Angiography is sometimes called conventional angiography to distinguish it from CT angiography (CTA) and magnetic resonance angiography (MRA). Angiography provides detailed images of blood vessels, commonly those in the heart, lungs, brain, and legs. Angiography can provide still images or motion pictures (called cineangiography).

IV contrast is injected through a catheter inserted into a blood vessel that connects with the vessel to be imaged. A local anesthetic or a sedative may be used. If the catheter is inserted into an artery, the insertion site must be steadily compressed for 10 to 20 min after all instruments are removed. Patients may need to lie flat for several hours or be hospitalized to reduce risk of bleeding at the puncture site. Angiography, although invasive, is relatively safe.

Uses

Angiography is the traditional gold standard for evaluating vascular lesions (eg, stenosis, obstruction, arteriovenous or other vascular malformations, aneurysms, dissections, sometimes vasculitis).

• Coronary angiography is usually done before percutaneous or surgical interventions involving the coronary arteries or heart valves. It is usually done with cardiac catheterization (see Cardiovascular Tests and Procedures: Cardiac Catheterization).
• Pulmonary angiography is the gold standard for diagnosis of pulmonary embolism.
• Cerebral angiography may be indicated after stroke or transient ischemic attack (TIA)—eg, if stenting or carotid endarterectomy is being considered.
• Iliac and femoral angiography may be indicated before interventions to treat peripheral arterial disease.
• Aortography is sometimes done to diagnose and provide anatomic detail about aortic aneurysms, aortic dissection, and aortic regurgitation.
• Angiography of the eye arteries can be done using fluorescein dye.

Angioplasty, stenting, and sometimes vascular repair can be done during angiography.

Variations

Digital subtraction angiography

Images of arteries are taken before and after contrast injection; then a computer subtracts one image from the other. Images of structures other than arteries are thus eliminated, enabling the arteries to be seen more clearly.

Disadvantages

Contrast reactions occasionally occur (see Principles of Radiologic Imaging: Radiographic Contrast Agents and Contrast Reactions).

The injection site may become infected or bleed, sometimes forming a painful hematoma. Rarely, an artery is injured by the catheter. Very rarely, shock, seizures, renal failure, and cardiac arrest occur. Risk of complications is higher in the elderly, although it is still low. The radiation dose used in angiography can vary and be significant (eg, coronary angiography is associated with an effective radiation dose of 4.6 to 15.8 mSv). Angiography must be done by highly skilled physicians, usually interventional radiologists.

Last full review/revision July 2008 by Jon A. Jacobson, MD