Angiogram and Interventions

Indications:

Gastrointestinal system

• Arterial interventions in gastrointestinal bleeding, Pseudo aneurysms, Fistulas
• Mesenteric ischemia Interventions

Renal

• Arterial interventions in bleeding, Pseudo aneurysms, Fistulas
• Reno-vascular hypertension
• Dialysis fistula Interventions

Pulmonary

• Pulmonary embolism
• Pulmonary hemorrhage

Reproductive system

• Embolization of varicoceles
• Embolization of ovarian veins in patients with pelvic congestion syndrome
• Fibroids embolization

Oncology

• Trans arterial therapies for benign and malignant lesions (e.g., chemotherapy and radio embolization)
• Trans venous Interventions (Portal vein embolization, Hepatic vein embolization)

Post-Transplant:

• Arterial and venous interventions

Trauma

• 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

Preparation:

• 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.

Procedure:

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.

Post procedure:

• Observed for 2-4 hrs. for any discomfort or complications.
• Flat if groin access was used.
• Analgesia.

Complications:  Minor or major

• Bruising, hematoma, pain at the puncture site
• Allergic reactions
• Pseudoaneurysm
• Acute renal failure
• Procedural complications (Differ based on the procedure)

Follow up:

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.