Angiogram

What is an angiogram?
An angiogram is an x-ray examination of the blood vessels (arteries and veins).  An Interventional Neuroradiologist performs this using fluoroscopy (x-ray) guidance. 

During the angiogram, you are awake, but are given medications to help you relax.  A thin tube (catheter) is placed in the femoral artery (groin area) through a small nick in the skin about the size of the tip of a pencil.  The catheter is guided to the area to be studied.  A contrast dye is then injected into the catheter while taking x-rays 1of the area.  The contrast makes the artery visible on the x-ray.  In most cases, several contrast injections and several pictures are needed to complete the examination.  Once the angiogram is complete the catheter is removed.  Pressure will be put on the place where the catheter was for 10 to 20 minutes.  The pressure stops the artery from bleeding. 

In most cases the angiogram takes one to two hours to complete.

 

Why an angiogram?
Angiography is used to image the blood vessels and the blood flowing through them.  It is used to detect abnormalities of the blood vessels.  An angiogram can identify exactly where an artery is blocked, how severe the blockage is and what is the cause of the blockage. An angiogram is used to detect cerebral aneurysms as well as other vascular abnormalities. 

An angiogram is used as part of a treatment for some conditions such as embolization of an aneurysm or blocking the blood supply to a tumor or vascular malformation prior to surgery. 

An angiogram is also used to find the cause of cerebral bleeding or to check to see if a prior treatment has been successful. 

An angiogram helps diagnose the cause of symptoms such as severe headache, memory loss, slurred speech, dizziness, blurred or double vision, weakness or numbness, or loss of coordination or balance.

 

What are the benefits and risks of an angiogram?
Benefits: 
Angiograms give a very detailed, clear and accurate picture of the blood vessels (arteries and veins).

Results from an angiogram are more accurate than other imaging studies (ie carotid ultrasound) to identify vascular issues.

Unlike a CTA or MRA, the use of an arterial catheter makes it possible to combine a diagnosis and treatment in a single procedure.

 

Risks:
All medical procedures carry some risks.  The risks of angiogram are very small.  Risks may include bruising, internal bleeding, hematoma or damage to the artery at the catheter insertion site and a small risk of stroke.  Allergic reaction to the contrast dye may cause a rash, swelling, difficulty breathing or heart problems. 

All efforts are made to ensure these risks are minimal.  Our Nurse Practioners and Interventional Neuroradiologists will discuss your specific risks with you prior to the angiogram.

 

How do I prepare for an angiogram?
Before
An angiogram requires a pre-operative history and physical.  You should have this scheduled with your primary care physician within 30 days of your scheduled procedure.  Blood work will need to be drawn within 14 days of your scheduled procedure.  Blood work needed includes BUN, creatinine, platelets, hemoglobin, potassium, sodium and INR.

Eating:  Do not eat or drink anything for 6 hours prior to your procedure.  Maintain hydration – drink extra fluids for 2 days prior to your procedure, unless you are on fluid restrictions from your physician.

Medication:   Medications can be taken in the morning with a sip of water.  Please bring a list of your medications with you to your appointment.

  • If you are a diabetic and take Glucophage (Metformin) do NOT take your morning dose.  If you take insulin, ask your doctor about modifying your insulin dose for the day of the angiogram.

  • If you are taking blood thinners (Coumadin/Warfarin, Pradaxa/dabigatran, Aggrenox/aspirin/dipyridamole (or similar medications) ask your doctor about stopping these medications at least 5-6 days prior to your procedure.   Please let us know if you are taking clopidogrel (Plavix) or prasugrel (Effient). 

  • If you are taking aspirin DO NOT stop this medication prior to the procedure

Allergies:  If you are allergic to contrast dye, please let us know.  You will need to take a prescription steroid medication methylprednisolone (Medrol) and diphenhydramine (Benedryl) prior to your procedure. 

Kidney Function:  If you have a history of renal insufficiency (an increased creatinine level or a decreased GFR) please let us know as you may need to be pretreated with Mucomyst (a medicine that helps to protect your kidney function).  Ask your primary care physician about with holding potential nephrotoxic medications you may be taking prior to your procedure.

Smoking:  No smoking for 72 hours prior to your procedure.

Driving:  You will not be allowed to drive for 24-48 hours after your angiogram.  You will need a driver to take you home after the procedure.

 

What happens on the day of the angiogram?
You will register in Radiology Registration 1 ½ hour prior to your procedure time. 

You will change your clothes and wear a hospital gown.

A nurse will review your health history as well as your medications and allergies.

You may need blood drawn, if not already completed within 14 days of your procedure.

You will have an IV started in your arm.  This will allow us to give you sedation for your angiogram. 

You will be asked to empty your bladder.

A Nurse Practitioner and the Interventional Neuroradiologist will meet with you to review the risks and benefits, answer any questions you may have and have you sign a consent form.

 

During

You will be taken by cart to the angiogram suite where you will be transferred to an x-ray exam table.  

Your heart rate and blood pressure will be monitored.  Your groin will be shaved, prepped and draped.  The Interventional Neuroradiologist will numb the area with a local anesthetic.

A small nick is made in the skin over the femoral artery.  Using x-ray guidance (fluoroscopy) a thin, small tubing (catheter) is inserted through the skin into the blood vessel and guided to the area to be examined (neck, head or spine).  The contrast is then injected though the catheter – you may feel a warm flush and/or a metallic taste in your mouth.   As the contrast flows through the blood vessels, several set of pictures are taken. 

At the end of the angiogram, the catheter is removed and pressure is applied to the groin puncture to stop any bleeding.  The opening is then covered with a dressing. 

You will be transferred back to the recovery area for observation.

 

After
While in the recovery area, nurses will periodically check your vital signs and the incision site. 

You will remain flat for minimally 3 hours after your angiogram.  After that you will be gradually allowed to get up.  Lightheadedness and dizziness may occur if you get up too quickly.

You will be allowed to eat.  You will be encouraged to drink lots of fluids.

 

Aftercare

  • It is important to drink plenty of fluids for the next several weeks.  This will help to avoid headaches. 

  • Gradually increase your activity as tolerated.

  • You should avoid lifting objects heavier than 10 pounds for 5 days

  • Avoid bending your leg at the hip and straining. 

  • Support your groin site with your hand when you cough, climb stairs or change positions for the first 48 hours following your procedure.

  • Keep the puncture site dry.  If you have bleeding or swelling under the skin, lie down and put firm pressure slightly above the puncture site for 10 to 20 minutes.  

  • You may shower 24 hours after your procedure.  Gently wash the site with warm water.  Dry gently.  If there is still a slit in the skin cover with a bandage until it closes.  Your may shower.  Do not take tub baths, or swim in lakes of pools until your puncture site is healed without a scab.

Because of the sedation given to you for your angiogram, you should not do the following for 24 hours after your procedure:

  • Drive a motor vehicle

  • Drink alcoholic beverages.

  • Make critical decisions or sign important documents.