Angiography

What is angiography?

Angiography describes a radiological examination that visualizes blood vessels of the human body. Basically, the principle is to inject a contrast medium into the blood vessels and carry out an X-ray or MRI examination. This visualizes the contrast agent and hence the vessels. The image obtained is called an angiogram. According to the indication, it is possible to examine arteries (arteriography), veins (phlebography) or lymphatic vessels (lymphography) in this way.

When and for what reason is an angiography performed?

An angiography is useful to diagnose a variety of vascular diseases.

We distinguish between different vessel systems in our body. Regarding angiography, a distinction is made between the blood vessel system and the lymph vessel system.

If you want to visualize blood vessels, either veins or arteries are examined. Veins are responsible for returning the blood to the heart, while arteries transport it away from the heart.

Angiography is a diagnostic tool for several diseases, based on the vascular system being examined.

Angiography of arteries

A visualization of arteries, a so-called arteriography, provides information about narrowing of the vessels, acute vessel occlusions, injuries or malformations.

A common reason for angiography is suspected arteriosclerosis. which refers to a process of aging that causes deposits to build up in the vessel walls, constricting them. The main purpose is to prevent secondary diseases like heart attacks or strokes.

Furthermore, arteriography is frequently used for the diagnosis and monitoring of peripheral arterial disease (PAD).

Arteriography can also be performed to reveal bulges, so-called aneurysms, in the vessel wall. Especially considering the risk of rupture, this is an important use of angiography.

In most cases, the heart and the brain are examined.

Angiography of veins

Angiography of veins mostly investigates the legs. To return the blood from the lower half of the body to the heart, the veins of the legs must do a great deal of work.

Narrowings in the leg veins can favor the development of thrombosis here. By detecting such constrictions at an early stage, angiography can minimize the risk of thrombosis.

Angiography of lymphatic vessels

Lymphangiographies are seldom performed these days. They were originally performed to examine lymph nodes. However, the high-tech imaging techniques provide a better alternative in this case. Sometimes lymphangiography can still be indicated in the diagnosis of lymphedema.

Different types of angiography

According to the radiological examination technique that is used, different types of angiography can be distinguished. Certain examinations may offer advantages compared to the others, based on the particular indication of the vessel examination.

CT angiography

CT angiography can visualize arteries or veins, for instance, by means of computed tomography. A contrast medium is also injected beforehand so that the vessels can be delineated from the surrounding tissue. Normally, a vein in the arm is used for the injection, which means that there is no need for a vascular catheter.  This is followed by X-ray imaging, i.e. CT, of the relevant region.

This technique is primarily used to detect narrowing or occlusion of the blood vessels. It is also capable of showing the surrounding connective tissue of the vessels.

One advantage of this examination is that it can also determine the degree of narrowing of a vessel.

Like with all kinds of angiography, CT angiography also has certain contraindications. That means that the examination shouldn't be performed if any of these criteria are met. Among these are an allergy to contrast agents, impaired kidney function, hyperthyroidism, or pregnancy.

MR angiography

Magnetic resonance angiography is a further way to visualize blood vessels. After contrast medium is given, a sectional image is taken using MRI. This produces three-dimensional images which can be used to assess the condition of the vessels from different angles.

The major advantage of this method is that, unlike conventional X-ray or computer tomography, the patient is not exposed to radiation. Some forms of MR angiography do not even require the use of a contrast agent. 

A disadvantage of this examination method, however, is that it takes relatively long and patients have to remain as still as possible during the scan. In case the patient moves, the quality of the image may be reduced and the evaluability may be limited.

Similarly to CT angiography, MR angiography shouldn't be performed in patients who are allergic to contrast agents or have impaired renal function. Moreover, it is also contraindicated in patients with metal implants or pacemakers.

Digital subtraction angiography

DSA (digital subtraction angiography) is a relatively new procedure. It involves taking digital X-ray images of the body region in question both before and after administration of a contrast agent. Using a computer program, both images are compared and anything which is identical is removed. What remains are only the vessels filled with contrast medium.

The method is used mainly for imaging arteries to detect occlusive diseases. In most cases, the contrast agent is injected into the vessel via an arterial line. Apart from the precise visualization of the vascular status, the advantage of this method is that vascular occlusions can be immediately treated by means of a catheter via this access.

Contraindications for the performance of a DSA are, as with CT angiography, a contrast agent allergy, impaired kidney function, hyperthyroidism and pregnancy.

Process of angiography

A specialist establishes the indication for carrying out an angiography following a detailed anamnesis, examination and consultation. The different diagnostic options should be discussed.

Prior to proceeding with the angiography, the physician will check the patient's blood values and test for possible allergy to contrast media. Most importantly, kidney impairment and hyperthyroidism need to be ruled out. The contrast medium is then administered to the patient through a catheter that is advanced to a position close to the vessel being examined. An exception is CT angiography, for which the contrast medium is administered into a vein in the arm.

This body region is then going through to an imaging procedure. That means an ultrasound examination, an X-ray, a computed tomography or magnetic resonance imaging (CT or MRI) is conducted.

The duration of the examination also varies depending on the type of angiography and the scope of the vessels to be examined. For instance, whenever a CT is done following the contrast agent administration, the whole exam generally won't take longer than 30 minutes. MR angiography takes about 45 minutes, and DSA requires about 1-2 hours.

In general, an angiography is done on an outpatient setting, and patients may go home soon afterward. Directly after the procedure, a pressure dressing is placed over the puncture site and about six hours of bed rest is prescribed.

It is recommended to rest physically on the same day and the next day and to drink plenty of water in order to speed up the breakdown of the contrast agent.

Risks of angiography

Angiography is a routine procedure. It is very rare for serious complications to occur, because careful prior examinations are a must. As with any injection, however, there may be bruising and blood clots, as well as infection. Many patients experience a sensation of warmth, slight dizziness or an unfamiliar taste upon receiving the contrast medium. This is, however, completely normal and not dangerous.

Costs of an angiography

With an appropriate medical indication for MR angiography or digital subtraction angiography, both statutory and private health insurance companies will cover the entire cost of the examination.

CT angiography, on the other hand, is generally not covered by statutory health insurance. In this case, costs of around 500 euros can be expected. The majority of private health insurances reimburse the costs for this form of angiography, too.

The best option for each patient should always be considered during a comprehensive counseling session.

Which doctors and clinics specialize in angiography?

Specialists in angiology focus on diseases of the vascular system and are consequently your first line of communication with regard to the use of angiography.

Although angiography is performed frequently, it is a rather invasive examination method for imaging the vessels. For this reason, patients should be able to have confidence in the professional competence and expertise of the physician.

All doctors listed here have been evaluated by us for their experience in the field of angiography and we would like to provide you with access to excellent medical treatment. Please feel free to schedule a first consultation with our experts, who are looking forward to your request for treatment.