[Invasive or noninvasive angiography? The role of "classical" catheter angiography]

Within the last decade, diagnostic and interventional angiography have been developed to a high degree of performance, due to the widespread use od DSA, the miniaturisation of the puncture trauma and the introduction sets (catheters, sheaths), the development of high-tech materials (e.g., Nitinol guidewires) and the application of non-ionic, low osmolal contrast media. The specific risks of the procedure, thereby, have been significantly reduced, but could not be totally eliminated. To evaluate vascular diseases non-invasively, special attention was attributed to the progress of colour coded duplex, (spiral) CT-angiography and (CE) MR-angiography, based on the established imaging with US, CT and MRT. The matter is question is whether or not they can substitute the role of conventional angiography as the "gold standard" of vessel imaging. Clinical validity and economic efficiency both determine the indication for the use of invasive or non-invasive methods. In diagnostic procedures, there is a growing tendency for the use of non-invasive techniques, like in imaging of the abdominal and thoracic aorta, the renal, pulmonary and extra- and intra-cranial arteries. Conventional angiography is still reserved for the evaluation of small vessels of the upper and lower extremities, and vessel status in preoperative conditions (carotid, celiac trunk, mesenteric and renal arteries and aneurysms of the cerebral vasculature). Fluoroscopic guiding of catheters and contrast enhancement in interventional procedures, however, cannot be substituted by alternative techniques in the foreseeable future.