What is an Arteriogram?
Arteriography is a minimally invasive test in which an arteriogram or “road map” of the arteries is made. An arteriogram looks a lot like an x-ray and is used to plan or guide treatments such as surgery, angioplasty, or stent placement.
How Should I Prepare and How is it Performed?
You will be asked not to eat for several hours prior to the exam so mild sedation can be given safely. You may need to have some simple laboratory blood tests prior to the arteriogram. The Interventional Radiologist (specializes in imaging-guided diagnosis) will explain the procedure and answer any questions you might have. Then you will go to a room with sophisticated imaging equipment. You will be given medicines through an intravenous line to make you sleepy and comfortable, and a sterile drape will cover you from your chest down. A tiny tube or catheter is then placed into the artery in the upper portion of the thigh after the skin is made numb. The catheter is then steered to its intended destination inside your vascular system using x-rays for guidance. A clear liquid called contrast dye is then injected through the catheter and a series of pictures are taken. You will usually feel a mild warm “flush” when the contrast is injected. Pressure will be applied to the groin after the sheath is removed in order to prevent bleeding from the artery. After the procedure and a short observation period, you may go home.
These pictures or images can be used to diagnose the cause of arterial blockage or to precisely guide an angioplasty balloon or stent into place to treat a blockage. The arteriogram may also be used to plan a surgical treatment such as a bypass graft.
Once the diagnosis of peripheral arterial disease has been established, one of the options for treatment is endovascular therapy.
What is Endovascular therapy?
In an effort to improve blood flow to a leg, different methods may be used:
A medical device made of an expandable wire mesh tube that is inserted into an artery narrowed by plaque. Once inserted it can expand and hold open the artery, allowing the blood to flow through. For further info on stents, go here.
Using tools that allow a physician to work inside the artery, a tiny balloon is placed directly in the narrowing. Liquid is put in the balloon; the balloon expands, and opens the blockage. The balloon is then deflated and removed.
Re-routing of blood from above an area of blockage to below the blockage, using either a piece of synthetic material, or the patient’s own vein.
How is balloon angioplasty performed?
Once the decision is made to perform angioplasty, the procedure is scheduled. Patients are instructed on which medications they should take on the morning of the procedure. Other than some morning medications, no food or liquid is allowed.
The patient is brought to the angiographic suite, and is asked to lay down on a table. A sedative is typically prescribed to lessen any discomfort. Then, using a tiny, flexible tube, called a catheter, and the x-rays, the doctor takes pictures of the arteries of interest, injecting a small amount of a liquid, called contrast dye, that generates a ‘road map’ of the areas of blockage.
Once these pictures have been reviewed by the doctor, and the decision has been made that an angioplasty can be performed, through the same location in the groin, the balloon catheter is placed into the narrowed artery, liquid is used to inflate the balloon, and the artery is opened. Often a metallic mesh scaffolding device, known as a stent, is fitted onto the balloon, and when the balloon is inflated and then deflated, the stent is embedded into the wall of the artery and is left in place permanently. Occasionally, the patient may feel some pressure in the area of the artery as the balloon is being inflated. Always report any discomfort to the physician.
After the procedure has been completed, the tube in the groin will be removed. In certain instances, the doctor will choose a closure device which seals the hole in the artery, preventing it from bleeding. In other circumstances, the doctor, nurse, or technologist will hold steady pressure on the groin for a few minutes to prevent bleeding, and allow the hole to seal. In either situation, the patient will need to lay flat for a period of time. The recovery period is generally a few hours during which the patient will be kept on bed rest.
Are there any risks with angioplasty?
Although the procedure is considered safe and of relatively low risk, there are certain problems which may develop. Always ask the physician if there are concerns.
- Bleeding from the groin hole-this is generally minimal, although in uncommon situations, there may be need for a procedure to stop the bleeding.
- Problems with the kidney function as a result of the contrast dye-this is usually a temporary issue, however, uncommon cases may result in permanent kidney damage.
- Artery tearing-this is very unusual, yet may require emergency surgery.
This is an effective procedure for many situations. The major limitation is re-narrowing of the angioplasty site. Generally, the larger the artery, the longer the artery stays open after angioplasty. With that in mind, the iliac arteries which arise from the aorta at the level of the belly button tend to last the longest. Arteries below the groin and worse yet, below the knee, tend to re-narrow faster.