An angiogram is commonly performed under sedation with the use of local anesthesia.
The procedure usually starts with injection of a local anesthetic at the access site (typically a groin, foot or wrist blood vessel) a needle is then put into the artery. From one treatment site, areas all over the body can be treated.
After access is established, catheters (thin tubes) and wires are used next and are threaded through the arterial system to a specific area of interest or throughout the entire body.
As a contrast agent (iodine dye OR Carbon dioxide gas CO2) is injected, X-ray images are taken to let your vascular surgeon view the flow of the dye and identify blockages. Your vascular surgeon can then choose the best mode of therapy for you – whether during or following the angiogram. This decision depends on your symptoms and the severity and characteristics of the blockages.
Generally the therapies that can be provided during the angiogram include atherectomy (debulking the hard calcified plaque), balloon angioplasty with or without stent placement. Sometimes, a special ultrasound (IVUS) may also be used during this procedure to further facilitate diagnosis and/or treatment.
Angioplasty refers to use of a balloon to open arterial blockages. Guided by X-ray, your vascular surgeon navigates through the blockage with a wire and introduces a special device equipped with an inflatable balloon. After positioning the balloon device across the blocked portion of the artery, the balloon is expanded inside the artery and compress the blockage. The balloon is then deflated and removed while keeping the wire in place across the area that has been treated. Next, contrast dye is injected to assess the result. Treatment is considered a success if blood flow is improved and less than 30% of the blockage remains. If the vessel is still considerably narrowed, placing a stent may be the next step.
Stents are used to prop open an artery at the site of a narrowing. Stents are generally placed after balloon angioplasty when there is residual narrowing or insufficient blood flow in a treated vessel. Stents are considered a permanent implant and cannot be used if you have a metal allergy. Stents that are used in the leg are constructed of a nickel-titanium alloy (Nitinol), a memory-shaped metal. This alloy has a predetermined size and shape at body temperature and expands to this size and shape after being introduced through a catheter. These stents resist kinking and are flexible so that damage from activities that involve your legs is minimized.
If surgery is felt to be a better option, your vascular surgeon will obtain any additional X-ray images needed to plan a surgical bypass of the blocked vessel/s and will then conclude the angiogram.