Angiography or Angeiography

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Angiography- aka angeiography, balloon and stent procedure, blood vessel x-rays, angiogram

 

What is it?

Angiography is an x-ray study of a patient’s blood vessels.  The angiogram uses a type of contrast so that the patient’s blood vessels are visible when an x-ray is taken.  Most radiographic contrasts use iodine as a key ingredient. 
This test is used by doctors to look for problems in the blood vessels, such as blockages and narrowing in a person’s blood vessels.  It’s often looked at in organs and throughout a patient’s circulatory system.  This procedure is often used to look for different problems a patient might have, such as diagnosing heart disease, atherosclerosis, evaluating functions of the kidneys, mapping anatomy of the renal area in donors for transplants, to look for an aneurysm, a tumour, blood clot, or an abnormal tangle of veins and arteries in a patient’s brain, and to look for and diagnose any problems that a patient has with the retina of their eye.  Surgeons also use it as a vascular map of a patient’s heart before performing open-heart surgery.  It is also used to look at a person’s brain before neurosurgery.  If the patient has had a penetrating trauma, such as a knife wound or a gunshot, it can be used to see whether or not there is injury to blood vessels. 

 

The Operation

The contrast medium that is required for this test is injected into the person’s body through something known as arterial puncture.  Usually the puncture is made through a patient’s neck, groin area, armpit, or the inside of their elbow.  When this test is scheduled, the patient should not eat or drink eight hours before the procedure.  They will be required to take off all their jewellery and change out of their street clothes and put on a hospital gown.   If the puncture will be made in the groin or the armpit, the patient may need to be shaved.  The patient may be given a sedative so that they are relaxed, and an IV will be inserted before the procedure starts.  This is in case the surgeon needs to administer blood products or medication. 

Before the procedure

 The patient will be told about the test, the risks and benefits, and the complications that may arise.   They will need to sign a form to show that they are informed of what could happen.

 

The area will be cleaned and a local anaesthetic will be injected in the site.  Then the surgeon will make a small incision in the skin to allow the needle to pass.  The needle that is inserted will have a solid inner core that is known as stylet will be inserted into the patient’s artery.  When the artery has been punctured, the stylet will be removed and it will be replaced with something known as a guide wire.  The patient may see blood spurting from the needle - don’t worry, this is normal.

 

The guide wire will then be fed through the outer part of the needle into the artery, going to the place where the angiographic study is needed.  A fluoroscope will display the view of the person’s vascular system and will be used to make sure the guide wire gets to the right spot.   When the wire is in the right spot, the needle will be removed and a catheter will be threaded over the length of that guide wire until it’s at the study area.  Then, the guide wire will be removed and the catheter will be left in place to prepare for the contrast medium to be injected.

There are two ways for the contrast medium to be injected, and they depend on what type of procedure is being done.  The contrast medium may be injected by hand through a syringe, or it’s injected with something called an automatic injector.  The automatic injector is something that is attached to the catheter.  This is used more frequently because of its ability to inject a big amount of contrast quickly to the site of angiography.  A small injection may be done to make sure that the catheter is where it needs to be and the positioning is correct.  When the injection is about to start, the patient will be told to keep very still.  The patient may feel some discomfort, which can be mild or moderate.  The possible reactions or side effects of the medium are irregular heartbeat, dizziness, nausea, burning sensation, chest pain, and headache.  Fortunately, these are only temporary and go away.  In order to see the area from different perspectives and angles, the radiologist may ask the patient to change their position and they may need to have more than injection. 
After the x-rays are finished, the catheter is removed, slowly and carefully.  When the catheter is out, something heavy will be applied to the site to allow the blood to clot and the puncture in the artery to reseal.  This is held for anywhere from 10 to twenty minutes.  After the pressure is removed, a pressure bandage will be applied.

 

The procedure may differ, depending on the area that is being studied.

 

After the surgery - In the hospital

Due to the possibility of internal bleeding, it is sometimes suggested that the patient in the hospital overnight, especially if it was a coronary or cerebral angiography.  If it’s done as an outpatient, the person is usually observed for anywhere from six to twelve hours before they are released.  If the femoral artery was punctured, the patient is told to keep their leg straight and as immobile as possible while they are being observed.  The vital signs and blood pressure of the patient are carefully monitored and the site of the puncture is observed.  If the patient has pain from the puncture wound, they may be given pain medication, and an ice pack may be applied so that swelling is kept to a minimum.   It’s normal to have soreness at the site of the puncture, and the patient may experience bruising.  It’s also possible for the patient to develop a hematoma at the site of the puncture, which is a very hard mass that is created by the blood vessels that have been broken.  A hematoma needs to be watched closely.

 

 

After the operation- At Home

Once the patient has been released, they are often advised to take a few days to rest.  This keeps them from putting any stress on the site of the puncture.  If the patient experiences abnormal swelling or continued bleeding, chest pain or sudden dizziness after they have had the procedure, they need to see a doctor right away.

 

 

Possible Complications
 

There are quite a few complications that may be associated with this procedure due to the fact that it punctures an artery.  Here are some of the possible complications:

bleeding

haemorrhage

stroke

heart attack

infections

hematoma

swelling

bruising

difficulty breathing

heart failure

drop in blood pressure

 

 

General Advice

 

Even though there seems to be a lot of risks that are involved with this procedure, sometimes it’s the only way to be certain about what is wrong with a patient.

 

 

 

Estimated Costs for Angioplasty

 

Country Costs  Angiography
USA $520-1000
India $500
Malaysia $500
Singapore $1000
Thailand $750

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