Angiogram- Types, Indications, and Risks

Introduction

An angiogram is an invasive approach that gives rise to several images of arteries. The arteries can be of any organ. An angiogram is generally done to view the arteries of the heart, brain, lungs, and kidneys. During an angiogram, the healthcare provider utilizes a contrast dye and X-rays of the organ to distinguish blood flow via the organ's arteries. This helps in finding the location as well as the presence of any kind of blockages.

An angiogram, also called an arteriogram, is related to the word angiography. Both terms refer to a specific procedure of observing the arteries in various organs. The aorta is the main artery of the body and is the widest as well as the most substantial artery of the heart. The blood is pumped out of the heart and into the body through the aorta. Aortic angiography or aortic arteriogram is a commonly conducted test in a patient with a cardiovascular disorder.

An angiogram identifies and assesses issues with blood vessels when signs of blockage, damage, or abnormalities are observed.

The duration of an angiogram procedure typically ranges from 30 minutes to an hour, but the actual time may vary depending on the case's complexity. If additional procedures are necessary during the angiogram, the duration may extend beyond the usual time frame.

What Are the Types of Angiograms?

An angiogram is typically a safe and routine medical procedure with low invasiveness and minimal risk of complications. While there is a slight degree of invasiveness, the potential benefits in diagnosing and treating cardiovascular conditions often outweigh the rare risks associated with the procedure.

Angiograms or arteriograms can be used to investigate several organs of the body. The word before angiogram or arteriogram generally refers to the type of angiogram supposed to be conducted.

A few of the most common types of arteriogram or angiography are mentioned below.

• Aortic angiography for the aorta.

• Cerebral angiography for the brain.

• Coronary angiography for the heart.

• Extremity angiogram for the arms, legs, hands, and feet.

• Fluorescein angiography for parts of the eye such as the retina and choroid.

• Pulmonary angiography for lungs.

• Renal arteriography for kidneys.

What Are the Risks of an Angiogram?

Any procedure has some amount of risk involved. Nevertheless, an angiogram has no specific complications or risks if performed with great expertise.

Mentioned below are some of the possible risks associated with arteriogram or angiography.

• Allergic reaction to the dye used during an angiogram.

• Kidney damage.

• Formation of blood clots.

• Damage to the blood vessels.

• Low blood pressure.

• Stroke.

• Pain at the site of an angiogram

• Bleeding.

• Infection at the place of catheter insertion.

When Is an Angiogram Indicated?

An angiogram is not a routine procedure; it is suggested based on detailed clinical history, signs, symptoms, and medical/drug history. Before this slightly invasive procedure, less invasive tests like EKG, treadmill, and heart ultrasound are typically conducted. If inconclusive, an angiogram helps assess damage and identify the source. Below are a few factors that may lead an individual to undergo an angiogram.

• Blocked blood vessels.

• Heavily damaged blood vessels.

• Blood vessels with abnormal anatomy.

• Chest pain.

• Constant chest discomfort.

• Episodes of a heart attack.

• Coronary artery disease.

• Angina pectoris.

• Pain in the jaw and neck.

• Stiffness of the arms and shoulder.

• Unstable angina.

• Congenital heart disorder.

• Abnormal results of stress test.

• Abnormal results of electrocardiography and ultrasound of the heart.

• Trauma.

• Valve disorders.

• Injury to the chest.

• Difficulty in breathing during strenuous activity.

• Heavy breathing while climbing the stairs.

• Inability to lift heavyweights.

• Decreased ability to perform physical activities.

What Is Coronary Angiography?

Coronary angiography, often called an angiogram, is a medical procedure to visualize the blood vessels that supply the heart muscles. During this diagnostic process, a contrast dye is injected into the coronary arteries, and X-ray imaging is used to capture detailed images of the blood flow within these vessels. This procedure is an important diagnostic tool to identify blockages, narrowings, or other abnormalities in the coronary arteries. It helps in the diagnosis of heart conditions such as coronary artery disease. By performing these diagnostic procedures, cardiologists can determine whether further interventions like angioplasty or stent placement are necessary to improve the blood flow to the heart.

How to Prepare a Patient for an Angiogram?

Patient preparation involves the following steps:

• Cath Lab Setup: The procedure happens in a specialized room called the catheterization laboratory (cath lab) within a hospital or medical center.

• Medication and Allergy Discussion: The healthcare team checks with medications and allergies to ensure a safe procedure.

• Attire Change: Switching into a hospital gown and may need to empty the bladder. Avoid wearing contact lenses, eyeglasses, jewelry, or hairpins.

• Vital Signs Check: The care team monitors the blood pressure and pulse.

• Heartbeat Recording: Sticky patches (electrodes) are placed on the chest and, at times, on the arms or legs. These record the heartbeat throughout and after the test.

• Preparation for Catheter Insertion: A small amount of hair may be shaved from the catheter insertion area. This area is then cleaned and numbed for the procedure.

What Happens During an Angiogram?

Patients are asked to avoid eating and drinking for 12 hours before the procedure. Breakfast should include only clear liquids. The process is done under local or general anesthesia per the patient's choice and the doctor's recommendation. Moderate sedation is given, and the following steps occur with the entire procedure getting over approximately within 3 hours.

• A catheter is carefully inserted into the groin or any other large artery of the body until its tip reaches the part of the blood vessel that needs to be investigated.

• A tiny quantity of contrast dye is inserted via the catheter into the blood vessel.

• Simultaneously, x-rays are taken.

• The contrast dye can highlight the blood vessel and the blockage viewed on the x-ray.

What Happens After an Angiogram?

The x-ray is then studied by a team of professionals who diagnose the cardiovascular condition. The patient is then monitored for 6 hours. A radiologist evaluates the patient before discharge. It is always advisable to stay overnight post-angiogram. This is because any reaction to the dye can be corrected. The result is discussed between the healthcare provider and the patient. The healthcare provider decides the best-fitting treatment plan or cardiac procedure based on the results. Coronary angioplasty or stenting is a way to clear blocked arteries. There is high chance that the healthcare provider completed the stenting process during an angiogram if the need arises.

What Are the Guidelines for Angiogram Recovery?

The recovery guidelines include:

• Individuals who typically return home on the same day as the procedure, including those who had angioplasty. Ensure someone is available to drive to home due to the administered anesthesia.

• Once home, refrain from lifting anything heavier than 10 pounds and avoid bending or stepping for two days to prevent incision bleeding.

• It is important to have a responsible adult stay overnight after the procedure. Some patients may need to stay in the hospital for proper angiogram recovery.

• For patients with diabetes, it's advised to avoid metformin intake for at least 48 hours after the test to minimize the risk of kidney complications.

Conclusion

An angiogram is a test that reveals the complete picture of a blood vessel through X-rays and contrast dye. The heart, brain, kidneys, and lungs are some of the many vital organs that undergo angiograms. An angiogram is performed after other cardiovascular diagnostic tools have failed to diagnose or understand the underlying cardiovascular disease accurately. In addition, an angiogram aids in determining the source of the extent of the damage. Knowing this information can help the healthcare provider shape the best treatment modality.