INVASIVE OR NON INVASIVE ANGIOGRAPHY - TH E ROLE OF CONVENTIONAL CATHETER ANGIOGRAPHY

Within the last decade, diagnostic and interventional angiography have been developed to a high degree of performance, due to the widespread use of DSA, the miniaturisation of the puncture trauma and the introd uction sets [catheters, sheaths], the development of high-tech materia ls (e. g., Nitinol guidewires) and the application of non-ionic, low o smolal contrast media. The specific risks of the procedure, thereby, h ave been significantly reduced, but could nor be totally eliminated. T o evaluate vascular diseases non-invasively, special attention was att ributed to the progress of colour coded duplex, (spiral) CT-angiograph y and (CE)MR-angiography, based on the established imaging with US, CT and MRT. The matter in question is whether or not they can substitute the role of conventional angiography as the ''gold standard'' of vess el imaging. Clinical validity and economic efficiency both determine t he indication for the use of invasive or non-invasive methods. In diag nostic procedures,there is a growing tendency for the use of non-invas ive techniques, like in imaging of the abdominal and thoracic aorta, t he renal, pulmonary and extra-and intra-cranial arteries. Conventional angiography is still reserved far the evaluation of small vessels of the upper and lower extremities, and vessel status in preoperative con ditions (carotid, celiac trunk, mesenteric and renal arteries and aneu rysms 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.