ENThe word «angiography» frightens people more than the procedure does: angiography in Germany is an examination that makes blood vessels visible on an image. Contrast goes into the bloodstream, and the doctor sees where blood flows freely and where a vessel is narrowed or blocked.
Below: how the three different examinations with this name differ, who needs which, how the clinic day goes, the risks, and what happens if a narrowing is found. For other methods, see diagnostics in Germany.
Three examinations under one name
Three different examinations share the name. In CT angiography, contrast goes into an arm vein, a computed tomography scanner takes the images within minutes, and no artery is punctured. Of the three, it is today the commonest way to look at the aorta and the vessels of the lungs, neck and legs.
MR angiography uses a magnetic resonance scanner and no X-rays, and some examinations need no contrast at all. It takes longer, though, and is unsuitable for people with certain implants. More on the page on MRI in Germany.
Catheter angiography is the classical kind: through a puncture in the wrist or groin, a thin catheter is guided to the vessel and the flow is filmed in real time. It gives the most detailed picture and, crucially, allows the vessel to be widened in the same procedure if needed.
When it is ordered
Angiography is ordered when a vessel may be narrowed, blocked or widened. The first group of reasons is the heart: chest pain and breathlessness on exertion, suspected narrowing of the coronary arteries, and preparation for valve surgery.
The second concerns the vessels of the head and neck: after a stroke, when ultrasound has found a narrowed carotid artery, or when an aneurysm (a bulge in a vessel) or a vascular malformation (a tangle of abnormal vessels) is suspected.
The third is everything else: leg pain on walking, swelling and a non-healing wound in diabetes, checking a graft or bypass, and assessing a tumour’s vessels before surgery. The general principle: ultrasound and CT first, the catheter when the examination should bring both the answer and the treatment. For heart ultrasound, see echocardiography in Germany.
How the day goes
The day starts with preparation: a blood test for kidney function and clotting, a talk about medication, some of which is paused, a check for allergy to contrast and iodine, and several hours without food. All this is discussed in advance, and patients from abroad get the list in their own language.
Only local anaesthetic is needed at the puncture site: the person stays awake, with no general anaesthetic. The doctor talks to them and asks them to hold their breath; warmth as the contrast goes in is normal. A catheter examination takes from half an hour, then comes a pressure dressing and several hours lying flat, or fewer after wrist access.
Afterwards, extra fluids help flush out the contrast. After a catheter examination, patients are observed until the evening or stay a night on the ward. They receive a written report and images on a disc; those from abroad also get a translation and an exact note of the contrast agent used and its volume.
Risks and what to ask the doctor
Bruising and tenderness at the puncture site are common; complications are rare: bleeding, damage to the vessel wall, a contrast reaction, worse kidney function where the kidneys are already impaired. That is why blood is checked beforehand and diabetes medicines such as metformin are discussed. Radiation exposure in a catheter examination is appreciably higher than in ultrasound, one reason it is not the first step. WHO’s fact sheet on ionizing radiation and health effects also covers WHO’s work to protect patients.
Before signing the consent form, ask why this examination rather than CT or ultrasound; whether treatment is planned in the same session and what must be decided in advance; how many days must pass before flying; and who will explain the images, and when.
If a narrowing is found
There are two scenarios. Either the doctor widens the narrowed segment with a balloon there and then, adding a stent (a small mesh tube) if needed, so diagnosis and treatment fit into one procedure; or the images go to a joint case conference, much like a tumour board, and the decision is surgery or drug therapy. See angioplasty and stenting in Germany and vascular surgery in Germany.
For someone who has travelled far, this means agreeing in advance whether they are ready for treatment on the same trip, how many extra days it would take and which medicines are needed after a stent. See also heart treatment in Germany.
Frequently asked questions
Does angiography hurt?
Only a little. In CT and MR angiography, the only discomfort is the needle in a vein if contrast is needed. For a catheter examination the puncture site is numbed: the injection may sting briefly, then you feel pressure and, as the contrast goes in, a normal wave of warmth. Bruising and tenderness afterwards are common.
Can angiography be done without contrast?
Yes, but only MR angiography, and not every MR examination: some need no contrast at all. CT and catheter angiography always need it, because contrast is what makes the vessels visible. That is why allergies and kidney function are checked beforehand; if either is a concern, the doctor explains which method is safer.
How is angiography different from a vascular ultrasound?
A vascular ultrasound uses no radiation and no needle, which is why examinations start with it. Angiography is needed when ultrasound is not enough to decide on treatment. The catheter version shows the most detail and allows a narrowing to be widened at once, but with more radiation, so it is kept for when both answer and treatment are expected.
How AlenMed arranges the examination
It starts with documents: reports, previous images and the medication list are translated for a specialist, who says which examination is needed, if any, and what can be done without a catheter. Then come the appointment, visa invitation, transfer, an interpreter at consultation and discharge, and the images and report to take home. AlenMed works with 86 partner clinics in 38 German cities.
Plan in advance how many days the examination with possible treatment will take, where a companion will stay and how the images will reach your doctor back home.
This material is for information only and is not an offer. The indication and type of examination are decided by a doctor in person.