Patient education: Angiography (The Basics)

What is angiography? — Angiography is a procedure doctors do to look at blood vessels in the body. There are 2 main types of blood vessels: arteries and veins. These carry blood around the body. If the doctor is looking at veins, it is also called "venography." If they are looking at arteries, it is also called "arteriography."

Doctors also use different terms depending on which part of the body they are looking at:

●"Coronary" angiography looks at blood vessels in the heart. You might also hear the term "cardiac catheterization."

●"Peripheral" angiography looks at blood vessels outside of the heart. You might also hear the term "digital subtraction angiography," or "DSA."

There are 2 parts to angiography:

●First, the doctor puts a thin tube, or "catheter," through the skin and into a blood vessel. They move the tube to the part of the blood vessel that is narrow or blocked. They use the catheter to inject a special dye called "contrast" into the blood vessel.

●Then, they do a type of imaging called "fluoroscopy" to see inside the body. Fluoroscopy is a moving X-ray. The dye shows up on the X-ray and shows how blood moves through the body. This can show if a blood vessel is blocked, damaged, or abnormal.

Doctors can do angiography to look at the blood vessels going to or in the brain, heart, lung, kidneys, liver, spleen, intestines, limbs, or another part of the body. This might be done if you have symptoms of cardiovascular disease. "Cardio" means having to do with the heart. "Vascular" means having to do with blood vessels.

Specifically, you doctor might want to:

●Check for a blood clot or other blockage

●Check for a blood vessel that is larger than it should be (called an "aneurysm")

●Find the source of bleeding inside your body

Your doctor will talk to you about what your options will be if they do find a problem during angiography.

How do I prepare for angiography? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests, including tests to check your kidney function

●Ultrasound – This is another type of imaging test that can look at the blood vessels. It might be done before or during the procedure.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have, especially if you have had a reaction to contrast dye

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before angiography. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure.

●Stopping smoking if you smoke – Smoking hardens your arteries.

●Lowering the risk of infection – In some cases, you might be asked to wash the area with a special soap.

●What help you will need when you go home – For example, you will need to have someone else bring you home and stay with you for some time while you recover.

●What will happen if the doctor finds a problem with a blood vessel during angiography

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during angiography? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●During the procedure, the doctor will use special medicines to prevent blood clots.

●The doctor might use ultrasound to help find the blood vessel. Or they might need to make a small cut in the skin to do this.

●The doctor will insert a special hollow needle through your skin and into your blood vessel. Then, they will put a wire through the needle, remove the needle but leave the wire, and then put the catheter over the wire and into the vessel (figure 1). The doctor will gently push the catheter through the blood vessel to reach the narrow or blocked area. Sometimes, they might need to reach the vessel from more than 1 place.

●While this is happening, the doctor will use fluoroscopy to see where the catheter is in your body. This helps them know when the catheter has reached the correct place.

●When the catheter is in place (the wire is removed), your doctor will inject the contrast dye into it. The dye can show narrow or blocked areas. Your body might feel warm during this part of the test.

●In some cases, the doctor will fix a problem with the blood vessel during the procedure. They might dissolve a clot, use a special balloon to open up a narrowing or blockage, or put in a stent. A stent is a small tube to help the blood vessel stay open.

●The doctor will remove the catheter from your body. They will put pressure on the "access site" where the catheter entered the blood vessel. Sometimes, they will use a special dressing to prevent bleeding, or stitches if a cut was made. They will cover the site with a bandage.

What happens after angiography? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. They will also watch for bleeding. You will have to rest in bed for a time, depending on your risk for bleeding.

●As you recover, the staff will let you know when it is safe for you to move around more.

●Many people are able to go home the same day. You might need to stay in the hospital overnight if your procedure was very long or if you need fluids or medicines through an IV.

●After your procedure, drink plenty of fluids for a few days. This helps clear the dye from your system.

What are the risks of angiography? — Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●A blood clot in the vessel

●A tear in the vessel

●The vessel getting blocked again

●Minor or serious allergic reaction to the dye

●Kidney damage from the dye

What else should I know? — You might get your results the same day, or it might take a little longer for them to be read by an expert. Your doctor or nurse will let you know when to expect your results.

If your angiography shows any abnormal results, your doctor or nurse will talk to you about what to do next.

More on this topic

Patient education: Peripheral artery disease and claudication (The Basics)
Patient education: Computed tomographic angiography (The Basics)
Patient education: Magnetic resonance angiography (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Questions to ask if you are having surgery or a procedure (The Basics)

Patient education: Peripheral artery disease and claudication (Beyond the Basics)