Angiography is an x-ray study of the blood vessels. An angiogram
uses a radiopaque substance, or dye, to make the blood vessels
visible under x ray.
Why is an angiography done?
Angiography is used to detect abnormalities or blockages in the
blood vessels throughout the circulatory system and in some
organs. The procedure is commonly used to identify
atherosclerosis; to diagnose heart disease; to evaluate kidney
function and detect kidney cysts or tumours; to detect an aneurysm
(an abnormal bulge of an artery that can rupture leading to
haemorrhage), tumour, blood clot, or arteriovenous malformations
in the brain; and to diagnose problems with the retina of the eye.
It is also used to give surgeons an accurate ‘map’ of the heart
prior to open-heart surgery, or of the brain prior to
neurosurgery.
What happens during the procedure?
Angiography is performed at a hospital by a trained radiologist
and assisting technician or nurse. Angiography requires the
injection of a contrast dye that makes the blood vessels visible
to x-ray. The dye is injected by an arterial puncture. The
puncture is usually made in the groin area, armpit, inside elbow,
or neck. Depending on the type of angiography procedure being
performed, the contrast medium is either injected by hand with a
syringe or is mechanically injected with an automatic injector
connected to the catheter. An automatic injector is used
frequently because it is able to propel a large volume of dye very
quickly to the angiogram site. The patient is warned that the
injection will start, and instructed to remain very still. The
injection causes mild to moderate discomfort. Possible side
effects or reactions include headache, dizziness, irregular
heartbeat, nausea, warmth, burning sensation, and chest pain, but
they usually last for a short time.
Throughout the dye injection procedure, x-ray pictures and/or
fluoroscopic pictures (or moving x rays) are taken. Because of the
high pressure of arterial blood flow, the dye will dissipate
through the patient's system quickly, so pictures are taken in
rapid succession. Once the x-rays are complete, the catheter is
slowly and carefully removed from the patient. A pressure bandage
is then applied.
What are the different kinds of
angiography?
A variety of common angiography procedures are:
1. Cerebral angiography
Cerebral angiography is used to detect aneurysms, blood clots, and
other vascular irregularities in the brain. The catheter is
inserted into the femoral or carotid artery and the injected
contrast medium travels through the blood vessels on the brain.
2. Coronary angiography
In a coronary angiography, the arterial puncture is typically
given in the femoral artery, and the cardiologist uses a guide
wire and catheter to perform a contrast injection and x-ray series
on the coronary arteries. The angiogram procedure takes several
hours, depending on the complexity of the procedure.
3. Pulmonary angiography
Pulmonary, or lung angiography is performed to evaluate blood
circulation to the lungs. It is also considered the most accurate
diagnostic test for detecting a pulmonary embolism. The contrast
medium is injected into the pulmonary artery where it circulates
through the lung capillaries. The test typically takes up to 90
minutes.
4. Kidney angiography
During a kidney angiogram, the guide wire and catheter are
inserted into the femoral artery in the groin area and advanced
through the abdominal aorta, the main artery in the abdomen, and
into the renal arteries. The procedure takes approximately one
hour.
5. Fluorescein angiography
Fluorescein angiography is used to diagnose retinal problems and
circulatory disorders. It is typically conducted as an outpatient
procedure. The patient's pupils are dilated with eye drops and he
rests his chin and forehead against a bracing apparatus to keep it
still. Sodium fluorescein dye is then injected with a syringe into
a vein in the patient's arm. The procedure does not require x
rays. Instead, a rapid series of close-up photographs of the
patient's eyes are taken. The entire procedure takes up to one
hour.
6. Coeliac and mesenteric angiography
Coeliac and mesenteric angiography involves x-ray exploration of
the coeliac and mesenteric arteries, arterial branches of the
abdominal aorta that supply blood to the abdomen and digestive
system. The test is commonly used to detect aneurysm, thrombosis,
and signs of ischaemia in the coeliac and mesenteric arteries, and
to locate the source of gastrointestinal bleeding. It is also used
in the diagnosis of a number of conditions, including portal
hypertension, and cirrhosis.
7. Splenoportography
A splenoportograph is a variation of an angiogram that involves
the injection of contrast medium directly into the spleen to view
the splenic and portal veins. It is used to diagnose blockages in
the splenic vein and portal vein thrombosis and to assess the
strength and location of the vascular system prior to liver
transplantation.
How to prepare for an angiography?
Patients undergoing an angiography are advised to stop eating and
drinking eight hours prior to the procedure. If the arterial
puncture is to be made in the armpit or groin area, shaving may be
required. A sedative may be administered to relax the patient for
the procedure. An IV line will also be inserted into a vein in the
patient's arm before the procedure begins in case medication or
blood products are required during the angiogram. Prior to the
angiography procedure, patients will be briefed on the details of
the test, the benefits and risks, and the possible complications
involved, and asked to sign an informed consent form.
What happens after the procedure?
Because life-threatening internal bleeding is a possible
complication of an arterial puncture, an overnight stay in the
hospital is sometimes recommended following an angiography
procedure, particularly with cerebral and coronary angiograms. If
the procedure is performed on an outpatient basis, the patient is
typically kept under close observation for a period of at least
six to 12 hours before being released. Pain medication may be
prescribed if the patient is experiencing discomfort from the
puncture, and a cold pack is applied to the site to reduce
swelling. It is normal for the puncture site to be sore and
bruised for several weeks. Angiography patients are also advised
two to three days of rest and relaxation after the procedure in
order to avoid placing any undue stress on the arterial puncture
site. Patients who experience continued bleeding or abnormal
swelling of the puncture site, sudden dizziness, or chest pains in
the days following an angiography procedure should seek medical
attention immediately. Patients undergoing a fluorescein
angiography should not drive or expose their eyes to direct
sunlight for 12 hours following the procedure.
What are the risks associated with the
procedure?
Because angiography involves puncturing an artery, internal
bleeding or haemorrhage are possible complications of the test. As
with any invasive procedure, infection of the puncture site or
bloodstream is also a risk, but this is rare. A stroke or heart
attack may be triggered by an angiogram if blood clots or plaques
on the inside of the arterial wall are dislodged by the catheter
and form a blockage in the blood vessels or artery. The movement
of the catheter through its chambers may also irritate the heart
during pulmonary and coronary angiography procedures, and
arrhythmias may develop. Patients with kidney disease or injury
may suffer further kidney damage from the contrast mediums used
for angiography. Patients who have blood clotting problems, have a
known allergy to contrast mediums, or are allergic to iodine, a
component of some contrast mediums, may also not be suitable
candidates for an angiography procedure. Because x-rays carry
risks of ionising radiation exposure to the fetus, pregnant women
are also advised to avoid this procedure.
Atherosclerosis
is when the artery walls begin to thicken from cholesterol
Coronary Artery Angiography
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