How do I prepare for the angiogram?
Before the test, you will be asked to remove all clothing and jewelry and put on a hospital gown. You will be asked about your medical history and given blood thinners to prevent clots during the procedure. You may be asked not to eat or drink in the 4 to 8 hours before the procedure.
Before you have the angiogram, be sure your doctor knows if you:
- Are allergic to any medications
- Are allergic to the iodine dye used in the test
- Have ever had a serious allergic reaction ( anaphylaxis) to any substance
- Have diabetes
- Have a history of bleeding problems or are taking blood-thinning medicines
- Have a history of kidney problems
- Have asthma
- Are breastfeeding (you should not resume doing so until the dye has been cleared from your body)
What happens during the test?
The angiography test will take place in the hospital in a specialized catheterization lab; the staff wears hospital gowns and masks, and the lights are dimmed. You will lie on an X-ray table and your head will be immobilized (to get the best image quality, your head must remain still).
You will be hooked up to an ECG with small sticky patches on your arms and chest so that your heart rate can be monitored. Your pulse, blood pressure, and breathing will also be monitored during the test. You will remain awake during the entire angiography procedure, although you may be given a sedative to help you relax.
Usually, the catheter is inserted through the femoral artery in your groin, but sometimes an artery in the elbow or wrist is used. The area will be cleaned, shaved, disinfected, and numbed with a local anesthetic. A small cut will be made and an introducer sheath will be placed in the opening. The sheath is a short hollow tube through which the catheter is fed into the artery. The catheter is steered over a wire through your arteries until it reaches the carotid artery in your neck, using X-ray images as a guide to make sure it is properly placed. You will probably feel a warm sensation when the contrast dye is injected into the catheter. As the dye circulates in your blood, a series of X-ray pictures is taken.
After the test, the catheter is removed and pressure is applied at the insertion site to stop the bleeding. There are two techniques for removing the introducer sheath that was placed when the catheter was inserted. The more traditional method is to wait 4 to 6 hours for the effects of the blood thinners to wear off, then to apply pressure while removing the sheath. A newer technique uses a small device that makes a tiny seal or stitch in the artery to close it off; the advantage of this is that there is no need to wait for the blood thinners to wear off.
The angiography procedure takes less than an hour. In most cases you will be able to leave the same day, but some patients remain in the hospital overnight for observation and to make sure the insertion site heals properly.
What happens after the test?
When the procedure is complete you will be transferred to a recovery room. You may feel groggy from the sedative, and the catheter insertion site (arm or groin) may be bruised and sore. If the catheter was inserted through the groin, you will be instructed to lie in bed with your legs out straight. If the arm was the insertion point, you should keep your arm straight for at least 1 hour and you can get out of bed sooner. While you are in the recovery room, the place where the catheter was inserted will be checked for bleeding and swelling and your vital signs will be continuously monitored. You should drink plenty of fluids to flush out the contrast dye.
You may be released from the hospital on the same day or the next day. Your doctor will give you instructions on how to make sure you have no further complications: these usually include avoiding any strenuous physical activity for a day or two.
Some soreness is common during the first week, and bruising (when it happens) can take as long as 3 weeks to heal. Be sure to alert your doctor if you feel numbness or have problems moving your leg or arm where the catheter was inserted, if you develop a fever, or if the area where the incision was made begins bleeding or shows signs of infection such as pain, swelling, warmth, or redness.
In rare cases the test can trigger a stroke, so be alert for any signs of stroke in the hours and days following the test, and call 911 immediately if you experience them.
