Angiography is the X-ray examination of your arteries. An artery is a blood vessel that carries blood and oxygen to all the tissues of your body. Angiography involves placing a small tube called a catheter into an artery and injecting contrast material or dye. The contrast material makes the artery visible on the X-rays. Angiography gives your physician detailed information about the condition of your arteries. This information is produced in a report called an angiogram. Your radiologist will interpret the angiogram to decide the next course of treatment.

Your physician may recommend angiography if you have reported symptoms of a blocked artery or if you have had other tests that show that you have a blockage. Other diagnostic tests may show a blocked artery but do not provide specific information about where the artery is blocked, and the severity and cause of the blockage. Your physician also may recommend angiography if an aneurysm is suspected. An aneurysm is an area of an artery that has ballooned out and is weaker than the rest of the artery.

The arteries

The primary cause of blocked arteries is atherosclerosis, commonly called "hardening of the arteries." Atherosclerosis causes fatty deposits (plaque) to build up on the inside of the arteries, much like rust on the inside of a metal pipe. When an artery becomes narrowed or blocked, the tissues do not get enough oxygen. The arteries must be open to keep the body's tissues healthy and alive.

Types of angiograms

Depending on your medical condition, radiologists can obtain several different types of angiograms. Some common angiograms include:

•	Aortogram — This test examines all or part of the aorta. The aorta is the main artery coming from the heart. It runs down the middle of the body and branches off to all of the parts of the body.
•	Carotid angiogram — This also may be called a carotid DSA (digital subtraction angiography) or carotid arteriogram. This procedure examines the arteries that go up each side of the neck and deliver blood to the brain.
•	Femoral aortogram with runoff — This procedure examines the aorta and the arteries going down into the legs and feet.
•	Renal angiogram — This test examines the renal arteries in the kidneys.

The risks of angiography

A small amount of risk is associated with angiography, and there is less than a 1 percent chance of any side effects. The risks vary with each case and will be explained to you by your radiologist. The benefit of knowing the exact condition of your arteries will be weighed against the risks involved.

Preparing for the catheterization

Follow these instructions unless your physician specifies otherwise:

•	Allergies — If you are allergic to contrast material, iodine or any other medication, let your radiologist know as soon as possible.
•	Eating — Do not eat any solid food after midnight the night before your procedure. Do drink plenty of clear fluids like water, broth, apple juice, etc. unless otherwise instructed by your physician. You also may eat gelatin.
•	Medication — Most prescribed medicines may be taken, but make sure your physician is aware of all the medications you are taking. Some medications, such as insulin, Glucophage, Coumadin and aspirin, may need special consideration.

If you are not already in the hospital, you will be admitted the day of your procedure. You will need to sign a consent form giving permission to do the test. You may receive blood tests unless you have had them recently. A nurse or X-ray technologist will take your health history. An IV will be started to give you fluids or medication. You do not need to remove your glasses, dentures or rings. Before leaving your room, make sure you empty your bladder; the IV fluids and contrast material may cause your bladder to fill quickly. You will be taken to the Catheterization Laboratory (Cath Lab) by wheelchair. The Cath Lab is located on the first floor of the main hospital and is a part of the Diagnostic Imaging Department. Because the temperature in the Cath Lab is cool, you will be covered with blankets. A waiting room is available for your family. Someone must be available to take you home and stay with you the night of the procedure.

After arriving in the Cath Lab, you will be asked to move onto the X-ray table. You will lie on your back during the procedure. Electrocardiography (EKG) electrodes will be placed on your chest to monitor your heart rhythm, and an automatic blood pressure cuff will be placed on your arm. A nurse or X-ray technologist will shave and cleanse the area where the catheter will be inserted, usually the groin area. This will help prevent infection and decrease discomfort when the tape is removed after the procedure. A sterile drape is then positioned over your lower body.

The procedure

The radiologist injects a local anesthetic to numb the area where the catheter will be inserted. This medication will burn for a few seconds when it is first injected; this is usually the most painful part of the procedure. No incision is made. You may feel pressure when the catheter is inserted into the artery, but this is not painful. You will not feel the catheter moving because the arteries do not have nerve endings. If you are uncomfortable or feel pain during the procedure, tell the radiologist or nurse immediately.

When the catheter is in position, contrast material is injected into the artery while X-ray pictures are taken. You will hear the camera run as the arteries are being injected, and the lights in the room will dim while the camera is running. The X-ray camera is positioned at various angles to get different views of each artery. While films are being taken of each artery, you will be asked to hold your breath. You should only have to hold it for five to 10 seconds; try not to bear down. When the camera stops running, you may breathe normally and the lights will come on. You may be asked not to swallow if the radiologist is taking pictures in your neck. If you are asked to cough, give two quick, vigorous coughs. This will help clear the material from your arteries.

Removing the catheter

After the catheter is removed, firm pressure will be applied to the insertion point for about 15 to 20 minutes until the artery seals itself. Removing the catheter does not hurt. A bandage will be applied, and you will be taken back to your room by stretcher and helped back to bed.

After the procedure

It is important for you to keep the affected leg straight. You must remain flat in bed for three to four hours to allow the area to heal. An hour after your test, the nurse can help you turn on your side with your leg straight. After lying flat for a long time, you may feel stiff, so ask for help when you first get up.

If you cough, sneeze, laugh or need to use the bedpan, use your fingers to apply pressure over the bandage. If you note bleeding from the area where the catheter was inserted, apply pressure with your fingers and call your nurse immediately. A nurse will check your blood pressure, pulse and circulation frequently. You will be allowed to have fluids shortly after the procedure. If you tolerate the fluids, you will be allowed to return to your normal diet. The contrast material will cause you to urinate more frequently. By increasing your fluid intake, you will excrete the material more quickly.

The results

After your angiography procedure has been completed, your radiologist will study the films in detail. The information gathered from your test will be discussed with your physician. Your physician will explain the results to you and your family, usually within a few hours after the test. You, your family, your physician and your radiologist will work together to form a plan of treatment. This may mean a change of medication, balloon angioplasty or surgery. If you should need further treatment at another hospital, copies of your medical record and your X-ray films will be sent to the hospital of your choice. When your treatment is completed, the hospital will return your films to Great River Medical Center where they will become a part of your permanent medical record.

Going home

You probably will be dismissed the evening of the procedure. By this time, your blood pressure will be well stabilized, and you should be eating a normal diet. You may remove your bandage the next morning, but the site should be kept clean and dry. You may take a bath or shower, but do not scrub the area; just wash it gently and pat dry. Avoid strenuous activity or heavy lifting for five days. If you have any persistent or sudden bleeding, apply pressure and call the Diagnostic Imaging Department immediately and ask for the "specialist doctor on call." An instruction sheet will be given to you. If you have any questions, call your physician’s office.

Using the affected leg will help relieve any stiffness you may feel. You may notice a small lump or bruise where the catheter was inserted. If you should notice increased swelling, tenderness, redness or warmth, contact your physician immediately.

Glossary of terms

Balloon angioplasty: A procedure similar to angiography that involves using a catheter with a special balloon at the tip. The balloon is positioned at the narrowed point in the artery and inflated for a very short time. It is re-inflated several times, resulting in widening of the narrowed area and improving the blood flow. Angioplasty sometimes can be performed at the same time as angiography.

Bruit: An abnormal sound within a vessel.

Cerebral vascular accident: This is commonly called a stroke. A cerebral vascular accident is a sudden attack caused by bleeding or blood clots in the brain. It is usually characterized by some degree of paralysis.

Claudication: A complaint of pain and/or weakness in the legs usually associated with exercise.

Dissecting aneurysm: The splitting of an arterial wall where blood leaks through a tear in the artery.

Stenosis: A narrowing of an artery.

Transient ischemic attack: The temporary disordering of brain function. This usually is resolved within 24 hours.

For more information

If you have any questions about angiography, please talk to your physician or call Great River Medical Center's Catheterization Laboratory at (319) 768-4840.

 

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