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Angiogram & Angioplasty

What is an Angiogram? 

An angiogram (also sometimes called an arteriogram) is a special x-ray examination of blood vessels. Normally, blood vessels do not show up on ordinary x-rays. However, by injecting a special dye called contrast medium into your fistula/graft through a fine plastic tube called a catheter, and taking x-rays immediately afterwards, detailed images of your fistula/graft can be produced.

Why Do I Need an Angiogram?

Your doctors feel that there may be a problem with part of your dialysis access. Other tests that you might have done, such as Doppler ultrasound, can provide useful information, but it is felt that in your case, the best way of obtaining the amount of detail required is by an angiogram.

What is an Angioplasty?

An Angioplasty is a way of relieving blockage or a narrowing in your dialysis fistula/graft without having an operation. A catheter is inserted through a blockage in an artery and a special balloon on the catheter is then inflated to open up the blockage and allow more blood to flow through it.

Who Has Made the Decision About My Treatment?

The doctors in charge of your case and the radiologist doing the angiogram will have discussed the situation and feel that this is the next step. However, you will also have the opportunity for your opinion to be taken into account and, if after discussion with your doctors, you do not want the procedure carried out, then you can decide against it.

Who Will Be Doing the Angiogram or Angioplasty?

The procedure will be performed by a team of specialists, including specialty trained nurses and radiographers. They are lead by a doctor specially trained as a vascular radiologist, often assisted by a radiologist undergoing further specialist training. Radiologists have special expertise in using x-ray equipment and also in interpreting the images produced. They need to look at these images while carrying out the procedure.

Where Will the Procedure Take Place?

At our facility at the San Saba clinic, in a special “Vascular Lab” room, which is equipped for specialized procedures.

How Do I Prepare for an Angiogram?

Usually, you will be admitted to a holding/recovery area on the day of your angiogram. You will be seen by a doctor, who may ask you to sign a consent form. You may be asked not to eat for 4-6 hours before your examination, but in most cases you will be encouraged to refrain from eating or drinking after midnight before your procedure. It is important tor you to take your blood pressure medicines prior to arriving to maintain control of your hypertension.

You will be asked to put on a hospital gown. An IV may be put into a vein in your non-fistula/graft arm so that the nurse can give you a sedative or painkillers during the procedure, if necessary. Once in place, this will not cause any pain. You will be asked to put on a hospital gown. An IV may be put into a vein in your non-fistula graft arm so that the nurse can give you a sedative or painkillers during the procedure, if necessary. Once in place, this will not cause any pain.

If you have any allergies, you must let the doctor know. If you have previously reacted to intravenous contrast medium, the dye used for kidney x-rays and CT scanning, then you must tell the doctor about this. You should also tell the doctor if you are diabetic and if you have previously had any problems with blood clotting or asthma.

What Actually Happens During an Angiogram?

• You will lie on the x-ray table, generally flat on your back. You will have a monitoring device attached to your chest and finger and may be oxygen through small tubes in or nose or a mask.

• The radiologist will keep everything sterile and will wear a gown, mask, and operating gloves.

• The skin near the point of insertion of your fistula will be cleaned with antiseptic and then the majority of your body will be covered with a drape.

• The skin and deeper tissues over your fistula/graft will be anesthetized with local anesthetic and then a needle will be inserted into your fistula/graft.

• Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through a needle and into the artery; then the needle is taken out allowing and allowing the fine, plastic tube (catheter) to be placed over the wire and into the fistula/graft.

• The radiologist uses the x-ray equipment to make sure that the catheter and the wire are moved into the right position and that the wire is taken out. The contrast medium is then injected through the catheter and x-rays are taken.

What Actually Happens During an Angioplasty?

• The placement of the catheter will be performed in the same way as for an angiogram.
• The radiologist will use the x-ray equipment to make sure that the catheter and the wire are moved into the right position, very close to the blockage in your fistula/graft, then the wire and the catheter are moved into the right position, very close to the blockage in your fistula/graft. The wire and the catheter will then be moved so that they will pass into the narrowed area. The balloon is inflated. It may be necessary to inflate the balloon several times in order for the narrowed area to open enough to improve the blood flow.
• The radiologist will check the progress by injecting contrast medium down the catheter to show how much the narrowed fistula/graft has opened up. When satisfied that a good result has been obtained, the balloon is let down and the catheter is removed.
• [endif]Once the radiologist is satisfied that the x-rays show all the information required, the catheter will be removed and the radiologist will then press firmly on the skin entry port for several minutes to prevent any bleeding. These are usually able to be removed after the procedure before you leave the recovery area.
Will It Hurt?

• When the local anesthetic is injected, it will sting at first, but this soon wears off and the skin and deeper tissues should then feel numb. After this, the procedure should not be painful, there will be a nurse or another member of clinical staff standing next to you and looking after you. If the procedure does become uncomfortable for you they will be able to arrange for you to have some painkillers through the needle of your non-fistula graft arm. As the contrast medium passes around your body, you may get a warm feeling which some people can find a little unpleasant. However, this soon passes off and should not concern you.

• Some people feel a degree of discomfort during the time that the angioplasty balloon is inflated, but this generally passes off swiftly when the balloon is removed.

How Long Will it Take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Most angiograms are generally straightforward and do not take very long, perhaps, half an hour. Other angiograms looking at much smaller vessels may be more complex, and take longer, perhaps over an hour. As a guide, expect to be in the x-ray department for about an hour and a half altogether.

What Happens Afterwards?

You will be taken back to the holding/recovery area on a stretcher. The nurse and/or medial technicians will carry out routine observations, such as taking your pulse and blood pressure to make certain there are no problems. They will also look at the point where the catheter was inserted to make certain that there is no bleeding from it. You will generally stay in bed for 30-45 minutes, until you have recovered. You should be able to go home on the same day.
Are There Any Risks or Complications Associated with Angiography?

Angiography is a very safe procedure, but there are some risks and complications that can arise. There may occasionally be a small bruise, called a hematoma, around the site where the needle has been inserted and this is quite normal. There is a chance that the bruise may become very large and uncomfortable, delaying discharge, but this does not happen very often. Very rarely, some damage can be caused to the fistula/graft by the catheter and this may need to be treated by surgery or another radiological procedure. You may notice a small lump in your fistula/graft, which may remain after the procedure for a couple of months. This is part of the body’s natural healing process, and is caused by the formation and gradual absorption of scar tissue. The lump will disappear with time.
Surveillance of Your Fistula/Graft After an Angioplasty

Narrowing of your dialysis site frequently will occur. We can follow your progress during dialysis and possibly schedule a follow-up appointment in 3-6 months or earlier, if your condition that had you come for the angiogram or angioplasty reoccurs before then. You will receive this appointment from the Vascular Laboratory. This is to check that the angioplasty ha s worked and that the blood flow through your fistula/graft is sufficient to use for dialysis. You may require a further angioplasty if the narrowing reoccurs or possibly a stent placement. The stent is a small metal spring-like device that assists in keeping the vein open and aids in preventing the re-narrowing of your vessel.

Finally …

Some of your questions should have been answered by this article, but remember, that this is only a starting point for discussion after your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure before you sign the consent form.
This feature is for informational purposes only and should not be used to replace the care and information received from your healthcare provider. Please consult a healthcare professionally with any health concerns you may have.