Our Dad hate doctors, hospitals and syringes; in any order. (He fainted after one blood extraction 40 years ago and that’s that. ^_^) So we had to literally pull him out of the house for his general check up due to some urgent concerns. Generally, our family has been self-sufficient, medically speaking; no heavy illnesses, just the simple colds, coughs and flu which we have managed fairly well. Childbirth was the only reason our parents visited hospitals.
But when Dad started to grow old (which he still can’t accept), several problems started to arise. Managing a rattan manufacturing firm for more than 20 years and being in the middle of all the production activities, he got exposed to paint, varnish and dusts. Add smoking to that and you wouldn’t be surprised if doctors suspect a case of emphysema and/or COPD. He has an enlarged heart (according to x-rays) and swelling in the feet and legs. When the doctors suggested he undergo an ANGIOGRAM, he vehemently refused; saying he doesn’t need nor want an operation. And that if we had the amount needed for that, it would be money well worth spending over other more important things than an angiogram.
But, wait… ANGIOGRAM is not a surgical operation. He thought it was an operation to be done for his heart. This we had to explain to our father.
So what is an angiogram?
An angiogram is an imaging test which uses x-rays to view our body’s blood vessels; to study narrow, blocked, enlarged, or malformed arteries or veins in many parts of our body, including our brain, heart, abdomen, and legs. It’s also known as a coronary angiogram or a cardiac catheterization.
Simply put, an angiogram allows our doctor to look inside our coronary arteries and find out where and how severe any narrowed areas are to help them decide what treatment a patient may need. The angiogram can also give information as to how effectively our heart is pumping and the blood pressure inside our heart. It is also very helpful for investigating other conditions, such as congenital heart disease.
When the arteries are studied, the test is also called an arteriogram. If the veins are studied, it is called a venogram.
The doctor may recommend an angiogram to diagnose a variety of vascular conditions, such as:
- Blockages of the arteries outside our heart (Peripheral Artery Disease (PAD)
- Problems in the arteries that branch off the aorta(Aortic Arch conditions)
- Enlargements of the arteries (Aneurysms)
- Kidney artery conditions (Renovascular conditions)
- Problems with our veins ( deep venous thrombosis (DVT) or blood clots in the lungs called pulmonary emboli)
- Malformed arteries, called vascular malformations
How is it done?
To create the x-ray images, the physician will inject a liquid, sometimes called “dye”, through a thin, flexible tube, called a catheter, which in turn is threaded into the desired artery or vein from an access point. The access point is usually in the groin, but it can also be in the arm, near the elbow or, less commonly, a blood vessel in another location.
Before the insertion, risk of infection is avoided by shaving and cleaning the skin parts involved. Then local anesthetic is applied to numb the skin and then the physician proceeds to make a tiny puncture to reach the artery below, using a hollow needle, then advances a thin wire through the needle, threads a catheter over the wire, and guides it to the desired location. The physician uses x-rays which are projected on a video screen(called fluoroscopy), to see the catheter as it moves through the arteries. Usually, the physician moves the x-ray table to follow the catheter as it is moved through the patient’s blood vessel.
Once the physician has positioned the catheter properly, the contrast dye is then injected; which makes the blood flowing inside the blood vessels visible on an x-ray. The contrast causes a brief, mild warm feeling as it enters the bloodstream. The physician then takes more x-ray images to see how the contrast is flowing through your arteries. During the test, your physician may ask you to hold your breath for about 5 to 15 seconds; to lie perfectly still to prevent sudden movements from blurring the x-ray pictures.
When the test is over, the physician will remove the catheter and press the insertion site for 10 to 20 minutes to help stop bleeding.
The whole procedure generally take about 1 hour to complete if only x-rays are required, but may extend if angioplasty and stenting is also performed.
Angioplasty is a procedure used to widen vessels and to surgically repair a blood vessel; stenting refers to making use of a small metal scaffold, called a stent, which is inserted to keep the blood vessel open. An angiogram can also help your physician plan operations to repair the arteries for more extensive problems; making it also possible for the physician tobe able to dissolve a clot that he or she discovers during the test. A physician may also perform an angioplasty and stenting procedure to clear blocked arteries during an angiogram, depending on the location and extent of the blockage.
Bruising at the puncture site is common and usually resolves on its own. But in as much as the procedure has been well-tested, complications from angiography is sometimes inevitable like bleeding, pain, or swelling on the access point where the catheter was inserted. Pain, numbness, or coolness in the arm or leg may be expected, too. These symptoms may signify either bleeding from the puncture site or blockage of the artery. Rarely though, impaired kidney function, or kidney failure, may occur after an angiogram, especially if the patient already have kidney disease. Likewise, severe allergic reactions could occur, especially among people who have had previous allergic reactions to the contrast dye. Less frequently, a patient may experience shortness of breath or fluid overload for those have a heart condition associated with poor pumping action, such as congestive heart failure.
Perhaps to avoid any misconception, the patient should be informed by the doctor, in simpler terms, with regards to certain procedures and not just to be told that “Hey Sir, you have to undergo an angiogram,” while showing a fixed, so-serious look. Accept it or not..medical terms can sound like bombs to nervous patients! ^_^