Aortography

Aortography involves placement of a catheter in the aorta and injection of contrast material while taking X-rays of the aorta. The procedure is known as an aortogram. The diagnosis of aortic dissection can be made by visualization of the intimal flap and flow of contrast material in both the true lumen and the false lumen. The catheter has to be inserted through the right femoral artery, because in about two thirds of cases the aortic dissection spreads into the left common iliac artery.

Aortography
B. Translumbar aortography shows near-total obstruction of the femoral arteries in a patient with Monckeberg's arteriosclerosis.
ICD-9-CM88.42
MeSHD001027

The aortogram was previously considered the gold standard test for the diagnosis of aortic dissection,[1] with a sensitivity of up to 80% and a specificity of about 94%.[2] It is especially poor in the diagnosis of cases where the dissection is due to hemorrhage within the media without any initiating intimal tear.

The advantage of the aortogram in the diagnosis of aortic dissection is that it can delineate the extent of involvement of the aorta and branch vessels and can diagnose aortic insufficiency. The disadvantages of the aortogram are that it is an invasive procedure and it requires the use of iodinated contrast material.[3]

Aortography has largely been replaced by the diagnostic tools of MRI, CT, and transesophageal echocardiography (TEE) all of which have high sensitivities.[4] TEE is favored in emergency situations, as it is relatively non-invasive and a rapid procedure (more so than MRI, which can takes hours).[5][6]

References
  1. Holloway, B J; Rosewarne, D; Jones, R G (December 2011). "Imaging of thoracic aortic disease". The British Journal of Radiology. 84 (3): S338–S354. doi:10.1259/bjr/30655825. PMC 3473913. PMID 22723539.
  2. Wilbers, Christopher R.H.; Carrol, Clark L.; Hnilica, Mark A. (1990). "Optimal Diagnostic Imaging of Aortic Dissection". Texas Heart Institute Journal. 17 (4): 271–278. ISSN 0730-2347. PMC 324936. PMID 15227519.
  3. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) (1 November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases". European Heart Journal. 35 (41): 2873–2926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
  4. Creager, Mark A.; Braunwald, Eugene (2013). Atlas of Vascular Disease. Springer Science & Business Media. p. 40. ISBN 9781475745641.
  5. Khan, Ali Nawaz (13 May 2016). "Aortic Dissection Imaging". Medscape. WebMD.
  6. Neskovic, A. N.; Hagendorff, A.; Lancellotti, P.; Guarracino, F.; Varga, A.; Cosyns, B.; Flachskampf, F. A.; Popescu, B. A.; Gargani, L.; Zamorano, J. L.; Badano, L. P. (13 December 2012). "Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations". European Heart Journal - Cardiovascular Imaging. 14 (1): 1–11. doi:10.1093/ehjci/jes193. PMID 23239795.
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