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Imaging and Intervention of Vascular Emergencies · PDF file Imaging and Intervention of Vascular Emergencies Masoud Pezeshki Rad, M.D. ... Organ artery or peripheral artery embolization

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  • Imaging and Intervention of

    Vascular Emergencies

    Masoud Pezeshki Rad, M.D. Assistant Professor of Radiology

    Radiology Department of Imam Reza Hospital MUMS

  • Introduction • Emergency situation deriving from vessels:

    1. Bleeding a. Traumatic transsection b. Rupture of aneurysm, pseudoaneurysm, dissection

    2. Thrombosis a. Traumatic vessel injurya. Traumatic vessel injury b. Hypercoagulability syndromes c. Arteriosclerosis

    3. Embolization a. Foreign body embolization b. Organ artery or peripheral artery embolization c. Pulmonary artery embolization

    4. Malperfusion syndromes a. Traumatic compression or spasm b. Static or dynamic true lumen compression in dissection

  • What Modalities Are Available?

    • Modalities using X-ray • Angiography

    • Computed Tomography – CTA

    • Doppler Ultrasound • Doppler Ultrasound

    • Magnetic Resonance Imaging – MRA

  • Angiography

    • Conventional

    • DSA

  • Advantages and Disadvantages of Angiography

    • Advantages: • Fluoroscopy is an excellent tool for image based

    interventional procedures

    • Disadvantages:• Disadvantages: • Invasive • Radiation exposure

    • Risks associated with use of contrast agents

  • Some Risks Associated With Use of Vascular Contrast Agents

    • Contrast allergies • Death from idiosyncratic anaphylactoid reactions: 1/100,000

    • Increased in asthmatics, prior reactions − Premedication with steroids, H1 (diphenhydramine) and H2 blockers (ranitidine)

    • Induced renal failure • Diabetics, Myeloma, dehydration, renal failure, sickle cell disease. • Diabetics, Myeloma, dehydration, renal failure, sickle cell disease. • Nephrotoxic meds – aminoglycosides, NSAIDS

    • Hydrate, stop nephrotoxic meds, minimize dose of contrast used

    • Metabolic acidosis – diabetics on metformin • Stop metformin after scan X 48 hrs and monitor renal function

    • Catecholamine release in pheochromocytoma

  • Computed Tomography- CT

  • Spiral or Helical CT

  • CT Angiography

  • Strengths and Weaknesses of Computed Tomography

    • Strengths • Good soft tissue contrast • 3D image rendering

    • Weaknesses• Weaknesses • Availability • Radiation • Contrast complications • Artifact with metals

  • Doppler Ultrasound

  • Doppler

  • Strengths and Weaknesses of US

    • Strengths • Real time imaging

    • able to direct interventions • Inexpensive and quick • No radiation • Portable• Portable

    • Weaknesses • Technical difficulty • Operator dependence • Need a good acoustic window

  • Magnetic Resonance Imaging – MRI

  • MR Angiography

  • Strengths and Weaknesses of MRI

    • Strengths • Excellent soft tissue contrast • Multi-planar • Not invasive • No radiation • Gadolinium IV contrast is not nephrotoxic and may be used in setting of

    renal failurerenal failure

    • Weaknesses • Availability/cost • Time • Poor bone detail • Claustrophobia • Metal and other artifacts • Risk of complications related to magnetic metal implants (pacemakers,

    aneurysm clips etc,) • Rare serious contrast reactions

  • Which One Is The Best?

    • Doppler Ultrasound

    • Computed Tomography – CTA

    • Angiography • Angiography

  • Interventional Procedures

  • Embolization of Bleeding Vessels

     Once arteriography has demonstrated the bleeding site, the offending vessel can then be embolized. can then be embolized.

  • Stent Grafting of Aneurysms

  • Thrombolysis

  • Endovascular Retrieval of a Central Venous Catheter Fragment

  • Stenting of Dissection

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