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
Angiography is a specialized test which is used to
examine the state and functioning of the arteries in
our heart. The arteries are the important blood
vessels that carry oxygenated blood from the heart
to the various parts of the body. When a person
suffers from a chest pain, which is also known as
angina, it becomes necessary to get an
angiography done. Angiographies are done in
order to study the biology of blood vessels like the
arteries and the veins. In short, it is the inspection
of the condition inside the 'tubular structures' in the
body.
This technique was first developed in the year 1927 by a
Portuguese physician and neurologist Egas Moniz. He came up
with this technique to provide contrasted x-ray cerebral
angiography which will help in diagnosing several kinds of
nervous diseases, such as tumors, artery disease and
arteriovenous malformations.
 He is recognized as one of the pioneers in this field. Moniz
performed the first cerebral angiogram in Lisbon in 1927, and
Reynaldo Cid dos Santos performed the first aortogram in the
same city in 1929. The Seldinger technique or the insertion of
radio opaque material was introduced in 1953. The technique is
named after Dr. Sven-Ivar Seldinger, a Swedish radiologist who
introduced the procedure in 1953.
 This technique made angiography a safe method as no sharp
introductory devices needed to remain inside the body.
 Till date, different types of angiography are used to determine
different ailments. Angiography has become a widely used
technique and is considered as a boon to the medical industry.

The process of angiography involves a fluorescent dye and an
x-ray examination. Basically, in this procedure the x-rays of the
chest are taken. But soft tissues or the 'inside' area of arteries
are not clear in a regular x-ray and hence the help of a
fluorescent dye or the contrast agent is taken.
 The dye or contrast is a fluorescein sodium is a highly
fluorescent chemical compound that absorbs blue light with
fluorescence. It is commonly referred as fluorescein, or
fluorescein sodium, the sodium salt of fluorescein.
 A radio opaque material is first inserted in the blood stream with
the help of a device called as the catheter which is a thin,
narrow, tube-like structure.
 Once the dye has entered the blood vessels, the x-ray machine
will capture visual descriptions called fluoroscopy. In case of
any blockage in the heart, the dye will not reach and the doctor
will understand that there is a blockage present in the heart.


A coronary angiogram is a procedure
that uses X-ray imaging to see the
inside of your heart's blood vessels.
Coronary angiograms are part of a
general group of procedures known as
cardiac catheterization. Catheterization
refers to any procedure in which a long,
thin, flexible plastic tube (catheter) is
inserted into your body.

A cerebral angiogram (also known as
an arteriogram) is a diagnostic
procedure that provides images of the
blood vessels in the brain and/or head.
The test is performed to find blocked or
leaking blood vessels. This test can help
to diagnose such conditions as the
presence of a blood clot, fatty plaque
that increases the patient's risk of
stroke, cerebral aneurysm or other
vascular malformations like AVM’s.

Carotid angiography, also called carotid
angio or an arteriogram, is an invasive xray procedure used to find narrowing or
blockage (atherosclerosis) in the carotid
arteries. Carotid angiography may be
performed when carotid artery disease is
suspected, based on the results of other
tests, such as a carotid duplex ultrasound,
computed tomography angiogram (CTA) or
magnetic resonance angiogram (MRA).

Peripheral angiograms test the arteries
which supply the blood to the head and
neck or those to the abdomen and legs.
An aortogram is an invasive diagnostic
test that uses a catheter to inject dye into
the aorta. X-rays are taken of the dye as it
travels within the aorta, allowing a clear
view of your blood flow. This way, any
structural abnormalities of the aorta can
be seen accurately.
What is CT angiogram?

A
computerized
tomography
(CT)
angiogram is an imaging test for various
types of heart disease. Unlike a traditional
coronary angiogram, CT angiograms don't use
a catheter threaded through your veins to your
heart. Instead, a CT angiogram relies on a
powerful X-ray machine to produce images of
your heart and heart vessels. CT angiograms
require less recovery time than traditional
angiograms and are becoming an increasingly
popular option for people who have a
moderate risk of blocked or narrowed arteries.

A CT angiogram can determine the location
and severity of artery narrowing of
blockages caused by:
-PAD in the legs
-Kidney and artery disease
- Aortic disease
- During a CT scan, a beam of x-rays is sent towards
your body in a 360-degree circle. Detectors pick up
the x-rays after they have passed through your
body, creating digital images in thin “slices” of your
body. A computer assembles these slices into a
complete 3 dimensional picture of the arteries and
surrounding tissues.

A pulmonary angiogram is an
angiogram of the blood vessels of the
lungs. A pulmonary angiogram may be
used to assess the blood flow to the
lungs. One of the primary indications for
the procedure is the diagnosis of a clot.
It may also be used to deliver
medication into the lungs to treat cancer
or hemorrhage.

Female conjoined twins, of 15 month of
age, were evaluated for evaluated for
the possibility of separation. They were
joined below the xiphoid process at an
angle of approximately 90 degrees. The
twins shared a single pelvis, and each
child exhibited a normal anterior lower
limb and a conjugated posterior lower
one. One of the twins was visibly bigger
than the other.

Pre-operative testing included:
 Bone structure- plain radiography and




helical CT scan
Cardiovascular system- plain radiography,
echocardium and helical CT
Urogenital System- intravenous pyelogram
and helical CT.
Gastrointestinal System- contrasted
radiological study of digestive system.
Liver and spleen- abdomen ultrasound and
helical CT.

An Angiographic study was performed under
general anesthesia.
The procedure was
carried out in the angiography suite through
the femoral arteries of both children using a
JV1 catheter and hydrophilic guide wire.
Celiac and mesenteric angiographic study
demonstrated a normal hepatic arterial supply
for the smaller twin. The study confirmed
agenesis of the IVC in the smaller twin but
also showed that the hepatic parenchyma
drained into her right atrium though small
hepatic veins, which allows the twins to be
successfully separated.
CASE STUDY



The use of the angiography in the procedure
of the conjoined twins was to accurately define
the hepatic arterial and venous vascular
anatomy, allowing the hepatic section without
complications.
The test allowed for surgical separation of the
children.
Despite
being
an
invasive
method,
angiographic study should be indicated as a
preoperative diagnostic complementation in
cases in which the vital anatomic vascular
structures are not identified by other tests.
Traditional diagnosis for various vascular
diseases should be done using a catheter
angiography as the gold standard of
reference.
 New
techniques such as an MRI
angiography are useful for diagnosing
atherosclerotic renovascular disease.
 The images produced by a CT angiogram
allow doctors to detect narrowing or
blockages in your blood vessels caused by
PAD.

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
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
The CT angiogram is an accurate and
reliable test for diagnosing and
investigating PAD. A large analysis of 12
studies that included 436 PAD patients
(24% were women) found that CT
angiography was about 92% accurate at
diagnosing PAD in aorta, abdomen, and
legs. CT angiogram technology continues
to improve and the latest studies find the
test can be 98% accurate.
CT angiograms can be used safely on
patients who can not have an MRI test
because of metal implants like
pacemakers or defibrillators
All available methods of diagnosing have
advantages and disadvantages
Based on our findings physicians might
consider using the ultrasound test as an
initial screen.
Contrast-enhanced MRI angiography and
CT angiography overcome the major
limitations of duplex
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angiography-a-boon-for-people.htm
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