Aortic angiography is a procedure that uses a special dye and x-rays to see how blood flows through the aorta. The aorta is the major artery. It carries blood out of the heart, and through your abdomen or belly. Angiography uses x-rays and a special dye to see inside the arteries. Arteries are blood vessels that carry blood away from the heart.
Aortic angiography, or an angiogram, is a procedure to test for defects and functional problems in your aorta, your largest artery. Your aorta begins in the left ventricle of your heart and extends to your abdomen. It’s responsible for delivering oxygen-rich blood to your entire body.
During the procedure, your doctor will inject a special dye into your arteries. Then they’ll use X-rays to look for potential problems with your aorta. The dye enhances visibility to help doctors identify defects and blood flow abnormalities.
Angiography – aorta; Aortography; Abdominal aorta angiogram; Aortic arteriogram
Types of angiography
There are several different types of angiography, depending on which part of the body is being looked at.
Common types include:
- coronary angiography – to check the heart and nearby blood vessels
- cerebral angiography – to check the blood vessels in and around the brain
- pulmonary angiography – to check the blood vessels supplying the lungs
- renal angiography – to check the blood vessels supplying the kidneys
Occasionally, angiography may be done using scans instead of X-rays. These are called CT angiography or MRI angiography.
There’s also a type of angiography that’s used to check the eyes, called fluorescein angiography. It’s different to the other types of angiography and is not covered in this topic.
What are some common uses of the procedure?
CT angiography is helpful in examining blood vessels and the organs supplied by them in various body parts, including:
- brain
- neck
- heart
- chest
- abdomen (such as the kidneys and liver)
- pelvis
- legs and feet
- arms and hands
Physicians use CT angiography to diagnose and evaluate many diseases of blood vessels and related conditions such as:
- aneurysms
- blockages
- blood clots
- congenital (birth-related) abnormalities of the cardiovascular system, including the heart
- disorganized blood vessels, such as vascular malformations
- injury
- tumors
- vessel rupture or tears
Also, physicians use CT angiography to check blood vessels following surgery, such as:
- identify abnormalities, such as aneurysms, in the aorta, both in the chest and abdomen or in other arteries.
- detect atherosclerotic (plaque) disease in the carotid artery of the neck, which may limit blood flow to the brain and cause a stroke.
- identify an arteriovenous malformation inside the brain or elsewhere.
- detect plaque disease that has narrowed the arteries to the legs and help prepare for angioplasty/stent placement or surgery.
- detect disease in the arteries to the kidneys or visualize blood flow to help prepare for a kidney transplant or stent placement.
- guide interventional radiologists and surgeons making repairs to diseased blood vessels, such as implanting stents or evaluating a stent after implantation.
- detect injury to one or more arteries in the neck, chest, abdomen, pelvis, or limbs following trauma.
- evaluate arteries feeding a tumor prior to surgery or other procedures such as chemoembolization or selective internal radiation therapy.
- identify dissection or splitting in the aorta in the chest or abdomen or its major branches.
- show the extent and severity of coronary artery disease and its effects and plan for an intervention, such as a coronary bypass and stenting.
- examine pulmonary arteries in the lungs to detect pulmonary embolism (blood clots, such as those traveling from leg veins) or pulmonary AVMs.
- look at congenital abnormalities in blood vessels, especially arteries in children (e.g., malformations in the heart or other blood vessels due to congenital heart disease).
- evaluate stenosis and obstructions of vessels.
What angiography is used for
If you have circulation problems, your GP may recommend that you have an angiogram to find out what’s causing the problem. The results of an angiogram can also help to determine suitable treatment options.
Dense areas of your body such as your bones and, to a lesser extent, certain organs, such as your lungs, absorb X-rays, so they show up as clear white areas on X-ray images. However, conventional X-rays don’t produce clear images of blood vessels and blood flow.
During an angiogram, a special type of dye (medically known as a contrast dye or contrast medium) is injected into the area where the blood vessels are to be examined. Like your bones and other dense areas of the body, the contrast dye absorbs X-rays.
As the contrast dye moves through your blood vessels, a series of X-rays can be taken to examine how it moves. By tracking its movement, it’s possible to identify any problems with the blood vessels, such as blockages or sections that are unusually narrow.
Head and neck
A similar procedure that’s used to study the blood vessels in your head and neck is called a cerebral angiogram.
A cerebral angiography may be used if it’s thought that the blood vessels supplying blood to your brain (the carotid arteries) have become narrowed, disrupting the flow of blood. This can be dangerous because it could trigger a stroke or a transient ischemic attack(mini-stroke).
If you’ve had a stroke, a cerebral angiogram can be used to assess the extent of the damage to the blood vessels. In some cases, it may be able to pinpoint the underlying cause of a stroke.
A cerebral angiogram can also help to identify an aneurysm (a bulge in the blood vessel wall in your brain) or a brain tumour, which is an abnormal growth of tissue in the brain. Studying the flow of blood to the tumour can help to determine whether it’s growing, which can be useful when planning treatment.
Heart
Coronary angiography is used to study the blood vessels that supply the heart muscle. It may be used if you have any of the following conditions:
- heart attack – a serious medical emergency where the supply of blood to the heart is suddenly blocked, usually by a blood clot
- angina – chest pain that occurs when the blood supply to the heart is restricted
- coronary heart disease – your heart muscle’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries (the blood vessels that supply the heart)
A coronary angiogram may also be used if you have a heart condition. It helps to determine the most appropriate type of treatment for you. This might be:
- a coronary angioplasty and stenting – a procedure to widen blocked or narrowed coronary arteries
- coronary artery bypass graft – a surgical procedure to divert blood around narrow or clogged arteries in order to improve the blood flow to the heart muscle
- aortic valve replacement – surgery to treat problems that affect the aortic valve, which is the valve that controls the flow of blood out of the left ventricle of the heart to the body’s main artery, the aorta
Lungs
A pulmonary angiogram can be used to examine the blood vessels in the lungs. It’s usually done when a person has a blood clot in one of the blood vessels in their lungs. This is known as a pulmonary embolism.
Performing a traditional catheter angiogram carries a high risk of complications. Therefore, another type of angiography, known as a computerised tomography pulmonary angiography (CTPA), is usually the preferred option.
A CTPA involves injecting contrast dye into the blood vessels of your lungs before taking a CT scan. If you have a pulmonary embolism in one of your lungs, it will show up on the CT scan as a blockage in your blood supply.
Arms and legs
An extremity angiogram can be used to examine the blood vessels in your arms and legs. This procedure is often used if it’s thought that the blood supply to your leg muscles has become restricted. This is known as peripheral arterial disease and it causes a range of symptoms, the most common of which is painful cramping when walking.
An extremity angiogram can also be used to check for narrowing and hardening of the arteries (atherosclerosis, see below) in the arms and legs.
Kidneys
Renal angiograms can be used to examine the blood vessels in your kidneys. It may be recommended if you have symptoms, which suggest that the blood supply to your kidneys has been blocked in some way.
These symptoms include:
- high blood pressure (hypertension) that doesn’t respond to treatment with medication
- swelling in certain areas of your body, such as your feet, due to a build-up of fluid (oedema)
- symptoms of kidney disease, such as itchy skin and blood in your urine
Atherosclerosis
Atherosclerosis is a condition in which one or more of the arteries becomes narrowed and hardened due to a build-up of fatty materials, such as cholesterol. These types of material are collectively known as plaques.
Atherosclerosis is potentially dangerous because it can lead to organ failure and tissue death (gangrene). Plaques may also rupture causing events such as a heart attack or stroke.
During its early stage, atherosclerosis doesn’t usually cause any noticeable symptoms, so the most effective method for early diagnosis is to identify people who are in high-risk groups and test them for the condition. High-risk groups for atherosclerosis include people who:
- are over 40 years old
- are overweight or obese
- smoke or have a previous history of heavy smoking
- have a high-fat diet
- have uncontrolled high blood pressure
- are diabetic
- have high cholesterol
- have a family history of cardiovascular disease
- are from south Asian ethnic decent
An angiogram is usually only carried out if initial tests, such as blood cholesterol tests and blood pressure tests, suggest that atherosclerosis is likely and symptoms have developed.
Other uses
An angiography can also be used to:
- locate the site of internal bleeding
- detect blood clots
- investigate injuries to organs
- plan surgery that involves the blood vessels
How the Test is Performed
This test is done at a hospital. Before the test starts, you will be given a mild sedative to help you relax.
- An area of your body, most often in your arm or groin area, is cleaned and numbed with a local numbing medicine (anesthetic).
- A radiologist or cardiologist will place a needle into the groin blood vessel. A guidewire and a long tube (catheter) will be passed through this needle.
- The catheter is moved into the aorta. The doctor can see live images of the aorta on a TV-like monitor, and x-rays are used to guide the catheter to the correct position.
- Once the catheter is in place, dye is injected into it. X-ray images are taken to see how the dye moves through the aorta. The dye helps detect any blockages in blood flow.
After the x-rays or treatments are finished, the catheter is removed. Pressure is applied to the puncture site for 20 to 45 minutes to stop the bleeding. After that time, the area is checked and a tight bandage is applied. The leg is most often kept straight for another 6 hours after the procedure.
or
You may be asked not to eat or drink anything for 6 to 8 hours before the test.
You will wear a hospital gown and sign a consent form for the procedure. Remove jewelry from the area being studied.
Tell your health care provider:
- If you are pregnant
- If you have ever had any allergic reactions to x-ray contrast material, shellfish, or iodine substances
- If you are allergic to any medicines
- Which medicines you are taking (including any herbal preparations)
- If you have ever had any bleeding problems
You will be awake during the test. You may feel a sting as the numbing medicine is given and some pressure as the catheter is inserted. You may feel a warm flushing when the contrast dye flows through the catheter. This is normal and most often goes away in a few seconds.
You may have some discomfort from lying on the hospital table and staying still for a long time.
In most cases, you can resume normal activity the day after the procedure.
How to Prepare for the Test
You will not eat or drink anything for 6 to 8 hours before the test.
You will wear a hospital gown and sign a consent form for the procedure. Remove jewelry from the area being studied.
Tell your health care provider:
- If you are pregnant
- If you have ever had any allergic reactions to x-ray contrast material or iodine substances
- If you are allergic to any medicines
- Which medicines you are taking (including any herbal preparations)
- If you have ever had any bleeding problems
How the Test Will Feel
You will be awake during the test. You may feel a sting as the numbing medicine is given and some pressure as the catheter is inserted. You may feel a warm flushing when the contrast dye flows through the catheter. This is normal and most often goes away in a few seconds.
You may have some discomfort from lying on the hospital table and staying still for a long time.
In most cases, you can resume normal activity the day after the procedure.
Why the Test is Performed
Your provider may ask for this test if there are signs or symptoms of a problem with the aorta or its branches, including:
- Aortic aneurysm
- Aortic dissection
- Congenital (present from birth) problems
- AV malformation
- Double aortic arch
- Coarctation of the aorta
- Vascular ring
- Injury to the aorta
- Takayasu’s arteritis
What Abnormal Results Mean
Abnormal results may be due to:
- Abdominal aortic aneurysm
- Aortic dissection
- Aortic regurgitation
- Aortic stenosis
- Congenital (present from birth) problems
- Double aortic arch
- Coarctation of the aorta
- Vascular ring
- Injury to the aorta
- Mesenteric ischemia
- Peripheral artery disease
- Renal artery stenosis
- Takayasu’s arteritis
Risks
Risks of aortic angiography include:
- Allergic reaction to the contrast dye
- Blockage of the artery
- Blood clot that travels to the lungs
- Bruising at the site of catheter insertion
- Damage to the blood vessel where the needle and catheter are inserted
- Excessive bleeding or a blood clot where the catheter is inserted, which can reduce blood flow to the leg
- Heart attack or stroke
- Hematoma, a collection of blood at the site of the needle puncture
- Infection
- Injury to the nerves at the needle puncture site
- Kidney damage from the dye
Considerations
This procedure may be combined with left heart catheterization to look for coronary artery disease.
Aortic angiography has been mostly replaced by computed tomography (CT) or magnetic resonance (MR) angiography.
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