Angiography Health Article

Risks

Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare.

A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiographic procedures, and arrhythmias may develop.

Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction.

Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients, particularly in those who have therapeutic procedures performed along with the diagnostic angiography.

Results

The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels.

Abnormal results of an angiogram may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiogram vary widely by the type of procedure performed, and should be interpreted by and explained to the patient, by a trained radiologist.

Health care team roles

Angiography is usually performed in a hospital-based imaging department by a trained radiologist and assisting technologist or nurse. Coronary angiography is performed by a cardiologist. It takes place in an angiographic suite, and for most types of angiograms, the patient's vital signs are monitored throughout the procedure.

KEY TERMS

Arteriosclerosis—A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation.

Carotid artery—An artery located in the neck.

Catheter—A long, thin, flexible tube used in angiography to inject contrast material into the arteries.

Cirrhosis—A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension.

Embolism—A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal.

Femoral artery—An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography.

Fluorescein dye—An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography.

Fluoroscope—An imaging device which displays "moving x-rays" of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patient's artery.

Guide wire—A wire that is inserted into an artery to guide a catheter to a certain location in the body.

Iscehmia—A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels.

Necrosis—Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures.

Plaque—Fatty material that is deposited on the inside of the arterial wall.

Portal hypertension—A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach.

Portal vein thrombosis—The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension.

BOOKS

Baum, Stanley, and Michael J. Pentecost, eds. Abrams' Angiography. 4th ed. Philadelphia: Lippincott-Raven, 1996.