View source for Angiography

[[Image:Cerebral angiography, arteria vertebralis sinister injection.JPG|right|thumb|250px|Angiogram showing a [[Transverse plane|transverse projection]] of the [[vertebral artery|vertebro]][[basilar artery|basilar]] and [[posterior cerebral]] circulation.]]
'''Angiography''' or '''arteriography''' is a [[medical imaging]] technique used to visualize the inside, or [[lumen (anatomy)|lumen]], of blood vessels and organs of the body, with particular interest in the [[artery|arteries]], [[vein]]s and the [[heart chamber]]s. This is traditionally done by injecting a radio-opaque [[radiocontrast|contrast agent]] into the blood vessel and imaging using [[X-ray]] based techniques such as [[fluoroscopy]]. The word itself comes from the [[Greek language|Greek]] words ''angeion'', "vessel", and ''graphein'', "to write or record". The film or image of the [[blood vessel]]s is called an ''angiograph'', or more commonly, an ''angiogram''.

The term ''angiography'' is strictly defined as based on [[projectional radiography]]; however, the term has been applied to newer vascular imaging techniques such as [[Computed tomography angiography|CT angiography]] and [[Magnetic resonance angiography|MR angiography]]. The term ''isotope angiography'' has also been used, although this more correctly is referred to as [[Perfusion_scanning#NM_Perfusion|isotope perfusion scanning]].

==History==
The technique was first developed in 1927 by the [[Portugal|Portuguese]] physician and neurologist [[Egas Moniz]] to provide contrasted x-ray [[cerebral angiography]] in order to diagnose several kinds of nervous diseases, such as tumors, coronary heart 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 tools 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 [[artery|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 wire]]s 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 [[image 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.

==Extensions==
=== Color (DSA) ===
Color (DSA) - provides a dynamic flow evaluation, greater understanding of the contrast flow within the pathology. Assists the clinician in planning of surgical procedures, and clearly demonstrate post-procedural results.

=== 3D-DSA ===
3D Angiography -  provides the radiologist with a 3D view of vascular structures. 3D view - helps determine spatial layout vascular structures and simplifies planning of surgical procedures.

==Uses==
===Coronary Angiography===
{{main|Coronary angiography}}
One of most common angiograms performed is to visualize the blood in the [[coronary artery|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 within the coronary arteries allows visualization of the size of the artery [[lumen (anatomy)|openings]]. Presence or absence of [[atherosclerosis]] or [[atheroma]] within the walls of the [[artery|arteries]] cannot be clearly determined. See [[coronary catheterization]] for more detail..

=== 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 [[aneurysm]]s and [[Arteriovenous malformation|AVM]] gluing can also be performed.

===Peripheral Angiography===
{{main|Peripheral artery occlusive disease}}
Angiography is also commonly performed to identify vessel [[stenosis|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]].

===Other===
Other angiographic uses include the diagnosis of [[retina]]l vascular disorders, such as [[diabetic retinopathy]] and [[macular degeneration]].

==Complications==
===Coronary Angiography===
Coronary angiographys are common and major complications are rare. These include [[Cardiac arrhythmias]], [[renal failure|kidney damage]], blood clots (which can cause heart attack or stroke), [[hypotension]] and [[pericardial effusion]]. Minor complications can include [[bleeding]] or [[bruising]] at the site where the contrast is injected, blood vessel damage on the route to the heart from the catheter (rare) and [[allergic reaction]] to the contrast.<ref name='nhs-angiography-complications'> {{cite web|url=http://www.nhs.uk/Conditions/Angiography/Pages/Complications.aspx |title=Angiography - Complications |accessdate=2010-03-24 |date=2009-06-01 |work=Health A-Z |publisher=NHS Choices }}</ref>
===Cerebral Angiography===
Major complications in Cerebral Angiography 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.<ref name='nhs-angiography-complications' />

==See also==
*[[Cardiac catheterization]]
*[[Computed Tomography Angiography]]
*[[Contrast Medium]]
*[[Echocardiogram]]
*[[Electrocardiogram]]
*[[Image intensifier]]
*[[Intravenous digital subtraction angiography]]
*[[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]
* [http://emedicine.medscape.com/article/1603072-overview] Coronary CT angiography by Eugene Lin

==References==
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{{Medical imaging}}
{{Vascular procedures}}
[[Category:Cardiovascular system]]
[[Category:Cardiology]]
[[Category:Radiology]]
[[Category:Surgery]]
[[Category:Medical imaging]]

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