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The abdominal aorta begins at _______?
The abdominal aorta ends at _______?
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The common iliac arteries divide into the ______ and ______ iliac arteries.
internal, external
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The ______ ________ ________ turn into the femoral arteries of the lower extremity.
external iliac arteries
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What is a flush study?
A flush study is a very large injection directly into the aorta, used to evaluate for pathology. A lot of contrast media is needed because the aorta is a large vessel with a quick flow rate. Some braches off the aorta will be visualizes because of normal blood flow. You will commonly see the renal arteries in a flush study.
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To visualize the abdominal aorta, where should the catheter be placed?
Just above the renal arteries at the level of T12-L1, so that they can be visualized.
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To visualize the distal aorta and the branches of the iliacs where should the catheter be placed?
2-3 centimeters above the aortic bifurcation.
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What is the most common type of catheter used for abdominal aortography?
Pigtail
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Which position will best demonstrate the bifurcation of the external and internal iliac arteries?
Oblique
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What is an abdominal runoff and how much contrast media would be used?
Contrast flowing from aorta to feet during exam; 80-100mL of contrast needed.
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List the 4 parietal branches of the abdominal aorta.
- Inferior Phrenic Arteries
- Lumbar Arteries
- Common Iliac Arteries
- Median Sacral Artery
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What does the term parietal mean?
Pertains to supplying the walls of a cavity or part.
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List the 6 visceral branches of the abdominal aorta.
- Middle Suprarenal (adrenal) Arteries
- Renal Arteries
- Gonadal Arteries
- Celiac Trunk
- Superior Mesenteric Artery
- Inferior Mesenteric Artery
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What does the term visceral mean?
Pertains to supplying organs.
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Branches off of the aorta anteriorly at the level of _____.
It is best visualized in the ______ position/projection.
The _____ projection will best demonstrate the origin of the celiac trunk.
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List the 3 main branches of the celiac trunk (artery):
- Common Hepatic Artery
- Left Gastric Artery
- Splenic Artery
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The kidneys lie at about the level of ______ but can vary either way by about _____ vertebral level.
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Explain which kidney is lies higher in the body and why.
Left kidney is higher than the right. The right kidney is lower because of the presence of the liver on the right side.
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Renal hilum -
Indented portion on the medial aspect. This is where renal arteries, veins and ureters enter and exit the kidney.
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Cortex-
Outer area of the kidneys. Contains glomeruli which are capsule like structures that enclose capillaries.
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Medulla-
Inner most area of the kidneys. Contains Henle’s loop, various collecting ducts, and contains renal pyramids.
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Nephrons-
Functional unit of urinary system. This is where at the microscopic level blood is filtered, reabsorption of water will occur and waste is removed from circulating blood. About 1 million nephrons are in each kidney.
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How would the nephrogram phase appear radiographically?
A nephrogram demonstrates the interlobar arteries. It appears radiographically as a defuse accumulation of contrast media over the entire kidney.
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What are the 3 vessels that supply the adrenal glands
- Superior Adrenal Artery
- Middle Adrenal Artery
- Inferior Artery
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At what level do the renal arteries arise?
L1-L2
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The right renal artery passes _______ in relation to the IVC.
posterior
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Renal arteries are _______ in relation to the renal veins.
posterior
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The gonadal arteries are also termed the _______ arteries in a male and the _______ arteries in a female.
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List 4 indications for an abdominal aortogram.
- Rupture
- Inflamation
- Arteriosclerosis
- To evaluate Renal Ateries
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List 4 indications for a renal angiogram.
- Renal vascular hypertension
- Pre-op mapping
- Trauma
- Artery laceration
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List 2 contraindications for renal angiography.
- Vessel stenosis
- Renal disease
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What are some causes of renal vascular hypertension?
Stenosis and atherosclerosis.
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Explain renin sampling and explain what it is used for.
Renin sampling is done to detect renal hypertension. A catheter is placed into the IVC, the renal veins are located and a 7mL blood sample is taken at each renal vein and within the IVC as well.
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List 4 indications for adrenal angiography.
- Masses
- Cancer
- Cushing’s Syndrome
- Adrenal Adenoma
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What is the primary indication for reproductive angiography for a female patient?
Uterine fibroids
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Name 2 contraindications for reproductive angiography for a female patient.
Pregnacy and severe renal insufficiency
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Define uterine fibroids.
Tumors on the uterine wall, most of the time they are benign and rarely metastasize.
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What is the primary indication for reproductive angiography for a male patient?
Varicocele
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Name 2 contraindications for reproductive angiography for a male patient.
- Contrast Media reaction
- Coagulation abnormalities
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Explain what a varicocele is.
Widening of veins along the cord that holds up the testicles.
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For procedures of the GU system what type of vessel access is most common?
Femoral
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Nephrostomy-
Catheter is placed into the kidney to drain urine externally. Most often done due to the presence of a stone or pathology such as a tumor.
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Ureteral stents-
Allows passage of urine from kidney to bladder due to stenosis or blockage.
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Percutaneous stone extraction-
Removes stone via puncture directly into the kidney through the abdominal wall. Removes larger stones if lithotripsy is ineffective.
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Abdominal aneurysm stent grafts -
Done for aneurysms of the abdominal aorta. Helps strengthen wall and cut off blood flow through the aneurysm or weakened wall. Blood flows through graft instead of pushing on weakened walls. Helps reduce the chances of an aneurysm rupture.
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Embolization-
Use of material (polyvinyl) to block blood flow to fibroids.
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Angioplasty and Stenting-
Ballooning push plaque against the walls of the artery. Most commonly done in the renal arteries.
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The celiac is the ______ major branch off of the abdominal aorta.
It arises ________ off of the abdominal aorta.
1st
anteriorly
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The Common Hepatic branch exits to the ____.
The Left gastric branch exits to the ____.
The Splenic branch exits to the ______.
Right
Left
Left
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List what regions/organs the left gastric artery supplies.
Fundus of stomach and lower esophagus.
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The splenic artery is considered the largest branch off the ______ ______.
celiac trunk
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Name the branches of the splenic artery
- Pancreatic vessels
- Left gastroepipolic
- Short Gastric
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List what regions/organs the splenic artery supplies.
Supplies spleen, stomach and pancreas.
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List the branches of the common hepatic artery.
- Gastroduodenal
- Right Gastric Epiploic Artery
- Right Gastric Artery
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List what regions/organs the common hepatic artery supplies.
- Stomach
- Liver
- Duodenum
- Gallbladder
- Head of pancreas
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The common hepatic artery continues as the ______ _________ _____ once all other branches have arisen.
hepatic artery proper
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Where is the SMA in relation to the celiac trunk?
Just below
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List what regions/organs the SMA supplies.
Supplies middle duodenum and transverse colon.
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The IMA is considered the _____ major branch off of the abdominal aorta.
3rd
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List the regions/organs the IMA supplies.
- Decending Colon
- Sigmoid Colon
- Rectum
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Where does the IVC begin?
L5
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State what 3 items may be included in a hepatic angiogram.
- Ateriography
- Portal Venography
- Transhepatic portography
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What approaches will be used for pancreatic angiography?
Axillary or Femoral
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Which arteries are demonstrated in pancreatic angiography?
Celiac and SMA
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What phases of circulation will be included in pancreatic angiography?
Venous, arterial, and capillary
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What is used to aid in opacification of pancreatic vasculature?
Vasodilator is used to increase blood flow to the area and help with opacification.
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What other diagnostic exams have replaced splenic angiography?
CT and MRI
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When might splenic angiography be done?
If intervention is needed
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What artery is selected to splenic angiography?
Celiac Trunk
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List 5 indications for visceral radiography exams.
- GI bleeding
- Ischemia
- Neoplasm
- Trauma
- Masses
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What is the #1 indication for visceral radiography exams?
GI Bleeding
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Name 3 contraindications for exams of the GI system.
- Elderly
- Contrast media reaction
- Hypertension
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List flow rates and total volume of CM for Abdominal aortography.
20ml/s for a total of 40ml
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List flow rates and total volume of CM for Celiac trunk
4-8 ml/s for a total of 30-60ml
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List flow rates and total volume of CM for Common hepatic arteries.
5-6ml/s for a total of 40ml
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List flow rates and total volume of CM for SMA.
5-7 ml/s for a total of 30-60ml
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List flow rates and total volume of CM for IMA.
3-6 ml/s for a total of 10-20ml
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List routine positioning for Abdominal Aortography.
AP, PA, Lateral
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List routine positioning for Celiac Trunk.
AP, LAO
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List routine positioning for Common Hepatic.
AP
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List routine positioning for SMA.
AP, LAO
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List routine positioning for IMA.
AP
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Name 4 complications of exams of the abdomen and GI system.
- Contrast Media Reaction
- Death
- Renal Failure
- Emboli
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Explain chemoembolization and how it is used to treat liver cancer.
Chemoembolization is a common treatment for cancer. Chemotherapeutic drugs are injected into the artery that supplies tumor within the liver. Artery is blocked off; this deprives the tumor of oxygen and nutrients. The dose of chemotherapy is a lot higher at tumor sire because of direct injection. The direct injection decreases the side effects of chemotherapy because drug is at the site instead of traveling throughout the body. The liver has a two way blood supply, the main blood supply being the hepatic artery. The hepatic artery is blocked off and the liver will then receive most of its blood supply from the portal vien.
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Define cholecystostomy and explain why it is performed.
Place a catheter within the gallbladder to aid in drainage and removal of stones.
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Define PTC.
Percutaneous Transhepatic Cholangiogram. A guide wire is inserted percutaneously directly puncturing the biliary ducts through the liver and contrast media is injected. Stenting can be done in these vessels.
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Define and explain TIPSS, why is this interventional exam done, what is the method of access?
Transjugular Intrahepatic Portosystemic Shunt. Done for portal hypertension. It helps alleviate the portal hypertension. The right jugular vein is accessed.
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Define J tube.
Jejunostomy Tube – catheter placed directly into the jejunum.
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Define GJ tube.
Gastrojejunostomy – catheter placed into the stomach and advanced into the jejunum.
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Define G tube.
Gastrostomy – utilized as feeding tube, used it food cannot pass down the esophagus.
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Define PEG tube.
PEG – Percutaneous Endoscopic Gastrostomy
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What is the most common use for G, J, GJ and PEG tube placements?
Feeding
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What is biliary drainage done for?
Biliary drainage is a therapeutic procedure done percutaneously to help drain the bile ducts. It is commonly done for people with jaundice.
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