What is an Angiogram Procedure?
Angio meaning these are related to the blood vessels. Gram refers to a record or picture. An angiogram is a procedure to make the arteries visible for the doctor to see blood flow through the arteries.
Angiograms are used to diagnose and determine treatment options for Peripheral Arterial Disease (PAD). PAD is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and extremities. PAD usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach.
Over time, cholesterol and plaque can harden and narrow the arteries. This reduces the amount of blood that can flow through them and limits the flow of oxygen-rich blood to your organs and other parts of your body like your legs. This is why many patients complain about leg pain caused by poor circulation. This pain can occur with activity (claudication) or while at rest.
What to expect?
Preoperative Clinical Evaluation
Detailed history needs to be obtained:
- Primary Medical History including risk factors such as high blood pressure
- Previous surgical history
- Social History including the use of tobacco products/nicotine-containing products
- Details about symptoms the patient is experiencing
Careful physical examination is mandatory
- Pulses in the affected extremity
- Temperature and color of the extremity
- Presence of slow healing or non-healing wounds/ulcerations
- Various examinations to rule out any other possible vascular conditions.
Initial Diagnostic Testing
- Duplex(Ultrasound) Study of the Extremity
- ABI readings in the lower extremities
What to expect during this procedure?
This is a minimally invasive outpatient procedure requiring no hospital stay with a short recovery period. Most procedures allow patients to return to normal activity within a few days.
Medicine will be administered through an IV to keep you comfortable but awake. Local anesthetic is usually given in the area where a needle/sheath will be inserted into the artery. The catheter is threaded through this needle. You will feel pressure/pain when the sheath punctures the skin. The sheath allows the procedure to be completed within the artery.
During the Angiogram procedure, a dye will be injected through the sheath into the arteries. The dye allows the doctor to view your arteries on an X-ray monitor. You may experience a warm/burning sensation when in the region where the dye is injected. You will be asked to stay still and not move so that the images that are taken will be clear so that areas of plaque build-up can be identified.
Additional images may be taken with the use of a special catheter that has an ultrasound device on the tip. This is called IVUS (Intravascular Ultrasound) and is used to gather more detailed information about the amount of plaque or blockage inside the artery.
Once the area of plaque has been identified several treatments are an option.
- Atherectomy: A device that helps to remove or lessen the amount of plaque inside of the artery.
- Angioplasty: A device with a small balloon on its tip is then inserted through the sheath into the artery in your leg or arm until it reaches the area of plaque(blockage) that needs to be treated. The balloon is inflated to flatten the plaque against the wall of the artery, opening the artery and restoring blood flow. Then the balloon is deflated and removed from your body.
- Stent placement: A stent is a small metal/mesh tube that is inserted into the artery through the sheath then expanded to open the artery in the area of the blockage. Once the stent is expanded it acts as a scaffold to support the artery and keep it open. All stents are permanent once placed inside the artery.
Lower level anesthesia: Patients receive minimal anesthesia delivery under constant monitoring. Transportation home will be required despite a lower level of sedation
Refrain from any heavy lifting (i.e. no more than 10 pounds), straining, pushing or impact exercises (i.e. running, jogging, cycling) for the first 5 days. You may walk and climb steps so long as you do not have excessive bruising, swelling or pain at the puncture site. You may resume driving the next day after the procedure.
You will be discharged with a dressing over the puncture site. This may be removed in 3 days. There are no sutures or staples present at the puncture site. Please inspect the puncture site daily for the first few days and notify us for any significant changes. Bruising around the area may be present and may not appear until a couple of days after the procedure. If you notice bleeding or swelling at the puncture site, apply constant direct pressure over the area and seek medical attention IMMEDIATELY.
Refrain from soaking in a bathtub, hot-tub or pool until puncture is healed.
Benefits of Angioplasty with CVM
There are many benefits to this procedure versus open surgery.
A minimally-invasive procedure has the following benefits.
- Requires no hospital stay with a short recovery period.
- Most procedures allow patients to return to normal activity within a few days.
- Procedures in an outpatient setting allow for continuity of care and higher levels of individual patient care.
- Procedures in an outpatient setting have lower rates of infection.
- A very small incision is used to access the artery.
Risks of Endovascular Procedures
Every procedure entails a certain level of risk. The advent of new technology including minimally-invasive vascular procedure and the experience of vascular doctors helps minimize risk. Here is a list of possible risk factors that may arise.
Any procedure that involves the placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. The chance of any of these events occurring is less than one percent. Precautions are taken to prevent/lower the risk such as the use of sterile technique when performing the procedure and close monitoring during recovery to reduce the risk of bleeding.
Allergy to X-ray Contrast Material
Patients may have an allergic reaction to the x-ray contrast material used during endovascular procedures. These episodes range from mild itching to severe reactions that can affect breathing or blood pressure. Patients having procedures are carefully monitored by a physician and a nurse during the procedure and recovery process. Patients with a known allergy to iodine-based products and/or shellfish can be pretreated to reduce the risk of an allergic reaction. Medications to counteract allergic reactions are kept on-site in the outpatient setting.
Endovascular procedures are done under an x-ray. Exposure levels usually are well below those where adverse effects on the patient or future children would be a concern.
Potential Adverse Effects on the Kidneys
Patients with a history of poor kidney functions are at higher risk of further damage. Blood work will be drawn to help identify patients at risk and levels will be monitored accordingly. IV fluids will also be given during and after the procedure to dilute the dye and filter the dye through the kidneys. CO2 may be used in cases where dye is contraindicated.
Medications to avoid
Medications such as Xarelto, Eliquis, Pradaxa, Coumadin (Warfarin) and injectable Heparin/Lovenox are potent blood thinners that can cause an increased risk of bleeding from the puncture site. We will give specific instructions to hold medications on a case by case basis.
If you take aspirin, Plavix, Cilostazol or Aggrenox, you may continue to use these medications as prescribed and only hold the medication on the day of your procedure.
Diabetic medications will be adjusted and/or held on the day of the procedure.
Please provide updated medication information to your physician so that appropriate and accurate instructions may be provided to you.
Exact procedure time can be difficult to predict and depends on the degree of plaque build up in the arteries. In simple cases the procedure time may only take as little as 45 minutes while more complicated cases may take a few hours. Please be prepared to spend the majority of your day at the facility to allow for optimal outcomes of the procedure and a safe recovery..
Medications will be given through your IV to keep you comfortable and mildly sedated. It is normal to have varying levels of awareness. You will be very closely monitored throughout the procedure to make sure your blood pressure, heart rate and breathing remain stable. It is our goal to not only keep you comfortable but also to keep you safe. We will adjust medications based on your comfort level and vital signs.
Yes. The artery heals after previous procedures and can be punctured again. Scar tissue may be present around these areas and adjustments can be made by the physician if needed. Please notify the physician if you have had any procedures involving closure devices or bypass surgeries in the area the doctor plans to puncture.
Recovery in the office setting ranges from 2-4 hours depending on the area(s) the physician punctures. Medical technology has advanced the past few decades. This is a minimally-invasive procedure, meaning it requires no hospital stays, very limited bleeding, and not an open surgery. The medical staff will direct you on recovery period for your individual needs.