Diagnostic angiography is one of the most commonly performed vascular interventional procedures. Using special catheters and guidewires, the body's arteries and veins are imaged with an angiography system to diagnose vascular disease. The procedure is named after the vessel being examined. Depending on the course of the disease and the patient's condition, interventional treatment can be carried out during the same procedure.

Narrowing or blockage of the arteries can have many causes. It can occur at any age but is more common in older people. The most important risk factors are genetic predisposition, smoking, high cholesterol, diabetes, high blood pressure, excess weight and physical inactivity.

Once the necessary tests have been carried out and a diagnosis made, balloon angioplasty is performed on the blocked vessel under imaging guidance to widen it. A tube called a stent is then placed inside the vessel to keep it from narrowing again.

Areas of Application

Carotid (Neck) Angiography

Blockage of the main arteries on either side of the neck, the carotid arteries, is a serious condition that can lead to permanent stroke or paralysis. This procedure is used in patients who do not respond to medication and have a carotid narrowing of 70% or more. Under angiographic guidance, the interventional radiologist opens the artery by placing a stent at the narrowed segment. Beforehand, a filter is placed just beyond the narrowing to stop any clot or calcium fragment from travelling to the brain; at the end of the procedure the filter is removed or left in place at the physician's discretion.

Cerebral (Brain) Angiography

This is the imaging of the brain's blood vessels with an angiography system after injecting a contrast agent. It is used when cerebrovascular disease suspected on other tests requires a definitive diagnosis, and particularly for the interventional treatment of the following conditions.

Brain aneurysms: These arise from a weakening of the wall of a brain artery, causing it to balloon. Although the exact cause is unknown, genetic factors, smoking and high blood pressure are thought to play a role. Aneurysms usually progress without symptoms and are found either by chance during brain imaging for another reason or after a rupture causes a brain haemorrhage. Patients may experience a very severe headache, double vision or loss of vision, difficulty speaking, numbness in the face, arm or leg, loss of balance and weakness.

There are two treatment options for aneurysms: open surgical clipping and a minimally invasive technique known as endovascular treatment. In both, the aim is to stop blood from filling the aneurysm sac. The specialist team decides on the method after considering the patient's condition, the location and size of the aneurysm, other illnesses and the patient's preference. With advances in technology, endovascular treatment has become the first choice for aneurysms.

A thin needle is usually inserted into the artery in the groin and a catheter is advanced to the aneurysm. The sac is filled with special spiral wires called coils. Depending on the size and shape of the aneurysm, a balloon, stent or flow-diverting stent may also be used in the same session. Because the procedure is performed through a small entry point without opening the skull, the hospital stay is shorter and patients recover faster.

Atherosclerosis (hardening of the arteries): In this condition, fatty deposits build up inside the arteries and form plaques that stiffen and narrow them. It can affect arteries throughout the body. Atherosclerosis has many causes and can lead to serious problems if left untreated. While the primary aim of treatment is to address the underlying cause, interventional procedures performed by specialists are a very successful option.

Brain tumours: In some brain tumours, the vessels supplying the tumour are blocked before surgery (embolisation) so that the tumour bleeds less during the operation.

Cerebral angiography is also used in the diagnosis and treatment of arteriovenous malformations, carotid artery dissections (tears in the artery wall), vasculitis (inflammation of the blood vessels) and blood clots in the brain's vessels.

Upper/Lower Limb (Arm/Leg) Arteriography

Arterial blockages, which are most common in the legs, cause pain in the hips and calves when walking and numbness in the toes. Over time the pain continues even at rest and starts to affect daily life. In more severe cases, reduced blood flow can cause coldness, discolouration, non-healing wounds and even gangrene in the leg. In the minimally invasive procedure, the blocked segment is treated with balloon angioplasty, stenting, thrombectomy (clot removal) or thrombolysis (clot dissolution).

Other Areas of Application

• Aortic arch aortography and thoracic (chest) angiography
• Abdominal aortography
• Renal (kidney) angiography
• Coeliac / SMA (abdominal organ) angiography