curs 6 vase interventional final(2)
TRANSCRIPT
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Examinarea radio-imagistica a arterelor si venelor
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Examinarea radio-imagistica a arterelor
ARTERE Metode Semiologie Patologie
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Metode de investigatie vasculara
* Ecografia
* Arteriografia / flebografia
* CT
* IRM
– lumen
– perete vascular
– curgerea sangelui
– structuri perivascualare
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Metode de investigatie vasculara
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CoronarografieReconstructie CT
Metode de investigatie vasculara
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Tehnica arteriografiei
PRINCIPIU - introducerea unei cantitati de substanta de contrast iodata in lumenul arterial pentru a vizualiza morfologia interna a vasului, traiectul si distributia lui
METODE: - punctia directa a vasului - cateterismul retrograd (Seldinger) - angiocardiografia largita (Vialet)
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Arteriografia Timpi circulatori
• TIMP ARTERIAL
• TIMP ARTERIOLAR
• TIMP PARENCHIMATOS
(CAPILAR)
• TIMP VENOS (FLEBOGRAFIC)
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Timpul arterial
- opacifierea trunchiului arterei explorate si ramurilor principale
- durata (cateva sec.) este variabila, depinde de mai multi factori:
- artera propriu-zisa (sediu, calibru,..) - cantitatea de produs de contrast injectat - debitul de injectare - arterele au : - un traiect variabil, precizat de anatomie - tonalitate omogena - margini nete, liniare, aproape paralele - diminuare brusca de calibru la emisia
colaterale
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- urmeaza timpului arterial
- durata aproximativ egala cu timpul arterial
- aspectul arterelor:
- artere ramificate cu aspect de "arbore“
- densitate variabila functie de teritoriul studiat
- omogeme, cu margini nete
- calibru ce se reduce brusc
Timpul arteriolar
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Timpul parenchimatos
- extrem de variabil, functie de teritoriul examinat
- la nivelul partilor moi (muschi, tesut conjunctiv...) nu poate fi observat cu precizie
- la nivelul diferitelor parenchime glandulare (rinichi, ficat, splina, tiroida...), precum si la nivelul diferitelor tumori circulatia este crescuta
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Timpul flebografic
- rezulta din drenajul prin vene a sangelui opacifiat - deseori greu de evidentiat datorata dilutiei mari - uneori se confunda sau coexista cu timpul parenchimatos, datorita fenomenului de retentie a substantei de contrast - metoda ideala de examinare a acestui timp circulator este angiografia cu substractie digitala
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Semiologia arteriala
- ingustari ale lumenului vascular - dilatari ale lumenului vascular - obliterare
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Semiologia Semiologia arterialaarteriala
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Semiologia arterialaSemiologia arteriala
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Ecografie• Stenoza arteriala:
– Ingustarea lumenului
– Cresterea vitezelor
– Turbulenta
• Ocluzie arteriala– Absenta fluxului
– Modificarea fluxului in aval (colaterale)
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= ateroame parietale arteriale, determinand stenoze, obliterari arteriale;
= clinic: claudicatie intermitenta, durere, paloarea teg., ulceratii, necroze, lipsa pulsului
* frecventa mare in a doua jumatate a vietii
– intereseaza in general toate arterele, cu predominenta aorta, marile vase si arterele membrelor inferioare
* Caracterele radiologie ale vaselor aterosclerotice:
•neregularitati parietale
•frecventa mare a stenozelor
•obstructii vasculare (tromboze)
•circulatie colaterala in general bine dezvoltata
•dilatari poststenotice sau anevrismale (aorta)
•calcifieri in peretele arterial
Patologie arterialaPatologie arteriala
Arteriopatia ateroscleroticaArteriopatia aterosclerotica
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Arteriopatia ateroscleroticaArteriopatia aterosclerotica
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Patologie Patologie arteriala / arteriala / Arteriopatie Arteriopatie ateroscleroticaaterosclerotica
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Angio , ct , irm, ecco
Arteriopatie aterosclerotica – Arteriopatie aterosclerotica – IRM / angiografieIRM / angiografie
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Patologie arteriala degenerativa / Patologie arteriala degenerativa / Sindromul LericheSindromul Leriche
•Sindromul de obstructie aorto-iliaca bilaterala
•Stenoza sau obstructie
•Circulatie colaterala bogata
•Dureri in fese si in lombe – motiv de confuzie cu o discopatie lombara
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Arteriopatii / Arteriopatii / Trombangeita obliteranta (b.BuergerTrombangeita obliteranta (b.Buerger))–Mai rara decat ateroscleroza
–Intereseaza barbati, fumatori
–Apare la varsta tanara
–Intereseaza vasele mici terminale
–Prognostic rau
• Caracterele radiologie ale vaselor:
•Artere cu calibru regulat diminuat in diametru
•Aspect spiralat
•Tromboze etajate pe arterele mici
•Circulatie colaterala saraca
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Arteriopatii – trombangeita obliteranta
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Afectiunile aortei - cu ingustarea lumenului : * congenitale : coarctatia hipoplazia dublu arc, Ao la dreapta * dobandite : stenoza aterosclerotica
- cu largirea lumenului: - insuficienta Ao - dilatatie poststenotica - anevrismul ( congenital, micotic, ATS, sifilis, - necroza chistica a mediei, inflamatii, HTA) - disectia - posttraumatic – complicatii > ruptura > disectia
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AA ascendenta
AA descendenta
= Crestera calibrului vascular : sacciform / fusiform
Afectiunile aortei Anevrismul Ao
PAOAS
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Afectiunile aortei / anevrismul Ao
- etiologie: congenital, micotic, ATS, sifilis, necroza
chistica a mediei, inflamatii, HTA)
- complicatii > disectia / ruptura
- adevarat / pseudoanevrism
- M:F = 3:1 (Ao toracica), 5:1 (abdominala)
- varsta > 60 ani
URGENTA
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Afectiunile aortei / anevrismul Ao
CT
IRM
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Afectiunile aortei / anevrismul Ao
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Anevrismele aortei /complicatii - rupturaAnevrismele aortei /complicatii - ruptura
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Disectia aortei / Tehnici Disectia aortei / Tehnici
•Ecografia transtoracica si abdominala•Ecografia transesofagiana•CT•IRM•* Angiografia
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Afectiunile aortei - disectia aortei= decolare / ruptura / flaps intimal
Clasificare Stanford:
Tip A = URGENTA CHIRURGICALA!
A B
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Anevrismele aortei / complicatii -disectieAnevrismele aortei / complicatii -disectie
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Disectia aortei – urgenta chirurgicala / Disectia aortei – urgenta chirurgicala / Tip A, ITip A, I
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Disectie aorta - tip BDisectie aorta - tip B