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This leaflet tells you about the procedure known as angiography (or having an angiogram), explains what is involved, and outlines the possible risks. It is not meant to replace informed discussion between you and your doctor, but can act as a starting point for such a discussion.
If the angiogram is a pre-planned procedure, you should have plenty of time to discuss the situation with your consultant, the radiologist doing the angiogram, and perhaps even your own GP. If you need the angiogram as an emergency, there may be less time for discussion, but you should still have sufficient explanation before you sign the consent form.
What is an Angiogram or Angioplasty?
An angiogram is a special X-ray examination of blood vessels. Normally, blood vessels do not show up on ordinary X-rays.
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By injecting a special dye, called contrast medium, into an artery through a fine plastic tube called a catheter, and taking X-rays immediately afterwards, detailed images of arteries and veins can be produced.
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If necessary, it is possible to relieve a blockage in a blood vessel or to stop bleeding from an artery without an operation.
Angioplasty and Stenting:
A catheter is inserted through the blockage in the vessel, and a special balloon can be inflated to open up the blockage (angioplasty), or a metal “spring” (stent) can be placed to keep the blood vessel open. This allows more blood to flow through it.
Embolisation:
If your procedure is being done because of bleeding from an artery, this can be stopped by blocking the artery with the aid of a coil or tiny particles (embolisation).
Why Do I Need an Angiogram/Angioplasty?
Your doctors feel that there may be a problem with part of your circulation. Other tests, such as Doppler ultrasound, provide useful information, but it is felt that an angiogram is the best way of obtaining the required detail in your case. At the same time as the angiogram, it is possible to perform other procedures such as angioplasty, stenting, or embolisation.
Who Has Made the Decision?
The doctors in charge of your case and the radiologist doing the angiogram will have discussed the situation and feel that this is the next step. You will have the opportunity for your opinion to be taken into account, and if, after discussion, 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 expertise in using X-ray equipment and interpreting the images produced. They need to look at these images while carrying out the procedure.
Where Will the Procedure Take Place?
Generally in the X-ray department, in a special “screening” room adapted for specialised procedures. Sometimes the procedure may be done in the operating theatre.
How Do I Prepare for an Angiogram?
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You will be asked to come into hospital either as a day case or for admission to the vascular ward.
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You are allowed to eat on the morning of the procedure, but we advise against having a large, heavy breakfast (you will be given more information about this).
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You will be asked to put on a hospital gown.
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Allergies: If you have any allergies, you must let your doctor know.
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Contrast Reaction: If you have previously reacted to intravenous contrast medium (the dye used for kidney X-rays and CT scanning), you must also tell your doctor about this.
What Actually Happens During an Angiogram?
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Preparation: You will lie on the X-ray table, generally flat on your back. A needle will be put into a vein in your arm for the radiologist to give you a sedative or painkillers. Monitoring devices may be attached to your chest and finger, and you may be given oxygen.
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Sterility: The radiologist will keep everything sterile, wearing a theatre gown and operating gloves. The skin near the point of insertion, probably the groin, will be cleaned with antiseptic and covered with a theatre towel.
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Catheter Insertion:
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The skin and deeper tissues over the artery will be anaesthetised with local anaesthetic (numbed).
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A needle is inserted into the artery.
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A guide wire is placed through the needle and into the artery, and the needle is withdrawn.
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The fine, plastic tube (catheter) is then placed over the wire and into the artery.
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Imaging & Treatment:
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The radiologist uses the X-ray equipment to position the catheter correctly.
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The special dye (contrast medium) is injected through the catheter, and X-rays are taken to show the areas of interest (seen on a screen above the bed).
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If treatment is needed for a blocked or bleeding vessel, the wire and catheter are positioned, and a balloon may be inflated, a stent left in place, or a coil injected. This may be done several times.
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Removal: Once the required information is obtained, the catheter is removed. The radiologist will press firmly on the skin entry point for several minutes to prevent any bleeding.
Will It Hurt?
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When the local anaesthetic is injected, it will sting initially but soon wears off, leaving the area numb. After this, the procedure should not be painful.
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A nurse or clinical staff member will be present. If it becomes uncomfortable, they can arrange for painkillers through the needle in your arm.
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As the contrast medium passes around your body, you may feel a warm feeling, which soon passes off. You may also feel as if you have passed water; this should not concern you.
How Long Will It Take?
Every patient’s situation is different, but as a guide, expect to be in the X-ray department for about an hour and a half altogether.
What Happens Afterwards?
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You will be taken back to your ward on a trolley.
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Nurses will carry out routine observations (pulse, blood pressure) and check the skin entry point for bleeding.
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You will generally stay in bed for a few hours until you have recovered.
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You may be allowed home on the same day or kept in hospital overnight.
Are There Any Risks or Complications?
Angiography is a very safe procedure, but some risks and complications can arise:
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Bruising (Haematoma): A small bruise around the insertion site is common. Rarely, the bruise may become very large and uncomfortable.
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Bleeding: Sometimes there may be bleeding at the site, which may require an operation to stop it.
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Artery Damage: Occasionally, the catheters, wires, and balloons may damage an artery. This can sometimes be treated by the radiologist during the angiogram, but may require an operation.
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Procedure Failure: The procedure may not succeed and can sometimes lead to further blockages in the artery, which may need an operation to fix.
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Stroke: Very rarely, angiography can carry the risk of causing a stroke, especially if the test is done to look at the arteries going to your brain.
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Kidney Damage: The dye used may cause damage to the kidneys. If your kidney function is normal, this is highly unlikely. If it is not normal, special measures will be taken to protect your kidneys.
Despite these possible complications, the procedure is normally very safe and is carried out with no significant side effects at all.
What Can I Do to Help?
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You will need to lie still while the procedure is performed.
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After the procedure, you will have to remain in bed for a period to avoid bleeding at the puncture site.
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You can also help to improve your general health by:
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Taking regular exercise.
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Stopping smoking.
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Reducing the fat in your diet.
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This may help slow down the hardening of the arteries and may avoid the need for further treatment in the future.
Finally…
Some of your questions should have been answered by this leaflet. Remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure before you sign the consent form.
Angiography is considered a very safe procedure, designed to obtain sufficient information about your circulation to allow you and your doctors to make an informed decision about your future treatment.
Legal Notice Please remember that this leaflet is intended as general information only. It is not definitive, and the RCR and the BSIR cannot accept any legal liability arising from its use. We aim to make the information as up-to-date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on the procedure or any concerns you may have with your doctor.
Prepared by the British Society of Interventional Radiology (BSIR) and the Clinical Radiology Patients’ Liaison Group (CRPLG) of the Royal College of Radiologists. (July 2000)
WPR16071 Feb 2008
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