Aortography

Visualization of the aorta and its branches is possible by several modalities today. Apart from angiography, aorta can also be visualized non-invasively by echocardiography, CT scan imaging and by MR Angiography imaging techniques.

For aortography, radiographic imaging techniques are used. These techniques have evolved over the years and have reached a high level of sophistication. Further Digital Subtraction

Angiography (DSA) has been added to the armamentarium to enhance the quality of images and information obtained from this procedure.
Catheters and Guide Wires

The commonly used guide wires vary in diameter from 0.012 to 0.052; with 0.035 or 0.038 being the most commonly used sizes. The standard length varies from 100 to 180 cm. The exchange length catheters vary from 260 to 300 cm and help to keep the wire tip in a particular position during catheter exchange. Catheter tip configurations include straight, angled or J-tip.Catheters sizes most commonly used are 5F, 6F or 7F. They may be only end-hole, end hole and side hole or only side-hole systems. Thoracic aorta visualization requires 100-120 cm length while abdominal aorta requires 60-80 cm length. Several catheters have been used for aortography, namely, straight catheter, pigtail or tennis racquet catheter, simple curved catheter and complex reverse curve catheter. The pigtail catheter is by far the most commonly used catheter.

Contrast Agents
Low osmolar contrast agents are preferred because of they deliver less osmotic load, cause less local pain, less intravascular volume augmentation and less allergic reactions. CO 2 and Gadolinium are emerging as useful alternative contrast agents.

Vascular Access

Femoral and brachial arteries are still the commonest routes of access for aortography.

Thoracic Aorta
A sound knowledge of the anatomy of the aorta is essential prior to performing aortography. The common disorders of thoracic aorta which can be diagnosed by aortography are:

1) Coarctation of aorta

2) Patent ductus arteriosus

3) Aortic aneurysms

4) Aortic dissection

5) Vasculitides–inflammatory diseases of aorta

6) Connective tissue disorders

Thoracic Aortography
Aortic arch angiography has been used to assess aortic valve or aortic root disease. Thoracic aortography is helpful for assessment of aneurysms, dissection, vascular rings, coarctation, patent ductus arteriosus as well as assessment of stenoses of origin of great vessels. It is also helpful in assessment of aorta after blunt or penetrating injuries to chest wall.

Abdominal Aortography
The abdominal aorta starts at the level of diaphragm (T12). Here too, prior to performing an abdominal aortogram, a sound knowledge of its anatomy is absolutely essential.

Abdominal aortography is performed by femoral approach using a 5F, 6F or 7F pigtail or tennis racquet catheter. If femoral access is not possible, translumbar, axillary, brachial or radial approaches may be helpful. The catheter tip is kept at T12 or L1 level. About 30 to 60 ml of contrast is injected at a rate of 15 to 30ml/sec. At least two views of aorta-AP and lateral are often enough to provide necessary information.

Abdominal aortography is useful in assessment of Abdominal Aortic Aneurysms (AAA),Atherosclerotic occlusive disease (ASO), Thrombotic occlusions, Leriche syndrome, Congenital coarctation syndromes, Renal artery involvement, Middle aortic syndrome (Abdominal aortic coarctation), and stenosis/occlusion of the various branches arising from abdominal aorta.

Treatment options for the various disorders include:
1) Percutaneous transluminal Angioplasty

2) Surgical Bypass grafting

3) Endovascular stenting for Abdominal aortic aneurysms