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Angiography or arteriography is a
medical imaging Medical imaging is the technique and process of imaging Imaging is the representation or reproduction of an object's form; especially a visual representation (i.e., the formation of an image). Imaging technology is the application of materi ...
technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the
arteries An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pulmonary arteries, pulmonary ...

arteries
,
vein Veins are blood vessels The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a biological system A b ...

vein
s, and the
heart chamber The heart is a muscular organ in most animals, which pumps blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survive, grow, ...
s. This is traditionally done by injecting a radio-opaque
contrast agent A contrast agent (or contrast medium) is a substance Substance may refer to: * Substance (Jainism), a term in Jain ontology to denote the base or owner of attributes * Chemical substance, a material with a definite chemical composition * Matter, an ...
into the blood vessel and imaging using
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Moti ...

X-ray
based techniques such as
fluoroscopy Fluoroscopy () is an imaging technique that uses X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is the natural science that studies matter, ...

fluoroscopy
. The word itself comes from the
Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately 10.7 million as of ...
words ἀγγεῖον ''angeion'', "vessel", and γράφειν ''graphein'', "to write" or "record". The film or image of the
blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a biological system A biological system is a comp ...
s 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. The term angiography has been applied to radionuclide angiography and newer vascular imaging techniques such as CO2 angiography,
CT angiography Computed tomography angiography (also called CT angiography or CTA) is a computed tomography A CT scan or computed tomography scan (formerly known as computed axial tomography or CAT scan) is a medical imaging Imaging is the representation ...
and
MR angiography
MR angiography
. The term ''isotope angiography'' has also been used, although this more correctly is referred to as isotope perfusion scanning.


History

The technique was first developed in 1927 by the
Portuguese Portuguese may refer to: * anything of, from, or related to the country and nation of Portugal ** Portuguese cuisine, traditional foods ** Portuguese language, a Romance language *** Portuguese dialects, variants of the Portuguese language ** Portug ...

Portuguese
physician and neurologist
Egas Moniz
Egas Moniz
at the
University of Lisbon The University of Lisbon (ULisboa; pt, Universidade de Lisboa, ) is a public university, public research university in Lisbon, and the largest university in Portugal. It was founded in 2013, from the merger of two previous public universities lo ...
to provide contrasted x-ray
cerebral angiography Cerebral angiography is a form of angiography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and t ...
in order to diagnose several kinds of nervous diseases, such as tumors, artery disease and
arteriovenous malformations Arteriovenous malformation is an abnormal connection between arteries and vein Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary vein, ...
. Moniz is recognized as the pioneer in this field. He performed the first cerebral angiogram in Lisbon in 1927, and
Reynaldo dos Santos Reynaldo dos Santos (3 December 1880 – 6 May 1970) was a Portuguese physician, writer, and History of art, art historian. As a physician, he was a pioneer in the fields of vascular surgery and urology; as an art historian, he published numerous ...
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
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. Radial access technique for angiography can be traced back to 1953, where Eduardo Pereira first cannulated the radial artery to perform a coronary angiogram. With the introduction of the
Seldinger technique The Seldinger technique, also known as Seldinger wire technique, is a medical procedure A medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, ...
in 1953, the procedure became markedly safer as no sharp introductory devices needed to remain inside the vascular lumen.


Technique

Depending on the type of angiogram, access to the blood vessels is gained most commonly through the
femoral artery The femoral artery is a large artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular sys ...
, to look at the left side of the heart and at the
arterial system An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits bloo ...

arterial system
; or the
jugular The jugular veins are vein Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary vein, pulmonary and umbilical veins, both of which carry ...
or
femoral vein In the human body The human body is the structure of a Human, human being. It is composed of many different types of Cell (biology), cells that together create Tissue (biology), tissues and subsequently organ systems. They ensure homeostasi ...
, to look at the right side of the heart and at the venous system. Using a system of guide wires and
catheters In medicine, a catheter is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. By modifying the ma ...

catheters
, a type of
contrast agent A contrast agent (or contrast medium) is a substance Substance may refer to: * Substance (Jainism), a term in Jain ontology to denote the base or owner of attributes * Chemical substance, a material with a definite chemical composition * Matter, an ...
(which shows up by absorbing the
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Moti ...

X-ray
s), 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
image intensifier An image intensifier or image intensifier tube is a vacuum tube A vacuum tube, electron tube, valve (British usage), or tube (North America), is a device that controls electric current flow in a high vacuum between electrodes to which an elect ...
or film, or motion images. For all structures except the heart, the images are usually taken using a technique called
digital subtraction angiography Digital subtraction angiography (DSA) is a fluoroscopy A barium swallow exam taken via fluoroscopy. Fluoroscopy () is an imaging technique that uses X-ray An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic radia ...
or DSA. Images in this case are usually taken at 2–3 frames per second, which allows the
interventional radiologist Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography A CT scan or computed tomography scan (formerly known ...
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 A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular Organ (anatomy), organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture) ...
(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.


Uses


Coronary angiography

One of the most common angiograms performed is to visualize the blood in the
coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation Coronary circulation is the circulation of blood in the blood vessels that supply the cardiac muscle, heart muscle (myocardium). Coronary arteries supply oxygen saturat ...
. A long, thin, flexible tube called a
catheter In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge) ...

catheter
is used to administer the X-ray contrast agent at the desired area to be visualized. The catheter is threaded into an artery in the
forearm The forearm is the region of the upper limb The upper Limb (anatomy), limbs or upper extremities are the forelimbs of an upright posture, upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the di ...

forearm
, and the tip is advanced through the arterial system into the major coronary artery.
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Moti ...

X-ray
images of the transient
radiocontrast Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is ...
distribution within the blood flowing inside the coronary arteries allows visualization of the size of the artery openings. The presence or absence of
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
or
atheroma An atheroma, or atheromatous plaque ("plaque"), is an abnormal accumulation of material in the inner layer of the wall of an artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulator ...

atheroma
within the walls of the
arteries An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pulmonary arteries, pulmonary ...

arteries
cannot be clearly determined. Coronary angiography can visualize coronary artery
stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular Organ (anatomy), organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture) ...
, 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. To detect coronary artery disease, a
CT scan A CT scan or computed tomography scan (formerly known as computed axial tomography or CAT scan) is a medical image, imaging Scientific technique, technique used in radiology to obtain detailed internal images of the body noninvasively for Diagno ...

CT scan
is more satisfactory than an
MRI scan Magnetic resonance imaging (MRI) is a medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some or ...
. The sensitivity and specificity between CT and MRI were (97.2 percent and 87.4 percent) and (87.1 percent and 70.3 percent), respectively. Therefore, CT (mainly multislice CT) is more accepted, more widely available, more favored by patients, and more economic. Moreover, CT requires shorter breath-hold time than MRI.


Fluorescein angiography

Fluorescein angiography Fluorescein angiography (FA), fluorescent angiography (FAG), or fundus fluorescein angiography (FFA) is a technique for examining the circulation of the retina The retina (from la, rete "net") is the innermost, light-sensitive layer of ti ...

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.


OCT angiography

Optical coherence tomography Optical coherence tomography (OCT) is an imaging technique that uses low-coherence light to capture micrometer-resolution, two- and three-dimensional images from within optical scattering media (e.g., biological tissue). It is used for medica ...
(OCT) is a technology using
near-infrared Infrared (IR), sometimes called infrared light, is electromagnetic radiation In physics Physics (from grc, φυσική (ἐπιστήμη), physikḗ (epistḗmē), knowledge of nature, from ''phýsis'' 'nature'), , is the natur ...
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.


Microangiography

Microangiography Microangiography ( ) is a type of angiography that consists of the radiography of microvessels, small blood or lymphatic vessels of an organ. While most other types of angiography cannot produce images of vessels smaller than 200 µm in diamet ...
is commonly used to visualize tiny blood vessels.


Neuro-vascular angiography

Another increasingly common angiographic procedure is neuro-vascular
digital subtraction angiography Digital subtraction angiography (DSA) is a fluoroscopy A barium swallow exam taken via fluoroscopy. Fluoroscopy () is an imaging technique that uses X-ray An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic radia ...
in order to visualise the arterial and venous supply to the brain. Intervention work such as coil-embolisation of
aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the ca ...
s and AVM gluing can also be performed.


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 Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel that takes blood away from the he ...
.


Post mortem CT angiography for medicolegal cases

Post mortem CT angiography for medicolegal cases is a method initially developed by the Virtopsy group. Originating from that project, both watery and oily solutions have been evaluated. While oily solutions require special deposition equipment to collect waste water, watery 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.


Complications

After an angiogram, a sudden shock can cause a little pain at the surgery area, but heart attacks and strokes usually don't occur, as they may in bypass surgery.


Cerebral angiography

Major complications in cerebral angiography such as in
digital subtraction angiography Digital subtraction angiography (DSA) is a fluoroscopy A barium swallow exam taken via fluoroscopy. Fluoroscopy () is an imaging technique that uses X-ray An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic radia ...
or contrast MRI are also rare but include
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
, an
allergic Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, i ...
reaction to the
anaesthetic An anesthetic (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American Eng ...

anaesthetic
other medication or the contrast medium, blockage or damage to one of the access veins in the leg, or
thrombosis Thrombosis (from Ancient Greek "clotting”) is the formation of a Thrombus, blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses pla ...

thrombosis
and
embolism An embolism is the lodging of an embolus An embolus (; plural emboli; from the Greek ἔμβολος "wedge", "plug") is an unattached mass that travels through the bloodstream The circulatory system, also called the cardiovascular system ...
formation.
Bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally ...

Bleeding
or
bruising A bruise, also known as a contusion, is a type of hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve bloo ...

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


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 Digital subtraction angiography (DSA) is a fluoroscopy A barium swallow exam taken via fluoroscopy. Fluoroscopy () is an imaging technique that uses X-ray An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic radia ...
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.


See also

*
Angiosarcoma Angiosarcoma is a cancer of the endothelial cells that line the walls of blood vessels or lymphatic vessels. It primarily affects older adults. Most tumors of visceral blood and lymphatic vessel walls are cancerous (malignant). Because these canc ...

Angiosarcoma
*
Cardiac catheterization Cardiac catheterization (heart cath) is the insertion of a catheter In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understan ...
*
Computed tomography angiography Computed tomography angiography (also called CT angiography or CTA) is a computed tomography technique used for angiography — the visualization of arteries and veins — throughout the human body. Using contrast injected into the blood vessels, ...
*
Contrast medium A contrast agent (or contrast medium) is a substance Substance may refer to: * Substance (Jainism), a term in Jain ontology to denote the base or owner of attributes * Chemical substance, a material with a definite chemical composition * Matter, an ...
*
Echocardiogram An echocardiography, echocardiogram, cardiac echo or simply an echo, is an Medical ultrasound, ultrasound of the heart. It is a type of medical imaging of the heart, using standard ultrasound or Doppler echocardiography, Doppler ultrasound. Echoc ...

Echocardiogram
*
Electrocardiogram Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is a graph of voltage Voltage, electric potential difference, electromotive force emf, electric pressure or electric tension is the difference in elec ...

Electrocardiogram
*
Fluorescein angiography Fluorescein angiography (FA), fluorescent angiography (FAG), or fundus fluorescein angiography (FFA) is a technique for examining the circulation of the retina The retina (from la, rete "net") is the innermost, light-sensitive layer of ti ...

Fluorescein angiography
*
Image intensifier An image intensifier or image intensifier tube is a vacuum tube A vacuum tube, electron tube, valve (British usage), or tube (North America), is a device that controls electric current flow in a high vacuum between electrodes to which an elect ...
*
Interventional radiology Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography A CT scan or computed tomography scan (formerly known a ...

Interventional radiology
*
Intravascular ultrasound Intravascular ultrasound (IVUS) is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing ...
* Intravenous digital subtraction angiography *
Magnetic resonance angiography Magnetic resonance angiography (MRA) is a group of techniques based on magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging Medical imaging is the technique and process of imaging Imaging is the representati ...

Magnetic resonance angiography
* Peripheral artery occlusive disease


References


External links


RadiologyInfo
for patients: Angiography procedures

from Angioplasty.Org
C-Arms types
Several types of C-Arms
Angiography Equipment
from Siemens Medical
Cardiovascular and Interventional Radiological Society of Europe

Coronary CT angiography by Eugene Lin
{{Authority control Vascular procedures Projectional radiography