Angiography - Causes, symptoms and treatment. MF.

What is angiography?

Angiography is a method for studying blood vessels using X-rays. Due to this method, it is possible to detect narrowing of the lumen of the blood vessels( as a result of their occlusion by a blood clot or atherosclerotic plaque), their expansion in aneurysms, and various developmental defects( convoluted course or king-kng, hemangiomas) in virtually all vascular pools in the body( in the heart, the brain, abdominal cavity, upper and lower limbs).If an examination of the arteries is carried out, then it is called arteriography, if the veins are examined, it is called venography.

To obtain an image due to X-rays, a radiopaque substance is inserted through a special flexible tube called a catheter, which is inserted into the artery or vein at a certain point. Usually a catheter is inserted into the femoral artery or vein in the inguinal region, but sometimes the examination can be carried out both through access to the ulnar artery and the vein, and less often through the accesses of other localization. The input contrast is distributed over the vessel and then allows to visualize the vessels using X-rays. Contrast substance is excreted from the body by the kidneys.

An angiographic examination can be recommended to you in the following case:

1) Atherosclerotic lesions of the aorta and its main peripheral branches, coronary arteries.

2) Expansion of the arteries, called aneurysms.

3) Lesions of the arteries of the kidneys.

4) Diseases of the aorta and its branches.

5) Defects in the development of arterial and venous vessels.

6) Deep vein thrombosis or the formation of a blood clot in the pulmonary artery, called pulmonary arterial thromboembolism.

How to prepare for the study?

Before performing angiography, you should be sure to perform a general blood test and determine the parameters of the blood coagulation system, as well as a biochemical blood test to evaluate the kidney function. Depending on the results of the research, you will be given appropriate instructions, in particular, aspirin or other drugs that reduce blood clotting may be temporarily canceled, and you will be told what preparations you should continue taking. Usually, 6 hours before the angiography is not recommended to drink or eat. But depending on the concomitant pathology, for example, with kidney disease, you may be recommended to use more fluid or intravenously injected a certain amount of fluid, and also prescribed special medications. If you have a tendency to develop allergic reactions and in particular to contrast components, iodine, then to reduce the risk of developing an allergic reaction, you can also be given the appropriate drugs. After the study, the vascular surgeon recommends the most appropriate treatment for you.

What complications can occur during angiography?

Violations of the blood clotting system, impaired renal function, obesity and advanced age are associated with an increased risk of complications during and after angiography. The risk of developing an allergic reaction to a contrast agent is also great. An increase in the amount of fluid administered before and after angiography may lead to progression of heart failure in patients with reduced myocardial contractility( chronic heart failure).

What happens during angiography?

The study is conducted in a specially equipped office with an X-ray unit. The doctor chooses a place through which the catheter will be inserted for angiography. Usually, angiography is performed through inguinal access to the femoral artery and vein. Before the introduction of the catheter, your skin will be treated with an antiseptic solution in order to reduce the risk of infection. Next, local anesthesia( administration of an analgesic agent subcutaneously and intramuscularly at the site of the vessel's puncture), then the needle is punctured with a special needle, the catheter is then carried to the desired vessel, and then a special radiopaque substance is injected. The motion of the catheter is monitored on the monitor during fluoroscopy.

When the catheter reaches the desired vascular pool, then a fertagnet contrast substance is introduced, through which, using X-rays, we can obtain an image on the computer screen. During the introduction of contrast, you can feel the heat as the contrast medium circulates through the circulatory system. During the study, the doctor may ask you to hold your breath for 5-15 seconds. At the same time, during the research, it is necessary to lie quietly, since a sudden movement can distort the image obtained by X-rays.

After completion of the study, the catheter is removed and a strong compression at the site of vascular puncture is required for 10-20 minutes to stop bleeding.

Angiography usually lasts about an hour. Longer-term studies are performed with angioplasty and stenting.

What should you do after angiography?

After conducting the research within 6 hours you will be supervised by medical personnel. In doing so, you should be in this position( with straightened limbs) to minimize the risk of bleeding from the site of the vascular puncture. After the bleeding is stopped and at normal rates of vital functions your doctor will allow you to get up. After discharge from the hospital, which usually happens the next day, at home you can eat normal food, but do not consume large amounts of liquid for 1-2 days. At the same time, if you have impaired renal function, you will be recommended to consume more fluid. After angiography, you should avoid heavy physical activity, in particular, drive a car, walk a lot. You can return to normal physical activity after 1-2 days.

What complications occur after angiography?

Complications after angiography can be: bleeding, pain, swelling at the site of insertion of the catheter. Coldness and blueing of the limb can be a sign of bleeding or thrombosis of a punctured vessel. A bruise( bruise) at the site of a vascular puncture is a common occurrence, but an increase in its size may indicate continued bleeding. Rarely with angiography, kidney failure and progression of kidney failure are possible, especially if the patient already has kidney disease. Allergic reactions to a contrast agent are also possible. Do not forget that it is possible to increase heart failure, which is manifested by shortness of breath. In addition, angiography may result in vascular trauma, stroke and myocardial infarction, as well as heart rhythm disturbances.