Arteriography

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Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. This is traditionally done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy. So angiography consists of MRI, CT-Scan. . .

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Nội dung Text: Arteriography

Arteriography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. This is traditionally done b y injecting a radio-opaque contrast agent into the blood vessel and imaging using X -ray based techniques such as fluoroscopy. So angiography consists of MRI, CT -Scan. . . Many kinds of Angiograms, for example Coronary angiography Microangiography Neuro-vascular angiography Peripheral angiography How does anteriography play important role in diagnosis Gastrointestinal bleeding?
Endoscopy for upper gastrointestinal bleeding and scintigraphy for lower gastrointestinal bleeding are important steps in the management and outcome of transcatheter angiography. Computerized tomography angiography is a promising tool for the treatment of both upper and lower GI bleeding, and this procedure has become part of the imaging toolset. In addition, angiography performed outside of working hours had a higher rate of clinical success than the angiographies performed in working hours, most likely secondary to much ap propriate timing of arteriogram in terms of critical bleeding intervals. In upper GI bleeding, arteriography is reserved for situations where brisk bleeding makes endoscopy difficult. Multidetector computed tomography (CT) allows excellent visualization of both the small and large bowel. Multiphasic multidetector CT allows direct demonstration of bleeding into the bowel and is helpful in the acute setting for
visualization of the bleeding source and its characterization. The additional information provided by multidetector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization. Some investigators advocate an upper GI endoscopy after colonoscopy yields negative results, as about 10% of cases are ultimately found to involve an upper GI source of bleeding Therapeutic angiography is most strongly indicated in poor surgical candidates (elderly, severely ill patients) but is increasingly offered to all acute GI bleeders who continue to bleed after endoscopy In small-bowel or lower GI bleeding, arteriography is utilized for both diagnosis and therapy of the acutely bleeding lesion, typically after initial localization with TRBC scanning or capsule endoscopy.
Because colonoscopy of an unprepared colon is more difficult than upper endoscopy and lesions may be missed in a dirty colon because of poor preparation or active bleeding, the evaluation of lower GI bleeding is less straightforward. Angiography remains the best option in a patient in unstable condition and should be performed in cases of massive bleeding The three diagnostic modalities employed emergently for evaluation of acute lower GI bleeding are colonoscopy/sigmoidoscopy, technetium bleeding scans and angiography. As with upper GI bleeding, angiography is typically reserved for heavy bleeding (>1 ml/min), and has two advantages as a prec edent to surgery—it may stabilize a patient through vasopressin and embolization to avoid surgery or allow for
elective surgery, and angiography can localize the bleeding site to reduce the extent of bowel resection Diverticulosis has been implicated as the source of bleeding in as many as 60% of cases of lower GI bleeding. The diverticula are more prevalent in the left or sigmoid colon, but positive arteriographic findings for bleeding localizes the bleeding to the right colon in 60% of cases.