World Library  
Flag as Inappropriate
Email this Article

Angiography

Article Id: WHEBN0000449966
Reproduction Date:

Title: Angiography  
Author: World Heritage Encyclopedia
Language: English
Subject: Projectional radiography, Computed tomography angiography, Uterine artery embolization, Vascular surgery, Medical imaging
Collection: Projectional Radiography, Vascular Procedures
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Angiography

Angiography
Intervention
Angiogram showing a transverse projection of the vertebrobasilar and posterior cerebral circulation.
ICD-9-CM 88.40-88.68
MeSH
OPS-301 code 3–60

Angiography or arteriography is a arteries, veins, and the heart chambers. This is traditionally done by injecting a radio-opaque 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" or "record". The film or image of the blood vessels is called an angiograph, or more commonly, an angiogram. Though the word itself can describe both an arteriogram and a venogram, in its everyday usage, the terms angiogram and arteriogram are often used synonymously, whereas the term venogram is used more precisely.[1]

The term angiography is strictly defined as based on projectional radiography; however, the term has been applied to newer vascular imaging techniques such as CT angiography and MR angiography. The term isotope angiography has also been used, although this more correctly is referred to as isotope perfusion scanning.

Contents

  • History 1
  • Technique 2
  • Uses 3
    • Coronary angiography 3.1
    • Microangiography 3.2
    • Neuro-vascular angiography 3.3
    • Peripheral angiography 3.4
    • Post mortem CT angiography for medicolegal cases 3.5
  • Complications 4
    • Cerebral angiography 4.1
    • Additional risks 4.2
  • See also 5
  • References 6
  • External links 7

History

The technique was first developed in 1927 by the Portuguese physician and neurologist Egas Moniz at the University of Lisbon to provide contrasted x-ray cerebral angiography in order to diagnose several kinds of nervous diseases, such as tumors, artery disease and arteriovenous malformations. He is usually recognized as one of the pioneers in this field. Moniz performed the first cerebral angiogram in Lisbon in 1927, and Reynaldo Cid dos Santos performed the first aortogram in the same city in 1929. 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.

Technique

Depending on the type of angiogram, access to the blood vessels is gained most commonly through the femoral artery, to look at the left side of the heart and at the arterial system; or the jugular or femoral vein, to look at the right side of the heart and at the venous system. Using a system of guide wires and 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 interventional radiologist or cardiologist to see stenosis (blockages or narrowings) inside the vessel which may be inhibiting the flow of blood and causing pain.

Uses

Finger angioma seen on angiogram

Coronary angiography

One of the most common angiograms performed is to visualize the blood in the coronary arteries. A long, thin, flexible tube called a 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, and the tip is advanced through the arterial system into the major coronary artery. X-ray images of the transient radiocontrast distribution within the blood flowing inside the coronary arteries allows visualization of the size of the artery openings. Presence or absence of atherosclerosis or atheroma within the walls of the arteries cannot be clearly determined. See coronary catheterization for more detail.

To detect coronary artery disease, Computed Tomography (CT) Scan is better than Magnetic Resonance Imaging (MRI). 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.[2]

Microangiography

Microangiography is commonly used to visualize tiny blood vessels.

Neuro-vascular angiography

Another increasingly common angiographic procedure is neuro-vascular digital subtraction angiography in order to visualise the arterial and venous supply to the brain. Intervention work such as coil-embolisation of aneurysms and AVM gluing can also be performed.

Peripheral angiography

Angiography is also commonly performed to identify vessel 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 atherectomy.

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[3] and oily[4] solutions have been evaluated.

While oily solutions[4] require special deposition equipment to collect waste water, watery[3] 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.[5]

Complications

After angiogram, the risk of heart attack is actually narrowed down. A sudden shock can cause little pain at the surgery area but heart attacks and heart strokes usually don't occur, like in bypass surgery. Heart strength doubles after an angiogram surgery.

Cerebral angiography

Major complications in cerebral angiography such as in Digital subtraction angiography or contrast MRI are also rare but include stroke, an allergic reaction to the anaesthetic other medication or the contrast medium, blockage or damage to one of the access veins in the leg, or thrombosis and embolism formation. Bleeding or bruising at the site where the contrast is injected are minor complications, delayed bleeding can also occur but is rare.[6]

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 are 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.[7]

See also

References

  1. ^
  2. ^
  3. ^ a b
  4. ^ a b
  5. ^
  6. ^
  7. ^ Clayman, Charles B., ed. Home Medical Encyclopedia. Vol. 1. New York: Reader's Digest Association, 1989. Print. A-H. 109.

External links

  • RadiologyInfo for patients: Angiography procedures
  • Cardiac Catheterization from Angioplasty.Org
  • Angiography Equipment from Siemens Medical
  • Cardiovascular and Interventional Radiological Society of Europe
  • Coronary CT angiography by Eugene Lin
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 


Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.