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What Is Angiography? All About It

What Is It About?

Angiography is a radiological examination that allows examining the blood vessels, visualizing their morphology and the relationships with the surrounding environment, through the intravenous injection of a contrast medium or a substance, often based on iodine, which appears opaque (like bones) on x-rays. This substance reaches the organ to be studied through a catheter inserted into a blood vessel, for example, the femoral artery. The exam can have different purposes and therefore be defined:

  1. Diagnostic: in case it is performed only for diagnostic and prognostic purposes;
  2. Interventional: in case it is performed not only for diagnostic purposes but also for therapeutic purposes. In this case, the operator cannot only perform the procedure but also intervene to resolve the causes of the damage in cases such as hemorrhages, vascular obstructions, tumor masses to be reduced, in-situ injection of chemotherapy, or other therapeutic substances. Interventional angiography is a fascinating branch in continuous evolution and requires highly specialized personnel.

Depending on the location and the method of investigation, the exam can take different names, for example:

  1. coronary angiography (or coronary angiography) when it allows you to study and simultaneously treat the coronary arteries of the heart in the event of a heart attack;
  2. peripheral angiography, when it allows studying the vessels of the limbs to discover any alterations, such as a reduction in caliber or an occlusion;
  3. renal angiography, when it allows to study of the blood supply to the kidney and indirectly evaluates its functioning;
  4. Cerebral valuable angiography, for example, in case of hemorrhages or aneurysms, as it allows to identify the blood vessel responsible for the bleeding and, in many cases, close it and stop it.

In oncology, angiography has two purposes: to study the vascularization of tumors in the various organs in preparation for surgery and to guide treatments that can be performed as an alternative to surgery ( interventional radiology ). In some cases, the radiological part of the examination is replaced by computed tomography ( CT ) or magnetic resonance imaging: in these cases, we speak of angio-CT and angio-MRI. The reconstruction of the images can be processed by sophisticated 3D graphics software (for example, the Three Dimensional Volume-Rendering Technique – 3D-VRT) that allows the doctor to examine the vascularization of the anatomical region from multiple points of view.

Is It A Test That Everyone Can Take?

The patient must have preventive blood tests, mainly to check kidney function. When the contrast medium is a type of substance eliminated mainly by the kidney, it is necessary to ensure that the filtration of the latter is standard to avoid its accumulation in the blood. Since the procedure involves ionizing radiation (angiography and CT angiography), it is typically contraindicated in pregnant women. It is preferred to resort to MR angiography, which uses magnetic fields instead of ionizing radiation and particular paramagnetic contrast media. Particular attention should also be paid to performing the MRI. 

If the patient is wearing prostheses, metal plates, or pacemakers, promptly report to the doctor. Allergies are other essential conditions to report, particularly those to contrast media if the patient is aware of them due to having already undergone similar tests. Food conditions, for example, seafood, are often associated with these. However, anaphylactic reactions are infrequent: in most cases of allergy, mild disorders appear that doctors keep under control with the use of medicines.

Do You Need Any Special Preparation For The Exam?

It is necessary to fast for at least eight hours before the exam, but drinking water is permitted. Generally, you should not stop taking medicines, but it is advisable to agree with the doctor on which drugs to take and which ones to suspend if necessary. Immediately before undergoing the investigation, jewelry and other metal objects should be removed and the bladder emptied. The nursing staff will provide a gown to wear during angiography and shave the catheter’s area.

Is The Exam Painful, Or Does It Cause Other Types Of Discomfort?

The procedure is performed under local anesthesia and is not painful; at most, slight discomfort is felt during catheter insertion. General anesthesia is reserved for exceptional cases, for example, in children, because they cannot remain adequately still. You may feel a sense of heat or burning as the contrast medium enters the bloodstream. Some also report nausea or experience a bitter or salty taste in their mouth. At the end of the examination, a compression dressing is applied to the catheter insertion point, and immobility is required for a few hours.

Does The Exam Involve Immediate Risks?

The risks may be related to the catheter insertion, which can rarely cause bleeding, infection, or injury to the blood vessels; or to the contrast agent, which can damage the kidneys or trigger a more or less severe allergic reaction. For this reason, it is essential to report to the staff before the examination the presence of kidney diseases and allergies, mainly those that have already emerged, to the components of the contrast medium.

Does The Exam Involve Any Long-Term Risks?

Angiography, except in the case where MRI is used, is exposed to ionizing radiation (X-rays) at low doses. Generally, such exposure is amply justified by the indications for which the examination is requested.

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How Long Does It Last?

The exam duration can vary greatly depending on the site concerned and the procedure chosen: on average, it ranges from 30 minutes to two hours.

In The End, Do I Have To Remain Under Observation? How Long?

After the procedure, the patient is taken to the ward, where he is monitored for a few hours. Sometimes an overnight stay in the hospital may also be appropriate.

Can I Immediately Resume My Everyday Life, Or Do I Have To Take Special Precautions?

Generally, at least 24 hours of rest are required, after which normal daily activities can be resumed.

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