Pulmonary angiography is a technique of invasive contrast radiography of pulmonary circulation vessels. There are selective (selective contrasting of individual branches of the pulmonary artery) and general (contrasting of the entire small circle) angiopulmonography. Lung angiography is indicated for detecting anomalies of pulmonary vessels, PE, etc. vascular pathology. Under local anesthesia, after puncture of the right femoral vein, a thin catheter is inserted into the right parts of the heart and installed in the pulmonary artery; contrast is injected and a series of angiograms are performed.
Methodology of conducting
Angiogpulmonography begins with a puncture of the right subclavian or jugular vein, into which the introducer 6 FR is installed. According to the introducer on the conductor, the right parts of the heart are catheterized using diagnostic catheters. A diagnostic catheter is installed in the pulmonary trunk in the area of bifurcation of the right and left main pulmonary arteries. With the help of an automatic injector, contrast is injected into the pulmonary artery. Next, to visualize the right pulmonary angiography, a catheter is installed in the right main PA and 40 ml of contrast was injected. To visualize the left pulmonary angiography, a catheter is inserted into the left main PA and the same amount of contrast is injected. During the introduction of contrast, the patient holds his breath, the surgeon performs a study of the pulmonary artery in two projections.
The next step is to insert a Swan–Ganz catheter through the right parts of the heart into the pulmonary artery. The distal end of the Swan-Ganz catheter is installed in one of the branches of the pulmonary artery. After measuring the indicators, the average pressure in the pulmonary artery is calculated. Next, air is injected into a special catheter port with a syringe, thereby jamming one of the branches of the pulmonary artery. In this way, the pressure of the jamming of the pulmonary artery is measured. Also, during angiopulmonography, cardiac output is measured using the thermodilution technique.
Next, the resistance of the vessels of the small circulatory circle is calculated. A mandatory stage of the study is cavagraphy – the catheter is lowered below the renal veins to detect possible blood clots and search for the mouths of the renal veins.
Complications
All procedures have certain risks. The risks of this procedure may include:
- Allergic reaction to a contrast agent
- Bleeding due to a punctured blood vessel
- Nerve injury during access to the vessel
- Thrombus (embolus) in a blood vessel
- Swelling of the puncture site (hematoma)
- Infection
- Exposure to X-rays
Your risks may vary depending on your general health and other factors.
Preparation
Your attending physician will explain the procedure to you. Ask him or her any questions you have. You may be asked to sign a consent form to perform the procedure. Read the form carefully. Ask questions if something is not clear.
Tell your doctor if you:
- Pregnant or think you may be pregnant
- Allergic to contrast dye or iodine
- Have kidney failure or other kidney problems
- Sensitive or allergic to any medications, latex, tape or anesthetics (local and general)
- Take any medications, including over-the-counter medications, vitamins and herbal supplements
- Have you had a blood clotting disorder
- Do you take blood thinning medications (anticoagulants), aspirin or other medications that affect blood clotting
What happens during a pulmonary angiography?
- You may be asked to remove jewelry or other items.
- You will need to empty your bladder before the procedure.
- You will be lying on your back) on the X-ray table.
- An intravenous catheter (IV) will be installed in the arm.
- Small sticky pads (electrodes) will be glued to the chest. They will be connected by wires to the device (ECG), which registers the electrical activity of your heart.
- Your pulse, blood pressure and breathing will be monitored during the procedure using a special monitor.
- An anesthetic (local anesthetic) will be injected into the puncture site.
- A thin, flexible tube (catheter) will be passed through the vein to the right side of the heart.
- Contrast agent through a catheter into the area of surgical interest. You can feel some effects when it’s done. These effects may include a feeling of a rush of blood, a salty or metallic taste in the mouth, short-term headache, nausea or vomiting. These effects usually last for a few moments.
- Tell your doctor if you feel any breathing problems, sweating, numbness or palpitations. After the contrast agent is injected, a series of X-rays will be taken.
- The catheter will be removed and the place of its insertion will be compressed with a special bandage.
What happens after a pulmonary angiography?
After the procedure, you will lie in the postoperative ward for 1 to 2 hours. Your blood pressure, pulse and breathing will be monitored. The puncture site of the groin or arm will be checked for bleeding. You will need to keep your leg or arm straight. If necessary, you will be given painkillers. You may be able to return home the same day. Or you may need to stay overnight.
At home, you can return to your normal diet and activities, if this is indicated by your attending physician. Drink plenty of water. This will help to wash off the contrast dye from your body. Do not do strenuous physical activity for several days. Do not take a hot bath or shower for a day or two. Check the puncture site in the groin or arm several times a day. Check for bleeding, pain, swelling, discoloration, or temperature. A small bruise is normal.
