Table of ContentsView AllTable of ContentsPurposeBeforeDuringAfterWhat Are the Risks of Angiography?ResultsTypes of Angiography
Table of ContentsView All
View All
Table of Contents
Purpose
Before
During
After
What Are the Risks of Angiography?
Results
Types of Angiography
Angiography is a medical procedure used to visualize blood flow in the body using imaging techniques, like anX-ray. During anangiogram,contrast substancesare injected into the blood to better show how it flows. This can help with diagnosing and treating various medical conditions, especially those that impact the heart and brain.
Angiography is not considered a high risk procedure.
This article discusses the reasons why angiography is performed. It also covers techniques, side effects, complications, and the recovery associated with this procedure.
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What Is Angiography Used For?
Angiography may be used to:
Angiography may also be used to deliver treatment. For example,angioplastymay be done to remove blockages and open up narrowed arteries. It is also possible to deploy fixed dilators called stents to widen arteries and coil or seal off aneurysms as part of an angiogram procedure.
Before an Angiogram
Prior to angiography, the healthcare provider who is conducting the procedure will likely take a thorough history and do a physical examination. They will also go over the purpose, risks, and benefits of the angiogram.
This is an excellent opportunity to ask any questions that might come up.
Your healthcare provider may want to use a more advanced imaging technique like angiography for diagnosis if initial non-invasive testing has been inconclusive.
Timing
It will be important to arrive prior to the testing for the intake process. This may involve completing paperwork, changing into a hospital gown, and having intravenous access placed.
Prior to the procedure, you will be transferred into the suite where the angiogram is performed. Depending on the intervention, the angiogram procedure may last more than an hour. Recovery after may add several additional hours.
Location
Angiography takes place in the catheterization lab or “cath lab” of a hospital or medical center. This sterile room has X-ray equipment, viewing monitors, and an examination table where you will lie still during the procedure.
What to Wear
Individuals undergoing an angiogram will disrobe and change into a hospital gown.
Food and Drink
To prepare for angiography, it is important to avoid eating in the eight hours leading up to the procedure. Drinking clear liquids until two hours before the procedure will help keep blood vessels open, flexible, and more easily accessible.
Cost and Health Insurance
The procedure may require a prior authorization process to ensure insurance coverage. Deductibles and co-payments may add to the out-of-pocket expense. Without insurance, the procedure could easily cost thousands of dollars.
What to Bring
It will be important to bring identification and health insurance information to the procedure. Comfortable, loose-fitting clothing is recommended to wear home. You will also need someone to drive you home after the angiogram is completed.
During Angiography
The healthcare provider, often a specialist in either cardiology or neurology, will lead a team that may include nursing staff as well as other providers, potentially including ananesthesiologist.
Pre-Test
Local orgeneral anestheticsare given to sedate you and numb the access point.
In most cases, you will be awake during an angiogram, however, medications will be given to help you feel relaxed.In some cases, like if a child is undergoing angiography, sedation may be heavier so they sleep during the procedure.
Throughout the Test
The angiography procedure involves several steps:
Is an Angiogram Painful?Throughout this process there may be mild stinging, pressure, or discomfort at the insertion site.
Is an Angiogram Painful?
Throughout this process there may be mild stinging, pressure, or discomfort at the insertion site.
Coronary angiography, which is done to see the heart’s blood vessels, is slightly different. It involves the following:
Angiography may take an hour or more, depending on what is required.
Post-Test
As the procedure ends, the catheter will be removed and a healthcare provider will apply pressure to the access site and monitor to ensure bleeding is not present. Often you will remain lying flat for a specified period of time.
Higher-risk angiograms, such as when the femoral artery is accessed, may require you to stay at the hospital for a few hours of bed rest and observation. You should not drive home.
After Angiography
Some people feel back to normal within a day or two. For the day after the procedure, it can be helpful to have someone around to monitor for any issues that may develop. They may need to help prepare food or administer medications. If there is a serious problem, it may be necessary to contact the healthcare provider and get emergency medical assistance.
For 24 hours following angiography, you should not:
For three days following angiography, it is important to avoid:
Engaging in certain activities within days following the procedure can reopen the access wound and increases your risk for side effects.
Managing Side Effects
If bleeding continues at the entry site, stay relaxed, apply direct pressure, and contact your healthcare provider as soon as possible.
If your chest hurts after an angiogram, call your healthcare provider. While you may notice some bruising, let your healthcare provider know if you have any pain, swelling, numbness, or fever.
As with any medical procedure, there is the possibility of side effects or complications. These may be more likely if there are procedural mistakes, allergies, or coexisting medical conditions. Major complications are exceedingly rare and almost never fatal, so there is no specific set of risk factors to prevent someone from having an angiogram.
General risks of angiograms include:
Allergic responses can occur due to a number of substances used in the procedure, and asthma or the use of beta-adrenergic blockers increase the likelihood of a serious allergic response. The mechanical movements of the instruments during the procedure can also cause problems like bleeding and clotting, which may, in turn, induce more serious complications like:
The risk of the procedure is always weighed against the potential benefit, which is often very high.
Local Anesthetic Reactions
Allergies or Toxicity
Some people may be at risk of allergies or complications from general anesthetics, contrast media, or heparin use during the procedure.
General Anesthetics
Thoughgeneral anestheticsare rarely needed to perform angiography, some risks are involved if they are utilized. While an anaphylactic allergic response is unlikely with conscious sedation, general anesthetics can affect the function of the heart if given at an improper dose.
The goal of general anesthesia in angiography is to limit sensation, rather than to make a person unconscious. However, loss of sensation could mask the recognition of some kinds of complications.
As with any surgical procedure, vital signs such as heart rate, heart rhythm, blood pressure, and blood oxygen level are monitored to identify any abnormal changes in heart or lung function.
In situations of an anesthetic overdose, reversal agents may be provided to restore normal organ function. A severe anaphylactic response may be treated with epinephrine, corticosteroids, high-flow oxygen delivered via a mask, and even intubation and ventilation until the reaction subsides.
Contrast Media
Though many types of contrast media have become available which drastically decrease sensitivity reactions, it may cause anaphylaxis and chemotoxicity. Contrast media can cause constriction of the throat through the release of histamines or induce allergic responses to iodine.
Chemotoxicity can result due to the interaction of the contrast media and blood. Minor side effects include:
Major side effects include:
In addition, contrast-induced nephropathy (CIN) is another danger that can affect people with vulnerable kidneys. Newer contrast media may reduce the risk. Decreasing the volume of contrast media administered and promoting hydration with intravenous fluids before, during, and after the procedure may also help.
Heparin-Induced Thrombocytopenia (HIT)
Heparin is a blood thinner used during angiography. In susceptible individuals, exposure to heparin may cause an amplified immune system response that activates platelets and leads to clotting and inflammation in blood vessels.
This may cause blood clots to form via thrombosis. As the supply of platelets in the blood is consumed, there may be an increased risk of bleeding (and possible hemorrhage). Treatment is possible and the platelet counts may be monitored to ensure normalization.
Physical Disruptions
A physical disruption could be an injury, irritation, or infection that happens during the procedure. These include:
Local Vascular Injury
Hematoma
The angiography procedure includes steps taken to reduce hematoma risks. Post-surgery, your healthcare provider applies pressure to the sheath site to keep large hematomas from forming. Likewise, resting after surgery limits the risk of forming hematomas.
If a hematoma causes dangerous blood loss, a second angiogram may be performed to identify and repair the damaged blood vessel.
False Aneurysm
A false aneurysm (called a pseudoaneurysm) can occur when a smaller artery is accidentally catheterized. The mismatch of size can damage the wall of the blood vessel and cause the subsequent formation of an aneurysm, an extension outside of the normal blood vessel. Most pseudoaneurysms can be spotted with an ultrasound and then treated with an injection of thrombin which stops blood from flowing into the aneurysm.
Arteriovenous Fistula (AVF)
An arteriovenous fistula (AVF) may form when an artery and vein are penetrated near each other and form a connection, allowing the higher arterial pressure to enter into the vein. Most fistulas should be monitored but will close off with time.
Dissection
Dissection, or cutting, of the femoral or iliac artery during sheath placement is very rare but risks limb loss or even death if untreated. A stent may need to be placed to restore normal blood flow to the limb and allow the damaged artery to heal.
Thrombosis and Embolism
A blood clot that travels along the bloodstream to cause damage at another site, called an embolism, may result in a stroke as well as numbness or pain affecting the limbs, hands, or feet. This may need to be treated with surgery to remove the clot (called thrombectomy).
Cholesterol Emboli
Physical disruption of cholesterol deposited along the lining of blood vessels can lead to an embolism. These cholesterol plaques commonly narrow blood vessels inatherosclerosis. Symptomatic occurrences of cholesterol emboli associated with an angiogram are rare.
Findings may include discoloration of an extremity or splotchy, purple patterns in the skin (known as livedo reticularis). Risk factors include age, repeated vascular procedures, and elevated amounts of inflammation-driven C-reactive protein.
Bradycardia
Tachycardia
Infection
The risk of infection in the setting of an angiogram is very low, but people who have a fever or other symptoms may require medical treatment.
Signs of Infection After Surgery
Significant Morbidity and Mortality
In rare cases, complications from angiography can lead to stroke or heart attack, which can be fatal.
Stroke
Hypertension, diabetes, prior strokes, abnormal kidney function, and emergency angiography can increase the risk of a stroke occurring during the procedure. An embolus that travels to the brain may occur when thrombosis occurs near the catheter or when plaque is dislodged. Stroke occurs in less than 1% of people with risk factors.
Heart Attack (Myocardial Infarction)
Heart attack can occur during angiography, but this happens in under 0.2% of angiograms. It is more likely to occur in longer, more complicated procedures.
Death
Unfortunately, death may also occur due to angiography in rare circumstances. Recent heart attacks, left main coronary artery disease, aortic stenosis, increased age, and poor kidney function are the main risk factors that increase the chance of death. Mortality occurs in less than 0.1% of angiograms, affecting 1 in 1000 people undergoing the procedure, but this outcome is more likely in those with known risk factors.
Interpreting Results
Often an angiogram is performed with both a diagnostic portion, to better visualize the nature of the problem, and a treatment portion, in which an intervention immediately corrects the underlying problem. Unlike other tests, it is often unnecessary to gather information to review and be used at a later date.
Due to the nature of the procedure, it is best to intervene promptly during the time that the individual is both medicated and the arterial access exists. Prior to the angiogram, the healthcare provider will outline the likely findings as well as how any abnormalities that are identified may be corrected before the conclusion of the procedure.
You’ll need a follow-up appointment with your healthcare provider in the weeks after the angiogram. This allows you to discuss the results of the intervention and whether your symptoms have improved. In rare cases, an angiogram may be repeated for further evaluation or intervention.
A healthcare provider may want to perform different types of angiography to identify the source of the problem, make a diagnosis, and plan the next steps in the treatment, like surgery, medication, or behavioral changes.
Coronary Angiography
The coronary arteries supply blood flow to the heart and are vital to its function. Coronary angiography may be used if you are experiencing:
Cerebral Angiography
It is also possible to image the blood vessels to the brain with cerebral angiography. Additional imaging techniques may be used with the procedure to enhance the visualization.
Cerebral angiography may be used to:
Microangiography
Microangiographymay be used to image the smaller blood vessels supplying other organs, particularly to address localized bleeding. It may also be useful in detecting and treatingcancerous tumorssince fast growing tumors contain a lot of blood vessels.
Summary
An angiogram is an effective procedure to diagnose and treat disorders that commonly affect the blood supply of the heart and brain. The procedure involves injecting contrast substances into the blood to better show how it flows. Risks of injury from angiography are generally slight, but complications, such as an allergic response or kidney issues, are possible.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Society for Cardiovascular Angiography and Interventions.Your angiogram: What to expect.Johns Hopkins Medicine.Angioplasty and stent placement for the heart.Al-Hijji, M. A., Lennon, R. J., Gulati, R., El Sabbagh, A., Park, J. Y., Crusan, D., Kanwar, A., Behfar, A., Lerman, A., Holmes, D. R., Bell, M., & Singh, M. (2019).Safety and risk of major complications with diagnostic cardiac catheterization.Circulation: Cardiovascular Interventions,12(7). https://doi.org/10.1161/circinterventions.119.007791Shen, L., Liu, X., Chen, L.et al.Heparin-induced thrombocytopenia post-cardiovascular interventional therapy: a case report.BMC Cardiovasc Disord22, 351 (2022). doi: 10.1186/s12872-022-02796-2Additional ReadingAmerican Heart Association.What is a coronary angiogram?MedlinePlus.Coronary angiography.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Society for Cardiovascular Angiography and Interventions.Your angiogram: What to expect.Johns Hopkins Medicine.Angioplasty and stent placement for the heart.Al-Hijji, M. A., Lennon, R. J., Gulati, R., El Sabbagh, A., Park, J. Y., Crusan, D., Kanwar, A., Behfar, A., Lerman, A., Holmes, D. R., Bell, M., & Singh, M. (2019).Safety and risk of major complications with diagnostic cardiac catheterization.Circulation: Cardiovascular Interventions,12(7). https://doi.org/10.1161/circinterventions.119.007791Shen, L., Liu, X., Chen, L.et al.Heparin-induced thrombocytopenia post-cardiovascular interventional therapy: a case report.BMC Cardiovasc Disord22, 351 (2022). doi: 10.1186/s12872-022-02796-2Additional ReadingAmerican Heart Association.What is a coronary angiogram?MedlinePlus.Coronary angiography.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The Society for Cardiovascular Angiography and Interventions.Your angiogram: What to expect.Johns Hopkins Medicine.Angioplasty and stent placement for the heart.Al-Hijji, M. A., Lennon, R. J., Gulati, R., El Sabbagh, A., Park, J. Y., Crusan, D., Kanwar, A., Behfar, A., Lerman, A., Holmes, D. R., Bell, M., & Singh, M. (2019).Safety and risk of major complications with diagnostic cardiac catheterization.Circulation: Cardiovascular Interventions,12(7). https://doi.org/10.1161/circinterventions.119.007791Shen, L., Liu, X., Chen, L.et al.Heparin-induced thrombocytopenia post-cardiovascular interventional therapy: a case report.BMC Cardiovasc Disord22, 351 (2022). doi: 10.1186/s12872-022-02796-2
The Society for Cardiovascular Angiography and Interventions.Your angiogram: What to expect.
Johns Hopkins Medicine.Angioplasty and stent placement for the heart.
Al-Hijji, M. A., Lennon, R. J., Gulati, R., El Sabbagh, A., Park, J. Y., Crusan, D., Kanwar, A., Behfar, A., Lerman, A., Holmes, D. R., Bell, M., & Singh, M. (2019).Safety and risk of major complications with diagnostic cardiac catheterization.Circulation: Cardiovascular Interventions,12(7). https://doi.org/10.1161/circinterventions.119.007791
Shen, L., Liu, X., Chen, L.et al.Heparin-induced thrombocytopenia post-cardiovascular interventional therapy: a case report.BMC Cardiovasc Disord22, 351 (2022). doi: 10.1186/s12872-022-02796-2
American Heart Association.What is a coronary angiogram?MedlinePlus.Coronary angiography.
American Heart Association.What is a coronary angiogram?
MedlinePlus.Coronary angiography.
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