Perpetual Help College of Manila V.Conception St.

, Sampaloc, Manila Bachelor of Science in Nursing

A Research
About

Angiography & Mammography

In Partial fulfillment of the requirement for STS

Submitted By: SOMIDO, ROSEBEN R. BSN 4th year

PART 1

ANGIOGRAPHY

CONTENTS: I. II. III. IV. V. VI. VII. Definition Indication/ Uses of Angiography Procedure Different types of Angiogram Risks of Undergoing Angiography History Complications of Angiography

Angiography

I.

Definition:

An angiogram is an imaging test that uses x-rays to view your bodys blood vessels. Physicians often use this test to study narrow, blocked, enlarged, or malformed arteries or veins in many parts of your body, including your brain, heart, abdomen, and legs. When the arteries are studied, the test is also called an arteriogram. If the veins are studied, it is called a venogram. To create the x-ray images, your physician will inject a liquid, sometimes called "dye", through a thin, flexible tube, called a catheter. He or she threads the catheter into the desired artery or vein from an access point. The access point is usually in your groin but it can also be in your arm or, less commonly, a blood vessel in another location. This "dye, properly called contrast, makes the blood flowing inside the blood vessels visible on an x-ray. The contrast is later eliminated from your body through your kidneys and your urine.

An Angiogram

In this picture, the radiologist uses monitors and table controls to position the person before an angiogram. The large C-arm can turn to take X-ray pictures from many different angles.

II.

Indication or Uses of Angiography

An angiogram is commonly used to check the condition of blood vessels. There are alternatives nowadays to angiography, such as CT scan, MRI scans, nuclear scans, and ultrasound scans, which often produce information as accurate and useful as angiograms. For many arteries, such as head, abdomen, or leg, these non-invasive tests are usually all that are required. However, for the heart arteries, unfortunately there's often still a need for coronary angiography to obtain absolutely reliable data.

Angiography may be used if the doctor is considering surgery, because it shows a clear picture of the blood vessels. Angiography may reveal aneurysms (a bulge on an artery caused by a blood vessel wall becoming weaker). An angiogram can also be used to give a good view of the carotid artery and its branches in the neck and head. This is generally done to investigate a bleed in the brain (cerebral bleed) or

identify the blood supply to a tumour. The angiogram can be used to show if an operation is necessary or possible. Angiography is used to look at the coronary arteries that send blood to the heart. The test is used to show if the arteries of the heart have narrowed. Angiography is used to look at the arteries in the legs and kidneys, as well as the aorta (the body's largest artery). Angiography is used to look at the liver to localise abnormalities, including tumours. This can be particularly useful when planning surgery.

III.

Procedure

Before taking an X-ray, a liquid dye is injected into the blood vessels. When the test is on the arteries of the heart, the carotid artery, or the major arteries coming from the aorta, the catheter is inserted into the groin or most commonly the arm.

Before a catheter can be inserted into an artery, the surrounding area has to be numbed with a local anaesthetic. A short, thin wire with a rounded tip is then carefully inserted into the artery using a needle. It is guided with the help of fluoroscopy (X-ray images) to the spot where the dye is needed. The needle is then removed and a vascular sheath inserted around the wire. A catheter may then be inserted along the guide wire. When the catheter is in the correct position, the wire is pulled out and dye is inserted through the catheter. The patient may experience a feeling of warmth in the area, but this will disappear after a few seconds. Now the blood vessels can be checked on a screen, or on a series of rapidly recorded X-rays.

IV.

Types of Angiogram

Common invasive angiograms can look at the arteries near your heart (coronary angiogram), lungs (pulmonary angiogram), brain (cerebral angiogram), head and neck (carotid angiogram), legs or arms (peripheral), and the aorta (aortogram). CT Angiograms are non-invasive and are most commonly used to review blood flow in and around your heart. A coronary angiogram is a procedure that uses X-ray imaging to see the inside of your heart's blood vessels. Coronary angiograms are part of a general group of procedures known as cardiac catheterization. Catheterization refers to any procedure in which a long, thin, flexible plastic tube (catheter) is inserted into your body.

Heart catheter procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of heart catheter procedure. A pulmonary angiogram is an angiogram of the blood vessels of the lungs. A pulmonary angiogram may be used to assess the blood flow to the lungs. One of the primary indications for the procedure is the diagnosis of a clot. It may also be used to deliver medication into the lungs to treat cancer or hemorrhage. A cerebral angiogram (also known as an arteriogram) is a diagnostic procedure that provides images of the blood vessels in the brain and/or head. The test is performed to find blocked or leaking blood vessels. This test can help to diagnose such conditions as the presence of a blood clot, fatty plaque that increases the patient's risk of stroke, cerebral aneurysm or other vascular malformations like AVMs.

Carotid angiography, also called carotid angio or an arteriogram, is an invasive x-ray procedure used to find narrowing or blockage (atherosclerosis) in the carotid arteries. Carotid angiography may be performed when carotid artery disease is suspected, based on the results of other tests, such as a carotid duplex ultrasound, computed tomography angiogram (CTA) or magnetic resonance angiogram (MRA). Peripheral angiograms test the arteries which supply the blood to the head and neck or those to the abdomen and legs. An aortogram is an invasive diagnostic test that uses a catheter to inject dye into the aorta. X-rays are taken of the dye as it travels within the aorta, allowing a clear view of your blood flow. This way, any structural abnormalities of the aorta can be seen accurately. A computerized tomography (CT) angiogram is an imaging test for various types of heart disease. Unlike a traditional coronary angiogram, CT angiograms don't use a catheter threaded through your veins to your heart. Instead, a CT angiogram relies on a powerful X-ray machine to produce images of your heart and heart vessels. CT angiograms require less recovery time than traditional angiograms and are becoming an increasingly popular option for people who have a moderate risk of blocked or narrowed arteries.

V.

Risks of Undergoing Angiography

A small minority of patients are allergic to the liquid dye, mainly due to the iodine content of the dye. Anyone who has previously experienced such reactions should mention this to the doctor. There is a small risk of the catheter damaging the blood vessels that it was inserted through. There is a small risk of angiography damaging blood vessels because it passes them. So, in heart (coronary) angiography, it is possible that the angiogram can provoke a stroke, heart attack, either of which occasionally lead to death. The absolute risk of some irreversible damage or death is of the order of 1 in 1000. This risk is clearly always balanced against the risks of not performing a coronary angiogram and not obtaining the data necessary to giving the best treatment. Cerebral angiography carries a small but significant risk of a serious adverse outcome. Pregnant women should enquire about the risks of the fluoroscopy (X-ray screening) harming their baby. Patients suffering from severe liver, heart or kidney diseases may be at greater risk, and should seek advice from the specialist. The risk of X-rays being harmful is very small. Modern X-ray machines are designed to take high quality pictures using the minimum radiation dose.

VI.

History

The technique was first developed in 1927 by the Portuguese physician and neurologist Egas Moniz at the University of Lisbon to provide contrasted x-ray cerebral angiography in order to diagnose several kinds of nervous diseases, such as tumors, artery disease and arteriovenous malformations. He is usually recognized as one of the pioneers in this field. Moniz performed the first cerebral angiogram in Lisbon in 1927, and Reynaldo Cid dos Santos performed the first aortogram in the same city in 1929. With the introduction of the Seldinger technique in 1953, the procedure became markedly safer as no sharp introductory devices needed to remain inside the vascular lumen.

VII.

Complications

Coronary angiography Coronary angiographies are common and major complications are rare. These include Cardiac arrhythmias, kidney damage, blood clots (which can cause heart attack or stroke), hypotension and pericardial effusion. Minor complications can include bleeding or bruising at the site where the contrast is injected, blood vessel damage on the route to the heart from the catheter (rare) and allergic reaction to the contrast.[2] Cerebral angiography Major complications in Cerebral Angiography are also rare but include stroke, an allergic reaction to the anaesthetic other medication or the contrast medium, blockage or damage to one of the access veins in the leg, or thrombosis and embolism formation. Bleeding or bruising at the site where the contrast is injected are minor complications, delayed bleeding can also occur but is rare. Additional Risks The contrast medium that is used usually produces a sensation of warmth lasting only a few seconds, but may be felt in a greater degree in the area of injection. If the patient is allergic to the contrast medium, much more serious side effects are inevitable; however, with new contrast agents the risk of a severe reaction are less than one in 80,000 examinations. Additionally, damage to blood vessels can occur at the site of puncture/injection, and anywhere along the vessel during passage of the catheter. If digital subtraction angiography is used instead, the risks are considerably reduced because the catheter does not need to be passed as far into the blood vessels; thus lessening the chances of damage or blockage