Femoral artery stricture post dilatation. Note the ragged appearance of the dilated atheromatous plaque.

This patient developed several strictures two years apart. This one is a popliteal stricture.

Popliteal stricture post dilatation

And this represents the second stricture two years later in the left lower femoral artery

And this is the post-dilatation image of the femoral stricture.

Thrombolysis can be performed on recently thrombosed sections due to embolic disease or focal narrowing by atheroma.

This is the image 8 hours post commencement of thrombolysis.

Post prandial mesenteric angina can be produced by strictures of the coeliac axis or superior mesenteric artery, usually both vessels are affected before symptoms occur. Here we see a stricture of the superior mesenteric artery which was successfully dilated and the patient was seen to eat breakfast with relish the next morning.

Fibromuscular dysplasia has a beaded appearance of narrowing and dilatation of the vessel wall and should be considered when a young patient presents with hypertension.

On the whole, fibromuscular dysplasia can be satisfactorily treated by balloon angioplasty. However, in this patient, it was not successful and surgical correction by a graft between abdominal aorta and renal artery was carried out.

However, the graft again stenosed as you can see.  Fibromuscular dysplasia may affect many arteries and here the arrow is pointing to disease of the right common iliac artery in the same patient.

This patient also has fibromuscular dysplasia of the right renal artery but the angle between the aorta and the renal artery did not invite a femoral approach for the balloon catheter.

For that reason, an approach via the right axillary artery proved easier, and the stenosis was successfuly dilated

Trouble in the chest, in a lady with a stroke. Surely you can just see the outline of the oval density in the right base through the liver!

The cause of the stroke in this lady is most likely the arteriovenous malformation in the posterior parietal region, where multiple ectatic sections are present which drain into superior sagittal sinus. Thrombus may form in the dilations and lead to a stroke or they could be areas of haemorrhage.  However, in this case, the arteriovenous malformations in the lungs could also have been the source of an embolus.

Lady with transient ischaemic attacks. Note the rounded density lateral to the right breast.

Which in the lateral projection can be clearly seen projected over the heart.

This turned out to be another AV malformation which was occluded by multiple coils. Note the post embolisation picture in the bottom right corner.

This 18 year boy had an abnormally high haemoglobin and tired easily. There were small blue venous spiders around his lips. Note the variety of rounded densities in both lungs.

Embolisation was begun and we can see several coils in situ on the right.

But eventually the number of aneurysms which needed to be closed was very large and most of the pulmonary circulation would be occluded. For this reason, the right middle lobe was surgically removed.

Several lesions were embolised on the left side

The patient was reexamined several years later and many more small fistulae had opened up in the interval.

Important complications of arteriovenous malformations are cerebral emboli or abscess, the latter if the thrombus in the malformation is infected.

A young man working at the supermarket found his legs becoming weaker and he became unable to push the trolley. A myelogram performed with the help of intrathecal contrast medium demonstrates a  tortuous dilated vein flowing along the dorsal aspect of the spinal cord. The conus is dilated, consistent with a syrinx.

A spinal angiogram was carried out. The hairpin bend of the artery of Adamkiewicz was identified in the middle thoracic region and other vessels extending upwards showed a very vascular area at T2.  It is important to identify the artery of Adamkiewicz as any fast obstruction of it may lead to infarction in the cord. In many elderly patients the artery is often not found at angiography, presumably due to slow obstruction due to atheroma which can be tolerated.

The small vascular lesion in the lower cervical cord has many small arteries feeding it. and this hyperaemia is responsible for the dilated veins and syrinx.

The patient had a very vascular lesion in the cervicodorsal region consistent with a haemangioma of the cord. The clips are there from past surgical attempts to remove this lesion, but it was impossible to achieve due to rapid bleeding.

In this view we can see the anterior spinal artery flowing beyond the lesion. The patient was hurriedly sent to the operating theater and the  haemangioblastoma was successfully removed. The vascularity decreased  after embolisation with the patient's own blood clot which inadvertently formed in the catheter.

The CT scan shows the bone destructive lesion in the left petrous temporal bone in a patient with headache and ringing in the left ear.

A highly vascular lesion consistent with a glomus tumour was seen as the cause of the bony defect on the MR scan.

Angiography demonstrates a very vascular mass fed by the ascending pharyngeal artery as they often are.

During the embolisation procedure it was noted that the patient did not converse with the radiologist and a cerebrovascular accident was suspected, here confirmed by a filling defect in the left middle cerebral artery.

Immediate thrombolysis removed the blood clot and restored patient consciousness.

This patient had a large cerebral haemorrhage, from an arteriovenous malformation fed by branches of the internal carotid and vertebral arteries.

Selective catherization of feeding vessels revealed a small aneurysm which presumably is the cause of the haemorrhage, as indicated by the green arrow.

The aneurysm was occluded by a minute amount of glue, which can be seen on the bottom left of the image.

This  patient was disturbed in his sleep by a noise in the head. Injection of the left common carotid artery revealed abnormal circulation over the posterior aspect of the brain which was shown to be supplied by a branch of the occipital artery which drained via small vessels into a larger vein.

The flow was gradually occluded by embolisation with particulate material until flow ceased. It is recommended that the venous end is also occluded to prevent recurrence of flow through the fistula via collaterals. This was not done at the initial session and the patient did return with recurrent symptoms two years later.

This patient was known to have a vascular cerebral lesion. The patient saw a neurosurgeon operating on a similar patient on TV. She then decided to consult the same surgeon who successfully removed the arteriovenous malformation. Pre-operative embolisation of the arteriovenous malformation made the operation easier and the lesion was excised in 4 hours . Post embolisation images are seen in the top right image.

Embolisation of the branches of the posterior cerebral artery. Note the reduced circulation of the left cerebral hemisphere.

We see the meningeal artery also supplying the lesion

Images showing the location of multiple coils and marked reduction in the blood supply from the internal carotid artery.  This procedure allowed the surgical removal of the AVM to be safer and much quicker, the lesion was removed in 4 hours.

Control of bleeding by embolization.

Bleeding from a pelvic vessel resulting from a fracture, controlled by embolisation

New equipment being installed in the angiography room. Here are the radiographers, Neal, Wayne and Peter with Dr Sacharias.

Dr Sacharias is here holding the control handle of the beloved  old angiography unit being replaced by the new one.  Dr Sacharias is here with Peter Hiscock, Neal Russell and Dianna Sullivan.

All radiographers and nurses working with Dr. Sacharias had to learn the new Ninaspeak which turned out to be very useful for quick communication