines, kidneys, spleen and uterus. Abdominal aortography is a fairly informative method of recognizing the localization of placenta previa.
This procedure allows you to diagnose the presence of various anomalies, polycystic cysts, the presence of solitary cysts in the body, to recognize pyelonephritis, hypernephroid malignant neoplasms, hydronephrosis and other pathological changes.
If the attending doctor has a suspicion of a pathological process developing in the patient’s body affecting the thoracic part of the aorta, then there is a need to confirm or refute this assumption. In this case, a thoracic aortography is prescribed to the patient by a specialist.
This study allows you to recognize:
- An aneurysm of a blood vessel developing precisely on the thoracic part of the aorta.
- Development of coarctation in the area of interest.
- Aortic valve dysfunction.
- Other anomalies of its development.
This procedure is prescribed quite rarely. Despite the fact that this technique is relatively easy to use, but cardiac aortography by means of a puncture of the cardiac aorta may be fraught with sufficient danger and cannot be offered for widespread use.
The essence of the problem of this procedure is that it does not make sense to conduct a study using a small-diameter needle, whereas a medical instrument of a diameter suitable for the study, due to its wide lumen, is not recommended due to the high probability of subsequent development of hemorrhage. This medical term refers to the outflow of blood from an injured vessel, violation of its integrity and permeability of its walls. The presence of bleeding increases the risk of serious complications, or even the threat of death.
The choice of the insertion site for this procedure does not save either – the brachial artery. If the contrast fluid is injected through the blood vessel specified above, before it gets into the necessary artery, the coloring drug will have to go a fairly long way. This will not make it possible to get a picture of the required accuracy. But this technique will save the patient and the doctor from the risk of hemorrhage.
It is preferable to perform 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 agent from entering the brain. At the moment of casting the liquid, a number of pictures are taken.
This research methodology is quite innovative and is currently produced only in specialized institutions.
Computed tomography angiography is, in fact, two in one. If there is a need and CT aortography is prescribed to the patient, then the patient can undergo almost two studies in one procedure: traditional scanning of the disturbing area using a computed tomography machine, angiography is performed in parallel. 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 computer’s hard disk. The doctor will help, if necessary, to use this data repeatedly.
After the end of the procedure, the attending physician has high-precision images of the aorta, the tissues and internal organs adjacent to it.
The very way of organizing and passing the procedure is akin to a conventional computed tomography. But an additional thing is that during the scan, a contrast fluid is supplied to a certain artery, after which several X-rays are recorded.
Due to the fact that most often the X-ray contrast preparation is fed into a vein, and not an artery, the ct aortography procedure is considered less invasive than in the case of only aortography.
The doctor may prescribe this study in the same cases that were indicated as indications for abdominal aortography. During the examination, the subject is placed on a special lounger (while the patient is on his back) and is “brought” into the cocoon chamber by means of special mechanisms. In it, the human body is penetrated by X-rays in a ring.
Receiving a response, a computer program creates images – slices of various parts of the body. The resulting image is in black and white negative gradation. During the intake of a contrast agent into the patient’s body, the picture becomes more distinct. In this case, the doctor receives the material in a three-dimensional (3D) image.
Magnetic resonance angiography is a fairly innovative method of examining the human body. The combination of two methods – MRI aortography – allows a specialist to obtain an image of the organ of interest in one procedure, as well as X-rays of this area.
The essence of the technique is that the patient is placed in the magnetic field of the device, while irradiating his body with radiological waves. In such a situation, the human body responds with electromagnetic energy, which is recognized and processed by a computer program.
Magnetic resonance angiography is prescribed when there is a need to obtain a three-dimensional image of blood vessels. At the same time, this technique allows you to get information and get a result without resorting to radiopaque means. Although if there is a need for a clearer picture, doctors resort to using a contrast agent.
The advantage of this method is that it proceeds painlessly. At the same time, the doctors did not note any negative effect of the magnetic field on the patient’s body.
Aortography by Seldinger
One of the most frequently encountered and used diagnostic techniques, according to the issue we are considering, is Seldinger aortography. This method of percutaneous catheterization of the femoral artery is performed using a set of special medical instruments. In this kit you can find:
A medical needle for puncture.
- Metal conductor with a soft end.
- Dilator – a tool for expanding natural or artificially created holes and channels. It is especially relevant in the case of their reduction due to the course of pathological changes in the patient’s body.
- A catheter is a medical device represented by a long thin tube and additional diverse nozzles that allow performing various functions.
- The introducer is a “conductor”, a plastic tube with a hemostatic valve built into it.
Before starting the study, the patient undergoes a standard preparation procedure, which has already been described above. The examination itself begins with the insertion of a puncture needle into the femoral artery. This allows you to insert a special metal conductor (similar to a string) into the puncture. The needle is removed, and using a “string” a medical catheter is fed into the passage section of the artery.
To improve the clarity of the image, a contrasting liquid is used, the quantitative input of which is calculated according to the formula 1 ml per kilogram of the patient’s body weight (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 quite painful, the patient receives anesthesia before it begins. More often, the examination is carried out under the influence of a local anesthetic (lidocaine or novocaine), but under certain conditions and medical indications, general anesthesia can be applied.
It is also worth noting that Seldinger aortography can be performed not only through the femoral aorta, but also through a puncture in the brachial or axillary artery. The doctor may decide to change the place of entry due to blockage of the femoral blood vessel.
This technique is considered basic and is used most often in the diagnosis of the diseases listed above.
If a doctor needs a visual examination of the abdominal aorta, or other large blood vessels that “serve” the pelvic organs and lower extremities of a person, then, often, he resorts to translumbal puncture. In case of blurring of the drawing and the need to get a clearer picture, doctors resort to another examination procedure called translumbal aortography.
Puncturing of a blood vessel is performed with a special medical hollow needle. The introduction takes place from the back of the body. A high-level translumbal aortography is also possible, while the catheter is inserted in the thoracic region at the level of the twelfth spine. If there is a need to examine the work of the vessels of the legs (along their entire length) or the abdominal zone, the translumbal insertion of the needle takes place in the area of the second lumbar vertebra.
When carrying out the procedure under consideration, it is very important to fulfill a number of mandatory requirements. One of these is the fact of gradual removal of the needle:
- It is initially 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 paraaortic region.
This research technique allows you to thoroughly examine almost any part of the arterial bed. The method is quite informative!
Studies of this nature are necessarily carried out in the conditions of specialized institutions. This makes it possible to minimize the risk of complications, and the patient will receive the help of highly qualified medical personnel.
Complications of abdominal aortography
Due to the fact that this examination takes place with the use of a medical instrument that damages the integrity of the skin and tissue structures of the body, while necessarily damaging the blood vessel, there is a possibility of complications.
The most common complications of abdominal Aortography:
- Soreness and swelling at the catheter insertion site.
- Occurrence of bleeding. It can be both internal and external in nature.
- Formation of a hematoma.
- Blood vessel thrombosis.
- Arterial embolism (blockage of the vascular lumen by an embolus, that is, a particle brought with the blood flow).
- Formation of an arterial or venous fistula.
- An allergic reaction to the iodine component of the contrast agent is possible.
- Development of an aneurysm at the catheter insertion site.
- There may be a malfunction in the heart rate.
- There is a possibility of developing acute renal and/or hepatic insufficiency.
- Perforation of a blood vessel.