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Angiography

About the Examination

Blood vessels are not dense enough to show up on a normal x-ray, so Radiologists perform a specialised procedure, called angiography.

What is Angiography?

Angiography is a specialised type of x-ray, using a Fluoroscopy machine, to examine blood vessels. It is performed by inserting thin, spaghetti-like tubes called catheters, into an artery either in the groin or arm. By injecting an x-ray dye, called Contrast Media, into an artery or vein, imaging of the vessels´ course and flow can be achieved. If ´disease´ is present it may be treated immediately using balloons or stents to improve blood flow.

What part of the body is examined during angiography?

Angiography is typically performed to monitor the health of circulatory systems in the following parts of the body:

  • Heart (coronary angiography)
  • Brain (cerebral angiography)
  • Lungs (pulmonary angiography)
  • Kidneys (renal angiography)
  • Gut (mesenteric angiography)
  • Arms and legs (peripheral angiography)

What Conditions can be Diagnosed by an angiography?

Angiography can be used to diagnose a number of conditions which affect blood flow and cause damage to the blood vessels. For example:

  • Atherosclerosis, causing narrowing of arteries called stenosis, affecting
    • Heart
    • Legs
    • Brain
  • Blood clots
  • Internal bleeding
  • Aneurysms, or ´ballooning´ of arteries

Why is angiography required?

Angiographies are required to detect damage to the blood vessels and internal organs because images of soft tissue cannot be captured during a normal x-ray.

What are the Risks and Complications of angiography?

There are a few risks associated with angiographies.

For example, there is a very minor risk that patients may suffer from a severe reaction to the contrast medium and experience:

  • Low blood pressure
  • Anaphylaxis (severe allergic response)
  • Cardiac Arrest

Allergic reactions to the Contrast Media are usually mild and can be treated immediately with medication.

This procedure uses x-rays, a form of radiation, to produce the required images. At high doses x-rays are known to increase the risk of cancer and cause localised skin changes to the area being imaged. During an angiogram great care is taken to reduce the radiation dose to a patient and maintain levels below an acceptable limit. In the case of complex and long procedures higher radiation doses are only accepted if the benefit to the patient is to outweigh the possible risks.

You can find out more about the levels and risks of x-rays from the Patient Dose Information Fact Sheet, published by Public Health England.

What are the consequences if the suspected condition is undiagnosed or untreated?

As angiography is used to detect and diagnose a number of severe vascular conditions, if left untreated the outcome may be life threatening.

Angiography can also pick up early changes to arteries, which, if left untreated may result in treatment being more difficult or impossible, resulting in surgery

About the Equipment

Angiography is performed using a Fluoroscopy Machine. This is a specialised x-ray device capable of producing low dose radiation images at a variable frame rate to produce seemingly ´live´ images. This allows doctors to place catheters into different arteries and produce highly detailed images of the desired vessels.

What are the benefits of angiography?

Angiography is generally a low risk, safe and relatively painless procedure, which produces high quality detailed images of arteries and veins and allows Specialists to treat diseased vessels.

Are there any alternatives to an angiogram?

It is possible to perform diagnostic angiograms using CT (computerised tomography) or MRI (magnetic resonance imaging) technology but these do not allow for the treatment of disease.

Preparation for an Angiography

What Special Diet is required before an angiogram?

Regardless of the site of the procedure you will be required to fast for several hours prior to the examination.

You will be given detailed instructions of how to prepare for your procedure when you book your appointment. This may involve ceasing certain medications and having a blood test.

What should a Patient Tell the Radiographer Before an angiogram

You will need to tell the radiographer if you are:

  • Pregnant
  • Suffering from any serious health conditions or allergies (i.e. diabetes or kidney disease)
  • Taking any medication

What to bring for an angiogram

Your GP or specialist may ask you to bring along any medications or copies of previous x-rays you have. Everything else needed will be supplied by the radiographer.

What to wear for an angiogram

You will be asked to remove any metallic items, such as jewellery, watches, eyewear and belts, as these items can show up on the x-ray.

You will be asked to remove any clothing obstructing the area to be x-rayed and given a medical gown to wear instead, so you should try and wear something that is comfortable and easy to remove.

How Long will an angiogram take?

The exact timing of an angiogram will vary depending on the type of procedure and can take between 30 mins and 3 hours to complete.

[Test] Procedure Description

What does an angiogram involve?

A specialist will carry out the angiogram procedure. Once you have been injected with Contrast Media the radiographer will take a number of x-rays to demonstrate the specific areas highlighted by the dye.

Detail the specific steps during an angiography

During a typical procedure a local anesthetic will be applied to the site of catheter insertion (arm or groin). If the procedure is particularly complex, or the patient is very young, sedation may also be required.

A thin tube, called a catheter is inserted, via a small incision, into an artery, usually located in your wrist or groin. The radiographer will use x-ray imaging to ensure that the catheter is positioned correctly before injecting the contrast media into the bloodstream.

Patients may experience the following sensations as the contrast agent moves through the body:

  • Warmth
  • Mild burning
  • A metallic taste or smell
  • An temporary urge to pass urine

Some patients may also suffer a small amount of bruising where the catheter is inserted.

Post Angiogram Instructions

What are the Recovery Details?

After the procedure you will need a few hours of rest, to allow the effects of the anesthetic to start to wear off and to prevent any bleeding from the catheter insertion.

Some patients may be asked to stay in hospital overnight for observation, but most will be able to go home after a couple of hours.

You will need a friend or family to stay with you as it usually takes eight to twelve hours before patients feel healthy enough to resume normal activities.

Can I Drive Home?

You will need someone to pick you up from the hospital as there will be an increased risk of bleeding from the catheter site for many hours. Patients should also abstain from any alcohol or the operation of any machinery for at least twenty-four hours after the procedure.

Resources

Diagnostic Imaging Pathways. (2013). Information for Consumers: Angiography (Angiogram). In Imaging Procedures. Retrieved from http://www.imagingpathways.health.wa.gov.au

Healthcare Imaging Service. (2016). Angiography. In Services. Retrieved from http://www.healthcareimaging.com.au

NHS Choices. (26 January, 2015). Angiography. In Health A-Z. Retrieved from http://www.nhs.uk/conditions

Angiography Information Sheet

What is an Angiogram?

An angiogram is an x-ray procedure which examines the arteries of the body. The procedure will be explained to you and you will be required to sign a consent form, so that you understand what is involved. Before the angiogram begins the Doctor will inject a local anaesthetic into the right side of the groin which will make your groin numb. A thin plastic tube called a catheter will be passed into the artery in the groin and advanced up to the artery that needs to be examined, you should not feel any discomfort. When the catheter is in the correct position contrast will be injected into the artery and x-rays taken to visualize the artery.

Patient Preparation

  • Drink approximately half a litre of water (2 glasses) during the hour prior to appointment (you may go to the toilet).
  • No fasting ‐ eat your normal diet and take normal medication.
  • Bring your Medicare card and any x-rays.
  • Bring a list of medications which you are currently taking and list any allergies.
  • You should not drive home.
  • You will be here for about 3 hours.
  • Bring reading material or music headsets to help pass the time post-procedure.

After the Angiogram

  • The catheter is removed after the angiogram is finished. You will then need to stay in our department for 1.5 to 2 hours to lie flat and prevent a bruise to the groin.
  • Have someone drive you home if possible.
  • Rest at home for the remainder of the day. There should be no heavy lifting for 24 hours following the angiogram.