First, let’s talk about how coronary angiography is done?
1, puncture catheter
- coronary angiography first step is puncture catheter. The catheter here is equivalent to opening a door on the artery, which can facilitate the inlet and exit of the angiography catheter.
- The choice of puncture artery can be femoral artery , radial artery , brachial artery , etc. However, the most common one is the radial artery at present. The radial artery is where we usually take our pulse. This place is easier to fix after the operation, but after the operation, it basically does not affect movement. The femoral artery is not easy to fix. After the operation, it takes about 12 hours to lie on the bed, and the leg cannot move randomly after the operation.
2. Send the catheter to the heart
- coronary angiography the second step is to send the catheter to the heart. Of course, sending the catheter requires guidance from the guidewire, along the radial artery, brachial artery, axillary artery, and to the heart. After the
- catheter enters the heart along the guidewire, pull the guidewire out of the catheter, connect it to the contrast dose, and then look for the left and right coronary sinuses.
3, contrast
- coronary artery is divided into left coronary artery and right coronary artery. The openings of are called the left coronary sinus and the right coronary sinus, respectively.
- After the contrast catheter reaches the coronary artery opening, push the contrast agent into the coronary artery through the syringe, and step on the ray on the other side, so that the shape of the coronary artery blood vessels can be clearly seen, and the narrow areas can also be seen intuitively.
right coronary artery
Possible harm to the human body?
Although coronary angiography is minimally invasive and generally safe, everything is always unexpected. There are some injuries that everyone will suffer, such as arterial puncture and ray irradiation. These two things cannot be escaped if you have an angiography. The following mainly talks about possible hazards.
1. Allergic reaction
1. Local anesthetics - lidocaine allergy
- Some people may be allergic to lidocaine, but I may have done to intervene in for a short time and have never encountered lidocaine allergies, but I believe such people exist.
2, contrast agent allergic
- coronary angiography uses iodine contrast agents, such as iodexamol, iodhelol, etc. Some people are allergic to contrast agents and are relatively common.
- The reactions of different people are different for allergic reactions. Some people may just have itchy and rashes on their bodies. Such patients may just use some medicine.
- Some people also have serious allergies and are very rapid. After using contrast agent, their blood pressure will drop immediately. shock , and even arrhythmia . In this case, they need to be rescued immediately. Of course, the rescue equipment in the operating room is very complete and can basically be rescued.
- Some patients know that they are allergic to contrast agents, so that they can use some anti-allergic drugs in advance.
2. Puncture-related complications
- Puncture-related complications refer to complications related to the first step of contrast puncture. For example, bleeding at the puncture site, retroperitoneal hematoma, pseudoaneurysm, , arteriovenous fistula, etc.
- As I said before, most of the puncture sites are now selected in the radial artery, and the right side cannot be selected on the left side, and you can also choose the ulnar artery. The femoral artery is selected unless the arteries of both hands are not good.
- choose radial artery, so there will be no problem of retroperitoneal hematoma, which is relatively safer. Of course, such as bleeding at the puncture site, arteriovenous fistula, the choice of radial artery may also occur. Of course, the probability of occurrence is relatively small.
In addition, after the operation, you need to use a radial artery compressor to compress and stop bleeding. Some people press too tightly, which may lead to blisters or even infection in the radial artery skin.
III. Embolization complications
Embolization complications include thromboembolic complications, atherosclerotic plaque embolization complications, air embolization complications, etc.
1. Complications of thromboembolism
- Contrast catheter and guided guidewire are foreign bodies for the human body, and blood clots may form on its surface. Thrombosis falls off with blood circulation may lead to embolization of certain organs, such as cerebral embolism, which is more common.
- Of course, in order to prevent this from happening, heparin will be injected before the imaging to prevent the formation of thrombus.
2. Atherosclerotic plaque embolization
- During the operation, plaque rupture may lead to thrombosis, resulting in the formation of thrombus, and thrombosis may also lead to corresponding organ embolization. Therefore, be careful during the angiography operation and do not be violent.
3, air embolism
- air embolism is why embolism is more common, mainly because the air in the contagious device is not removed cleanly. For example, there is air in the syringe that contains contrast agent and it is not drained.
- A small amount of air enters the artery and has little effect. If the amount of air entering the coronary artery is relatively large, it will hinder the blood flow, which is equivalent to the sudden and complete blockage of blood vessels, which means that acute myocardial infarction attack. Through ECG monitoring, it can be clearly seen that the patient's ECG ST is elevated. In this case, rescue is also needed.
IV. Coronary artery open dissection
- Arteries can usually be divided into three layers, inner membrane , middle membrane and outer membrane. Dissection refers to the rupture of the inner membrane, and blood enters between the inner membrane and the middle membrane along the rupture of the inner membrane, forming a hematoma and blocking the arteries.
- Coronary artery opening dissection is a very serious complication, which is equivalent to acute myocardial infarction caused by trunk occlusion, and the infarction range is very wide.
- The open dissection of the coronary artery is usually caused by improper operation, such as violent operation, the contrast catheter and the coronary artery are not on the same plane, and the force is too strong when pushing the contrast agent.
- I have seen such a case (not my own operation) in which the patient's dissection was from the opening of the right coronary artery to the medium and distant section, such a long-distance dissection.
5. contrast agent nephropathy
- contrast agent nephropathy refers to the increase of blood creatinine after contrast after contrast or the absolute value is 44.2umol/L. Contrast nephropathy leads to an increase in mortality during hospitalization, with mortality during hospitalization between 10% and 50%-70% during follow-up.
- contrast agent The overall incidence of nephropathy is less than 1%, but people with poor kidneys are more likely to occur, with an incidence rate of 5.5%; those with poor kidneys and combined with diabetes have a incidence rate of 50%.
Summary: Although
- coronary angiography is a minimally invasive surgery, the possible harm is still quite large. Therefore, although it is a minor operation, doctors should not take it lightly during the operation.
- And patients should also have a clear mind about possible problems. Some complications cannot be decided by doctors.
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