Pelvic phlebography is an X-ray examination of the pelvic veins using a contrast agent. It is carried out in case of suspected developmental abnormalities, acute thrombosis, post-thrombotic disorders and other pathological conditions of the pelvic and inferior vena cava veins. It is used to assess the prevalence of malignant neoplasia of the pelvic organs. Usually, contrast…
Angiography is an invasive X-ray examination of blood vessels with the preliminary introduction of special radiopaque preparations. Depending on the type of vessels studied (arterial, venous, lymphatic), arteriography, phlebography and lymphography are distinguished. It can be general (in the study of all major arteries and veins) and selective (in the study of vessels of a specific anatomical region). The latter may include cerebral angiography, angiopulmonography, coronary angiography, renal angiography, retinal angiography, etc. Angiography allows you to visualize vessels of any caliber, assess their architectonics, identify anomalies (aneurysms, constrictions, malformations), damage, obstacles to blood flow (blood clots, atherosclerotic lesions).
Types of angiography
Taking into account the characteristics of the studied vessels, arteriography, phlebography (venography), kappilarography and lymphography are distinguished. Taking into account the scale of the study, general and selective (local) angiography are distinguished. There are the following types of selective angiography:
- Cerebral – examination of the vessels of the brain.
- Coronary – examination of the heart vessels.
- Peripheral – examination of the vessels of the upper and lower extremities.
- Aortography: thoracic (examination of the thoracic aorta) and abdominal (examination of the abdominal aorta).
- Angiopulmonography is a study of pulmonary vessels.
- Portography is a study of the portal vein.
- Renal – examination of the vessels of the kidneys.
Methodology of conducting
Within 4 hours before the procedure, the patient is forbidden to eat and drink. Before starting angiography, the patient is placed on a special table. A tranquilizer is administered intramuscularly to reduce anxiety and an antihistamine to prevent allergies. An artery, vein or lymphatic vessel is selected, the skin area above the vessel is treated with an antiseptic drug, local anesthesia is performed, a small incision is made on the skin and an introducer is installed (a special device for installing a catheter through which a contrast agent will be injected into the vessel during angiography).
A catheter is inserted through the introducer and pushed to the vessel in the study area. An X-ray is taken to make sure that the catheter is in the right place, and then an X-ray contrast agent (triiotrast, cardiotrast, urographin, hypac) is injected into the catheter and a series of images are taken. If necessary, the procedure is repeated several times until the data necessary for diagnosis, determination of treatment tactics, etc. are obtained (depending on the purposes of angiography).
At the end of the study, the catheter is removed, the incision site is closed with a sterile cloth and a bandage is applied. Within 6-10 hours after angiography, the patient is advised to observe bed rest for the prevention of thrombosis. Iodine-containing contrast agents can have a negative effect on the kidneys, so the patient is recommended to drink more fluids to reduce the concentration of the drug in the blood and facilitate its excretion in the urine.
The grounds for conducting cerebral angiography are causeless dizziness and headaches, recurrent episodes of nausea, fainting and pre-fainting states of unclear etiology, residual disorders after traumatic brain injuries, neurocirculatory dystonia, acute or chronic cerebral ischemia, a history of micro-stroke or stroke. The purpose of angiography is to make a diagnosis, choose treatment tactics, determine the effectiveness of therapy already performed, or assess the dynamics of the patient’s condition in the long-term period after injuries and diseases.
Angiography allows you to diagnose circulatory disorders by hemorrhagic (aneurysms, vascular diverticula, angiomas) and ischemic (atherosclerotic changes, blood flow disorders, vascular deformities) type. In addition, according to the study, changes in the vascular pattern characteristic of benign and malignant neoplasms of the brain are revealed. To increase the information content, along with classical radiography, vascular CT is used, which allows to obtain layered images of brain vessels and their three-dimensional computer image.
Indications for coronary angiography are severe stable angina pectoris, ineffectiveness of drug therapy for angina pectoris, a previous myocardial infarction accompanied by clinical death or severe rhythm disturbances, a high probability of sudden death from cardiac arrest, myocardial infarction or the appearance of symptoms of angina pectoris within a year after stenting, the period of preparation for heart valve surgery in patients older than 40 years, the presence of contraindications for ultrasound or ECG with load, as well as clarification of the diagnosis with ambiguous data, obtained in the course of other studies. The purpose of angiography is to assess the degree of blood flow disorders, diagnose and determine treatment tactics.
Based on the results of the study, a decision may be made to conduct conservative therapy, coronary artery bypass grafting or artery stenting. Angiography of coronary vessels can detect stenosis (narrowing of the vessel), occlusion (blockage of the vessel), aneurysm (bulging of the vessel wall) and calcinosis (deposition of calcium salts in the vessel wall). Narrowing of the vessel lumen by 75 percent or more is an indication for surgical intervention on the coronary arteries.
Extremity vessels angiography
Indications for angiography of the vessels of the extremities are diseases and pathological changes of the arteries (atherosclerosis, obliterating endarteritis, thromboembolism, diverticulitis, delaminating aneurysm), venous diseases (phlebitis, thrombophlebitis of superficial veins), diabetic foot syndrome in diabetes mellitus, traumatic vascular injuries of the extremities, trophic ulcers and purulent necrotic lesions of the extremities, clarification of the surgical treatment plan for injuries and diseases veins and arteries and assessment of vascular condition in the postoperative period.
In clinical practice, angiography of the vessels of the lower extremities is more often required, due to the widespread prevalence of diseases of the arteries and veins in this area. Angiography of the vessels of the upper extremities is usually performed for injuries. In case of venous lesions, phlebography is prescribed, in case of injuries and diseases of the arteries – arteriography.
The purpose of the examination is to make a diagnosis, determine the tactics of conservative and surgical treatment, or evaluate the effectiveness of therapy. Angiography of the lower extremities makes it possible to assess the condition of the main vessels, the number of collaterals and their ability to provide adequate blood circulation after ligation of a large vessel, the condition of the walls of arteries and veins (the presence of blood clots and atherosclerotic plaques, pathological expansion or narrowing of the lumen).
Lower extremities phlebography is an X-ray contrast study conducted to assess the nature of blood flow, condition and anatomical structure of the peripheral parts of the venous system. It is performed for varicose veins, deep vein thrombosis, post-thrombophlebitic disease and vascular abnormalities in case of insufficient information content or unavailability of less invasive diagnostic methods. The…
Peripheral arteriography is a method of examining blood vessels, in which their images are obtained using an X-ray machine and special X-ray contrast substances that are clearly visible in X-rays. This method is carried out if the following vascular pathology is suspected: aneurysm (bulging of the vessel wall) obturation (blockage) damage to the wall inflammation narrowing…
Celiac angiography (angiography of the ventral trunk) is a selective radiopaque examination of the ventral trunk of the aorta and its branches. Coeliacography allows you to visualize the architectonics of blood vessels supplying the stomach, duodenum, liver, pancreas, spleen, gallbladder and its ducts, large and small omentum; to identify their pathology (tumors, injuries, condition after surgical…
Portography is an X-ray examination of the portal vein and its intrahepatic branches. It is used to visualize the vessels of the portal vein system in order to study their structure, lumen width and collateral blood flow. The technique is used in the diagnosis of inflammatory diseases, congenital abnormalities of the liver and its vessels. It…
Lymphography is a way to diagnose the lymphatic system. It implies the use of a contrast agent, as well as an X-ray. This method of diagnosis is also called radiolymphography. This method of diagnosis allows you to find out the state of the lymphatic system, detect an increase in lymph nodes or other changes in this…
Coronary bypass is a method of invasive X-ray examination of the heart vessels with a series of images. It is used for visualization of coronary vessels in order to assess their number, location and width of the lumen. It is used in the diagnosis of inflammatory, congenital and atherosclerotic stenoses, it is carried out with the…
Coronary angiography is a radiopaque endovascular examination of the state of the coronary vascular bed. Coronary angiography is indicated for objective signs of myocardial ischemia, postinfarction or unstable angina, acute coronary syndrome, before elective heart surgery, etc. conditions in order to determine further medical tactics (drug therapy, balloon angioplasty, coronary artery bypass grafting). Coronary angiography is…
Bronchial arteriography is an invasive contrast radiography of the bronchial arterial bed. It is carried out in an X-ray operating room, informative for identifying the source and causes of pulmonary bleeding, congenital vascular anomalies. With bronchial arteriography, puncture and catheterization of the femoral artery is performed, retrograde catheter insertion into the aorta to the mouth of…
Fluorescein angiography is an objective diagnostic method in ophthalmology that allows you to register the circulation of fluorescein in the vessels of the inner shell of the eye. The technique makes it possible to identify functional and organic changes, to determine the structure and localization of focal lesions of the retina. It is used to study…