Understanding Angiography - A Guide

MEDICALLY REVIEWED BY

Andrada Costache, MD

Dr. Costache is a radiologist with over 10 years of experience. She specializes in thoracic radiology.

What is an angiography procedure?

Angiography is a medical procedure used to visualize blood vessels and identify any abnormalities or blockages. During the procedure, a contrast agent or dye is injected into the blood vessels, which allows the vessels to be seen more clearly on X-ray or other imaging tests.

There are different types of angiography procedures depending on the area of the body being examined. For example, coronary angiography is used to examine the blood vessels in the heart, while cerebral angiography is used to examine the blood vessels in the brain.

During the procedure, the patient lies on an exam table and a small incision is made in the skin, typically in the groin or arm. A catheter, which is a long, thin tube, is then inserted into an artery and guided through the blood vessels to the area being examined. Once the catheter is in place, the contrast dye is injected and X-rays or other imaging tests are taken to create detailed images of the blood vessels.

After the procedure, the catheter is removed and pressure is applied to the incision site to prevent bleeding. The patient may need to lie still for a period of time to allow the incision site to heal. In some cases, angioplasty or other treatments may be performed during the angiography procedure to open up any blockages that are identified.

An illustration showcasing the Angiography Procedure

How angiography/ angiogram is done?

The exact steps of the angiography procedure can vary depending on the specific type of angiography being performed and the area of the body being examined, but the general steps are as follows:

  1. Preparation: The patient will typically be asked to fast for a certain amount of time before the procedure, usually around 6 hours. The patient will also be asked to remove any jewelry or other metal objects, and may be given a gown to wear. The patient will be asked to sign a consent form and will be given instructions on how to prepare for the procedure.
  2. Anesthesia: Local anesthesia is usually used to numb the area where the catheter will be inserted. In some cases, general anesthesia may be used to make the patient sleep through the procedure.
  3. Catheter insertion: A small incision is made in the skin, typically in the groin or arm, and a catheter is inserted into an artery or vein. The catheter is then guided through the blood vessels to the area being examined.
  4. Contrast dye injection: Once the catheter is in place, a contrast dye is injected through the catheter. The dye allows the blood vessels to be seen more clearly on X-ray or other imaging tests.
  5. Imaging: X-rays or other medical imaging tests are taken as the dye moves through the blood vessels. This creates detailed images of the blood vessels, which can be used to identify any abnormalities or blockages.
  6. Catheter removal and recovery: After the procedure, the catheter is removed and pressure is applied to the incision site to prevent bleeding. The patient may need to lie still for a period of time to allow the incision site to heal. In some cases, angioplasty or other treatments may be performed during the angiography procedure to open up any blockages that are identified.

The entire angiography procedure usually takes between 30 minutes to 2 hours to complete, depending on the specific type of angiography being performed and the area of the body being examined. After the procedure, the patient may be monitored for a short time before being released, and will typically be advised to rest and avoid strenuous activity for a period of time. The results consists of a series of standardized medical images, which can be saved locally or in a cloud PACS for later analysis or comparison with other studies using a DICOM viewer.

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What is coronary angiography? / coronary angiogram?

Coronary angiography is a medical procedure used to visualize the coronary arteries that supply blood to the heart muscle. The procedure is typically performed to diagnose and evaluate the severity of coronary artery disease, which is a condition where these arteries become narrowed or blocked, leading to reduced blood flow to the heart.

During a coronary angiography procedure, a contrast dye is injected into the bloodstream through a catheter that is inserted into a blood vessel in the groin or arm. The dye allows the coronary arteries to be seen on X-ray or other imaging tests. The catheter is then guided through the blood vessels to the coronary arteries, and the contrast dye is injected into these arteries.

This special dye is visible by X-ray, which details the narrowing, occlusions, and other abnormalities of specific arteries. These images obtained are called angiograms. [1]

Coronary angiography is typically performed in a hospital or outpatient setting and takes about 30 to 60 minutes to complete. The procedure is usually done with local anesthesia to numb the area where the catheter is inserted, and the patient is awake during the procedure.

After the procedure, the patient may need to lie still for several hours to allow the incision site to heal and to prevent bleeding. The patient may also be prescribed medication to prevent blood clots and reduce the risk of infection.

Coronary angiography is a safe and effective procedure that allows doctors to diagnose and evaluate the severity of coronary artery disease, and to determine the best treatment options for the patient.

Curious about what an angiography looks like in Medicai?

Using our embeddable DICOM Viewer, you can easily view your angiography scans anywhere online (on the web, in a mobile application). Your DICOM files are stored in your Medicai workspace, in a Medicai cloud PACS.

What is CT angiography? What are the types of angiography?

CT angiography (CTA) is a medical imaging technique that uses computed tomography (CT) technology to visualize blood vessels throughout the body. During a CTA procedure, X-rays and computer processing are used to create detailed images of the blood vessels, which can be used to diagnose a variety of medical conditions.

CTA is a non-invasive procedure that is typically faster and less invasive than traditional angiography. CTA can be used to diagnose a variety of medical conditions, including blood clots, aneurysms, and arterial blockages. CTA is generally considered safe, but as with any medical procedure, there is a small risk of complications, such as an allergic reaction to the contrast dye.

Some reasons to have a CT angiogram include:

  • To find an aneurysm (a blood vessel that has become enlarged and may be in danger of rupturing)
  • To find blood vessels that have become narrowed by atherosclerosis (fatty material that forms plaques in the walls of arteries)
  • To find abnormal blood vessel formations inside your brain
  • To identify blood vessels damaged by injury
  • To find blood clots that may have formed in your leg veins and traveled into your lungs.
  • To evaluate a tumor that is fed by blood vessels

Information from CT angiography may help prevent a stroke or a heart attack. This type of test may also help your healthcare provider plan cancer treatment or prepare you for a kidney transplant. Your healthcare provider may have other reasons for ordering this test. [2]

How much does a CT angiography cost?

The cost of a CT angiography (CTA) procedure can vary widely depending on a number of factors, including the location where the procedure is performed, the specific type of CTA being performed, and the patient's insurance coverage.

According to a 2021 report by Healthcare Bluebook, the average cost of a CTA procedure in the United States is approximately $1,200-$1,500. However, this cost can vary widely depending on the specific circumstances of the procedure.

In addition to the cost of the procedure itself, there may be additional costs associated with the CTA, such as the cost of any pre-procedure testing, anesthesia, or follow-up care.

It is important for patients to discuss the cost of the CTA with their healthcare provider and their insurance company prior to the procedure, in order to fully understand their financial responsibility and any potential out-of-pocket expenses. Patients may also wish to compare costs between different healthcare providers and imaging centers in their area, in order to find the most affordable option for their specific needs.

How long does angiography take?

The length of an angiography procedure can vary depending on the specific type of angiography being performed and the area of the body being examined. Generally, angiography procedures take between 30 minutes to 2 hours to complete.

Coronary angiography, which is used to examine the blood vessels in the heart, typically takes about 30 minutes to an hour to complete. This procedure may be followed by angioplasty or stenting to treat any blockages that are found, which can add additional time to the procedure.

Peripheral angiography, which is used to examine blood vessels in other parts of the body, such as the legs or arms, can take up to 2 hours to complete.

CT angiography (CTA) and magnetic resonance angiography (MRA), which use imaging technology to visualize the blood vessels, are typically faster than traditional angiography procedures, taking between 15-30 minutes to complete.

After the procedure, the patient may need to lie still for a period of time to allow the incision site to heal. In some cases, the patient may need to stay in the hospital for observation before being released. The total time spent in the hospital or medical center for the angiography procedure can vary depending on the individual case.

What is cerebral angiography?

Cerebral angiography is a medical imaging procedure that uses X-rays and contrast dye to visualize the blood vessels in the brain. During a cerebral angiography procedure, a small catheter is inserted into an artery in the groin or arm and guided up to the blood vessels in the brain. Contrast dye is then injected through the catheter, and X-ray images are taken to visualize the blood vessels and any abnormalities, such as aneurysms or arteriovenous malformations (AVMs).

Cerebral angiography can be used to diagnose a variety of conditions affecting the blood vessels in the brain, including:

  1. Aneurysms: bulges or weak spots in blood vessel walls that can potentially rupture and cause a stroke.
  2. Arteriovenous malformations (AVMs): abnormal connections between arteries and veins that can cause bleeding or stroke.
  3. Blood clots: blockages in blood vessels that can cause stroke.
  4. Narrowed blood vessels: caused by atherosclerosis or other conditions, which can reduce blood flow and cause stroke.
  5. Tumors: can cause abnormal blood vessel growth or compression of blood vessels.

Cerebral angiography is an invasive procedure that carries a small risk of complications, such as bleeding, infection, or stroke. However, it is a highly effective diagnostic tool and is often used in cases where other imaging techniques, such as CT or MRI, are unable to provide a clear diagnosis. The procedure is typically performed in a hospital or outpatient setting under local anesthesia, and the patient is typically able to return home the same day.

What is pulmonary angiography?

The technique of pulmonary angiography involves fluoroscopically directed insertion of a guidewire, followed by a modified pigtail catheter into the right and left main pulmonary arteries in turn, with injection of a nonionic contrast at an appropriate flow rate. [3] It is primarily used to identify and locate blood clots (pulmonary embolism) or other abnormalities within the pulmonary arteries.

During the procedure, a thin, flexible tube called a catheter is inserted into a large vein in the groin or neck and threaded through the blood vessels to the pulmonary artery. Once the catheter is in place, a contrast dye is injected into the bloodstream and X-rays are taken to visualize the pulmonary arteries and any abnormalities that may be present.

Pulmonary angiography is an invasive procedure and carries some risks, including bleeding, infection, and allergic reactions to the contrast dye. It is usually reserved for cases where other diagnostic tests, such as CT scans or ultrasound, have been inconclusive or when urgent diagnosis is needed.

What can be diagnosed using angiography?

Angiography is a medical imaging technique that uses a contrast agent and X-rays to visualize the blood vessels in the body. It is used to diagnose a variety of conditions that affect the blood vessels, including:

  1. Coronary artery disease: Angiography of the coronary arteries can be used to identify blockages or narrowing in the arteries that supply blood to the heart.
  2. Peripheral artery disease: Angiography of the peripheral arteries can be used to identify blockages or narrowing in the arteries that supply blood to the arms or legs.
  3. Aneurysms: Angiography can be used to identify aneurysms, which are bulges in the blood vessels that can rupture and cause bleeding.
  4. Vascular malformations: Angiography can be used to identify abnormal connections between blood vessels, such as arteriovenous malformations.
  5. Tumors: Angiography can be used to identify blood vessels that are supplying tumors, which can help guide treatment.
  6. Pulmonary embolism: Angiography of the pulmonary arteries can be used to identify blood clots that have traveled to the lungs.
  7. Stroke: Angiography of the blood vessels in the brain can be used to identify blockages or narrowing that may be causing a stroke.

Angiography is an invasive procedure and carries some risks, including bleeding, infection, and allergic reactions to the contrast dye. The decision to perform angiography is made on a case-by-case basis, taking into account the risks and benefits for each individual patient.

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How does angiography work?

In general, angiography works by injecting a contrast agent into the bloodstream. The contrast agent is a substance that is opaque to X-rays or other imaging modalities, allowing the blood vessels to be seen on the resulting images. The contrast agent may be injected into a vein, artery, or directly into a specific blood vessel, depending on the type of angiography being performed.

Once the contrast agent has been injected, X-rays or other imaging modalities are used to capture images of the blood vessels. The images may be captured in real-time or as a series of still images.

Depending on the type of angiography being performed, the procedure may be performed using an invasive or non-invasive approach. Invasive angiography involves the insertion of a catheter into a blood vessel and the direct injection of contrast agent, while non-invasive angiography uses imaging modalities such as MRI or CT scans to capture images of the blood vessels without the need for catheterization.

Angiography can be used to diagnose a variety of conditions that affect the blood vessels, including blockages, aneurysms, and vascular malformations. The specific risks and benefits of angiography depend on the type of angiography being performed and the individual patient's medical history and condition.

What does a CT angiography show?

A CT angiography (CTA) is a medical imaging technique that uses computed tomography (CT) scans to visualize the blood vessels in the body. It can provide detailed images of the blood vessels and their surrounding tissues.

CT angiography can be used to diagnose a variety of conditions that affect the blood vessels, including:

  1. Aneurysms: CT angiography can detect aneurysms, which are bulges in the blood vessels that can rupture and cause bleeding.
  1. Blockages: CT angiography can identify blockages or narrowing in the blood vessels that can cause decreased blood flow to organs or tissues.
  1. Stroke: CT angiography can identify blockages in the blood vessels in the brain that may be causing a stroke.
  1. Coronary artery disease: CT angiography can identify blockages or narrowing in the coronary arteries that supply blood to the heart.
  1. Pulmonary embolism: CT angiography can identify blood clots that have traveled to the lungs.

CT angiography is a relatively safe procedure, although there may be some risks associated with the contrast agent, including allergic reactions and kidney damage in patients with pre-existing kidney disease. The decision to perform CT angiography is made on a case-by-case basis, taking into account the risks and benefits for each individual patient.

What is MRI angiography?

In order to examine blood vessels, magnetic resonance angiography (MRA), a non-invasive diagnostic procedure, combines MRI technology with intravenous (IV) contrast dye. Contrast dye makes blood vessels on the MRI picture seem opaque, allowing the doctor to see the blood vessels being assessed. [4].

MRA can be used to diagnose a variety of conditions that affect the blood vessels, including aneurysms, blockages, and narrowing. It can also be used to monitor the progress of treatments for these conditions.

MRA is generally considered safe, although there may be some risks associated with the contrast agent, including allergic reactions and kidney damage in patients with pre-existing kidney disease. Patients who have certain types of medical devices, such as pacemakers or metal implants, may not be able to undergo MRI angiography.

Magnetic resonance angiography vs. CT angiography

Both of these are noninvasive imaging methods providers can use to see your blood vessels. However, a CT (computed tomography) angiogram is faster than an MRA. Also, they use different kinds of contrast materials. A CT angiogram exposes you to radiation during the scan. An MRA doesn’t use radiation. [5]

Why is angiography necessary?

Angiography is necessary in certain medical situations to diagnose or evaluate conditions that affect the blood vessels in the body. Some of the specific reasons why angiography may be necessary include:

  1. To diagnose blockages or narrowing in the blood vessels: Angiography can be used to identify blockages or narrowing in the blood vessels that can cause decreased blood flow to organs or tissues.
  2. To diagnose aneurysms or vascular malformations: Angiography can detect aneurysms, which are bulges in the blood vessels that can rupture and cause bleeding. It can also identify abnormal connections between blood vessels, such as arteriovenous malformations.
  3. To diagnose or monitor treatment of cancer: Angiography can identify blood vessels that are supplying tumors, which can help guide treatment.
  4. To evaluate coronary artery disease: Angiography can identify blockages or narrowing in the coronary arteries that supply blood to the heart.
  5. To diagnose pulmonary embolism: Angiography of the pulmonary arteries can identify blood clots that have traveled to the lungs.
  6. To evaluate stroke: Angiography of the blood vessels in the brain can identify blockages or narrowing that may be causing a stroke.

Angiography is a specialized medical procedure that carries some risks, including bleeding, infection, and allergic reactions to the contrast dye. The decision to perform angiography is made on a case-by-case basis, taking into account the risks and benefits for each individual patient.

Why is angiography important in diagnosing vascular conditions?

Angiography is an important diagnostic tool in identifying and evaluating a variety of vascular conditions. The blood vessels play a critical role in the body, supplying oxygen and nutrients to organs and tissues, and any abnormalities in the blood vessels can have significant consequences.

Here are some reasons why angiography is important in diagnosing vascular conditions:

  1. Accurate diagnosis: Angiography provides detailed images of the blood vessels, allowing for accurate diagnosis of vascular conditions such as blockages, aneurysms, and vascular malformations.
  1. Treatment planning: Once a vascular condition has been diagnosed, angiography can be used to plan the most appropriate treatment strategy, whether it be medical management, minimally invasive procedures, or surgery.
  1. Minimally invasive procedures: Many vascular conditions can be treated using minimally invasive procedures, such as angioplasty or embolization. Angiography allows for precise targeting of the affected blood vessels, minimizing damage to surrounding tissues.
  1. Real-time monitoring: In some cases, angiography can be performed in real-time, allowing for immediate assessment of blood flow and treatment effectiveness.
  1. Evaluation of treatment outcomes: After treatment, angiography can be used to evaluate the effectiveness of the intervention and monitor for any recurrence of the vascular condition.

What are Non-Invasive Angiography Techniques? An Alternative to Traditional Methods

Non-invasive angiography techniques are medical imaging methods that allow visualization of blood vessels without the need for invasive procedures such as catheterization. These techniques provide an alternative to traditional angiography methods, which can be more invasive and carry greater risks.

Here are some examples of non-invasive angiography techniques:

  1. Magnetic Resonance Angiography (MRA): MRA uses magnetic fields and radio waves to produce detailed images of blood vessels. It is a safe and non-invasive method that does not require radiation exposure.
  1. Doppler Ultrasound: Doppler ultrasound uses sound waves to create images of blood vessels and measure blood flow. It is a non-invasive method that can provide real-time images of blood vessels and detect abnormalities such as narrowing or blockages.
  1. Optical Coherence Tomography (OCT): OCT uses light waves to produce images of blood vessels. It is a non-invasive method that can provide high-resolution images of blood vessels within tissues, allowing for the detection of abnormalities such as plaque buildup.

Non-invasive angiography techniques offer several advantages over traditional methods, including lower risk of complications, less discomfort for patients, and faster recovery times. These techniques are particularly useful in cases where traditional angiography is not possible or carries higher risks, such as in patients with kidney disease or allergies to contrast dye. However, each technique has its own limitations and may not be appropriate for all patients or conditions. It is important for healthcare providers to carefully consider the specific needs of each patient when selecting the most appropriate imaging method.

What is The Future of Angiography? Advances in Medical Imaging Technology

The future of angiography is bright, with ongoing advances in medical imaging technology promising to improve the accuracy, safety, and convenience of this diagnostic tool. Here are some of the exciting developments that are shaping the future of angiography:

  1. Artificial Intelligence (AI):  AI has the potential to revolutionize medical imaging by improving image analysis and interpretation. For example, AI algorithms can be trained to identify specific features in angiography images, such as arterial stenosis or aneurysms, which can help healthcare providers make more accurate diagnoses and treatment decisions.
  1. 3D Printing:  3D printing technology is being used to create patient-specific models of blood vessels, allowing healthcare providers to plan and practice complex procedures before performing them on patients. This can improve safety and reduce the risk of complications.
  1. Miniature Devices:  Advances in micro-electromechanical systems (MEMS) are enabling the development of miniature devices that can be used to perform minimally invasive procedures within the blood vessels. These devices can be remotely controlled and can deliver drugs, perform biopsies, or remove clots.
  1. Augmented Reality:  Augmented reality (AR) technology is being developed to overlay angiography images onto the patient's body during surgery, providing real-time guidance and improving precision.
  1. Nanoparticles:  Nanoparticles are being developed as contrast agents for angiography imaging. These tiny particles can provide high-resolution images of blood vessels and can be targeted to specific areas of the body.

In summary, ongoing advances in medical imaging technology are expanding the capabilities of angiography, making it safer, more accurate, and more convenient for both patients and healthcare providers. These innovations promise to improve the diagnosis and treatment of a wide range of vascular conditions, leading to better patient outcomes.

FAQs:

What is the procedure of angiography?

Angiography, specifically coronary angiography, is a procedure used to visualize the blood vessels (arteries and veins) in various parts of the body, particularly the heart and major blood vessels. Here’s a detailed outline of the procedure:

  1. Preparation:
    • Before the procedure, the patient is typically briefed on what to expect and any necessary preparations, such as fasting. Vital signs are monitored, and consent is obtained.
  2. Local Anesthesia:
    • A local anesthetic is applied to the area where the catheter (a thin, flexible tube) will be inserted, usually in the groin or arm. In some cases, general anesthesia may be used.
  3. Catheter Insertion:
    • A small incision is made at the site, and a catheter is inserted into a blood vessel. Guided by X-ray imaging (fluoroscopy), the catheter is carefully threaded through the arteries until it reaches the heart or the area of interest.
  4. Contrast Injection:
    • Once the catheter is in place, a contrast dye (iodine-based contrast medium) is injected through the catheter into the bloodstream. This dye makes the blood vessels visible on X-ray images (angiograms).
  5. Imaging:
    • X-ray images (angiograms) are taken rapidly as the contrast dye moves through the blood vessels. This process provides detailed images of the coronary arteries, heart chambers, and other blood vessels.
  6. Assessment:
    • The cardiologist or radiologist reviews the images in real-time to assess the condition of the blood vessels, looking for any narrowing (stenosis), blockages, or abnormalities that may indicate heart disease or arterial disease.
  7. Completion and Removal:
    • Once the procedure is complete and all necessary images are obtained, the catheter is carefully removed. Pressure is applied to the insertion site to prevent bleeding, and a bandage is applied.
  8. Post-Procedure Care:
    • The patient is monitored closely for a period after the procedure to check for any complications. Instructions are given regarding activity restrictions, medications, and follow-up appointments.

Angiography plays a crucial role in diagnosing conditions such as coronary artery disease, evaluating chest pain (angina), and assessing blood circulation within the heart and major arteries. It is often used in conjunction with other diagnostic tests, such as coronary CT angiography, to provide a comprehensive evaluation of cardiovascular health.

Is angiography very painful?

Angiography, including a coronary angiogram, is generally not considered very painful. The procedure involves inserting a catheter into the arterial system, often through the groin or wrist, to visualize the coronary arteries and assess for coronary disease.

Patients might feel some discomfort or pressure when the catheter is inserted, but significant pain is uncommon. Local anesthesia is typically used to numb the insertion site, reducing pain. Some patients may experience a warm sensation when the contrast dye is injected, but this usually subsides quickly.

In the context of coronary interventions for conditions like aortic stenosis or other coronary diseases, the overall discomfort is generally minimal, with the benefits of accurately diagnosing and treating potentially serious conditions outweighing the temporary discomfort.

Different types of angiograms can have varying levels of discomfort, but advancements in techniques and sedation options have significantly reduced pain associated with these procedures.

References

[1] - https://www.nhs.uk/conditions/mri-scan/

[2] - https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/computed-tomography-angiography-cta

[3] - https://www.sciencedirect.com/topics/medicine-and-dentistry/pulmonary-angiography

[4] - https://stanfordhealthcare.org/medical-tests/a/angiogram-arteriogram/types/magnetic-resonance-angiography.html

[5] - https://my.clevelandclinic.org/health/diagnostics/24024-mra

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