Patients suffering from diseases of the heart and blood vessels undergo regular clinical studies. Primary diagnosis allows to differentiate the pathology and make the correct diagnosis, and examinations in dynamics help to clarify the state of the body during the period of therapy and are a preventive measure for the development of complications. A commonly used method for examining diseases of the cardiovascular system is angiography. What is diagnostically important is shown by manipulation and how it is carried out is discussed in the article.
General data
It took more than 30 years to implement the idea of the appearance of angiography since the physiologist Bekhterev voiced his idea: "If there are solutions that do not transmit X-rays, then such liquids can be filled with vessels and photographed." It took another four decades for manipulation to become widespread and effective in use.
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 usingradiopaque agents. The procedure allows you to evaluate the following indicators:
- blood flow velocity;
- location of vessels;
- presence of congenital anomalies;
- narrowing;
- formation of roundabout pathways;
- the condition of the vessels that feed the tumors.
Where is the procedure done?
Diagnostic centers (narrow or wide profile) and hospitals are equipped with special rooms for angiography.
Here all the conditions of asepsis are met. The necessary equipment is located in the premises:
- angiograph - a device that has an X-ray unit for assessing the condition of blood vessels (arteries, veins, capillaries, lymphatic vessels);
- high-speed fluorographic camera;
- apparatus, the task of which is to conduct X-ray multi-shooting and video recording.
CT angiography is performed in highly specialized diagnostic institutions. This procedure allows you to get a clearer picture of the state of the vessels (in detail), and therefore requires the use of the latest advanced devices.
Research principles
Into the blood vessel that needs to be examined and studied, a radiopaque substance, which is a derivative of iodine, is injected. 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 with a syringe (puncture).
Catheterization is used for deeper arteries or veins. ATprojections of the investigated vessel make local anesthesia. After an incision in the skin and subcutaneous adipose tissue, the vessel under study is found, and an introducer is introduced into it (a thin plastic tube about 10 cm in length). The rest of the instruments and the catheter are moved through the introducer, so as not to accidentally damage the walls of the vessels. A contrast agent is injected through the catheter.
After the solution enters the vessel, it spreads throughout the system. Arteries and veins are filled first, then arterioles, venules and capillaries. At this time, several pictures or a short video filming are taken with the help of an X-ray machine.
The performed angiography of arteries or veins (research results) is recorded on a digital medium, which allows you to show these manipulations to other specialists.
Where does it apply?
Examination of the condition and patency of blood vessels is used in such areas of medicine as:
- vascular surgery - before surgery, the doctor specifies the location and structure of the operated areas;
- oncology - the location of the primary area and metastases is examined at the time of building their capillary network;
- pulmonology - allows you to evaluate the vascular network of the lungs, as well as determine the localization of the bleeding that has appeared;
- phlebology - experts determine the presence of narrowing, the appearance of aneurysms, the formation of blood clots, vascular damage by atherosclerosis, congenital anomalies;
- neurology - angiography of cerebral vessels shows the presence of aneurysms, hemorrhages,narrowing, tumor processes.
If it is necessary to examine all the vessels of a certain area, then this procedure is called a general angiography. In the case of assessing the state of individual vessels, such a study is called selective.
Cerebral Angiography
For the examination, a radiopaque substance is administered by catheterization of one of the arteries, such as:
- right femoral;
- shoulder;
- elbow;
- subclavian.
The catheter is advanced through the system of blood vessels to the area where the branch of the studied vessel is located. A solution is injected into its lumen. Immediately take a series of pictures from the side and front of the head. If it is necessary to study more distant structures, a second portion of the substance is injected. Again, a series of shots follows in the required projections. The entered instruments are removed and the diagnosis is considered complete.
Angiography of the brain requires the use of local anesthesia to anesthetize the site where the catheterization is performed. While the catheter is being advanced through the body, the patient does not feel any discomfort. With the introduction of the solution, a taste of metal in the mouth, flushing of the skin of the face, a feeling of spilled heat may appear. The phenomena disappear after a few minutes.
Indications for examination of cerebral vessels
A number of pathological conditions that require diagnosis (MRI angiography is performed for clarification of details):
- aneurysm is an expansion of a vessel that can lead to hemorrhage;
- angioma -vascular tumor;
- ischemic stroke - the doctor evaluates the need for thrombolysis;
- hemorrhagic stroke - the source of the 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 injury;
- hematoma - the specialist assesses the location and size;
- tumor - determine the size, location, condition of the supply vessels.
Angiography of the vessels of the heart
Coronary angiography - what is it? This is a method of studying the vessels of the heart. Catheterization of the femoral or radial artery is carried out and the catheter is passed to the aorta. X-ray contrast solution is injected alternately into the right and left coronary arteries. A burst of shots is taken instantly.
The patient may complain of symptoms such as:
- heat in the face;
- arrhythmia;
- dizziness;
- nausea, vomiting;
- cough.
Indications for conduction are heart attack, coronary heart disease, cardiosclerosis, anomalies of the heart vessels of a congenital nature.
Examination of the vessels of the extremities
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 injecting a radiopaque substance into the brachial artery. For the lower extremities - into the abdominal aorta or femoral artery, depending on the level from which it is necessarydiagnostics. To study the vessels of the foot and lower leg, a puncture of the posterior tibial artery is performed. When the solution is injected, the patient may feel a surge of heat in the legs.
Indications for study:
- atherosclerosis of the lower extremities;
- obliterating endarteritis;
- thrombosis, thrombophlebitis;
- thromboembolism;
- damage accompanied by vascular ruptures;
- dissecting aneurysm;
- assessment of treatment effectiveness.
Preparing for diagnostics
The absence of individual hypersensitivity to iodine and its derivatives must be specified. If the patient is pregnant, x-rays are not used. In this case, MR angiography is preferable.
For two weeks exclude alcoholic beverages, for a week - anticoagulants ("Heparin", "Warfarin", "Aspirin"). A few days before the diagnosis, a series of studies such as:
- clinical blood and urine tests, coagulogram, biochemistry;
- ECG and ultrasound of the heart;
- lung fluorography;
- determination of blood type and Rh factor;
- testing for infections (HIV, hepatitis, syphilis).
On the eve of angiography, a test for a radiopaque substance is performed. 0.1 ml of solution is injected into a vein. In case of urticaria, allergic rhinitis, conjunctivitis, arrhythmia, the drug should not be used.
In the evening before the procedure, a cleansing enema and hygiene procedures are performed. Specialistprescribes sedatives to allow the patient to relax and unwind. In the morning, the subject should not eat or drink, before the manipulation it is necessary to empty the bladder.
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 to ensure that the diagnosis goes without complications?
High blood pressure needs to be stabilized. For this purpose, "Nifedipine", "Dibazol", "Raunatin" or any other antihypertensive drug that is in constant therapy of the patient is used.
In the presence of cardiac arrhythmias, "Panangin" or potassium chloride is administered. As prescribed by the doctor, cardiac glycosides are used. With coronary artery disease or cardiac pain syndrome, "Nitroglycerin", "Erinit", "Sustak" are used.
Kidney disease requires saturating the body with water. The radiopaque agent used will act less as an irritant and be excreted from the body more quickly in the urine.
If there are chronic sources of infection (sinusitis, bronchitis), the specialist prescribes antibacterial drugs or sulfonamides 2 weeks before the study.
Contraindications for angiography
Diagnostic procedure is not performed when there is a threat to the condition and he alth of the patient. This occurs under conditions such as:
- spicyinflammatory diseases;
- mental abnormalities;
- kidney failure;
- heart failure in the stage of decompensation;
- allergic 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.
