At Your Appointment
Heart Failure Appointment Guide
Sarah Lewis, PharmD
What is angiography?
Angiography is an imaging test that makes a detailed picture (called an angiogram) of blood vessels. Angiography makes images of arteries and veins in the abdomen, brain, heart, kidneys, lungs and legs.
Angiography shows blood flow and blood vessels that are obstructed, blocked, narrowed, enlarged or malformed. Doctors use angiography to diagnose diseases and abnormalities of the blood vessels, including atherosclerosis, blood clots, aneurysm, and coronary artery disease.
Your body has two types of blood vessels, the arteries and veins. When angiography examines arteries, the picture is called an arteriogram. When veins are examined, the picture is called a venogram.
An angiography is only one method used to test for blood vessels diseases and conditions. You may have less invasive testing options. Discuss all of your testing options with your doctor to understand which
Types of angiography
The types of angiography procedures include:
Catheter angiography involves inserting a catheter into a blood vessel in your groin or elbow. The catheter wire is fed or guided to the appropriate area. X-rays are used to produce the angiogram (picture) of the vessel.
Noninvasive angiography uses computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI) to make the angiogram. CT involves X-rays but MRA and ultrasound do not. MRI of blood vessels is also called magnetic resonance angiography, or MRA.
Catheter angiography, and in some cases, noninvasive angiography, use a contrast agent. The contrast agent is sometimes called a dye. It improves the quality of the images. The contrast agent is given through an IV.
Other procedures that may be performed
Your doctor may perform treatments during a catheter angiography including:
Angioplasty involves widening a narrowed or blocked blood vessel.
Blood clot removal involves injecting clot-dissolving medications into the blood vessel via the catheter.
Stent placement involves inserting a mesh tube into the blood vessel to hold it open.
These treatments are not performed during noninvasive angiography. Your doctor will recommend a catheter procedure to complete these treatments if needed.
Why is angiography performed?
Your doctor may recommend angiography to diagnose and possibly treat the following diseases and conditions of the blood vessels:
Aneurysms, weakened or diseased areas of a blood vessel that enlarge or bulge. Aneurysms occur in many different areas of the body and cause serious or life-threatening bleeding if they rupture or burst.
Aortic dissection, a tear or damage to the inner wall of the aorta. Your aorta is the main artery leaving your heart.
Atherosclerosis, a buildup of plaque on the walls of large and medium-sized arteries. Atherosclerosis is commonly known as hardening of the arteries.
Digestive tract bleeding, also called gastrointestinal hemorrhage. Angiography can identify and treat the bleeding source.
Blood clot, also called a thrombus. Blood clots include deep vein thrombosis (DVT) in the legs or pulmonary embolism (PE) in the lungs.
Blood vessel malformations, defects that are usually present at birth. They can cause problems at various ages from birth to adulthood.
Carotid artery disease, narrowing of the neck arteries that supply blood to the brain
Cerebral vascular disease including stroke and transient ischemic attacks (TIAs)
Heart disease including coronary artery disease
Mesenteric artery ischemia, decreased blood flow through the arteries that supply blood to the intestines
Peripheral artery disease (PAD), a narrowing or blockage of arteries outside the heart. PAD is also called peripheral vascular disease or PVD.
Renal artery stenosis, a narrowing of the arteries that supply blood to the kidneys
Ask your doctor about all of your testing and treatment options and consider getting a second opinion before deciding on an angiography.
Who performs angiography?
The following specialists perform angiography:
Cardiologists specialize in conditions and diseases of the heart and its blood vessels.
Radiologists or radiologic technologists perform noninvasive angiographies. A radiologist is a doctor who specializes in medical imaging. A radiologic technologist is a medical professional specializes in medical imaging and the care of patients during imaging procedures.
Vascular neurologists specialize in conditions and diseases of the blood vessels in the brain and spinal cord.
Vascular and interventional radiologists are doctors who specialize in diagnosing and treating diseases using imaging technology and catheter techniques. They perform catheter angiographies.
Vascular surgeons specialize in the surgical treatment of blood vessels outside the heart and brain.
How is angiography performed?
Your angiography will be performed in a hospital or outpatient setting. It takes about an hour and generally includes these steps:
You dress in a patient gown and lie on a procedure table.
Your team inserts an IV to provide fluids, medications, or a contrast agent.
Your team attaches devices to monitor your heart rate and blood pressure.
- For catheter angiography:
Blood tests are done to check kidney function and blood clotting.
Your team gives you sedative medications through the IV to help you relax.
Your doctor determines the location to insert the catheter. The catheter is often placed in the artery in the groin. The area is shaved, cleaned and numbed.
Your doctor makes a small incision. The catheter and wire is inserted through the incision and guided it into place in the blood vessel.
Your team injects a contrast agent through the catheter. You may feel flushing at this time. X-rays are taken as the contrast agent flows through your blood vessels.
You will need to hold still for the X-rays and hold your breath briefly.
Your doctor will remove the catheter and close the catheter site.
A team member removes your IV.
5. For noninvasive angiography:
For MRI, you will wear earplugs because the machine makes loud thumping and humming noises. Closed MRI machines are long cylinders, so your team may be give you a mild sedative if you are claustrophobic. The procedure table will slide into the machine for the test.
CT machines also have a tunnel, but it is much shorter than an MRI tunnel. The procedure table will slide into the machine for the test. Your team may ask you to hold your breath briefly during the procedure.
If a contrast agent is used, it will be give through an IV. You may feel a sensation of warmth when the contrast agent is injected.
It is very important for you to lie still during the procedure. Movement causes blurry images.
You wait briefly while the radiologist verifies that the imaging is complete
A team member removes your IV.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel a pinch or pinprick pain during IV placement, but the imaging itself is painless.
You will receive sedative medications as needed to keep you comfortable during catheter angiography. You may receive sedative medications for MRI procedures if you are claustrophobic. Tell your care team if you are uncomfortable in any way.
What are the risks and potential complications of angiography?
As with all procedures, angiography involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications of angiography are uncommon but can occur during the procedure or recovery.
Risks and potential complications of angiography include:
Adverse reaction or problems related to sedation or contrast agents, such as an allergic reaction and problems with breathing
Bleeding or clotting problems
Damage to the artery from the catheter
Exposure to radiation, which may be harmful in excessive doses
Injury from metal objects in or on your body or in the room during an MRI
Kidney injury from the contrast agent, especially if you have kidney disease
Reducing your risk of complications
You can reduce your risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor and care team if you have any metal in your body. This includes screws, pins, plates, pacemakers, implants, intrauterine devices (IUDs), or bullet fragments.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor right away of any concerns, such as bleeding, fever, or increase in pain
Removing all jewelry and metal objects and leaving them outside the MRI room. This includes glasses, credits cards, hair accessories, and removable dental work.
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
Telling your doctor if you have kidney disease or diabetes
How do I prepare for my angiography?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome and help obtain the most accurate results.
You can prepare for angiography by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home if you have sedation
Following instructions for eating and drinking before angiography. Stay well hydrated until the time you are told to stop drinking for the procedure.
Leaving jewelry, metal objects, credit cards, and other valuables at home
Taking or stopping medications exactly as directed. Your doctor will give you specific instructions about taking your medications.
Instructions may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. With certain types of contrast dyes, you should not take metformin (Glucophage), an oral medication for diabetes, for 48 hours before and after your angiography.
Questions to ask your doctor
Having an angiography can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor about concerns and questions before angiography and between appointments.
It is also a good idea to bring a list of questions to your appointments. Common questions include:
Why do I need angiography? Are there any other options for diagnosing or treating my condition?
How long will the procedure take? When can I go home?
What will happen if you find a problem or condition during the procedure? Will you treat it right away, or will I need to have another procedure or surgery later?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain or anxiety?
When and how will I get the results of my test?
What other tests or procedures might I need?
When should I follow up with you?
When and how should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my angiography?
Knowing what to expect after angiography can help you get back to your everyday life as soon as possible.
How will I feel after the angiography?
You may have mild drowsiness if you receive sedative medications. It is unlikely that you will feel pain after angiography, but it is common to have mild tenderness and bruising at the catheter incision site. Tell your doctor if you are uncomfortable.
Your activities may be restricted following catheter angiography. Follow your doctor’s instructions for eating, drinking and resting after angiography.
When can I go home?
You will be monitored for about four to six hours after an outpatient catheter angiography before going home. You will likely go home right away after a non-invasive angiography unless you receive sedative medications. The care team will discharge you home when you are fully alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation you had.
Some people need to stay in the hospital for further treatment and monitoring after an angiography. This is more common if a treatment was performed during the angiography. Common treatments include angioplasty, stent placement, and blood clot removal.
You will need a ride home and cannot drive for about 24 hours if you had sedation. Someone should also stay with you for a day or so.
When should I call my doctor?
It is important to keep your follow-up appointments after angiography. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter
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