Angiography

Introduction

Angiographic procedures were first performed only months after Roentgen’s discovery of X-rays. Haschek and Lindenthal injected mercury salts into an amputated hand and created one of the first recorded images of the arterial system ( Fig. 43.1 ). This showed the enormous potential of radiographic visualization of the arterial system. In 1924, Brooks reported concentrated sodium iodide arterial injection as a means of demonstrating lower extremity vessels ( Fig. 43.2 ). Over the next 50 years, multiple contrast agents were used. Iodinated compounds initially used to treat infection were soon found to be X-ray contrast agents.

Conventional angiography plays a vital role in the diagnosis and management of peripheral vascular disease. Recently, advanced, non-invasive techniques, such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and vascular ultrasound have made a significant impact on the diagnosis of vascular disease. These modalities are safe and effective in characterizing vascular disease and providing critical preprocedure planning. Despite the increased use of noninvasive measures, conventional angiography remains the gold standard. Endovascular therapy is considered less invasive compared with traditional open surgery. It translates to lower cost, decreased recovery time, and fewer postprocedural complications. Although catheter angiography is considered an extremely safe procedure, it is not without risk, with complications seen in 3%–5% of cases. Using noninvasive modalities prior to angiography, procedure times and complication rates can be reduced. We will review some of the complications encountered during and following conventional angiography.

Selection of Access Site and Approach

Transfemoral (TF) arterial access is widely accepted as the standard approach for angiography. It is generally well tolerated; however, alternative approaches have recently been explored, including transbrachial (TB) and transradial (TR). Preprocedure planning with CTA or MRA have simplified angiography procedures. Through creating “road maps,” physicians are able to prepare appropriate access for the safest procedure to complete an intervention. TR access is found to be associated with lower complication rates compared with the TF approach. However, technical success for TR is slightly lower and requires increased familiarization for improved physician’s technical success. Additionally, vessel size must also be considered when planning an endovascular intervention.