1. What is an Arteriogram?
An Arteriogram (angiogram) is a special x-ray that enables us to identify the site of a blockage or malfunction in the arteries of the body. Mr Braithwaite frequently requests an arteriogram to treat some types of blockages. Before the arteriogram, you may have had another test such as a Duplex ultrasound scan or a Magenetic Resonance Scan. In order to do an arteriogram a long fine tube (catheter) is inserted into the artery at the groin or in the arm. A special dye (contrast) is injected down the tube and x-ray pictures are taken as the solution passes along the blood vessels. The whole procedure will last approximately half an hour to one hour. In Nottingham the procedure is done either at the Queens Medical Centre, the Park Hospital or the Spire Nottingham Hospital.
2. Before the test.
Your Veincare specialist will usually explain to you what is going to happen. An interventional radiologist is the specialist doctor who will perform the angiogram. The radiologist may arrange to see you in a pre-admissions clinic. At this appointment, they will discuss the angiogram and may ask that you sign a consent form. It may be necessary for you to stop taking some medicines before the angiogram. If you take Warfarin or Metformin, please tell the doctor at the clinic.
On the day of the arteriogram, you will normally be admitted to the ward for a few hours beforehand to check out your general health and to prepare you for the arteriogram. On the day of the test you may eat and drink as normal. If you take regular medications please have your usual morning dose. If you are a diabetic on insulin please have your normal food and insulin dose.
On arrival, you will be seen briefly by the doctor, the test will be explained to you again and you will be asked to sign a consent form, if this has not already been done. Please tell the doctor if you have had any allergies or bad reactions to drugs or other tests. It would also be helpful to mention to the doctor if you have asthma, hayfever, diabetes, or any heart or kidney problems. If you have any worries or queries at this stage don’t be afraid to ask. The staff will want you to be as relaxed as possible for the test and will not mind answering your queries.
You will be asked to put on a hospital gown. The test will take place in the x-ray department. A nurse will escort you to the x-ray department.
3. During the test.
The radiologist (x-ray doctor) will inject a local anaesthetic into the skin at the groin, or in the arm, “freezing” the area. Then a long fine tube (catheter) is inserted into the artery, and using x-rays to help, the radiologist manipulates the catheter into the correct position. You will not feel the catheter being moved around your body. X-ray pictures are taken whilst the dye is injected down the catheter into the blood vessels. Some injections may cause hot flushing for a few seconds, and an occasional feeling of wanting to pass water. When the test is completed the catheter is removed and pressure will be applied to the site of the skin puncture for approximately ten minutes to minimise any bruising.
You will be taken back to the ward to rest for a few hours. It is important that you lie quietly so that the groin does not bleed again. The nursing staff will check the puncture site, and the pulses at regular intervals.
It is important that you rest completely until the next day to ensure that the puncture site in the groin heals up. If after you get home you notice any swelling or bleeding at the puncture site, you should press on this and call your GP.’s surgery for advice.
5. When do I know the result?
The radiologist and vascular surgeon will look at the x-ray pictures and discuss their findings either the day after the procedure or in clinic.
6. What is an Angioplasty?
An angioplasty is a procedure where a balloon is passed into your artery at the time of an arteriogram. The balloon is on the end of a tube (catheter) and it is inflated to treat a narrowed or blocked artery. This technique means that surgery may be avoided. As far as you are concerned, angioplasty is very similar to an arteriogram except that we use a slightly bigger catheter and therefore the risks of bleeding are slightly greater. For this reason, in most cases, you may be asked to stay overnight. You will usually be asked to start taking aspirin before you are admitted as this makes the blood less sticky. A common dose is 75mg per day (ask you pharmacist). If you have an ulcer or are allergic to aspirin, please tell your doctor.
7. The procedure.
Angioplasty takes a little longer than simple arteriography and you may feel the doctor changing, and pushing, catheters in and out of your groin artery. Although this is occasionally a little uncomfortable, it will not hurt. Sometimes, it will be necessary to insert a special device called a stent to keep the artery open. This is just a small metal cage that expands in your artery to keep the area opened out and allow more blood to flow through.
In some cases Heparin injections (anticoagulation) will be given for 24 hours to prevent the blood clotting at the site of the angioplasty. Rarely you may require warfarin tablets to thin the blood for a few months. You will normally be allowed home the following day. If you are given heparin or warfarin this may delay your departure by a few days. You will be seen again in the clinic by your surgeon to assess the success of the angioplasty and to decide upon any further treatments.
9. Are there any side effects?
Some degree of bruising is quite common and this normally disappears in a few days. Serious bleeding is very uncommon. Unfortunately, in about 5% of cases, angioplasty is not successful and other treatments will need to be considered. In addition, even where successful angioplasty has been performed, there is a risk that the area in the artery will narrow down again. After one year, about 20% of arteries will have re-narrowed. In some cases, it may be possible to repeat the angioplasty at that time although in others this may not be possible. Very rarely, if angioplasty does not work, the circulation may actually worsen. If this is a particular risk in your case, your surgeon and /or radiologist will discuss the risks with you.
10. What can I do to help?
You cannot do anything to relieve the actual narrowing. However, you can improve your general health by taking regular exercise, stopping smoking and reducing the fat in your diet. These actions will help slow down the hardening of the arteries which caused the problem in the first place, and may avoid the need for further treatment in the future.