Definition and Overview
Also referred to as angiogram or angiography, an arteriogram is an imaging test that involves the use of a contrasting dye material injected into the arteries, so they become more visible in an X-ray. The principle behind X-rays and contrast dyes is called fluoroscopy since the latter causes the internal parts of the blood vessel to be opaque. Thus, it’s easier for the doctor to analyze them.
Arteries are types of blood vessels that deliver blood supply from the heart to various parts of the body. For this reason, even if the name denotes that it’s a heart-related procedure, angiography can be performed elsewhere. These include cerebral angiography if it’s carried out in the brain, pulmonary angiography if it’s in the lungs, renal angiography if it’s in the kidneys, and extremity arteriography if it’s in the extremities like the arms and legs. It can also be used to check the arteries of the eyes (fluorescein angiography) and the aorta of the heart (aortic angiography).
Who Should Undergo and Expected Results
One of the most common reasons why arteriogram is carried out is to confirm and manage stenosis, or the narrowing of the arteries. The arteries look like a long narrow tube composed of many different layers. In the middle is the space that allows smooth blood flow.
However, there are cases wherein the opening becomes narrow usually due to the buildup of fatty deposits from cholesterol. When this happens, less blood reaches the cells and tissues while the heart becomes overworked as it exerts more effort to pump blood.
Some of the usual signs and symptoms of stenosis include angina (chest pain), shortness of breath, difficulty in breathing, and quick exhaustion even after a light activity.
Another possible reason is an aneurysm, which is characterized by the bulging of the walls of the arteries as the vessels become weak. Meanwhile, risk factors include hypertension, family history, and smoking. A serious consequence of an aneurysm is a rupture, in which case the patient suffers from internal bleeding and organ damage. If it happens in the brain, it can lead to stroke and death of the brain’s tissues. Usually, though, aneurysms do not rupture, but they are constantly monitored through tests like arteriogram to monitor their progress. Once they become high risk, interventions are performed.
An arteriogram is also a common test to diagnose thrombosis or a blood clot in the blood vessel. Blood vessels can also be injured, and as a natural process, they form a blood clot. The clot, however, can obstruct the flow. The test can be helpful in keeping track of the thrombosis and planning for medical intervention. Thrombosis is different from embolism, wherein a plaque can also work like a blood clot. The embolus moves from its original site to another part of the body like the lungs through the blood vessel.
In some cases, arteriogram can be helpful in delivering medications directly to the site. For example, a chemo drug to kill off cancer cells and tumors can be injected directly into an artery.
The test usually takes at least an hour to complete, but more hours may be spent on preparations including searching for a good IV (intravenous) access. The physician may also recommend that the patient avoids taking certain medications at least a few days before the procedure to avoid complications.
The patient can expect some discomfort especially in the injected site and a feeling of flushing, but all these should subside a few hours after the procedure.
The test can be carried out alone or in conjunction with other imaging exams such as CT or MRI scan, especially if the results are unclear or inconclusive.
How Does the Procedure Work?
The health care provider may administer either local or general anesthesia depending on the site. For example, if it’s for extremities, local anesthesia will suffice. However, for anxious patients and children including infants, general anesthesia may be necessary to minimize movement during the injection and X-ray imaging.
The specific steps performed during an arteriogram depends on the actual body part tested. But normally, it involves the following:
- The patient is ushered into the X-ray table wearing light clothing or a hospital gown.
- An intravenous line, which will be used to deliver the contrast dye, is attached either to the arm or leg. It may take a few minutes for the dye to be fully absorbed by the body.
- A small incision is made either in the groin or the arm (radial) where a catheter is inserted.
- A catheter is slowly inserted into the artery.
- A contrast dye is injected through the catheter.
- X-ray imaging begins. Multiple images may be obtained to get the best picture of the entire artery.
Once the test is over, the catheter is slowly removed while the patient is wheeled into the recovery room, where he normally stays for a few hours. The dye is expected to be naturally eliminated by the body a few hours after the procedure.
Possible Risks and Complications
Arteriogram rarely results in complications. In the UK, they occur in one in every 1,000 procedures. Some of the common complications are bleeding and infection in the incised site.
Some patients may also develop allergic reactions to the dye. Thus, it is essential that the patient discusses common allergies to the doctor prior to an arteriogram.
Although very rare, around 2% of patients that are administered with contrast dye will develop contrast-induced nephropathy (CIN) or damage to the kidneys. According to the National Kidney Foundation, the risks of CIN increase by as much as 30% to 50% if the patient is diagnosed with diabetes, hypertension, and chronic kidney disease. At this point, the test may not be recommended to the patient. It’s also necessary the patient goes through a series of physical tests to ensure that the kidneys can handle and effectively eliminate the dye.
Kern M. Catheterization and angiography. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 57.
White CJ. Atherosclerotic peripheral arterial disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 79.
Zivin JA. Approach to cerebrovascular diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 413.