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Angiography

By

Sarah Lewis, PharmD

What is angiography?

Angiography is an imaging test that makes a detailed picture (called an angiogram) of blood vessels. Angiography makes images of arteries and veins in the abdomen, brain, heart, kidneys, lungs and legs. 

Angiography shows blood flow and blood vessels that are obstructed, blocked, narrowed, enlarged or malformed. Doctors use angiography to diagnose diseases and abnormalities of the blood vessels, including atherosclerosis, blood clots, aneurysm, and coronary artery disease.

Your body has two types of blood vessels, the arteries and veins. When angiography examines arteries, the picture is called an arteriogram. When veins are examined, the picture is called a venogram.

An angiography is only one method used to test for blood vessels diseases and conditions. You may have less invasive testing options. Discuss all of your testing options with your doctor to understand which 

Types of angiography

The types of angiography procedures include:

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  • Catheter angiography involves inserting a catheter into a blood vessel in your groin or elbow. The catheter wire is fed or guided to the appropriate area. X-rays are used to produce the angiogram (picture) of the vessel.

  • Noninvasive angiography uses computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI) to make the angiogram. CT involves X-rays but MRA and ultrasound do not. MRI of blood vessels is also called magnetic resonance angiography, or MRA.

Catheter angiography, and in some cases, noninvasive angiography, use a contrast agent. The contrast agent is sometimes called a dye. It improves the quality of the images. The contrast agent is given through an IV. 
Other procedures that may be performed

Your doctor may perform treatments during a catheter angiography including:

  • Angioplasty involves widening a narrowed or blocked blood vessel.

  • Blood clot removal involves injecting clot-dissolving medications into the blood vessel via the catheter.

  • Stent placement involves inserting a mesh tube into the blood vessel to hold it open.

These treatments are not performed during noninvasive angiography. Your doctor will recommend a catheter procedure to complete these treatments if needed.  

Why is angiography performed? 

Your doctor may recommend angiography to diagnose and possibly treat the following diseases and conditions of the blood vessels:

  • Aneurysms, weakened or diseased areas of a blood vessel that enlarge or bulge. Aneurysms occur in many different areas of the body and cause serious or life-threatening bleeding if they rupture or burst.

  • Aortic dissection, a tear or damage to the inner wall of the aorta. Your aorta is the main artery leaving your heart.

  • Atherosclerosis, a buildup of plaque on the walls of large and medium-sized arteries. Atherosclerosis is commonly known as hardening of the arteries.

  • Digestive tract bleeding, also called gastrointestinal hemorrhage. Angiography can identify and treat the bleeding source.

  • Blood clot, also called a thrombus. Blood clots include deep vein thrombosis (DVT) in the legs or pulmonary embolism (PE) in the lungs.

  • Blood vessel malformations, defects that are usually present at birth. They can cause problems at various ages from birth to adulthood.

  • Carotid artery disease, narrowing of the neck arteries that supply blood to the brain

  • Cerebral vascular disease including stroke and transient ischemic attacks (TIAs)

  • Heart disease including coronary artery disease

  • Mesenteric artery ischemia, decreased blood flow through the arteries that supply blood to the intestines

  • Peripheral artery disease (PAD), a narrowing or blockage of arteries outside the heart. PAD is also called peripheral vascular disease or PVD.

  • Renal artery stenosis, a narrowing of the arteries that supply blood to the kidneys

Ask your doctor about all of your testing and treatment options and consider getting a second opinion before deciding on an angiography.

Who performs angiography?

The following specialists perform angiography:

  • Cardiologists specialize in conditions and diseases of the heart and its blood vessels.

  • Radiologists or radiologic technologists perform noninvasive angiographies. A radiologist is a doctor who specializes in medical imaging. A radiologic technologist is a medical professional specializes in medical imaging and the care of patients during imaging procedures.

  • Vascular neurologists specialize in conditions and diseases of the blood vessels in the brain and spinal cord.

  • Vascular and interventional radiologists are doctors who specialize in diagnosing and treating diseases using imaging technology and catheter techniques. They perform catheter angiographies.

  • Vascular surgeons specialize in the surgical treatment of blood vessels outside the heart and brain.

How is angiography performed?

Your angiography will be performed in a hospital or outpatient setting. It takes about an hour and generally includes these steps:

  1. You dress in a patient gown and lie on a procedure table.

  2. Your team inserts an IV to provide fluids, medications, or a contrast agent.

  3. Your team attaches devices to monitor your heart rate and blood pressure.

  4. For catheter angiography:
  • Blood tests are done to check kidney function and blood clotting.

  • Your team gives you sedative medications through the IV to help you relax.

  • Your doctor determines the location to insert the catheter. The catheter is often placed in the artery in the groin. The area is shaved, cleaned and numbed.

  • Your doctor makes a small incision. The catheter and wire is inserted through the incision and guided it into place in the blood vessel.

  • Your team injects a contrast agent through the catheter. You may feel flushing at this time. X-rays are taken as the contrast agent flows through your blood vessels.

  • You will need to hold still for the X-rays and hold your breath briefly.

  • Your doctor will remove the catheter and close the catheter site.

  • A team member removes your IV.

  5. For noninvasive angiography:

  • For MRI, you will wear earplugs because the machine makes loud thumping and humming noises. Closed MRI machines are long cylinders, so your team may be give you a mild sedative if you are claustrophobic. The procedure table will slide into the machine for the test.

  • CT machines also have a tunnel, but it is much shorter than an MRI tunnel. The procedure table will slide into the machine for the test. Your team may ask you to hold your breath briefly during the procedure.

  • If a contrast agent is used, it will be give through an IV. You may feel a sensation of warmth when the contrast agent is injected.

  • It is very important for you to lie still during the procedure. Movement causes blurry images.

  • You wait briefly while the radiologist verifies that the imaging is complete

  • A team member removes your IV.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel a pinch or pinprick pain during IV placement, but the imaging itself is painless.

You will receive sedative medications as needed to keep you comfortable during catheter angiography. You may receive sedative medications for MRI procedures if you are claustrophobic. Tell your care team if you are uncomfortable in any way.

What are the risks and potential complications of angiography?  

As with all procedures, angiography involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications of angiography are uncommon but can occur during the procedure or recovery. 

Risks and potential complications of angiography include: 

  • Adverse reaction or problems related to sedation or contrast agents, such as an allergic reaction and problems with breathing

  • Bleeding or clotting problems

  • Damage to the artery from the catheter

  • Exposure to radiation, which may be harmful in excessive doses

  • Infection