[The vascular patient--diagnosis and minimally invasive therapy. Which technique for what illness?].
The non-invasive imaging modalities, color coded duplex sonography (CCDS), magnetic resonance tomography (MRT), and computed tomography (CT), have pushed conventional angiography out of most diagnostic fields. The experienced user will achieve fast, reliable answers with CCDS in dedicated clinical settings. MRT as well as CT are concurring imaging modalities for the most appropriate diagnostic answer. Not only pure image quality, but also patient management, and availability play a major role. Catheter based angiography will in the future still play a role in mesenteric ischemia (non occlusive disease) and for imaging of very small vessel pathology, e.g. on panarteritis nodosa. At the moment, peripheral leg run-offs are still best performed with conventional angiography, nevertheless, MR as well as CT seem to have the ability to perform diagnostic procedures. Ongoing studies will allow a solid judgement in the near future. The true value of catheter angiography is in the direct assessment, planning, and performance of interventional procedures, e.g. catheter based obliteration or revascularization. Implantation of stent devices and a whole range of different mechanical and pharmacological revascularization procedures have improved the interventional management of vascular stenoses and occlusions. The interventional radiologist is treating physician in the classical sense in this setting. Acute bleeding episodes, e.g. in the brain, thorax, abdomen, or pelvis, are best imaged with computed tomography. Conventional angiography still plays a major diagnostic and therapeutic role in bleeding into preformed cavities, such as the bile ducts or the intestine. In this setting, all available information including CT scans should be valued. For complex therapeutic regimens in oncology or in pure palliative situations, angiographic diagnosis followed by embolization and/or ablation therapy is established.
Kauffmann
G W
GW
Radiologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg.
Grenacher
L
L
Bahner
M L
ML
Hess
T
T
Richter
G M
GM
D000800:Angioplasty, Balloon; D003952:Diagnostic Imaging; D004621:Embolization, Therapeutic; D006801:Humans; D011379:Prognosis; D015607:Stents; D014652:Vascular Diseases / Q000175:diagnosis* / Q000628:therapy