The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. Historically, catheter-directed pulmonary angiography has been used most commonly for the diagnosis of suspected pulmonary embolism (PE). Over the past two decades, however, catheter angiography has become almost entirely supplanted by CT angiography (CTA), which is now the accepted standard of care for diagnosis of suspected PE, in part owing to its superior sensitivity and specificity. [1, 2, 3, 4, 5] Other noninvasive methods, such as MRI/A and V/Q scans, are also used to evaluate the anatomy and hemodynamics of the pulmonary vasculature. 
Currently, the main clinical utility of conventional pulmonary angiography is for therapeutic intervention and, in selected cases, preoperative evaluation of the pulmonary arteries.
Selected examples of abnormalities identified with pulmonary angiography are shown below.
Catheter pulmonary angiography is indicated for diagnosis and treatment of PE in certain circumstances. Pulmonary angiography can be used in a diagnostic dilemma, although CTA is the clinically preferred method. In chronic PE, pulmonary angiography is used for surgical planning prior to pulmonary endarterectomy.  As for treatment indications, thrombectomy and catheter-directed thrombolysis are used for acute massive or submassive PE. [8, 9, 10, 11, 12] Indications include hemodynamic instability, right heart strain/failure, severe hypoxemia, free-floating right ventricular (RV) thrombus, patent foramen ovale (PFO), and failed systemic thrombolysis. [13, 14]
Pulmonary angiography is indicated in the treatment of pulmonary arteriovenous malformations or fistulas. Endovascular coiling is indicated when the feeding artery is greater than 3 mm in diameter. 
Pulmonary angiography is indicated as part of a complete embolization for severe cavitary or inflammatory lung lesions.
It is indicated in the evaluation of the pulmonary arteries for tumor encasement.
Catheter pulmonary angiography is also used in the retrieval of foreign objects, such as an embolized catheter fragments or even inferior vena cava (IVC) filters. 
According to American College of Radiology (ACR) and Society of Interventional Radiology (SIR) guidelines,  there are no absolute contraindications to catheter pulmonary angiography. As with any interventional procedure, evaluation of the patient’s clinical and renal status, any allergies to intravenous contrast, and anticipated hemodynamic or cardiac issues should be carefully weighed.
If the catheter does not easily advance into the RV, the coronary sinus may have been entered inadvertently. Gently inject contrast material under fluoroscopy to check for this if the catheter does not advance.
Be cognizant of left bundle branch block (LBBB) before starting the procedure. To avoid complete heart block, a transvenous pacemaker or external pacing leads should be in place prior to starting the procedure.
With the use of modern equipment and nonionic low osmolar contrast agents, complications in conventional pulmonary angiography are rare and usually minor. They include the following: 
What would you like to print?
- Periprocedural Care