What is Angiography / Interventional Radiology?
Angiography is an x-ray study of the arteries. This procedure involves injecting a contrast material (x-ray dye) into a blood vessel to make it visible on an x-ray. The dye is placed directly in the artery through a very small flexible tube called a catheter, which is inserted into the artery through a small nick in the skin.
The procedure is often used to detect abnormalities of the blood vessels, such as narrowing and blockage caused by fatty deposits or blood clots, and aneurysms (defined as weakening or ballooning of the wall of the artery). Angiography can also detect abnormal patterns of blood vessels caused by tumors and can show sites of internal bleeding. Demonstrating these blood vessel abnormalities can help the physician determine the extent of the disease and determine the best treatment option.
The list of treatments and tests that can be performed by the interventionalist continues to grow and now includes the removal of tissue samples from the liver, lungs, and other vital organs; drainage of fluid from the chest, abdomen, or kidneys; and removal of gallstones and kidney stones. By injecting beads, coils, or other materials through catheters, radiologists can cause the intentional blocking of arteries that are bleeding or supplying nutrients to life-threatening cancers or tumors.
Interventional radiology offers an alternative to the surgical treatment of many conditions. It results in significant reductions in the risk, pain, and recovery time compared to traditional surgical treatments. Because it is less invasive, it is generally safer, less costly, and faster than surgery, and results in a significantly reduced hospital stay. This is important for the stronger patient and can be a matter of life and death to a very weak patient who could not survive the trauma of a surgical procedure.
Interventional radiology involves the treatment of the patient, rather than just the diagnosis of the disease. The Society of Cardiovascular and Interventional Radiology describes Interventional Radiology as a specialty within radiology "in which specially trained physicians use x-rays and other imaging techniques to see inside the body while they guide narrow tubes (catheters) and other small instruments through the blood vessels and other pathways in the body to the site of a problem, treating a variety of medical disorders without surgery."
One of the most dramatic applications of the interventionalist's art is in the treatment of patients suffering from blockages in arteries. If blood vessels become totally blocked they can cause loss of function of the tissue or even death of the organ or limb.
To increase blood flow, the interventionalist can insert a catheter into a blood vessel and thread it to the point of the narrowing or blockage, then inflate a tiny balloon on the end of the catheter (angioplasty). Using angioplasty, the radiologist can open the blockage and return normal blood flow to the tissue. Other techniques are available to open blocked vessels, including the use of stents to hold arteries open from the inside. These stents stay in the vessel permanently. The effect of these treatments is dramatic and immediate, and the need for subsequent surgery is often eliminated.
These techniques are frequently used to open narrowed or blocked leg arteries, which cause pain during exercise (claudication), and to treat narrowed arteries to the kidneys, which can cause renal failure or high blood pressure.
What to Expect During an Arteriogram
An intravenous line is placed prior to the test, and a catheter, a thin hollow tube, inserted into an artery. The area where the catheter is placed will be shaved and cleaned. Patients are given a local anesthetic before a small incision is made in the skin and the catheter inserted. The catheter is guided by the radiologist to the area of the body that needs to be visualized. Once the catheter is in place, a contrast agent is injected. This may cause a warm flushed feeling for a short period of time.
Images of the arteries are recorded for evaluation. The arteriogram usually takes 60 to 90 minutes.
After the test is completed, the catheter is removed and pressure is applied to the artery to stop any bleeding. An ice bag may also be placed over the area of the incision. Patients are taken back to their hospital room and typically stay there for several hours. Your doctor or nurse will tell you when you can get out of bed.
You will be given instructions to care for the puncture site after you are released from the hospital. You will need to watch for any bleeding.
If there is a small amount of blood on your band aid that covers the puncture site, do not be alarmed. Just remove the band aid and apply a new one. If there is no oozing from the puncture, the band aid may be removed the day after your surgery. However, if there is bright blood at the site of the puncture, you need to apply slight pressure to the site and call your doctor as soon as possible. typically, patients are allowed to take a shower or bath the day following the procedure. There may be a knot in the skin, bruising, or tenderness in the puncture area, which could take several weeks to disappear. Remeber to keep the site clean and dry.
Signs of infection, include increased redness or swelling, drainage from the site, or an oral temperature of 101 degrees or greater, and should be reported to your doctor.