10 Aortography
Specific Indications and Contraindications
For the following indications additional angiographic imaging of the ascending aorta, of the aortic arch, or of the thoracic aorta is done during left heart catheterization and coronary angiography:
Nonselective visualization of the coronary arteries if selective engagement was unsuccessful
Nonselective visualization of coronary bypass grafts if selective engagement was not successful
Aortic regurgitation
Aortic valve stenosis
Aortic aneurysm/aortic dissection
Before endovascular repair of a dissection
Sinus of Valsalva aneurysm
Coarctation of the aorta
Congenital malformations, for example, aortopulmonary septal defect, anomalous origins of supra-aortic vessels
In addition to the usual precautions regarding catheter handling and contraindications regarding contrast medium exposure, it should be noted that aortography requires a relatively high additional volume of contrast medium, which frequently is not tolerated by patients with impaired ventricular function and especially impaired renal function.
Special caution must be observed when open-end catheters are used, for example, the Sones catheter. The correct intraluminal position must be confirmed. With incorrect placement, contrast medium can be injected accidently, and at high flow rates, into the coronary arteries or into the aortic wall.
Procedure
Catheter
The standard catheter for aortography is the pigtail catheter, size 4F to 7F. In most cases aortography can be done with a 5F pigtail. In patients with a dilated aorta, higher injection rates (> 15 mL/s) are required to opacify the aorta sufficiently. In these cases 7F catheters should primarily be used.
Procedure
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