Angiography is a medical imaging technique used to visualize blood vessels and organs after injecting contrast material. It involves a team of health professionals including a radiologist, nurse, and technologist. The procedure begins by obtaining consent from the patient and inserting a catheter into the vessel of interest using the Seldinger technique. Contrast material is then injected through the catheter and x-ray images are taken. Digital subtraction angiography improves image quality by subtracting non-contrast images from contrast images, clearly showing the blood vessels. Angiography provides information to diagnose and treat various vascular diseases but carries some risks like bleeding, infection, and reaction to contrast material.

1. ANGIOGRAPHY
Dr. Tayseer Jamal Al-deen / Radiology Specialist1/16/2021
Dr.Tayseer Jamal Al-Deen 1

2. Definition …
 angiography refers to radiological imaging of
blood vessels after injection of contrast media.
 contrast media is injected by a catheter that is
placed in the vessel of interest
 Angiography can be more specifically described
as follows:
 • Arteriography: Imaging of the arteries
 • venography: Imaging o the veins
 • Angiocardiography: Imaging of the heart and
associated structures.
1/16/2021Dr.Tayseer Jamal Al-Deen
2

3. Angiography team …
 Angiography is
performed by a team of
health professionals,
including
 (1) radiologist,
 (2) nurse ,
 (3) radiology
technologist,
1/16/2021Dr.Tayseer Jamal Al-Deen
3

4. Patient consent…
 A detailed explanation of the procedure is
given to the patient, which is important to
ensure full understanding and cooperation.
 The explanation includes possible risks and
complications of the procedure so that the
patient is fully informed before signing the
consent.
 Medical history obtained include
 the patient’s ability to tolerate the contrast
media injection (allergy history, renal
function)
1/16/2021Dr.Tayseer Jamal Al-Deen
4

5. the Seldinger technique…
 To visualize the vessel of interest, a catheter must
be introduced into the patient’s vasculature,
through which the contrast media is injected.
 It is a percutaneous (through the skin) technique
that can be used or arterial or venous access as
well as access to other structures.
 Four vessels are typically considered for
catheterization: (1)femoral, (2) axillary,
(3)brachial, and (4) radial.
1/16/2021Dr.Tayseer Jamal Al-Deen
5

6. the Seldinger technique…
 Step 1. Insertion of Needle
 Step 2. Placement of
Needle in Lumen of Vessel
1/16/2021Dr.Tayseer Jamal Al-Deen
6

7.  Step 3. Insertion of
Guidewire
 Step 4. Removal of Needle
1/16/2021Dr.Tayseer Jamal Al-Deen
7

8.  Step 5. placement of
Catheter over the guide
wire
 Step 6. Removal of
Guidewire
1/16/2021Dr.Tayseer Jamal Al-Deen
8

9.  A sterile tray contains the
basic equipment
necessary or a Seldinger
catheterization o a femoral
artery. Basic sterile items
include the following
 Preparation sponges,
Scalpel blade, Syringe and
needle or local anesthetic
1/16/2021Dr.Tayseer Jamal Al-Deen
9

10. 1/16/2021Dr.Tayseer Jamal Al-Deen
10

11. Contrast media…
 The contrast media of choice is a water-
soluble, nonionic iodinated substance because
of its low osmolality and reduced risk or
allergic reaction.
 The amount required depends on the vessel
being examined.
1/16/2021Dr.Tayseer Jamal Al-Deen
11

12. 1/16/2021Dr.Tayseer Jamal Al-Deen
12
 Angiographic procedures always involve some
level of risk for the patient.
 Common risks and complications include the
following:
1. Bleeding
2. Thrombus formation
3. Vascular dissection
4. Infection
5. Contrast media reaction

13. Digital acquision…
1/16/2021Dr.Tayseer Jamal Al-Deen
13
 Digital acquisition allows
images to be archived
directly to a PACS, if
available, with all the
inherent advantages (e.g.,
ease of access to images
by specialists, elimination
of lost films, simultaneous
viewing of images). If
there is no PACS, the
images may be printed
and archived as hard
copies

14. Digital subtraction angiography (DSA)…
1/16/2021Dr.Tayseer Jamal Al-Deen
14
 Digital subtraction angiography is used to
produce images of the blood vessels without
interfering shadows from overlapping tissues.
This provides a clear view of the vessels.

15. 1/16/2021Dr.Tayseer Jamal Al-Deen
15
 the non-contrast image (mask image) of the
region is taken before injecting contrast
material and therefore shows only anatomy, as
well as any radiopaque foreign bodies
(surgical clips, stents, etc.) as would a regular
x-ray image.
 contrast images are taken in succession while
contrast material is being injected. These
images show the opacified vessels
superimposed on the anatomy and are stored
on the computer.

16. 1/16/2021Dr.Tayseer Jamal Al-Deen
16
 the mask image is then subtracted from the
contrast images pixel by pixel. The resulting
subtraction images show the filled vessels only

17. 1/16/2021Dr.Tayseer Jamal Al-Deen
17

18. 1/16/2021Dr.Tayseer Jamal Al-Deen
18
Thank you