What is an angiogram?
An angiogram is a procedure where x-rays are used to examine blood vessels. Normally, blood vessels do not show up on ordinary x-rays and a special dye, called contrast medium, is injected into the artery through a fine plastic tube called a catheter. X-rays are then taken immediately afterwards, producing detailed images of arteries and veins.
Why do I need an angiogram?
The reason you may require an angiogram is that there may be a problem with your circulation. Previous tests that have been carried out such as a Doppler ultrasound can provide useful information, but it may not be the best way of obtaining the amount of detail required by an angiogram.
Who has made the decision?
The consultant in charge of your case and the radiologist doing the angiogram believe this is the next step. However, you will also have the opportunity for your opinion to be taken into account, and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.
Who will be doing the angiogram?
A specially trained doctor called a radiologist. Radiologists have special expertise in using x-ray and scanning equipment, and also in interpreting the images produced. They will look at these images while carrying out the procedure.
How do I prepare for an angiogram?
You will be asked to put on a hospital gown. As the procedure is generally carried out using the big artery in the groin, you may be asked to shave the skin around this area. You may receive a sedative to relieve anxiety.
If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), you must also tell your doctor about this.
When you arrive, please report to the reception desk at the Radiology Department.
What happens during an angiogram?
You will lie on the x-ray table, generally flat on your back. You may have a needle put into a vein in your arm, so that the radiologist can give you a sedative or painkillers. You may have a monitoring device attached to your chest and finger, and may be given oxygen through small tubes in your nose.
The radiologist will keep everything as sterile as possible, and may wear a theatre gown and operating gloves. The skin near the point of insertion, probably the groin, will be cleaned with antiseptic, and then the rest of your body will be covered with a theatre towel.
The skin and deeper tissues over the artery will be anaesthetised with local anaesthetic, and then a needle will be inserted into the artery. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into the artery. Then the needle is withdrawn allowing a fine plastic tube called a catheter to be placed over the wire and into the artery.
The radiologist uses the x-ray equipment to make sure that the catheter and the wire are moved into the right position, and then the wire is withdrawn. A special dye, contrast medium, is then injected through the catheter and x-rays are taken. Once the radiologist is satisfied that the x-rays show all the information required, the catheter will be removed.
Will it hurt?
Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, standing nearby looking after you. If the procedure does become uncomfortable they will be able to arrange for you to have a painkiller through the needle in your arm. As the dye, or contrast medium, passes around your body, you may get a warm feeling, which some people can find a little unpleasant.
How long will it take?
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. For example, if looking at a large artery in the leg, this could take half an hour, if looking at smaller arteries it may be more complex and take longer, possibly up to an hour. As a guide, expect to be in the x-ray room for two hours altogether.
What happens afterwards?
You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. They will also look at the skin entry point to make sure there is no bleeding from it. You will generally stay in bed for a few hours, until you have recovered. You may be allowed home on the same day, or kept in hospital overnight.
Are there any risks or complications?
An angiogram is a safe procedure, but there are some risks and complications that can arise. There may be a small bruise around the site where the needle has been inserted and this is quite normal. There is a chance that the bruise may become very large and uncomfortable, but this does not happen very often.
If a large bruise develops, there may be a risk of it getting infected, and this would be treated with antibiotics. In some hospitals, a large bruise is treated by having a small operation to drain it. As with any mechanical device, there is also the possibility the catheter may fail. Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side-effects at all.
When will you get the results?
After the angiogram, the images will be examined further by the radiologist, who will prepare a report on their findings.
Some of your questions should have been answered here, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.
© The Royal College of Radiologists, May 2008.