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Angiography

By

Mehmet Kocak

, MD, Rush University Medical Center

Last full review/revision Apr 2021| Content last modified Apr 2021
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Procedure for Angiography

Before the angiography procedure, people are usually asked to refrain from eating and drinking for 12 hours.

For the procedure, people lie on an x-ray table (one that x-rays can easily pass through). Because the table may be tilted, straps may be applied across the chest and legs. X-ray cameras can be positioned as needed. Electrodes are placed on the chest to monitor the heart. Blood pressure and oxygen levels are also monitored.

After injecting a local anesthetic, a doctor makes a small incision, typically in the groin or sometimes in the arm. Then a thin, flexible tube (catheter) is inserted, usually into an artery, and is threaded through blood vessels to the area being evaluated. When the catheter is in place, a radiopaque contrast agent Radiopaque Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more (a liquid that contains iodine and can be seen on x-rays) is injected. The contrast agent flows through the blood vessels and outlines them. The images appear on a video screen and are recorded. Thus, doctors can assess the structure of blood vessels and identify any abnormalities present.

Before angiography, people are often given a sedative intravenously to help them relax and remain calm, but they remain conscious during the procedure. During the procedure, people may be asked to take deep breaths, hold their breath, or cough. People should report any discomfort they feel.

Angiography may take less than an hour or several hours, depending on the area of the body being evaluated and the type of the examination or procedures being done. It is usually done as an outpatient procedure.

If the catheter is inserted into an artery, the insertion site must be steadily compressed for 10 to 20 minutes after all the instruments are removed. Compression reduces bleeding and bruises. Alternatively, a small closure device may be used to seal the hole in the blood vessel. People may also need to lie flat for several hours after the procedure to help prevent bleeding. Rarely they need to stay overnight in the hospital. For the remainder of the day, they are advised to rest and to drink extra fluids to help eliminate the contrast agent from the body.

Uses of Angiography

Angiography is used to check for abnormalities in blood vessels, usually arteries. Abnormalities may include

During angiography, procedures to treat the abnormalities detected can sometimes be done:

  • Narrowed arteries can be widened.

  • Blockages can be removed.

  • A tube made of wire mesh (stent) can be placed to keep an artery open.

  • Tears or weakened areas in a blood vessel can be repaired.

  • Blood flow to tumors or arteriovenous malformations can be blocked.

Variations of Angiography

Arteriography

This term refers to imaging of arteries. It is the most common type of angiography.

Venography

Digital subtraction angiography

X-ray images of blood vessels are taken before and after a radiopaque contrast agent Radiopaque Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more is injected. Then a computer subtracts one image from the other. Images of structures other than arteries (such as bones) are thus eliminated. As a result, the arteries can be seen more clearly.

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Disadvantages of Angiography

For some people, the procedure is uncomfortable. In a few people, allergic-type reactions Allergic-type contrast reactions During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more to the contrast agent occur. The injection site may bleed, become infected, or be painful. Rarely, the catheter damages a blood vessel.

Serious complications, such as shock, seizures, kidney damage, and sudden stopping of the heart’s pumping (cardiac arrest), are very rare. Sometimes during cardiac catheterization, the heart skips beats or slows briefly.

The risk of complications is higher in older people, although it is still low.

The dose of radiation Risks of Radiation in Medical Imaging Imaging tests that use radiation, usually x-rays, are a valuable tool in diagnosis, but exposure to radiation has some risks (see also Radiation Injury). Different diagnostic tests require different... read more used in angiography varies depending on the procedure but typically is much higher than in plain x-ray tests. For example, the radiation dose in coronary angiography is 350 to 750 times as much as that used in a single-view plain x-ray of the chest.

Angiography is not always readily available. It must be done by highly skilled doctors.

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