Angiography

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"Angio" redirects here. For subjects associated with the prefix "angio-", see
Lymph vessel
.
Angiography
posterior cerebral circulation.
ICD-9-CM88.40-88.68
MeSHD000792
OPS-301 code3–60
]

Angiography or arteriography is a

contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy
.

The word itself comes from the Greek words ἀγγεῖον angeion 'vessel' and γράφειν graphein 'to write, record'. The film or image of the blood vessels is called an angiograph, or more commonly an angiogram. Though the word can describe both an arteriogram and a venogram, in everyday usage the terms angiogram and arteriogram are often used synonymously, whereas the term venogram is used more precisely.[1]

The term angiography has been applied to

isotope perfusion scanning
.

History

Renal artery angiography video

The technique was first developed in 1927 by the

arteriovenous malformations. Moniz is recognized as the pioneer in this field.[3] He performed the first cerebral angiogram in Lisbon in 1927, and Reynaldo dos Santos performed the first aortogram in the same city in 1929. In fact, many current angiography techniques were developed by the Portuguese at the University of Lisbon. For example, in 1932, Lopo de Carvalho performed the first pulmonary angiogram via venous puncture of the superior member. In 1948 the first cavogram was performed by Sousa Pereira. With the introduction of the Seldinger technique in 1953, the procedure became markedly safer as no sharp introductory devices needed to remain inside the vascular lumen. Radial access technique for angiography can be traced back to 1989, when Lucien Campeau first cannulated the radial artery to perform a coronary angiogram.[4]

Technique

Depending on the type of angiogram, access to the blood vessels is gained most commonly through the

catheters, a type of contrast agent (which shows up by absorbing the X-rays
), is added to the blood to make it visible on the X-ray images.

The X-ray images taken may either be still, displayed on an

interventional radiologist to evaluate the flow of the blood through a vessel or vessels. This technique "subtracts" the bones and other organs so only the vessels filled with contrast agent can be seen. The heart images are taken at 15–30 frames per second, not using a subtraction technique. Because DSA requires the patient to remain motionless, it cannot be used on the heart. Both these techniques enable the interventional radiologist or cardiologist to see stenosis
(blockages or narrowings) inside the vessel which may be inhibiting the flow of blood and causing pain.

After the procedure has been completed, if the femoral technique is applied, the site of arterial entry is either manually compressed, stapled shut, or sutured in order to prevent access-site complications.[5]

Catheterization Lab
Catheterization in selective angiography

Uses

Finger angioma seen on angiogram

Coronary angiography

Main articles: Coronary catheterization and Coronary CT angiography

One of the most common angiograms performed is to visualize the

radiocontrast distribution within the blood flowing inside the coronary arteries allows visualization of the size of the artery openings. The presence or absence of atherosclerosis or atheroma within the walls of the arteries
cannot be clearly determined.

Coronary angiography can visualize coronary artery stenosis, or narrowing of the blood vessel. The degree of stenosis can be determined by comparing the width of the lumen of narrowed segments of blood vessel with wider segments of adjacent vessel.[5]

Cerebral angiography

Main article: Cerebral angiography

Cerebral angiography provides images of blood vessels in and around the brain to detect abnormalities, including arteriovenous malformations and aneurysms.[6] One common cerebral angiographic procedure is neuro-vascular digital subtraction angiography.[7][8]

Pulmonary angiography

Main article: Pulmonary angiography

Pulmonary angiography is used to visualise the anatomy of pulmonary vessels.

Peripheral angiography

Angiography is also commonly performed to identify vessels narrowing in patients with leg claudication or cramps, caused by reduced blood flow down the legs and to the feet; in patients with renal stenosis (which commonly causes high blood pressure) and can be used in the head to find and repair stroke. These are all done routinely through the femoral artery, but can also be performed through the brachial or axillary (arm) artery. Any stenoses found may be treated by the use of balloon angioplasty, stenting, or atherectomy.

Fluorescein angiography

Fluorescein angiography is a medical procedure in which a fluorescent dye is injected into the bloodstream. The dye highlights the blood vessels in the back of the eye so they can be photographed. This test is often used to manage eye disorders.[9]

OCT angiography

near-infrared
light to image the eye, in particular penetrate the retina to view the micro-structure behind the retinal surface. Ocular OCT angiography (OCTA) is a method leveraging OCT technology to assess the vascular health of the retina.[10]

Microangiography

Microangiography is commonly used to visualize tiny blood vessels.

Post mortem CT angiography

Post mortem CT angiography for medicolegal cases is a method initially developed by a virtopsy group. Originating from that project, both watery[11] and oily[12] solutions have been evaluated.

While oily solutions[12] require special deposition equipment to collect waste water, watery[11] solutions seem to be regarded as less problematic. Watery solutions also were documented to enhance post mortem CT tissue differentiation whereas oily solutions were not. Conversely, oily solutions seem to only minimally disturb ensuing toxicological analysis, while watery solutions may significantly impede toxicological analysis, thus requiring blood sample preservation before post mortem CT angiography.[13]

Complications

Angiography is a relatively safe procedure. But it does have some minor and very few major complications. After an angiogram, a sudden shock can cause a little pain at the surgery area, but heart attacks and strokes usually do not occur, as they may in bypass surgery.

Cerebral angiography

Major complications in cerebral angiography such as in

bruising at the site where the contrast is injected are minor complications, delayed bleeding can also occur but is rare.[14]

Additional risks

The contrast medium that is used usually produces a sensation of warmth lasting only a few seconds, but may be felt in a greater degree in the area of injection. If the patient is allergic to the contrast medium, much more serious side effects are inevitable; however, with new contrast agents the risk of a severe reaction is less than one in 80,000 examinations. Additionally, damage to blood vessels can occur at the site of puncture/injection, and anywhere along the vessel during passage of the catheter. If digital subtraction angiography is used instead, the risks are considerably reduced because the catheter does not need to be passed as far into the blood vessels; thus lessening the chances of damage or blockage.

Infection

embolisation. Routine diagnostic angiography is often considered a clean procedure. Prophylaxis is also given to prevent infection from infected space into blood stream.[15]

Thrombosis

There are six risk factors causing thrombosis after arterial puncture: low blood pressure, small arterial diameter, multiple puncture tries, long duration of cannulation, administration of vasopressor/inotropic agents,[16] and the usage of catheters with side holes.[17]

See also

References

  1. ^ G. Timothy Johnson, M.D. (1986-01-23). "Arteriograms, Venograms Are Angiogram Territory". Chicago Tribune. Retrieved 12 September 2011.
  2. ISBN 9780199687817
    .
  3. S2CID 22225524
    .
  4. PMID 2912567
    .
  5. ^
    S2CID 11647732. {{cite book}}: |journal= ignored (help
    )
  6. ISBN 9780191744358
    . Retrieved 24 August 2022.
  7. ^ Glick, Yair. "Digital subtraction angiography | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 2021-09-29.
  8. PMID 2334014
    .
  9. ^ "Fluorescein Angiography". EMPIRE RETINA CONSULTANTS. Retrieved 22 August 2016.
  10. PMID 28760677
    .
  11. ^
    PMID 18430859
    .
  12. ^
    PMID 17056884
    .
  13. PMID 22704555
    .
  14. ^ "Angiography – Complications". Health A-Z. NHS Choices. 2009-06-01. Retrieved 2010-03-24.
  15. PMID 21029949
    .
  16. PMID 15354915
    .
  17. PMID 32764790
    .

External links

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