Complications of contrasts & angiography

radiology

1. Complications of Contrasts & Angiography

2. Angiography “ It is an imaging technique used to visualize the lumen of blood vessels and organs of the body by means of injecting a radio opaque agent into the blood vessels followed by images taken using x-ray based techniques ”

3. ANGIOGRAPHY PERFORMED IN….. Heart--(  coronary angiography ) Brain --( cerebral angiography) Lungs --( pulmonary angiography) Kidneys --( renal angiography) Arms or legs --( extremity angiography)

4. INDICATIONS Congenital arterial anomalies Aneurysms Stenosis Thrombosis Arteritis Trauma Embolus AV fistulas Hemorrhage Masses/tumors

5. The Angiography Procedure A catheter is inserted through a small cut and into one of the arteries, usually in the groin . A radiologist then guides the catheter into the area that needs to be examined. The contrast medium is injected through the catheter and into the blood vessel. A series of X-rays is then taken. Anesthesia

6. COMPLICATIONS OF CONTRASTs

7. Contrast Media Contrast media is primarily divided into two categories: high osmolar contrast media ( HOCM ) low osmolar contrast media ( LOCM ) Most non-ionic agents are placed into the LOCM category while all ionic agents are in the HOCM category.

8. Mechanisms of Contrast Reactions ANAPHYLACSIS Anaphylactic reactions are the immediate type of hypersensitivity that result from interaction of antigens with specific antibodies bound to mast cells and basophils . They involve the release of vasoactive bronchoconstrictive substances such as: Histamine, Leukotrienes Occur within 30 minutes 60% within 5 minutes 94% within 20 minutes Respiratory decompensation : 40% of deaths

9. Anaphylactic Reaction

10. Mechanism CHEMOTOXICITY Chemotoxic effects are related to does and chemical nature of agent ( osmolality , viscosity, hydrophilicity , etc.) More likely in debilitated or unstable patients

11. MAJOR RISK FACTORS Allergy(asthma)extremes of age Cardiovascular disease Previous history

12. MINOR RISK FACTORS DIABETES MELLITUS DEHYDRATION IMPAIRED RENAL FUNCTION HAEMOGLOBINOPATHIES B BLOCKERS INTERLEUKIN 2 THERAPY

13. MILD REACTIONS Sneezing Mild urticaria Nausea Mild pallor Sweating Mild urticaria Arm pain Tachycardia/ bradycardia

14. INTERMEDIATE REACTIONS Widespread urticaria Bronchospasm Laryngospasm Angioneurotic edema Moderate hypotension Faintness Headache Severe vomiting Rigors Dysnoea Chest/abdominal pain

15. SEVERE REACTIONS Cardiopulmonary collapse Severe hypotension Pulmonary edema Edema of glottis Bronchospasm Laryngospasm MI Arrhythmias Loss of consciousness

16. NEPHROTOXICITY Oliguric renal failure(severe form) Direct toxic effect Vasoconstriction Cast formation in tubules leading to obstruction

17. IODISM Interference of free iodine present in contrast with iodine function tests of thyroid----hyperthyroidism

18. Management of Contrast Reactions Reassurance Emergency drugs I/V fluid administration Oxygen administration Vagal reaction(hypotension + bradycardia )>epinephrine Anaphylactoid reaction(hypotension + tachycardia)>atropine

19. COMPLICATIONS OF Angiography

20. INFECTION Improper sterilization techniques ARTERIAL WALL DAMAGE Directly by needle/catheter puncture. Subintimal injection

21. THROMBOSIS Trauma to arterial wall Subintimal injection of contrast Prolonged cathterization:3000 units of heparin(systemic heparinization )

22. ALLERGY Urticaria Sneezing Coughing Severe form: cardiopulmonary collapse Severe reaction:dexamethsone10-20mg iv Edema of glottis : epinephrine 0.5 mg , Subcut / im Antihistamine

23. HYPOTENSION Release of chemical mediaters Patient having atheromatous stenosis ---high risk Hemiplegia ---carotid thrombosis

24. CATHETER CLOT EMBOLUS

25. CHOLESTEROL EMBOLIZATION Atheromatous disease Cholesterol crystals  dislodged into circulation

26. AIR EMBOLUS: When syringe points upward or horizontally. HAEMATOMAS AND FALSE ANEURYSMS: Application of firm pressure at the puncture site Hypertensive's are highly susceptible. Anticoagulant drugs must be stopped

27. NERVE DAMAGE NERVE PALSIES: Femoral nerve palsy Brachial plexus damage during transaxillary catheterization. Caused by direct puncture or by hematoma compression

28. VITAL ORGAN DAMAGE Cortical blindness—vertebral angiography Paraplegia: Artery of Adamkewicz , supplies the cord from T8 downwards. Tetraplegia : excess contrast in deep cervical artery Ventricular fibrillation, MI.

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