Introduction of renal arteriography, what is its function?

Directory 1 pinyin 2 English reference 3 operation name 4 indications for renal arteriography 5 contraindications for renal arteriography 6 preparation 7 methods 8 precautions 1 pinyin shèn dòng mài zào yǐng o y ǐ ng o y ǐ ng

English reference renal arteriography

3 operation name renal arteriography

Indications Renal arteriography is suitable for:

1. Renal vascular diseases.

2. Diagnosis of renal tumor lesions and before and after interventional therapy.

3. Tumor lesions around the kidney.

4. Renal trauma bleeding and before and after interventional therapy.

5. Hydronephrosis, understanding renal parenchyma and functional damage.

6. For patients with partial nephrectomy, the scope of lesion should be defined before operation.

7. Unexplained hematuria.

8. After kidney transplantation.

9. Renal small hemangioma, arteriovenous fistula and microaneurysm.

Contraindications 1. Contrast agent and anesthetic allergy.

2. Serious systemic diseases such as severe heart, liver and renal insufficiency.

3. Extreme weakness and severe coagulation dysfunction.

4. Puncture local infection and high fever.

6 ready 1. Patient preparation

(1) Explain the imaging purpose, possible complications and accidents to patients and their families, and sign an imaging agreement.

(2) Explain the process and precautions of radiography to patients, eliminate worries and strive for intraoperative cooperation.

(3) Check the heart, liver and kidney functions, as well as blood routine and bleeding and coagulation time.

(4) necessary imaging examinations, such as B-ultrasound and CT.

(5) Iodine and anesthetic should be treated according to the requirements of Pharmacopoeia.

(6) Do not eat for 4 hours before operation. Empty urine and urine, and train patients to hold their breath.

(7) Skin preparation at puncture site is routine, and sedatives are given when necessary.

(8) Establish venous access to facilitate intraoperative medication and rescue.

2. Equipment preparation

(1) Cardiovascular X-ray machine and its accessories.

(2) Disinfection kit for imaging surgical instruments.

(3) Puncture and intubation instruments, such as puncture needle, catheter sheath, catheter, guide wire, etc.

(4) Pressure injector, injector and connecting pipe.

3. Drug preparation

(1) contrast agent: organic iodine water preparation (ionic or nonionic with corresponding concentration of 40% ~ 76%).

(2) Anesthetics, anticoagulants and various rescue drugs.

Method 1. Seldinger technique was used to puncture femoral artery or brachial artery and intubate after local routine disinfection and anesthesia.

(1) Femoral artery puncture: Femoral artery pulsation is most obvious at the midpoint of inguinal ligament, and the general puncture point is below this point 1 ~ 2 cm. Cut the skin about 0.2 ~ 0.3 cm with a sharp blade, fix the femoral artery with the index finger and middle finger, and pierce it with a puncture needle at an angle of about 45. When the puncture needle touches the artery, it can be seen that the puncture needle beats with the pulse of the artery, and its direction is consistent with the longitudinal axis of the artery. Pull out the needle core, slowly withdraw the trocar until arterial blood is ejected, quickly insert the guide wire to make sure that the guide wire has entered the artery, then withdraw the trocar, and press the puncture site with your hand to prevent blood from flowing around the guide wire. Insert the catheter along the guide wire (if necessary, insert the dilator with the same thickness as the catheter into the artery for many times to dilate the wound and make the soft catheter pass easily, pull out the dilator and then insert the catheter along the guide wire), pull out the guide wire, connect the three-way switch, connect it with the syringe filled with heparin saline (heparin 20 ~ 30 mg is added to 250ml of saline), inject several ml of heparin solution to heparinize the catheter after blood transfusion, close the three-way switch, and then connect it with the syringe filled with heparin saline. If you want to use a catheter sheath, put the catheter sheath around the dilation tube, insert the dilation tube into the blood vessel along the guide wire, pull out the dilator and insert the catheter through the catheter sheath. The main advantage of using catheter sheath is that it is convenient to replace catheter.

(2) Axillary artery puncture: Generally, patients lie on their backs, stretch their arms and bend their elbows, put their palms up on their heads, and touch the pulse of axillary artery on the outside of axillary skin folds. Generally, the puncture point is the lower back of the deltoid muscle of pectoralis major, and the needle tip of the puncture needle is inserted into the top of the armpit at an angle of about 45 with the skin. Other steps are as above.

2. Abdominal aortography was performed first, then selective renal arteriography was performed, and superselective renal segmental arteriography was performed when necessary. In selective angiography, the catheter should not be too deep to avoid the illusion of kidney deficiency.

3. The injection parameters include the dose of contrast agent for renal angiography 10 ~ 15ml/ time, and the injection flow rate is 5 ~ 7ml/s; The dosage of contrast agent for renal segmental arteriography is 4 ~ 6ml/ time, and the injection flow rate is 2 ~ 3 ml/s.

4. Photograph * * * is the positive position, with oblique position if necessary. The image intensifier is inclined to the same side by 7 ~15.

5. The imaging procedure is 3 ~ 6 frames per second, and the injection delay is 0.5s. Breath-holding exposure to microvascular phase and early venous phase.

6. After angiography, pull out the catheter, apply local pressure 10 ~ 15 min, and then apply pressure to bandage.

7. Photographers should carefully fill in the relevant items and technical parameters of the inspection application form and sign it.

8 precautions 1. Master indications and contraindications.

2. Be prepared before operation.

3. First, abdominal aortography was performed to understand the renal artery opening.

4. Observe the patient's reaction closely during the operation.

5. Stay in bed for 24 hours after operation, inject antibiotics intravenously, and observe for a certain period of time, paying attention to the possible angiographic complications of patients.

6. Prevention and treatment of the following complications

(1) Complications of puncture and intubation: temporary arterial spasm, local hematoma, pseudoaneurysm and arteriovenous fistula, intra-arterial rupture of catheter, intimal detachment, atherosclerotic plaque shedding, vascular rupture, cerebral vascular thrombosis and gas embolism.