What is an Angiogram?
An angiogram is an imaging technique used to identify a narrowing or blockage in an artery by injecting dye (contrast) into the artery and taking X-rays. (See figure 1) A standard angiogram is performed as a daycase procedure under local anaesthetic through an artery at the top of your thigh (femoral artery) or your upper arm (brachial artery).
The procedure is typically performed in an angiosuite (X-ray room) or a hybrid operating theatre, which combines the X-ray features of an angiosuite with the operating capacity of a traditional surgical theatre. The choice of which environment your procedure is to be performed in is predominantly dependent on the complexity of your procedure and whether or not concurrent surgery is anticipated.
What is an angioplasty?
Often the operator will advise treatment of any identified narrowing or blockage at the same time as undertaking the angiogram. This is undertaken by passing a thin tube with a balloon attached to one end across the diseased segment and inflating the balloon to stretch the artery back to its normal diameter – angioplasty.
(See figure. 2)
The operator may also elect to place a stent across the stretched lesion. A stent is a small metal mesh tube that acts as reinforcement for the newly stretched artery and helps to prevent recurrence of the narrowing/blockage. The decision to use a stent is based on the pattern and location of disease, and the responsiveness of the narrowed artery to the initial angioplasty.
What are the risks of undergoing an angiogram/angioplasty?
Some of the more common risks associated with undergoing an angiogram/angioplasty are listed below. These do vary between individuals and according to the type, extent and location of disease being treated. Each client will have their individualised treatment plan explained in detail including a full explanation of the risks associated with that treatment. Although the risks appear daunting angioplasty is normally a safe procedure performed successfully with very few complications.
Bruising: an angiogram is an invasive procedure that involves puncturing an artery with a needle and passing wires and catheters through that arterial puncture site. Thus, there will normally be a bruise at the site of the needle insertion which may persist for 2-3 weeks. Occasionally this can be quite extensive, as blood thinning medication may have been necessary during your angioplasty, and extend into your genitalia and thigh.
False aneurysm: Occasionally a bruise continues to be fed by tiny jet of blood from the artery puncture creating an expanding bruise (false aneurysm). This may require treatment either in the form of an injection into the bruise or if very large an open surgical procedure to repair the artery itself.
Embolisation: Sometimes during an angioplasty debris or newly formed clot at the site of the treated artery can break off and travel downstream (embolism) and lodge in the arteries of your calf or foot. These can often be retrieved at the time of occurrence, but on the very rare occasions they cannot and are also causing a significant reduction in the blood flow to the foot emergency surgery is required.
Kidney injury: The contrast media used to visualise the artery on the X-ray machine is excreted through your kidneys. Patients with underlying kidney disease may suffer a further deterioration in their kidney function as a result of the contrast injuring the kidney filtration system. This is temporary in the vast majority of cases, but can occasionally cause permanent damage to the kidneys leading to the requirement for dialysis. Prior to your angiogram your kidney function will be assessed to guide your requirement for prophylactic therapy to help prevent this complication.
Allergic reaction: Some clients may have an allergy to the contrast media or other materials used during these procedures which has not been previously identified. On rare occasions an anaphylactic reaction can occur requiring emergency treatment.
Arterial injury: undertaking an angioplasty involves inflating a high-pressure balloon within a narrowed artery. On rare occasions this causes rupture of the artery and bleeding. We can often treat this complication with the placement of stent-graft (covered stent) across the bleeding point. However, on occasion an emergency operation is required to gain control of and repair the damaged artery.
Pain/discomfort: An angiogram/angioplasty is an invasive procedure and despite all the efforts made by our operators to reduce the amount of discomfort experienced by our clients some clients will experience a degree of discomfort during their procedure. If the procedure does become uncomfortable then your team will arrange for you to have painkillers. If the procedure becomes too uncomfortable we will stop and arrange for you to have a further meeting with your supervising consultant to discuss alternative treatment options.
Miscellaneous: Often during the injection of contrast into your artery you have a sensation of passing urine; this is entirely normal and is relieved very quickly.
How do you close the artery at the end of the angiogram/angioplasty?
There are two main methods of closing the artery and the technique employed depends on location of the arterial puncture and level of disease affecting the artery punctured. Many operators opt to press on the puncture site until the bleeding stops on its own accord. Alternatively, a closure device may be inserted into the artery to close the defect; these are eventually reabsorbed by the body. Depending on the technique used depends on how quickly you can mobilise after the procedure.
Is there anything I should look out for after the procedure?
Please check you wound every 30 minutes when awake for the first 24 hours post-procedure. Very rarely you may see fresh blood from the wound or notice a swelling developing under the skin. If this occurs ask your partner or the person who is staying with you for 24 hours to apply firm pressure for 5 minutes over the site. If despite this there continues to be ongoing bleeding or increased swelling we advise you to contact the emergency services.
If your leg or foot becomes very painful, cold or numb we advise you to seek medical advice through the emergency services.
When can I return to normal activity?
You can return to normal day to day living activities 48 hours after your procedure but we advise you to resist the temptation to undertake strenuous exercise for one week following the procedure.
When will I be able to drive?
You should refrain from driving for 3 days following your procedure. If you are undergoing a daycase procedure we ask you to ensure somebody is available to drive you home after and remain with you for 24 hours post-procedure.
When will I see my surgeon again?
Typically, your surgeon will organise to review you 4-6 weeks after your angiogram/plasty. This may vary according to individual client requirements.
Figure 1: Right leg percutaneous angiogram of the popliteal (knee) artery
Figure 2: Right leg popliteal artery angioplasty