Angiogram Dx

Description: Angiography is a radiographic imaging technique that uses intravenous or intraarterial contrast media to visualize the vasculature.

Indications: Arteriography is most useful in supporting a diagnosis of vascular occlusion. It is particularly helpful in diagnosing and assessing thrombotic disorders and the vasculitides, such as polyarteritis nodosa (mesenteric and renal vessels imaged), isolated central nervous system (CNS) angiitis (brain), Takayasu arteritis (aortic arch and subclavian vessels), and, rarely, giant cell arteritis (aortic arch and its proximal branches). Irregularities of the vascular lumen (taperings and dilatations), aneurysms, and nonatherogenic-appearing occlusions may help establish a vasculitic diagnosis. Angiograms are useful in assessing vascular aneurysms, arteriovenous malformations and obliterative disorders. An example of the latter includes the characteristic stenotic, occlusive or cork-screw arterial findings in the distal extremities in patients with thromboangiitis obliterans (Buerger’s disease). Pulmonary angiography may help diagnose pulmonary embolisms and allow concurrent measurement of right-sided intracardiac pressure, useful in establishing the diagnosis of pulmonary hypertension. Venography is occasionally needed as a follow-up procedure to noninvasive vascular studies when a deep venous thrombosis is suspected [such as in the antiphospholipid (APL) antibody syndrome].

Cost: Depending on the procedure, $500–1,500.

Comment: Angiography is a moderately safe approach to vascular imaging that may provide considerable assistance in substantiating some diagnoses. Angiography is usually performed by interventional radiologists in a hospital setting.  All patients should be questioned about hypersensitivity to intravenous contrast agents. Digital subtraction angiography is infrequently used and has been replaced by computed tomography angiography (CTA) or magnetic resonance angiography (MRA).  These have supplanted conventional angiograms in many clinical scenarios.  Howeve, the greater resolution and accuracy of dye contrast angiography may trump the more convenient MRA in some. Careful monitoring of renal function and volume status is needed after all intravascular radiographic contrast procedures.

BIBLIOGRAPHY

Pipitone N, Versari A, Hunder GG, Salvarani C.   Role of imaging in the diagnosis of large and medium-sized vessel vasculitis. Rheum Dis Clin North Am. 2013;39:593-608.  PMID: 23719077