Procedure for Performing an Angiogram:
An angiogram is a diagnostic imaging procedure that visualizes blood vessels using X-ray contrast media and fluoroscopic imaging in a specialized angiography suite equipped with fixed X-ray fluoroscopy machinery to provide real-time imaging.
The procedure starts with vascular access, usually gained via percutaneous puncture of an artery (commonly the femoral or radial artery) using the Seldinger technique to introduce a catheter into the vascular system. The catheter is navigated under fluoroscopy guidance to the vessel of interest.
Once the catheter is positioned, an iodinated X-ray contrast medium is injected intra-arterially to opacify the vessel lumen, allowing visualization of vascular anatomy and flow dynamics. The volume of contrast used varies depending on the vascular territory: for example, peripheral arteriography in adults typically requires 10–90 ml, while coronary arteriography may use 4–10 ml per artery, with the dose tailored by patient size and procedure specifics SmPC Iomeron,SmPC Iomeron,SmPC Iomeron.
During contrast injection, digital subtraction angiography (DSA) is employed to acquire high temporal resolution images by subtracting pre-contrast images, which eliminates background anatomical structures, providing clear visualization of the vessels and blood flow in near real-time Arjomandi et al. 2026. This high temporal resolution distinguishes DSA as the gold standard for dynamic vascular assessments such as arteriovenous malformations, aneurysms, or flow characteristics Zeng et al. 2026 Arjomandi et al. 2026.
While static imaging modalities like CT or MR angiography provide excellent spatial resolution, conventional angiography (DSA) allows continuous image acquisition at multiple frames per second, crucial for assessing complex hemodynamics and guiding interventions such as embolization or stent placement Arjomandi et al. 2026 Seema et al. 2026.
Throughout the procedure, radiation dose parameters including fluoroscopy time and kerma-area product are continuously monitored to optimize dose and adhere to the ALARA (as low as reasonably achievable) principle to minimize radiation risks for patients and staff Seema et al. 2026.
After the diagnostic images are acquired and reviewed, devices (catheter, guidewires) are withdrawn, and vascular access site hemostasis is achieved either by manual compression or closure device. Post-procedure monitoring for complications follows in accordance with institutional protocols.
In specific clinical scenarios like intracranial aneurysm evaluation, selective angiography is performed with precise catheter positioning and contrast injections to delineate vascular anatomy and flow patterns for accurate diagnosis and therapeutic planning Zeng et al. 2026.
Overall, angiography integrates catheter-based intra-arterial contrast injection with real-time fluoroscopic imaging and digital subtraction techniques to dynamically visualize vascular architecture and physiology, enabling both diagnostic and interventional applications SmPC Iomeron,SmPC Iomeron,SmPC Iomeron,Seema et al. 2026.
Key References
- SmPC: Iomeron 350, solution for injection
- SmPC: Iomeron 400, solution for injection
- SmPC: Iomeron 300, solution for injection
- NICE CG126: Stable angina: management
- (Tardif et al., 2013): Atherosclerosis imaging and the Canadian Atherosclerosis Imaging Network.
- (Evangelista, 2014): Imaging aortic aneurysmal disease.
- (Albayati and Clough, 2014): Optimising pre- and postoperative imaging for thoracic aortic pathology.
- (Arjomandi et al., 2026): Optimizing imaging in orbital vascular anomalies: a review on matching modality to pathology for effective diagnosis and treatment planning.
- (Seema et al., 2026): Patient radiation doses in an angiography suite at a tertiary hospital in Pretoria.
- (Zeng et al., 2026): Flow-mediated pseudolesion mimicking an intracranial aneurysm secondary to cervical internal carotid artery dissection: illustrative case.