Digital angiography is the X-ray examination of the blood vessels: a catheter carries a contrast medium visible on X-ray into the arteries. Where indicated, it makes it possible to treat a narrowing in the same session. In the NefroCenter Group it is available at the Casa di Salute Santa Lucia in San Giuseppe Vesuviano, in the province of Napoli.
The name angiography covers examinations that follow the same technique but differ by region: coronary angiography studies the coronary arteries, peripheral angiography the other arteries.
01 — SCOPE
What angiography is and how it works
Angiography is an X-ray examination that highlights the blood vessels to study their shape and identify any abnormalities: narrowings (stenoses), blockages, dilations. The physician introduces a very thin catheter into an artery and advances it inside the vessels to the region to be studied. Through the catheter a contrast medium visible on X-ray is injected, which shows the vessels and their branches selectively.
The images are obtained with the angiography system, an X-ray unit with an arm that rotates around the patient without moving them and films them from different angles; the physician follows the images in real time.
Digital angiography processes the images on a computer: in the subtraction technique (DSA, Digital Subtraction Angiography) the system records an image before the injection of the iodinated contrast medium, the “mask”, and subtracts it from those acquired with the contrast, so that the vessels stand out.
Together with coronary angiography, cardiac catheterization can be performed, which measures the pressures inside the chambers of the heart with thin tubes (catheters).
X-ray examination of the blood vesselsThin catheter and contrast mediumLocal anesthesia, patient awakeReal-time imagesDiagnosis and, where indicated, treatment in the same session
02 — SIGNS
Who angiography is indicated for
Chest pain that is new or different from usual, even with tightness, shortness of breath or pain in the arm, neck or jaw, may be a heart attack: call the emergency number 118 immediately, without waiting for a scheduled examination.
Angiography is an invasive examination that exposes the patient to ionizing radiation: it is decided by the specialist, only with a specific clinical indication and normally when the examination and non-invasive tests are not enough to clarify the cause of the complaints. For example:
Suspected coronary artery disease, with pain or tightness in the chest (angina pectoris), shortness of breath without an apparent cause, pain in the neck or left arm
Suspected heart valve defect
Finding out whether heart surgery is needed: angioplasty or bypass
Checking the coronary arteries after a heart attack or heart surgery
Arterial disease of the legs with calf pain when walking (claudication), when an angioplasty or an operation is being considered
03 — SERVICES
Coronary angiography, peripheral angiography and angioplasty
Coronary angiography
It studies the coronary arteries, the arteries that carry oxygenated blood to the heart, and, when needed, the left ventricle (ventriculography): it shows whether the coronary arteries are clear or narrowed by atherosclerotic plaques or clots and how the ventricle contracts. After the examination the physician indicates the strategy: continuing with medication, surgery such as a bypass, or coronary angioplasty.
Peripheral angiography and arteriography
With the same technique other regions are studied: the carotid arteries, the renal arteries and the iliac-femoral region. In peripheral artery disease, which reduces blood circulation in the arteries of the arms and legs and more often affects the legs, angiography shows precisely where the narrowings and blockages are.
Angioplasty and stents
Angioplasty widens the narrowed artery by inflating a balloon placed at the tip of the catheter; often a stent is also implanted, a small metal tube that keeps the artery open. It can be performed at the end of the diagnostic examination, but it is a genuine procedure.
04 — THE VISIT
How angiography is performed
The examination takes place in the cardiac catheterization lab: you lie on your back, awake, connected to the instruments that monitor vital functions; in coronary angiography you are given medication to help you relax.
After local anesthesia the physician introduces the catheter into an artery in the groin (femoral) or wrist (radial), more rarely at the bend of the elbow, and advances it to the region to be studied.
Through the catheter the contrast medium is injected, which may give a sensation of warmth, and the images are acquired: cooperation matters, for example holding your breath when asked.
The physician observes the images in real time and, if a significant narrowing is found and the patient has given consent, can perform an angioplasty immediately.
At the end the catheter is removed and the access point is compressed, then bandaged, or closed with a special device.
A few hours of rest and observation follow, depending on the access used and the team’s instructions; you are usually discharged within 24 hours.
05 — THE GROUP
Angiography and coronary angiography in the province of Napoli: Casa di Salute Santa Lucia
In the NefroCenter Group angiography is available at the Casa di Salute Santa Lucia, in via Aielli 109, San Giuseppe Vesuviano (NA). The facility has two Siemens Artis Genio angiography systems, with software that also relies on artificial intelligence, designed to improve the visualization of coronary arteries and vessels and to limit the radiation dose for patients and operators.
It also has two cardiac catheterization labs, which also serve as invasive cardiac diagnosis units: cardiac catheterization, coronary angiography, angioplasty, digital arteriography. The examinations and treatments performed on site, for each region, are confirmed by the facility at the time of booking.
Preparing for angiography, risks and contrast medium
How to prepare
Recent blood tests are needed, including serum creatinine for kidney function: with iodinated contrast, a report no older than three months is normally requested. Allergies, kidney problems, diabetes, ongoing treatment and any pregnancy must be reported beforehand; the exact list of tests is provided by the facility.
Risks and complications
Like every invasive procedure, angiography is not free of risks, even though complications are infrequent. Among the most common: a hematoma at the puncture site and vagal reactions, with nausea and a drop in blood pressure. Complications related to the puncture of the vessel remain below 1% overall. Exceptionally, especially in already serious conditions, dissection of the artery, embolism, stroke, heart failure, heart attack and death can occur. The contrast medium can cause mostly mild reactions, even delayed by up to a week, and usually transient kidney damage; serious reactions are very rare. The medical use of ionizing radiation is regulated so that the risk remains very small and justified by the benefit.
08 — IN DEPTH
Differences from CT angiography, MR angiography and color Doppler ultrasound
Color Doppler ultrasound, CT angiography and MR angiography, less invasive examinations, may precede angiography. Color Doppler ultrasound uses sound waves to assess blood flow and identify narrowings or blockages; CT angiography and MR angiography follow the path of the contrast medium with CT or magnetic resonance imaging. In CT angiography the contrast is injected into a vein, whereas in angiography it reaches the artery directly through the catheter. For the coronary arteries there is also a non-invasive examination, coronary CT.
Catheter angiography is more invasive, but it documents the anatomy of the heart and vessels in high resolution and, where indicated, makes it possible to treat the narrowing in the same session.
09 — FAQ
Frequently asked questions
What is the difference between angiography and coronary angiography?
Coronary angiography is the angiography of the coronary arteries, the arteries that carry blood to the heart. Angiography is the general term: with the same technique the carotid arteries, the renal arteries and those of the legs are also studied, and this is called peripheral angiography or arteriography.
Is angiography painful?
It is performed under local anesthesia and you remain awake; in coronary angiography you are given medication to help you relax. The contrast medium may give a sensation of warmth. During any coronary angioplasty, the inflation of the balloon may cause chest pain, which passes when it is deflated.
How long does angiography take?
A diagnostic coronary angiography takes on average 20-30 minutes. For the other regions and for angioplasty procedures the duration is indicated by the team. To the examination time are added the compression of the access point and a few hours of rest and observation, depending on the artery used.
Do you need to fast for angiography? Should medicines be stopped?
The facility’s instructions for the examination apply. Heart examinations and other contrast examinations may require a few hours of fasting from solid food; water and usual medicines, unless otherwise indicated, can generally be taken. No medicine should be stopped on your own initiative: ongoing treatment, including any metformin, must be reported to the physician, with whom those with diabetes agree the dose of antidiabetic medication or insulin.
Can angiography be performed with an allergy to contrast medium, kidney problems or during pregnancy?
Previous reactions to iodinated contrast medium, allergies, uncontrolled asthma and kidney diseases must be reported beforehand: the physician assesses whether to perform the examination or postpone it for a consultation. With reduced kidney function the angiography physician decides. Because of ionizing radiation, women of childbearing age must rule out pregnancy.
In angiography, is the catheter inserted through the wrist or the groin?
Usually through the femoral artery, in the groin, or the radial artery, in the wrist; more rarely through the brachial artery, at the bend of the elbow. With wrist access you can move sooner. After groin access, however, you must stay in bed with the leg straight for a few hours.
What happens after angiography and when do you go home?
Unless the physicians indicate otherwise, for example in dialysis or if fluids must be limited, you drink plenty of water to eliminate the contrast medium and for about an hour you do not eat solid food. You are usually discharged within 24 hours, with the report and the images. Pain or bleeding at the access point, or discomfort and tingling in the leg or arm used, must be reported to the physicians immediately.
If a narrowing is found, is angioplasty with a stent performed immediately?
It can happen, if the narrowing is significant and the treatment is indicated: doing it immediately avoids a new puncture of the artery and the risks of waiting, and the patient is asked for consent. The stent is not rejected and does not move, but the narrowing can recur (restenosis). On discharge, the instructions on check-ups and antiplatelet medicines must be followed, to be taken for the time established by the physicians without stopping them on your own initiative.
Where are angiography and coronary angiography performed in the province of Napoli?
In the NefroCenter Group at the Casa di Salute Santa Lucia, in via Aielli 109, San Giuseppe Vesuviano (NA), which has two cardiac catheterization labs and two Siemens Artis Genio angiography systems. The examinations and treatments performed on site, for each region, are confirmed by the facility at the time of booking.
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