Which aery is disected most frequently following aeriography by femoral route:
Correct Answer: Inferior mesentric aery
Description: C i.e. Inferior mesentric aery Direct catheter aeriography (angiography) is percutaneous aerial catheterization based on original work of Seldinger (in Stockholm, 1953). The most useful and commonly used sites for inseion of catheter into the aerial tree are 1) femoral aery (most preferred & most common route) and 2) axillary aery (although most proximal poion of brachial aery is punctured rather than axillary aery, so high brachial is preferred term). The most common vessel punctured for diagnostic and therapeutic angiography is common femoral aery. Retrograde femoral aery puncture is the most common technique used to approch aeries above inguinal ligament (such as coronary, carotid etc). Antegrade femoral aery puncture is used when performing ipsilateral superficial femoral, popliteal or infragenicular aery angioplasty. In practice, femoral & axillary aeries permit investigation of most areas so other sites like popliteal, lower brachial, radial aery, common carotid, etc are used in special circumstances (eg if femoral approach is not possible d/t iliac-occlusive disease). In recent years, there has been a trend toward a greater use of upper extremity access even in those individuals with patent femoral vessels because of lower morbidity caused by small caliber catheters (and DSA technique enables adequate studies to be obtained by injection through small caliber catheters). Digital substraction angiography (DSA), digitally substract (manipuletes computer) the shadow that are present on plain films from the films taken after contrast injection resulting in an image containing detalis of opacified structures only. Selective catheterization of renal aery, coeliac axis etc is done by fluoroscopic manipulation of special shape catheters like straight flush/pigtail/cobra/sidewinder. Superselective (or subselective) catheterization is catheterization of small subsidiary aeries that themselves arise from named branch aeries mostly during embolization procedure. A co-axial catheter (one that passes through the lumen of a diagnostic or guiding catheter) is often used for catheterization of these small vessels. Damage to aerial wall (like subintimal stripping) leading to dissection occurs during puncture, manipulation and injection of saline/large volumes of contrast. The decreasing order of aery damaged during femoral route celiac angiography is external iliac aery > internal iliac aery > inferior mesenteric > gastroduodenal > celiac trunk > superior mesenteric aery.
Category:
Radiology
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