Angiography
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Introduction

Angiography is a technique used to visualise the inside of of blood vessels, whereby radio-opaque die is injected into the patient, and imaging studies are subsequently performed.

These can be x-rays or CT scans (“CT angio”).

Angiography can be performed on many different structures. Common examples include coronary angiography (when assessing for coronary artery disease and MI), CTPA (looking for pulmonary embolus), cerebral angiography (when looking for stroke), abdominal angiography (looking for ischaemic bowel), and of the limbs (when assessing for peripheral vascular disease and acute limb ischaemia).

To get an idea of the basic principles go angiography, in this article we discuss coronary angiography, unless otherwise stated.

Coronary angiography is used to assess the extent of angina and ischaemic heart disease. It involves cardiac catheterisation. Once the catheter is in place, an iodine based dye is injected into the coronary vessels, and the extent of narrowing (atheroma) can be asses by –x-ray.
  • The angiogram is often recorded as a moving picture as many low-dose x-rays are taken in quick succession.
A coronary angiogram
A coronary angiogram showing good blood flow int he left circumflex artery after a stunting procedure. This file is taken from wikimedia commons and is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Procedure

  • The patient will lie flat on a bed, with the x-ray machine above them. The catheter is usually passed at the radial or femoral artery. The catheter will be passed up to the opening of the cardiac vessels from the aorta.
    • Patients may feel an occasional missed or extra heart beat during the procedure – this is normal.
  • Basically – its exactly the same as cardiac catheterisation! – except that a bit of dye is squirted in and x-rays taken.
  • The test normally lasts about 30 minutes.

Complications

  • Mortality is about 1%
  • May be some bruising at the entry site
  • Some patients may have stitches at the entry site to seal it up
  • May have a false aneurysm at the femoral artery if this was used as the entry site
  • May get angina-type pain during the procedure
  • May get an infection at the site of entry
  • May have a warm flushing feeling when the dye is injected
  • Stroke and MI are possible but rare
  • Also rarely, the coronary artery may be damaged and emergency bypass may need to be performed

References

  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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