Angiogram

What is an angiogram?

An angiogram is a diagnostic procedure that uses X-ray images to look for blockages or narrow spots in your blood vessels (arteries or veins). An angiogram test can show how blood circulates in blood vessels at specific locations in your body. Healthcare providers use an angiogram of your heart, neck, kidneys, legs or other areas to locate the source of an artery or vein issue.

Your healthcare provider may want to do an angiogram procedure when you have signs of blocked, damaged or abnormal blood vessels. An angiogram test helps your provider determine the source of the problem and the extent of damage to your blood vessels.

With an angiogram procedure, your provider can diagnose and plan treatment for conditions like:

• Coronary artery disease (blockage or narrowing in the arteries that supply your heart)
• Peripheral artery disease (blockage or narrowing in your leg arteries)
• Blood clots (mass of blood cells)
• Aneurysm (weak artery wall)

How does an angiogram work?

An angiogram procedure involves injecting contrast material (dye) that your provider can see with an X-ray machine. Images on a screen show blood flow and blockages in your blood vessels.

Your provider will give you medicine to make sure you’re relaxed and comfortable. Most people receive sedation. Others get general anesthesia, which makes them sleep. Either way, someone will need to drive you home afterward.

How to prepare for an angiogram procedure

Before your angiogram test, your provider may want to check your blood to determine how well your blood clots. They also want to make sure your kidneys are working well.

Medications

Always consult with your provider before you stop taking any medication, especially antiplatelets and anticoagulants. With provider approval:

• Don’t take clopidogrel for five days before your procedure.
• Don’t take blood thinners like dipyridamole or warfarin within 72 hours before the test and 24 hours after the test.
• Take all other medications as usual.
• If you have diabetes, ask your provider for instructions about if and when to take your insulin and/or medicine.

Don’t eat anything after midnight the night before your angiogram. If you’re having general anesthesia during the procedure, don’t eat or drink anything after midnight.

The day of your angiogram

Be sure to:

• Drink only clear liquids for breakfast on the day of your procedure.
• Leave your jewelry and other valuables at home.
• Make sure you arrange for a responsible adult to drive you home.
• Bring a current list of your medications and allergies.
• Bring a book or magazine in case your healthcare provider has to handle an urgent case before yours.
• Let all of your providers know if you have diabetes.
• Change into a hospital gown and lie down on a special X-ray table.
• Meet with your provider to review instructions, questions and your medical history.

What to expect during angiography

During an angiogram procedure, your provider will:

1. Numb the area where the catheter will go.
2. Access your blood vessel with a needle.
3. Thread a wire through the needle.
4. Slide a long, slender tube called a catheter over the needle and into a large artery (usually in your groin or wrist area).
5. Slowly and carefully thread the catheter through your artery until the catheter’s tip reaches the part of the blood vessel they want to examine.
6. Inject a small amount of contrast material (dye) through the catheter and into your blood vessel segment. For a few seconds, this can make you feel flushed or like you need to pee.
7. Take X-rays.
8. Watch where the contrast agent goes on the X-ray monitor to see where and how well blood is moving in your blood vessels.

How long does an angiogram take?

An angiogram can take as little as 15 minutes. But some can take a few hours. It depends on what procedures your provider does after they find the issue.

If your provider finds a blockage, they may treat it right away with an angioplasty. This procedure uses a tiny balloon to force the blockage against your artery wall. An angioplasty may be all you need if it makes your blood flow better and there’s less than 30% of your blockage left after the procedure.

If an angioplasty doesn’t create a large enough opening for blood to get through, you may need a stent. This tiny metal tube stays in your blood vessel to keep it open. Your provider can place this right after your angioplasty.

Another treatment, surgery for your heart (coronary artery bypass) or legs (peripheral artery bypass), creates a way around your blockage. A provider will do this on a different day.

What to expect after angiography

Your healthcare provider will take out the catheter and bandage the area where they punctured your skin. They’ll press on the bandaged area for at least 15 minutes to stop or prevent bleeding.

If they put the catheter in through your leg, you’ll need to rest in bed for four to six hours. This will make your incision less likely to bleed.

Your provider will evaluate you and discuss at-home instructions with you before you go home.

Angiogram recovery

You should be able to go home the same day as your angiogram procedure or the next day, even if you had angioplasty and stenting. Because you received anesthesia, you’ll need someone to drive you home.

After you get home, don’t lift anything heavier than 10 pounds or stoop or bend for the next two days. This should keep your incision from bleeding.

A responsible adult should stay with you overnight after your procedure. Some people may need to spend the night in the hospital for their angiogram recovery.

If you have diabetes, don’t take metformin for 48 hours after the test. This reduces the risk of kidney complications.

Drinking water will help flush the contrast dye out of your system.

What are the risks of angiography?

Angiogram risks are low. But you can have complications in the area where your provider went through your skin to reach your artery. Angiogram complications happen in less than 1% of cases.

Risks of an angiogram procedure usually involve your puncture site and include:

• Bruises, which are common and go away in one to three weeks
• Bleeding
• Infection
• Pain
• Kidney issues
• An allergic reaction to the contrast material (dye)
• Injury to blood vessels
• Abnormal heart rhythm (arrhythmia) or cardiac arrest that requires resuscitation
• A blood vessel blockage from a blood clot that could cause a heart attack or stroke (rarely)
• A blood vessel leak (rarely)

What type of results do you get and what do the results mean?

Your healthcare provider may find small blockages that don’t need another procedure. You may need to take medication or make changes to your daily life. For example, you may need to exercise more or eat healthier foods.

You may have larger blockages that need more invasive treatment. Your provider may perform an angioplasty and place a stent (small tube) to open your artery and keep it open. They can do this during your angiogram procedure.

Some people need a separate procedure on another day. Your provider may recommend a bypass operation that creates a way for blood to flow around the blocked area.

When should I know the results of the test?

Your provider will most likely speak with you after your angiography is done. But they may want to spend time looking over your X-rays before deciding what to do next.

When should I call my healthcare provider?

Contact your healthcare provider if you have:

• Pain or discomfort that doesn’t improve with medication
• A hard time speaking or smiling
• Numbness, weakness, warmth or swelling in the arm or leg where they were working
• Fever
• A lump near your wound
• Bleeding where they put the catheter into your skin

Is an angiogram a major surgery?

No. Angiography is a minimally invasive procedure. It’s not surgery. Your provider works through a tiny incision that’s big enough to put a catheter through and into your blood vessel.

How serious is an angiogram?

Angiography is a low-risk procedure. Still, it’s important to follow your provider’s instructions on how to prepare for it.

How painful is an angiogram?

An angiogram isn’t very painful. You’ll feel a needle going into your skin when your provider injects an anesthetic to numb the area where they’ll insert a catheter. After that, you most likely won’t feel any more pain during the procedure. You might feel a little pressure when the catheter goes in. You may have some soreness or bruising at the catheter site after the angiogram procedure.

Are angiogram and angioplasty the same?

No. An angiogram lets your provider see a blockage in your artery. During an angiogram, your provider can do an angioplasty to treat a blockage.

Who performs this test?

An interventional cardiologist performs a cardiac angiogram. Interventional radiologists and vascular surgeons perform angiograms of peripheral arteries. Interventional neurologists perform cerebral angiograms. The provider who performs the angiogram can study your images and identify problem areas.