DOCSLIB.ORG

Needle-Catheter Aortography and Selective Angiography Technical Note

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Needle-Catheter Aortography and Selective Angiography Technical Note I. Neurosurg. / Volume 32 / April, 1970 Needle-Catheter Aortography and Selective Angiography Technical Note JOSEPH T. MCFADDEN, M.D., F.A.C.S. Medical Centel, Nor]olk, Virginia LTHOUGH angiography has now be- come the foremost diagnostic method in neurosurgery for tumors and vas- cular lesions, the needle techniques evolved from Egas Moniz' original contribution (1927) :3 are too limited in scope for ade- quate study of the patient with arterial insufficiency. Furthermore, the percutaneous needle approach, while almost never failing in the cranial and partial extracranial evalu- ation of carotid arteries, cannot produce sat- isfactory total vertebrobasilar artery pictures in some patients. Only catheter angiography overcomes these limitations. The percutaneous introduction of a cath- eter into an artery for the purpose of making selective or regional angiograms distant and circuitous to the point of entry requires the Fro. 2. Upper Diagram: Arterial entry with the use of either the Seldinger 4 or the needle- assembled needle-catheter. Lower Diagram: Cathe- catheter 1,2 technique. The alternative, cath- ter in the arterial lumen, with the needle unit re- eter introduction through a cannula, makes moved. an arterial hole larger than the catheter, causing bleeding problems during and after the procedure. Seldinger's method, reported in 1953, entails a multi-step procedure em- Received for publication July 1, 1969. Revision received August 25, 1969. ploying a needle (cannula), a guide wire, and a catheter. The needle-catheter tech- nique requires one step only, the assembled instrument acting as a needle (cannula) for arterial entry, then becoming a catheter on removal of the puncturing core (Figs. 1 and 2). While the Seldinger method was devel- oped under the aegis of neuroradiology, the needle-catheter* evolved during the past 4 years for use primarily as a neurosurgical in- strument. It was introduced in 19652 (pub- lished in 1967) 1 specifically for retrograde common carotid catheterization to perform arch aortography and four-vessel cranial an- Fro. 1. Upper Diagram: Disassembled needle- giography. catheter showing imbedded metal tip with abut- ment inside the catheter lumen (A), and twin The needle-catheter has been adapted sub- mural holes equal in diameter to the catheter sequently to selective arterial catheterization lumen (B). Lower Diagram: The outer sheath of and aortography by several modifications: the double cannula puncture unit locks the tip abutment. Luer-Locks on the hub lock the can- * Manufactured by United States Catheter and nulae unit. Instrument Corporation, Glens Falls, New York. 491 492 Joseph T. McFadden Fro. 3. Diagram showing three-dimensional range of catheter tip control with the Muller Guide Fro. 4. Diagrams showing the range of tip con- system. trol in the aortic arch (one-vessel panangiog- raphy). Upper Diagram: Transcarotid route. Lower 1. The metal tip shortened to 2.5 mm al- Diagram: Transfemoral route. lows tip deflection (Fig. 1). 2. Two mural holes proximal to the metal Directed by the Muller Guide system, the tip, each equal in diameter to the cath- catheter tip curves 180% and rotates com- eter lumen, permit maximum flu!d out- pletely clockwise or vice versa, so that it flow with minimum tip retropulsion goes to any chosen point either vertically or (Fig. 1 ). horizontally (Fig. 3). Additionally, the de- 3. A metal mesh incorporated in the flected tip, on advancement, moves ahead of catheter wall prevents lumen collapse the deflection curvature, and thus progresses under torque. down the lumen of a selected vessel circui- Fro. 5. Le]t: X-ray film showing the percutaneously placed catheter descending the right carotid artery into the innominate and curving into the right subclavian (curved arrow) to demonstrate the vertebral artery by the flooding technique. The straight arrow points to the catheter tip. Center: Trans-carotid (right) arch aortogram and four-vessel angiogram. Note percutaneously placed catheter descending the carotid and innominate arteries into the ascending aorta (arrow). Right: The percutaneously placed catheter descends the right carotid and innominate arteries into the aortic arch and curves into the left subclavian artery (arrow) to visualize the vertebral artery by the flooding technique. .
Load more

Recommended publications
  • Acr–Nasci–Sir–Spr Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (Cta)
    The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2021 (Resolution 47)* ACR–NASCI–SIR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF BODY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1.
    [Show full text]
  • Equilibrium Radionuclide Angiography/ Multigated Acquisition
    EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION Equilibrium Radionuclide Angiography/ Multigated Acquisition S van Eeckhoudt, Bravis ziekenhuis, Roosendaal VJR Schelfhout, Rijnstate, Arnhem 1. Introduction Equilibrium radionuclide angiography (ERNA), also known as radionuclide ventriculography (ERNV), gated synchronized angiography (GSA), blood pool scintigraphy or multi gated acquisition (MUGA), is a well-validated technique to accurately determine cardiac function. In oncology its high reproducibility and low inter observer variability allow for surveillance of cardiac function in patients receiving potentially cardiotoxic anti-cancer treatment. In cardiology it is mostly used for diagnosis and prognosis of patients with heart failure and other heart diseases. 2. Methodology This guideline is based on available scientifi c literature on the subject, the previous guideline (Aanbevelingen Nucleaire Geneeskunde 2007), international guidelines from EANM and/or SNMMI if available and applicable to the Dutch situation. 3. Indications Several Class I (conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective) indications exist: • Evaluation of left ventricular function in cardiac disease: - Coronary artery disease - Valvular heart disease - Congenital heart disease - Congestive heart failure • Evaluation of left ventricular function in non-cardiac disease: - Monitoring potential cardiotoxic side effects of (chemo)therapy - Pre-operative risk stratifi cation in high risk surgery • Evaluation of right ventricular function: - Congenital heart disease - Mitral valve insuffi ciency - Heart-lung transplantation 4. Contraindications None 5. Medical information necessary for planning • Clear description of the indication (left and/or right ventricle) • Previous history of cardiac disease • Previous or current use of cardiotoxic medication PART I - 211 Deel I_C.indd 211 27-12-16 14:15 EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION 6.
    [Show full text]
  • Comparison of Echocardiography and Angiography in Determining the Cause of Severe Aortic Regurgitation
    Br Heart J: first published as 10.1136/hrt.51.1.36 on 1 January 1984. Downloaded from Br Heart J 1984; 51: 36-45 Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation NICHOLAS L DEPACE, PASQUALE F NESTICO, MORRIS N KOTLER, GARY S MINTZ, DEMETRIOS KIMBIRIS, INDER P GOEL, E ELAINE GLAZIER-LASKEY, JOHN ROSS From the LikoffCardiovascular Institute, Hahnemann University, Philadelphia, Pennsylvania, USA SUMMARY To assess the accuracy of echocardiography in determining the cause of aortic regurgita- tion M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a biscuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgi- tation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation. Aortic regurgitation may be caused by valvular dis- ment for predominant aortic regurgitation were http://heart.bmj.com/ ease, aortic root disease, or a combination of both. reviewed.
    [Show full text]
  • ICD~10~PCS Complete Code Set Procedural Coding System Sample
    ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00
    [Show full text]
  • Introduction
    RIMS, IMPHAL ANNUAL REPORT 2014-15 INTRODUCTION 1. DESCRIPTION : The Regional Institute of Medical Sciences (RIMS), Imphal was established in the year 1972. It is an institution of regional importance catering to the needs of the North Eastern Region in the field of imparting undergraduate and post graduate medical education.The Institution brings together educational facilities for the training of personnel in all important branches of medical specialities including Dental and Nursing education in one place. The Institute is affiliated to the Manipur University, Canchipur, Imphal. 2. MANAGEMENT : The Institute was transferred to the Ministry of Health & Family Welfare, Government of India from North Eastern Council, Shillong (under Ministry of DoNER, Government of India) w.e.f. 1st April, 2007. Under the existing administrative set-up, the highest decision making body is the Board of Governors headed by the Union Minister of Health & Family Welfare as the President and the Director of the Institute as the Secretary. The Executive Council is responsible for the management of the Institute. The Secretary, Ministry of Health & Family Welfare, Government of India is the Chairman of the Executive Council while the head of the Institute remains as Secretary. Thus, the institute is managed at two levels, namely the Board of Governors and the Executive Council. A. Board of Governors : 1. Hon’ble Union Minister, - President Health & Family Welfare, Government of India. 2. Hon’ble Chief Minister, Manipur. - Vice-President 3. A Representative of the Planning Commission, - Member Government of India. 4. Health Ministers of the Beneficiary States - Member 5. Secretary, Ministry of Health & Family Welfare, - Member Government of India.
    [Show full text]
  • Using Sound Advice—Intravascular Ultrasound As a Diagnostic Tool
    Commentary Using sound advice—intravascular ultrasound as a diagnostic tool Yasir Parviz1, Khady N. Fall1, Ziad A. Ali1,2 1Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, USA; 2Cardiovascular Research Foundation, New York, USA Correspondence to: Ziad A. Ali. Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA. Email: [email protected]. Submitted Sep 06, 2016. Accepted for publication Sep 08, 2016. doi: 10.21037/jtd.2016.10.64 View this article at: http://dx.doi.org/10.21037/jtd.2016.10.64 Intravascular ultrasound (IVUS) uses varying-frequency (6.0% vs. 13.6%) (5). catheter-based transducers for assessment of blood vessel By extrapolation, IVUS may also have utility in the dimensions and morphology. Along with advances in the emergency setting for pathologies involving the LMCA field of interventional cardiology, IVUS technology has such as spontaneous or iatrogenic dissection. The incidence progressed in the last two decades. Dedicated training of spontaneous dissection in the LMCA has been reported centers in combination with enthusiasm from a new to be ~1% of all epicardial coronary arteries (6,7). Similar generation of cardiologists complemented by well- to aortic dissection, a spontaneous dissection of the established evidence for simplicity, safety and efficacy of LMCA leads to generation of a false lumen and intramural IVUS systems have led to increased routine use of this hematoma with or without intimal tear that may propagate imaging modality. Currently available catheters use sound retrograde into the aorta.
    [Show full text]
  • Crucial Role of Carotid Ultrasound for the Rapid Diagnosis Of
    m e d i c i n a 5 2 ( 2 0 1 6 ) 3 7 8 – 3 8 8 Available online at www.sciencedirect.com ScienceDirect journal homepage: http://www.elsevier.com/locate/medici Clinical Case Report Crucial role of carotid ultrasound for the rapid diagnosis of hyperacute aortic dissection complicated by cerebral infarction: A case report and literature review a a, b a Eglė Sukockienė , Kristina Laučkaitė *, Antanas Jankauskas , Dalia Mickevičienė , a a c a Giedrė Jurkevičienė , Antanas Vaitkus , Edgaras Stankevičius , Kęstutis Petrikonis , a Daiva Rastenytė a Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania b Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania c Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania a r t i c l e i n f o a b s t r a c t Article history: Aortic dissection is a life-threatening rare condition that may virtually present by any organ Received 24 January 2016 system dysfunction, the nervous system included. Acute cerebral infarction among multiple Received in revised form other neurological and non-neurological presentations is part of this acute aortic syndrome. 14 September 2016 Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of Accepted 8 November 2016 thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Available online 19 November 2016 Department within a 4.5-h window after symptom onset. Systemic intravenous thrombolysis in the case of an acute brain infarction due to aortic dissection may lead to fatal outcomes.
    [Show full text]
  • Acute Chest Pain-Suspected Aortic Dissection
    Revised 2021 American College of Radiology ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome Variant 1: Acute chest pain; suspected acute aortic syndrome. Procedure Appropriateness Category Relative Radiation Level US echocardiography transesophageal Usually Appropriate O Radiography chest Usually Appropriate ☢ MRA chest abdomen pelvis without and with Usually Appropriate IV contrast O MRA chest without and with IV contrast Usually Appropriate O CT chest with IV contrast Usually Appropriate ☢☢☢ CT chest without and with IV contrast Usually Appropriate ☢☢☢ CTA chest with IV contrast Usually Appropriate ☢☢☢ CTA chest abdomen pelvis with IV contrast Usually Appropriate ☢☢☢☢☢ US echocardiography transthoracic resting May Be Appropriate O Aortography chest May Be Appropriate ☢☢☢ MRA chest abdomen pelvis without IV May Be Appropriate contrast O MRA chest without IV contrast May Be Appropriate O MRI chest abdomen pelvis without IV May Be Appropriate contrast O CT chest without IV contrast May Be Appropriate ☢☢☢ CTA coronary arteries with IV contrast May Be Appropriate ☢☢☢ MRI chest abdomen pelvis without and with Usually Not Appropriate IV contrast O ACR Appropriateness Criteria® 1 Suspected Acute Aortic Syndrome SUSPECTED ACUTE AORTIC SYNDROME Expert Panel on Cardiac Imaging: Gregory A. Kicska, MD, PhDa; Lynne M. Hurwitz Koweek, MDb; Brian B. Ghoshhajra, MD, MBAc; Garth M. Beache, MDd; Richard K.J. Brown, MDe; Andrew M. Davis, MD, MPHf; Joe Y. Hsu, MDg; Faisal Khosa, MD, MBAh; Seth J. Kligerman, MDi; Diana Litmanovich, MDj; Bruce M. Lo, MD, RDMS, MBAk; Christopher D. Maroules, MDl; Nandini M. Meyersohn, MDm; Saurabh Rajpal, MDn; Todd C. Villines, MDo; Samuel Wann, MDp; Suhny Abbara, MD.q Summary of Literature Review Introduction/Background Acute aortic syndrome (AAS) includes the entities of acute aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU).
    [Show full text]
  • Measurement of Peak Rates of Left Ventricular Wall Movement in Man Comparison of Echocardiography with Angiography
    British HeartJournal, I975, 37, 677-683. Br Heart J: first published as 10.1136/hrt.37.7.677 on 1 July 1975. Downloaded from Measurement of peak rates of left ventricular wall movement in man Comparison of echocardiography with angiography D. G. Gibson and D. J. Brown From the Cardiac Department, Brompton Hospital, London, and the Medical Computer Centre, Westminster Hospital, London Estimates ofpeak systolic and diastolic rates of left ventricular wall movement were made in 23 patients by echocardiography and angiocardiography. Echocardiographic measurements were calculated as the rate of change of the transverse left ventricular dimension, derived continuously throughout the cardiac cycle. These were compared with similar plots of transverse left ventricular diameter, in the same patients, derived from digitized cineangiograms taken within IO minutes of echocardiograms. The results indicate close correlation between the two methods, and suggest that either can be used to measure peak rates of left ventricular wall movements in patients with heart disease. Identification of echoes arising from the interven- Echocardiograms tricular septum and posterior wall of the left In order to reduce the time interval between the two ventricle has proved to be a significant advance in investigations, echocardiograms were performed at the study of cardiac function by allowing the trans- cardiac catheterization using techniques that have pre- verse diameter of the left ventricle to be measured viously been described (Gibson, 1973). Clear, con- http://heart.bmj.com/ at end-systole and end-diastole (Chapelle and tinuous echoes were obtained from the posterior surface Mensch, I969; Feigenbaum et al., I969). More of the septum and the endocardium ofthe posterior wall recently, it has been possible to derive this dimension of the left ventricle, which were distinguished from those originating from the mitral valve apparatus.
    [Show full text]
  • Public Use Data File Documentation
    Public Use Data File Documentation Part III - Medical Coding Manual and Short Index National Health Interview Survey, 1995 From the CENTERSFOR DISEASECONTROL AND PREVENTION/NationalCenter for Health Statistics U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics CDCCENTERS FOR DlSEASE CONTROL AND PREVENTlON Public Use Data File Documentation Part Ill - Medical Coding Manual and Short Index National Health Interview Survey, 1995 U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, Maryland October 1997 TABLE OF CONTENTS Page SECTION I. INTRODUCTION AND ORIENTATION GUIDES A. Brief Description of the Health Interview Survey ............. .............. 1 B. Importance of the Medical Coding ...................... .............. 1 C. Codes Used (described briefly) ......................... .............. 2 D. Appendix III ...................................... .............. 2 E, The Short Index .................................... .............. 2 F. Abbreviations and References ......................... .............. 3 G. Training Preliminary to Coding ......................... .............. 4 SECTION II. CLASSES OF CHRONIC AND ACUTE CONDITIONS A. General Rules ................................................... 6 B. When to Assign “1” (Chronic) ........................................ 6 C. Selected Conditions Coded ” 1” Regardless of Onset ......................... 7 D. When to Assign
    [Show full text]
  • Computed Tomography Angiographic Assessment of Acute Chest Pain
    SA-CME ARTICLE Computed Tomography Angiographic Assessment of Acute Chest Pain Matthew M. Miller, MD, PhD,* Carole A. Ridge, FFRRCSI,w and Diana E. Litmanovich, MDz Acute chest pain leads to 6 million Emergency Depart- Abstract: Acute chest pain is a leading cause of Emergency Depart- ment visits per year in the United States.1 Evaluation of acute ment visits. Computed tomography angiography plays a vital diag- chest pain often leads to a prolonged inpatient assessment, nostic role in such cases, but there are several common challenges with assessment duration often exceeding 12 hours. The associated with the imaging of acute chest pain, which, if unrecog- estimated cost of a negative inpatient chest pain assessment nized, can lead to an inconclusive or incorrect diagnosis. These 2,3 imaging challenges fall broadly into 3 categories: (1) image acquis- amounts to $8 billion per year in the United States. ition, (2) image interpretation (including physiological and pathologic The main challenge to diagnosis is the broad range of mimics), and (3) result communication. The aims of this review are to pathologies that can cause chest pain. Vascular causes describe and illustrate the most common challenges in the imaging of include pulmonary embolism (PE), traumatic and acute chest pain and to provide solutions that will facilitate accurate spontaneous aortic syndromes including aortic transection, diagnosis of the causes of acute chest pain in the emergency setting. dissection, intramural hematoma, and penetrating athero- sclerotic ulcer, aortitis, and coronary artery disease. The Key Words: acute chest pain, challenges, pulmonary angiography, latter will not be discussed in detail because of the com- aortography, computed tomography plexity and breadth of this topic alone.
    [Show full text]
  • Intravascular Ultrasound for Coronary Vessels Policy Number: MP-091 Last Review Date: 11/14/2019 Effective Date: 01/01/2020
    Intravascular Ultrasound for Coronary Vessels Policy Number: MP-091 Last Review Date: 11/14/2019 Effective Date: 01/01/2020 Policy Evolent Health considers Intravascular Ultrasound (IVUS) for Coronary Vessels medically necessary for either of the following indications: 1. IVUS of the coronary arteries (consistent with the 2011 ACCF/AHA Guidelines for Percutaneous Coronary Intervention (PCI) 5.4.2) is indicated for any of the following medical reasons: a. To confirm clinical suspicion of a significant left main coronary artery stenosis when standard angiography is indeterminate; b. To detect rapidly progressive cardiac allograft vasculopathy following heart transplant; c. To determine the mechanism of stent thrombosis or restenosis; d. To assess non-left main coronary arteries with angiographic intermediate stenosis (50-70%) to aid the decision whether or not to place a stent; or, e. To assist in guidance of complex coronary stent implementation, especially involving the L main coronary artery. 2. In lieu of coronary angiography when performed to minimize use of iodinated contrast material in an individual with compromised renal function, congestive heart failure or known contrast allergy. Limitations Coronary IVUS is not covered for any of the following (this is not an all-inclusive list): 1. Screening for coronary artery disease in asymptomatic individuals; 2. Routine lesion assessment is not recommended when revascularization with PCI or Coronary Artery Bypass Grafting (CABG) is not being considered; 3. Carotid stent placement; 4. Follow-up monitoring of medical therapies for atherosclerosis; 5. Peripheral vascular intervention; or, 6. Evaluation of chronic venous obstruction or to guide venous stenting. Background Ultrasound diagnostic procedures utilizing low energy sound waves are being widely employed to determine the composition and contours of nearly all body tissues except bone and air-filled spaces.
    [Show full text]