Arteriogram

1. What is an arteriogram [angiogram]?

An arteriogram is a special x-ray that enables us to diagnose a blockage or malfunction in the arteries [deep vessels that convey blood from the heart] of the body. In order to do the test a long fine tube [catheter] is inserted into the artery at the groin. A special dye [contrast] is injected into the tube and x-ray pictures are taken as the contrast passes along the blood vessels. The whole procedure will last approximately one hour and is performed in the x-ray department.

In most of the cases an ultrasound scan had already been performed during the consultation with your specialist. With the ultrasound information, when an arteriogram is arranged, in most of the cases your specialist looks into some form of intervention [i.e. angioplasty] or wants to have a road map of the arteries before the vascular surgeon decides about surgical treatment or not.

Although a pretty good guess can be made with the ultrasound if angioplasty is feasible, it is not that accurate and in most cases you will be informed about the decision to intervene or not during the arteriography.

2. Before the test

    If you are taking warfarin, please stop it three days before the procedure. If you have any queries regarding this please ring the department.

    On the day of the test you may eat and drink as normal. If you take regular meditations please have your usual morning dose. If you are diabetic on insulin please have your normal food and insulin dose.

    On arrival, the doctor [radiologist] who will do the procedure will see you, the test will be explained to you and you will be asked to sign a consent form. This is to ensure you understand the test and its implications. Please tell the doctor if you have had any allergies or bad reactions to drugs on other tests. It would also be helpful to mention to the doctor if you have asthma, hay-fever, diabetes [if you take metformin, the drug should be stopped a week ago] or any heart or kidney problem. The staff would like you to be as relaxed as possible for the test and will not mind answering your queries.

    Diagnostic arteriograms are usually performed as “outpatient” but you will need to remain for up to 4 hours after the procedure.

3. During the test

The radiologist [x-ray doctor] will inject local anaesthetic into the skin at the groin, “freezing” the area. After this the procedure should be painless. The long fine tube [catheter] is then inserted into the artery at the groin and, using the x-rays to help, the radiologist manipulates the catheter into the correct position. Then he will inject the dye to take pictures of the inside of the blood vessels.

You will not feel the catheter being moved around your body. The dye injections may cause hot flushing for a few seconds, and an occasional feeling of wanting to pass water.

When the test is completed the catheter is removed and pressure will be applied to the groin for approximately ten minutes to minimize any bruising.

4. Afterwards

You will remain on your bed to rest for a few hours. It is important that you lie quietly so that the groin does not bleed again. The nursing staff will check the groin and foot pulses at regular intervals. Providing all is well, you will be allowed home, but you need an able bodied person to accompany you home. It is important that you rest completely until the next day to ensure that the puncture site in the groin heals. If after you get home you notice any swelling or bleeding at the puncture site, you should press on this and call your GP’s surgery or the hospital ward for advice.

5. When do I know the result?

The radiologist and vascular surgeon will look at your x-rays at their weekly vascular meeting and discuss the findings. They will decide the best form of treatment for you [i.e. surgery, angioplasty, conservative treatment, etc.] and then write to you or see you again in the outpatient clinic.

Angioplasty

1. What is an angioplasty?

An angioplasty is a procedure where a balloon is passed into your artery on a catheter and is inflated to treat a narrowed or blocked artery. This technique means that surgery may be avoided or postponed for later years in many cases.

As far as you are concerned, angioplasty is very similar to an arteriogram except that we use a slightly bigger catheter and therefore the risks of bleeding are slightly greater. For this reason, plus the small risk of complications, in most cases, you will be asked to stay overnight. Sometimes you will be asked to stop the aspirin you usually take [A common dose is half a tablet [150mg] per day], before you are admitted, as this makes the blood less sticky and the risk of bleeding is slightly higher. If you have an ulcer or bleeding diathesis, please tell your doctor.

2. The procedure

Before the procedure you will be admitted to the ward to check out your general health and to prepare you for your angioplasty.

The procedure is the same as in a simple angiogram but takes a little longer and you may feel the doctor changing and pushing catheters in and out of your groin artery. Although this is occasionally a little uncomfortable, it will not hurt.

Sometimes it will be necessary to insert a special device called a stent to keep the artery open. This is just a metal cage that expands in your artery to keep the area opened out and allow more blood to flow through.

In some cases a stent-graft [stent covered by dacron material] may have to be inserted to exclude an aneurysm from the circulation. However, if this is the case, you will be informed about the plan at the clinic, when arrangements for the procedure will be made.

In some urgent conditions, especially when there is acute ischaemia [accompanied by pain], the angiography catheter may have to stay longer in order to infuse a special agent that dissolves the clot [thrombolysis]. You will be informed about the decision at that time. A repeat angiogram will follow in the next 24 hours to check how things are going.

3. Afterwards

In some cases heparin injections [anticoagulation] will be given for 24 hours to prevent blood clotting at the site of angioplasty. Rarely you may require warfarin tablets to thin the blood for a few months.

You will be allowed home the following day. If you are given warfarin, this may delay your departure for a few days.

The same is true in acute cases followed by thrombolysis.

You will be seen again in the clinic by your vascular surgeon to assess the success of the angioplasty and to decide upon any further treatments.

At the outpatient clinic a special ultrasound test will be performed to assess the result and the pressures down your ankles will be measured.

4. Are there any side effects?

    Some degree of bruising is quite common and this normally disappears in a few days or weeks.

    Serious bleeding is extremely uncommon.

   Unfortunately, in about 10% of cases, angioplasty is not successful and other treatments will need to be considered.

    In addition, even where successful angioplasty has been performed, there is a risk that the area in the artery will narrow down again or even occlude [block]. After one year, about 25% of arteries will have re-narrowed. The larger arteries remain open for longer time than the smaller [the outcome is considerably better in the iliac arteries than the femorals] and angioplasties in cases of narrowing give a better long-term result than in cases of blocked arteries. In some cases it may be possible to repeat the angioplasty at that time although in others this may not be possible.

   Very rarely, if angioplasty does not work, the circulation in your leg may actually worsen [1%]. If this is a particular risk in your case, your surgeon / radiologist will discuss the risks with you.

    Even if something goes wrong, the vascular surgeon will be standby in case urgent surgery is needed to correct things.

5. What can I do to help?

You cannot do anything to relieve the actual narrowing. However, you can improve your general health by taking regular exercise, abstaining from smoking, taking aspirin and reducing the fat in your diet. These actions will help to slow down the progression of atherosclerosis [hardening of the arteries], which caused the problem in the first place, and you may avoid the need for further treatment in the future.