Angiogram

Angiography" or "arteriography is a medical imaging technique in which an X-ray image is taken to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers.

Its name comes from the Greek words "angeion", "vessel", and "graphein", "to write or record". The X-ray film or image of the blood vessels is called an angiograph, or more commonly, an angiogram.

The Portuguese physician and neurologist Egas Moniz, Nobel Prize winner in 1949, developed in 1927 the technique of contrasted x-ray cerebral angiography to diagnose several kinds of nervous diseases, such as tumors and arteriovenous malformations. He is usually recognised as one of the pioneers in this field. 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 the arterial system or the jugular or femoral vein, to look at the right side of the heart and 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 X-ray images taken may either be still images, displayed on a Iimage intensifier or film, or motion images. For all structures except the heart, the images are usually taken using a technique called digital subtraction angiography (DSA). Images in this case are usually taken at 2 - 3 frames per second, which allows the 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 radiologist or cardiologist to see stenosis (blockages or narrowings) inside the vessel which may be inhibiting the flow of blood and causing pain.

Uses

Coronary Angiography

One of 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 groin or forearm, and the tip is advanced through the arterial system into one of the two major coronary arteries. X-ray images of the transient radiocontrast distribution within the blood flowing within 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..

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 angioplasty.

Other

Other angiographic uses include the diagnosis of retinal vascular disorders, such as diabetic retinopathy and macular degeneration.

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 and AVM glueing can also be performed

Historic usage

The term angiography, or angeiography, was originally used of a description of the weights, measures, vessels, etc, used by several nations.

The Future

Due to the advancement in medical imaging, it is now possible to perform almost all Angiograms through a CT scanner, known as Computed tomography angiography. This is better for the patient as it is less invasive with fewer associated risks, although it may often involve a greater radiation dose. It also is a purely diagnostic technique, and so procedures such as balloon angioplasty are still carried out under standard angiography control.

ee also

*Intravenous digital subtraction angiography
*Contrast Medium
*Image intensifier
*Computed Tomography Angiography
*Cardiac catheterization
*Peripheral artery occlusive disease

External links

* [http://www.mdct.com.au MDCT] - The radiology information resource for Cardiologists, Radiologists, Cardiac and Radiologic Techs - A Free Resource For Cardiac Imaging
* [http://radiologyinfo.org/en/sitemap/modal-alias.cfm?modal=Angio RadiologyInfo] - The radiology information resource for patients: Angiography procedures
* [http://www.ptca.org/imaging/cath.html Cardiac Catheterization] from Angioplasty.Org
* [http://www.medical.siemens.com/webapp/wcs/stores/servlet/CategoryDisplay?categoryId=12751&langId=-1&catalogId=-1&storeId=10001&catTree=100001,12764,12751&overviewId=12751&userviewId=12813&parentName=Angiography&level=0 Angiography Equipment] from Siemens Medical
* [http://www.cirse.org/index.php?pid=85 Cardiovascular and Interventional Radiological Society of Europe]