Angiography at Exeter Hospital

What is angiography?

Angiography uses X-rays to build a detailed picture of your blood vessels. Blood vessels are difficult to spot on an ordinary X-ray, so beforehand your doctor puts a dye, known as a contrast agent, into your bloodstream to make them show up clearly.

Why might I need angiography?

You might be offered angiography if you've had chest pain, breathlessness or other symptoms suggesting something isn't right with your circulation. Doctors also often turn to this test once an earlier check, such as an ECG or blood pressure reading, has pointed to narrowed or blocked arteries.

The test can help get to the bottom of several conditions, including:

• Atherosclerosis: This is where fatty deposits build up and narrow your arteries
• Peripheral arterial disease: This cuts down the blood reaching your leg muscles
• Angina: This causes chest pain because your heart isn't getting enough blood
• A pulmonary embolism: Where a clot blocks blood on its way to the lungs
• An aneurysm affecting the brain: This is where part of a vessel wall bulges outward and weakens
• Poor blood flow reaching your kidneys: This can affect how well they work.

Your doctor might also turn to angiography to plan out your treatment, or to look more closely at a heart problem you were born with.

What are the benefits of having angiography?

Angiography lets your doctor see exactly what's going on inside your blood vessels, which means your treatment can be based on clear evidence rather than guesswork. It reveals whether your arteries are narrowed or blocked, and gives a sense of how well your heart is pumping.

For anyone with angina, or who's had a heart attack in the past, the test can pin down what's behind the symptoms. Doctors also rely on it to look into heart conditions present from birth, and to plan ahead of an operation or another procedure.

Skipping the test isn't without consequence either: without it, a doctor may struggle to properly investigate or treat an underlying problem with your heart or blood vessels.

Are there different types of angiography?

Yes, and which type you have depends on the part of your body your doctor wants to examine. The main ones include:

• Coronary angiography: Focuses on the heart and the arteries around it
• Cerebral angiography: Examines the vessels around and within the brain
• Pulmonary angiography: Follows the vessels carrying blood into the lungs
• Renal angiography: Follows the vessels leading to the kidneys.

For some tests, your doctor might use a CT or MRI scanner rather than X-rays. A CT coronary angiogram, for instance, skips the catheter altogether: instead, the dye is given through a simple arm vein injection, making it a gentler option than the traditional version of the test.

This gentler scan is generally less accurate for spotting narrowing in your smaller arteries, though. So if it picks up a possible problem, you may still need the standard, catheter-based version so your doctor can treat it there and then.

Do I need a referral for angiography?

Angiography is usually recommended by a GP or a specialist you're already under, often once an earlier check, such as a blood pressure reading, a cholesterol test or an ECG, has flagged a possible problem with your circulation. Your results then guide what treatment, if any, comes next.

How do I prepare for angiography?

Beforehand, you'll typically attend an appointment so your team can check you're fit for the procedure. This usually covers your medical history and any allergies, a check of your blood and kidney function, and a chance to talk through exactly what's involved.

To get ready, your team might ask you to:

• List every medicine you take, including anything over the counter or herbal
• Continue most regular medications unless specifically instructed otherwise – anticoagulants such as warfarin, apixaban, rivaroxaban, dabigatran, or edoxaban may need adjustment, and patients taking metformin may receive specific advice, particularly if there is concern about kidney function
• Go without food for several hours beforehand, though sipping water is usually fine right up until the test
• Arrange transport home if the procedure is being performed as a day case and sedation is anticipated
• Leave valuables and jewellery at home
• Before the test itself, you'll be asked to sign a form confirming you understand what's involved and are happy to go ahead.

What happens during angiography?

Angiography takes place in a specialist X-ray or catheter suite, sometimes known simply as a cath lab. Most procedures are finished within 2 hours, and some take as little as 30 minutes, depending on what your doctor finds along the way.

1. You change into a gown provided by the hospital and settle yourself onto the X-ray table
2. Your team injects a local anaesthetic to numb an area close to your groin or wrist – you'll normally stay awake for the whole thing, though a sedative can be arranged if you'd like to feel more relaxed
3. Your doctor makes a small nick in the skin and feeds in a catheter, a slim, bendable tube
4. Guided by X-ray images on a screen, they steer the catheter carefully towards the area under investigation, such as your heart – this shouldn't be something you can feel
5. Next, a dye (the contrast agent) is released through the catheter – many people notice a brief hot, flushing feeling as it enters the bloodstream, along with a passing sensation of needing to wee; both fade within seconds
6. As the dye travels through your blood vessels, a run of X-ray pictures, the angiograms, are captured
7. Should a narrowing or blockage turn up, your doctor may deal with it there and then, for instance by fitting a small balloon or a mesh tube (stent) to widen the artery
8. Once finished, the catheter comes out and firm pressure is held over the small wound until any bleeding stops. Stitches aren't usually necessary.

What happens after angiography?

Once it's over, you'll be taken to a recovery area, where staff monitor your pulse, blood pressure and the wound site. A groin puncture generally means staying flat for several hours so it doesn't start bleeding again, while a wrist puncture tends to let you sit up and move about sooner.

Many people head home on the same day, though an overnight stay isn't unusual. You'll need someone else to drive you home, and it's worth having company for the first day too, in case you feel unwell.

Once you're home:

• take things gently for what remains of the day
• keep your fluids topped up, which helps carry the dye back out of your body
• eat and drink as you normally would, but steer clear of alcohol for 24 hours
• give the gym, and any heavy lifting, a miss for several days
• expect some bruising and tenderness around the wound, which can linger for several days and occasionally up to 2 weeks.

Everyday activities can usually resume the following day. Getting back behind the wheel takes a little longer: 3 days tends to be the guide after a wrist procedure, 5 days after a groin procedure, and at least a week if a heart attack or stent procedure occurred.

Some results might be shared with you before you're discharged, though a fuller report can take a few weeks to come through, once the images have been studied closely. Your team will also flag up any follow-on appointments you need.

What are the risks of angiography?

Angiography carries a good safety record overall. Complications are uncommon, affecting fewer than 1 in 100 people who have the test, and anything serious is rarer still.

Minor, fairly common effects include:

• bruising and tenderness near the wound
• a small lump or pocket of blood beneath the skin
• mild discomfort that eases within a few days to around 2 weeks.

Less common problems include:

• infection developing at the wound
• a mild response to the contrast dye, for example an itchy rash
• kidney function dipping temporarily because of the dye
• reddened skin resembling sunburn from the X-rays, which can be harder to spot on brown or black skin.

Rare but serious complications can include:

• an irregular heart rhythm
• a heart attack or a stroke
• bleeding inside the body, should a vessel be accidentally injured
• a severe allergic reaction, sometimes called anaphylaxis, which can affect breathing or cause fainting.

Doctors only recommend angiography where they judge the benefits outweigh these risks for you personally, and they should walk you through them in advance.

Get in touch with your care team or hospital straightaway if:

• the wound keeps bleeding despite a few minutes of firm pressure
• pain is severe and painkillers aren't touching it
• the area around the wound turns red, hot or swollen
• the arm or leg used for the test looks pale, feels cold, or seems different from the other side
• a fever develops.