- Arterial interventions in gastrointestinal bleeding, Pseudo aneurysms, Fistulas
- Mesenteric ischemia Interventions
- Arterial interventions in bleeding, Pseudo aneurysms, Fistulas
- Reno-vascular hypertension
- Dialysis fistula Interventions
- Pulmonary embolism
- Pulmonary hemorrhage
- Embolization of varicoceles
- Embolization of ovarian veins in patients with pelvic congestion syndrome
- Fibroids embolization
- Trans arterial therapies for benign and malignant lesions (e.g., chemotherapy and radio embolization)
- Trans venous Interventions (Portal vein embolization, Hepatic vein embolization)
- Arterial and venous interventions
- Bleeding vessels causing internal bleeding from visceral injury and pelvic trauma uncontrollable by conservative measures
There are other systems and various indications where an angiogram is recommended. These could be diagnostic and therapeutic.
Contraindications: Some are absolute and some are relative
- Safety concerns.
- Technical concerns
- Severe iodinated contrast medium allergy
- Renal impairment
- Coagulopathy, INR > 2, and platelet count < 50,000/microliter
- Well hydrated to minimize the risk of contrast medium-induced nephrotoxicity.
- Fasting for 6 to 8 hours may be required in certain circumstances.
- All other issues relevant to the procedure should be addressed.
This procedure is performed under local anesthesia and moderate sedation. Sometimes, there is a need for anesthesia support. Depending on the type of angiogram, the vascular access site differs. For abdominal or thoracic arterial interventions, most common access is from common femoral artery in the groins. Access can also be obtained from the radial or brachial arteries in the arms. These all depend on the type of procedure. Venous interventions require access into the veins which could be femoral, Jugular and direct access (Portal vein) depending on the type of interventions.
Access is obtained with a needle under ultrasound guidance which is later exchanged for tools like sheath. Through this various catheters, wires are introduced into the vascular system under fluoroscopic guidance. Contrast medium is used where required to opacify the structures. Based on the type of procedure, further interventions are performed like embolization, stenting etc.
Once the procedure is finished, the access is closed either by manual compression or using a closure device depending on the type of procedure.
- Observed for 2-4 hrs. for any discomfort or complications.
- Flat if groin access was used.
Complications: Minor or major
- Bruising, hematoma, pain at the puncture site
- Allergic reactions
- Acute renal failure
- Procedural complications (Differ based on the procedure)
If the patient is to be admitted or is an inpatient, clinical assessment of the access site and over all clinical evaluation has to be performed at regular intervals.
If the patient is an outpatient, the operator would evaluate and discuss about home instructions before discharge.
What is an angiogram?
Angiogram is a procedure performed with the use of X rays and contrast medium to visualize the vascular structures. This assists in the diagnostic and therapeutic aspects of the procedure. Various types of angiograms are present which differ based on the system imaged and intervention performed.
Who does the procedure?
Interventional radiologist performs these procedures. Depending on the area of expertise, these can also be performed by Interventional Cardiologists or vascular surgeons.
The provider who performs the procedure can discuss the findings either during or after the procedure.
Is it painful?
These procedures are performed with local anesthesia and some conscious sedation. Depending on the complexity of the intervention, sometimes anesthesia (General or MAC) is involved.
What are the risks involved?
This depends on the procedure. Some of these include discomfort, pain, bleeding, and hematoma.
Do I need pain medications after the procedure?
Mild analgesics are recommended for discomfort
Do I need to stop any of my medications prior to the procedure?
This depends on the type of medications that you are. Some of the anticoagulants have to be stopped prior to the procedure. Please refer to your local hospital guidelines where the procedure is being performed.
What about the recovery?
Depending on the type of angiogram, instructions will be given.
What about the results?
These will be discussed by the physician after the procedure.