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Aortography – Imaging of the Aorta Explained

Aortography is an imaging procedure that uses X-rays and contrast dye to visualize the aorta. It helps diagnose diseases of the main artery of the body.

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Aortography is an imaging procedure that uses X-rays and contrast dye to visualize the aorta. It helps diagnose diseases of the main artery of the body.

What is Aortography?

Aortography is a diagnostic imaging procedure in which the aorta – the largest artery in the human body – is visualized using X-rays and an injected contrast agent. It belongs to the broader category of angiography and allows physicians to assess the anatomy, structure, and function of the aorta and its major branches in detail.

The aorta runs from the heart through the chest and abdomen, supplying virtually all organs of the body with oxygen-rich blood. Abnormalities in this vessel can be life-threatening and require precise diagnosis.

Indications – When is Aortography Performed?

Aortography is indicated when diseases of the aorta or its branches are suspected. Common indications include:

Aortic aneurysm: A pathological widening of the aorta that can rupture and become life-threatening.
Aortic dissection: A tear in the inner wall of the aorta allowing blood to flow between the vessel wall layers.
Atherosclerosis: Plaque buildup in the vessel wall that restricts blood flow.
Aortic stenosis: Narrowing of the aorta or its branches.
Congenital malformations of the aorta, such as coarctation of the aorta.
Preoperative planning for vascular surgery or endovascular interventions.
Follow-up after aortic procedures, e.g., after stent placement.

How is the Procedure Performed?

Aortography is an invasive procedure performed in a cardiac catheterization laboratory or an angiographic suite. The procedure consists of the following steps:

Preparation

The patient is informed about the procedure and typically receives mild sedation. The skin at the puncture site – usually the groin (femoral artery), and less commonly the arm or wrist – is disinfected and locally anesthetized.

Catheter Insertion

A thin, flexible catheter (tube) is inserted through the puncture site into the artery and advanced under X-ray guidance to the aorta. The position of the catheter is continuously monitored throughout the procedure.

Contrast Injection and Imaging

An iodine-based contrast agent is injected through the catheter into the aorta. This makes the blood vessel visible on X-ray images. A rapid sequence of X-ray images or a video sequence – known as serial angiography – is then captured to document blood flow through the aorta and its branches.

Post-procedure Care

After the procedure, the catheter is removed and the puncture site is sealed with a compression bandage or a vascular closure device. The patient must remain lying down for several hours and is closely monitored for complications.

Types of Aortography

Depending on the segment of the aorta being examined, different types of aortography are distinguished:

Thoracic aortography: Examination of the thoracic aorta, e.g., in cases of suspected chest aneurysm or dissection.
Abdominal aortography: Visualization of the abdominal aorta and its branches, including the renal and mesenteric arteries.
Panaortography: Complete imaging of the entire aorta from the heart to the iliac bifurcation.

Risks and Side Effects

As with any invasive procedure, there are potential risks that should be discussed with a physician beforehand:

Contrast allergy: Hypersensitivity reactions, in rare cases severe allergic responses.
Kidney damage: Contrast agents may impair kidney function in patients with pre-existing renal conditions.
Vascular injury: Bleeding, bruising, or injury at the puncture site.
Thrombosis or embolism: Clot formation caused by the catheter.
Radiation exposure: From X-rays, though the dose in a single examination is considered low.

Alternatives to Aortography

Since conventional aortography is an invasive procedure, less burdensome alternatives are frequently preferred today:

CT Angiography (CTA): Computed tomography imaging of the aorta – fast, highly accurate, and widely available.
MR Angiography (MRA): Magnetic resonance imaging of blood vessels without radiation, suitable for patients with iodine contrast allergies.
Duplex Ultrasonography: Ultrasound examination of the aorta, especially useful for the abdominal aorta – radiation-free and non-invasive.

Conventional invasive aortography is now primarily performed when a therapeutic intervention (e.g., stent placement) is planned simultaneously or when other imaging methods do not provide sufficient diagnostic information.

References

Reiser, M. et al.: Radiology. Georg Thieme Verlag, Stuttgart, 3rd edition, 2011.
Lederle, F. A. et al.: Abdominal Aortic Aneurysm. In: New England Journal of Medicine, 2021; 385:1320-1331. DOI: 10.1056/NEJMcp2105274.
European Society of Cardiology (ESC): Guidelines on the Diagnosis and Treatment of Aortic Diseases, 2014. Available at: https://www.escardio.org

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