Medical

Heart

Angiogram

Article 1

What Is An Angiogram

An angiogram is an examination of your blood vessels using x-rays. A doctor specially trained in interventional radiology performs this procedure in the Special Procedures Department. The doctor will insert a small tube (catheter) into the blood vessel and then he/she will inject x-ray dye (contrast) that makes the vessels visible when the x-ray pictures are being taken. This will then allow the doctor to determine how well the blood moves through the vessels of your brain, lung, abdomen, arms or legs.

Why Do I Need An Angiogram?

You need an angiogram because your doctor suspects there is abnormal blood flow in one or more of your vessels. By injecting contrast through a catheter into your vessels and taking x-ray pictures, the radiologist is able to see if there is a problem and help your doctor plan a method of treatment for you.

What Happens When I Get To The X-Ray Room?

In the x-ray room you will see lots of special equipment. The staff will position you on the x-ray table and begin to prepare you for the procedure. This includes monitoring of your heart and blood pressure. If you don't already have an IV (intravenous line), the nurse will start one so that you can receive fluids and medications during the procedure.

What Is An Angiogram Like?

An angiogram involves three major steps: 1) insertion of a catheter (small tube) into your body, 2) taking x-ray pictures while contrast (x-ray dye) is being injected into a vessel, and 3) removal of the catheter.

Catheter insertion: The staff will clean your skin with cold soap where the doctor will place the catheter. This is usually at the top of the leg (groin) or the upper arm. You will then be covered with a sterile sheet. Next, the doctor will use a small needle to numb your skin where the catheter will be inserted. The nurse will give you medications in your IV to relieve the pain and allow you to relax. You may feel pressure or brief discomfort as the catheter goes in. The doctor will guide the catheter through the body to the vessel that is to be studied by watching it on a TV-like monitor. You will not feel the catheter moving through your blood vessels.

Taking x-ray pictures: Once the catheter is in the correct vessel, contrast will be injected through the catheter while x-ray pictures are being taken. You may feel hot inside when the contrast is injected, but the sensation only lasts a few seconds. Several series of contrast injections and x-ray pictures may be needed to complete the examination.

Removal of the catheter: When the angiogram is completed, the doctor will remove the catheter from your blood vessel. He/she will apply pressure for 10-15 minutes over the catheter site to prevent bleeding. A bandaid will be placed on the insertion site. The angiogram usually takes one or more hours to complete. The radiology staff will always be nearby to keep you comfortable and answer any questions you may have.

How Do I Get Ready For My Angiogram?

If you are already a patient in the hospital your doctors and nurses will give you instructions on how to get ready for your angiogram. If you are not already a patient in the hospital you will be admitted to the Day Hospital Unit either the day before, or on the morning of your test. It is important that you do not eat or drink anything after midnight before your exam. You may have a small amount of water or another clear liquid with any medications you need to take. Be sure to ask your doctor if you have any questions about eating or drinking before your exam.

Prior to your angiogram you will be visited by a doctor from the Radiology Special Procedures Department who will explain the procedure to you. At that time you should ask any questions you may have about the angiogram. If you have any allergies or problems with medications, or think you might be pregnant, you should let the doctor know. If you are allergic to X-ray dye, iodine, or shellfish, it is important to let your doctor know as soon as possible. You will be asked to sign a special form giving the doctor permission to perform the angiogram.

Everyone having an angiogram will have blood tests done prior to the procedure. Your groin will also be shaved on one or both sides where the doctor will insert the catheter. Sometimes the arm may also be prepared in this way. You may be asked to remove jewelry and dentures. You will be asked to put on a hospital gown. It is a good idea to go to the bathroom before you leave your room. You will then be taken to the Special Procedures Department by stretcher. While this examination is being done, your family can wait in your room or in one of the hospital waiting areas.

What Do I Do After My Angiogram?

When you return to your room you will be asked to stay in bed with your leg straight or your arm immobile for 6-8 hours. If you have any swelling, tingling or pain, or feel something wet at your puncture site, call the nurse for assistance. A nurse or nursing assistant can help you with a bedpan or urinal while you are on bed rest. You should be able to resume your regular diet following the procedure. You are also encouraged to drink plenty of fluids. The X-ray pictures will be studied by the radiologist (doctor who specializes in reading and interpreting X-rays) and a report will be sent to your doctor who will discuss the results with you and answer your questions.

Article 2

What is an angiogram?

An angiogram is simply an x-ray image of blood vessels after they are filled with a contrast material. A coronary angiogram is the "gold standard" for the evaluation of coronary artery disease (CAD). A coronary angiogram can be used to identify the exact location and severity of CAD.

How is a coronary angiogram performed?

Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not terribly uncomfortable. During a coronary angiogram, a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery in either the groin or the arm. Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with x-ray images) is injected into each coronary artery. The images that are produced are called the angiogram.

The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm is either sutured, "sealed," or treated with manual compression to prevent bleeding.

What does a coronary angiogram demonstrate?

Angiographic images accurately reveal the extent and severity of all coronary artery blockages. For patients with severe angina or heart attack (myocardial infarction), or those who have markedly abnormal noninvasive tests for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty, coronary stenting, atherectomy ("roto-rooter"), or coronary artery bypass surgery . The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions. In appropriate patients, the therapeutic information learned from the angiogram is far more valuable than the relatively small risk of the procedure. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of experienced physicians, this risk is quite small (well below one per cent).