| The word peripheral refers to those arteries which are located away from the center of the body or the heart. This procedure is safe and a commonly used diagnostic procedure, which will help in the management of your peripheral vascular disease. With the knowledge obtained from the peripheral angiogram, the cardiologist will be able to discuss your best treatment options. | ||
Why would I need a Peripheral Angiogram? |
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One of the most common reasons for peripheral angiogram is the need to visualize the arteries which supply blood flow to the legs; however, an angiogram is also performed to obtain information regarding blood flow in the abdominal region (aorta, intestinal, and renal systems) as well as the upper body (subclavian, pulmonary, or carotid systems). |
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How is the Angiogram performed? |
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 You will be taken to a specially equipped room where the angiogram will take place. After transfer to an X-ray table, heart monitoring equipment will be placed on your chest and blood pressure equipment will be placed on your arm. The angiogram is performed under sterile conditions. You will be draped with sterile sheets and all personnel will be wearing sterile clothing. The area of catheter insertion will be cleansed with a cool antiseptic solution and the cardiologist will inject the area with a local anesthetic. You will experience a momentary stinging sensation quickly followed by numbness. At the beginning of the angiogram, a small puncture is made in the skin at the chosen insertion site. A sheath is inserted into the opening and a guiding catheter is fed through the sheath into your blood vessel. Usually, the site of insertion is the femoral artery in the right groin, although the left femoral or brachial artery in the arm can also be used. The catheter is advanced in the circulation to the blood vessel being studied and a liquid dye, which appears white on an X-ray, is injected into the blood vessel. As areas are filled with dye, these vessels can be visualized and X-rays are recorded on videotape and later developed into film. These films are reviewed by the peripheral interventionalist. Once a diagnosis has been reached, your cardiologist will recommend the most appropriate form of treatment.
Intravasculary stents (metal coils) are then frequently placed in the artery to further enlarge the opening. Frequently, the diagnostic angiogram will be performed in the same setting as the treatment. The advisability of performing the two procedures together will be discussed in detail by the cardiologist prior to the procedure and signing of the consent form. You will be awake during the procedure, but sedated. You should not feel any significant discomfort during the catheterization. Please let the interventionalist know how you feel. Further sedation may be given intravenously. At the end of the procedure, the catheter is removed and the site is sealed to prevent bleeding. This is accomplished by holding pressure over the arterial puncture site and then applying a bandage. Special sealing techniques using collagen and sutures are also available. The closure technique will be chosen by the cardiologist at the end of the procedure. You will then be transferred to the holding area for a short period of observation and then to a room in the Mid America Heart Institute. The peripheral angiogram can take half an hour to perform. If an intervention is necessary, this can add one to two hours to the procedure. |
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What happens prior to the Angiogram? |
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After your evaluation and recommendation for peripheral angiogram, certain blood tests will need to be obtained. This will include tests which give information concerning blood count, blood coagulation, kidney function, electrolytes and lipid (blood fat) status. Between 5 and 6 o'clock the evening prior to the procedure, you will be asked to call the cardiac catheterization holding area at St. Luke's Hospital (816-932-3141) to obtain final instructions and to determine the time you will need to arrive at the hospital the day of your procedure. This should give you adequate time to notify family members who wish to be present. You will be requested to drink six to eight large glasses of fluid (8 oz.) the day prior to your catheterization in order to maintain hydration and reduce the impact the contrast dye may have on your kidneys. If you are allergic to contrast dye, you will be given a special medication the night prior to and the morning of the catheterization. Please notify us if you have a contrast allergy. If your procedure is in the first part of the morning, you will be NPO (nothing per mouth) except for clear liquids and medication after midnight. If your procedure is later in the day, then you may have a clear liquid breakfast. Patients with diabetes will be given special instructions. You will be admitted to Saint Luke's Hospital cardiac catheterization lab the morning of your procedure and spend a short time in the holding area. Your evaluation, electrocardiogram, and pre-procedure blood work will have been reviewed and you will meet the members of the interventional team. In the holding area, the angiogram site will be washed and shaved. An intravenous line will be started in your arm to provide a route for medication and fluid. You will be asked to sign a consent form for the procedure. Immediately prior to being moved to the laboratory, you will be given oral sedation to promote comfort and relaxation. Your family will then be directed to the cardiac holding area waiting room. |
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What happens after the Angiogram? |
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You will need to remain in bed for approximately six hours after the procedure to immobilize the puncture site. This is done to allow the artery time to seal and prevent bleeding complications. If a special sealing technique is used, bed rest may be only two to three hours after the procedure. You may eat and drink as soon as you return to your room. If you become uncomfortable, medication will be available upon your request. After the 6 hour period, you may return to your previous activity level. The staff nurse will be checking your blood pressure, heart rhythm, and general well-being frequently upon your return to a room. The nurse will also be assessing the procedure site during the first few hours to make sure that you are not experiencing bleeding complications. Overnight stays are based on the results of the angiogram, type of closure used, and the time of day that the procedure is completed. Since this is so variable, it is recommended that you come to the hospital with your personal items and be prepared to spend the night. |
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When will I have my results? |
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If you are admitted for a same-day procedure, the interventional cardiologist who has just completed your angiogram will be responsible for discussing your results and making treatment suggestions. This will be done the same day as the procedure. The cardiologist or nurse clinician will tell you when this consultation will take place. If possible, your spouse, a family member, or a friend should be present for this discussion. Your local referring physician will promptly receive a letter containing all the information regarding your catheterization, recommendations, and hospital course. |
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How do I clean and care for the angiogram site after I leave the hospital? |
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Special care is not necessary for the normal angiogram puncture site. Usually, keeping the area clean and dry is all that is necessary. If your undergarments rub against the puncture site, then a Band-Aid can be used to protect the area. Avoid the use of powder or rubbing alcohol on the site. When the bandage is removed from the puncture site, please assess the puncture area. Look at it and feel around the area with your hand. It is normal to have a small hard knot and some bruising at the site, which may take several weeks to completely disappear. As you stand after the procedure, gravity may pull the bruise (blood under the surface of the skin) down toward your knee, giving the appearance of active bleeding. As long as the bruise is soft to the touch, this is not cause for concern. If you experience mild discomfort in the area after the procedure, you should obtain relief with Tylenol; one or two tablets every four hours. Applying warm, moist heat to the site for 15 minutes four times per day may also be helpful. |
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What is not normal and should cause concern about my angiogram site? |
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It is not normal to have:
These are all causes for concern and must be managed promptly by calling your local physician or cardiologist. |
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The purpose of this procedure is to open blocked arteries and is accomplished by maneuvering a catheter with a small balloon on the tip across the arterial blockage. Once it is positioned, the balloon is inflated, compressing the fatty deposits against the wall of the blood vessel and remodeling the vessel's shape. In the way, the diameter of the vessel is increased and blood flow is improved.