Hepatic Angiography: Indications, Procedure, and Interpretation

Introduction

The hepatic artery, portal vein, and hepatic venous systems may now be easily accessed for angiography with minimal to no morbidity because of improved procedures. Even though the indications for angiographic procedures are more limited than those for noninvasive studies like computer-assisted tomography, ultrasonography, and radionuclide scanning, these techniques unquestionably have a place in specific diagnostic situations like the assessment of portal hypertension and variceal bleeding, intrahepatic mass lesions, abdominal trauma, and suspected hepatic venous occlusion (Budd-Chiari syndrome). The vascular supply of malignant hepatic tumors and bleeding esophageal varices can be blocked using various angiographic procedures.

An X-ray examination of the blood arteries supplying the liver is called hepatic angiography. Through a tiny incision, a catheter—a thin, flexible tube—is inserted into a blood artery to perform the treatment. A physician often carries out the treatment with specialized training, known as an interventional radiologist.

What Is Hepatic Angiography?

Hepatic angiography is an imaging procedure. It examines the blood arteries that carry blood to the liver using X-rays. A thin, flexible tube is used for the test (catheter). Through a tiny slit, the catheter is inserted into a blood vessel (incision). The catheter is then injected with X-ray dye (contrast media). The blood vessels are more visible on the X-rays thanks to the dye. In most cases, an interventional radiologist performs this treatment.

An interventional radiologist is a medical professional with specialized training and American Board of Radiology certification in minimally invasive image-guided treatments for illness diagnosis and treatment. This method assesses the presence of liver tumors, liver cancer, liver cirrhosis, and portal hypertension. It is normally carried out in a hospital or an outpatient imaging facility under the supervision of a radiologist or an interventional radiologist and is considered invasive.

What Are the Indications of Hepatic Angiography?

A range of disorders that affect the liver, blood arteries, and bile ducts can be identified and assessed using hepatic angiography. Common reasons for hepatic angiography include the following:

1. Liver Tumors: To identify and assess the size and location of liver tumors and establish a course of therapy.

2. Liver Cancer: To identify the presence of liver cancer, ascertain the disease's stage, evaluate the tumor's blood supply, and formulate a treatment strategy.

3. Cirrhosis of the liver: To gauge the extent of the condition and gauge the blood flow through the liver.

4. Portal hypertension: To evaluate the existence and severity of portal hypertension, a condition marked by elevated blood pressure in the portal vein, which carries blood to the liver.

5. Obstruction of the Bile Duct: To identify and assess bile duct blockage, which can result in jaundice, stomach discomfort, and other symptoms.

6. Hemangiomas: To identify and assess liver hemangiomas, benign tumors that may present with discomfort, unusual bleeding, or other signs.

7. Trauma: To assess liver damage or bleeding following a stressful incident, like a fall or automobile accident.

These are a few of the typical hepatic angiography indications. However, the particular indication for the treatment will rely on the unique circumstances, the patient's medical history, and their symptoms.

How Is Hepatic Angiography Performed?

• Before The Procedure: One should adhere to any preparation advice offered, such as:

• The six hours before the test should be spent fasting.

• Inform the technician if the patient is pregnant, if the patient uses any medicines or supplements, and if there are drug allergies, including those to contrast media (the X-ray dye).

• During the Procedure:

1. The patient will have to put on a hospital gown for the procedure and recline on an X-ray table.

2. The patient gets fluids and drugs through an IV (intravenous) line inserted into a vein. Medication to promote relaxation and sleep may be administered.

3. The area next to the groin may be administered a topical anesthetic to numb it. The femoral artery is then reached via the skin using a guide wire.

4. The radiologist guides the wire through the arteries to the liver using X-ray pictures as a reference. The guiding wire is then covered with a catheter.

5. Next, the guide wire is taken out.

6. Through the catheter, a contrast medium is delivered into the artery. This makes the liver's arteries more visible on X-rays.

7. As the liver is being X-rayed, one may be instructed to remain motionless and occasionally hold the breath. The patient might need to move about so pictures can be shot from various perspectives.

8. The catheter is taken out when the test is finished.

9. In order to halt bleeding, pressure is applied to the insertion site for ten to 15 minutes.

• After the Procedure:

1. In order to stop bleeding at the insertion site, the patient will be instructed to rest flat with legs extended for six hours following the procedure.

2. Either the patient will be allowed to leave the hospital that day or will be required to spend the night there.

3. In order to assist the body in ridding itself of the contrast medium, drink a lot of water.

4. As instructed, take care of the insertion site.

5. If the patient has a lump or bleeding at the place of insertion, call the healthcare professional.

What Are the Instructions for Hepatic Angiography Discharge?

What to do at home following the surgery is listed below:

1. Wait until the healthcare professional advises it is safe to drive.

2. As advised by the doctor, get some rest. Within a few days, most people can resume their regular activities.

3. For three to four days, avoid lifting anything more than ten pounds.

4. For two weeks, refrain from any vigorous activities. Follow the doctor's advice on exercise.

5. The day following the surgery, one can take a shower.

6. Consulting the healthcare practitioner when swimming or taking a bath is okay.

7. Exactly as prescribed, take the medications. Never miss a dosage.

8. Drink six to eight glasses of water daily, unless otherwise instructed, to avoid dehydration. Additionally, it will aid in removing the dye used during the treatment from the body.

9. For a week, take the temperature every day.

10. Additionally, look for any symptoms of infection at the site of the incision (redness, swelling, or warmth)

What Are the Risks of Hepatic Angiography?

Possible dangers and complications are:

1. Bruising at the insertion site.

2. Complications brought on by contrast agents, such as allergic response or renal damage.

3. Irritation of the artery.

What Are the Advantages and Disadvantages of Hepatic Angiography?

• Advantages-

1. High-Resolution Images: Hepatic angiography offers clear pictures of the liver's blood arteries, enabling precise diagnosis of disorders, including liver cancer and tumors.

2. Multiple Diagnoses: Hepatic angiography can identify various diseases affecting the liver, blood vessels, and bile ducts.

3. Treatment Planning: Hepatic angiography can also be used to plan for operations that can be carried out using the same catheter, such as embolization.

• Disadvantages-

1. Invasive Procedure: It is considered an intrusive operation even though it is minimally invasive and involves a modest risk of consequences such as bleeding.

2. Radiation Exposure: Hepatic angiography, like other X-ray treatments, exposes patients to ionizing radiation, which over time, can raise the chance of developing cancer, particularly in young patients or those who need regular imaging.

3. Allergy: The contrast material used in hepatic angiography may produce allergic responses in some people, resulting in symptoms including itching, rashes, or shortness of breath.

4. Limited Access: In some circumstances, the liver's blood arteries may be challenging to reach or see, reducing the procedure's diagnosis ability.

Conclusion

In conclusion, hepatic angiography is a medical imaging process that produces fine-grained pictures of the blood arteries in the liver using X-rays and a contrast agent. It identifies and assesses many ailments involving the liver, blood vessels, and bile ducts. The diagnosis and management of liver disorders can be aided by hepatic angiography, which is regarded as a relatively less invasive technique. However, hepatic angiography has some risks and potential side effects. In order to decide if hepatic angiography is the best option, it is crucial to have a full conversation with the doctor about the benefits and restrictions of this treatment.