Angiography (shortly angio), which is a diagnostic method, is the demonstration of vessels with ‘contrast‘, a kind of medical dye. The nomenclature varies according to the region performed, for example, coronary angiography to show the heart vessels, carotid, and vertebral angiography to show the neck vessels, and lower extremity peripheral angiography to show the leg vessels. The data obtained from this procedure are guiding both in diagnosis and in determining the form of treatment.
WHAT IS ANGIOGRAPHY?
Coronary angiography is an invasive diagnostic test that shows the occlusion and enlargement of the heart vessels in a laboratory environment, which includes radiation. According to the result of coronary angiography, the patient is either taken to drug therapy, or balloon and stent are placed or taken to coronary bypass surgery. Coronary angiography is the best technique for the structural and functional evaluation of coronary heart vessels. It is not only a diagnostic method but also a technique in which treatment is planned and also treated. Coronary angioma maps the heart vessels and also determines the number of vessels for treatment or coronary bypass surgery. You have heard that your neighbor or relative will have cardiac surgery such as triple bypass, quadruple bypass, single bypass. Here, coronary angiography determines the number of vessels be bypassed. In addition, the coronary angio method is used to determine the condition of the vessels after coronary bypass surgery.
Coronary angiography is an invasive diagnostic method that is accepted as the gold standard in both the diagnosis and treatment of coronary heart diseases. In the continuation of the diagnostic procedure or in subsequent sessions, it also has a guiding feature in the methods of balloon or stenting of the coronary vessels and coronary artery surgery. As the name suggests, it should not be forgotten that it is a bloody intervention in the old term, and it carries the risk of complications that can lead to death. Coronary angiography laboratories, which were collected only in certain centers and in a limited number until the last 15 years, are now found almost even in districts. Because of this dizzying number of laboratories, the coronary angiography procedure requires the best equipment available in the laboratory, from the characteristics of the laboratory space to the most appropriate procedure of coronary angiography, from the best physician to perform the procedure. The physical conditions of the coronary angiography laboratory, the basic features of the angiography device, other equipment that must be found in the laboratory are the issues that need to be paid attention to. Regarding this, there are well-prepared guidelines in western countries. The main purpose here is; The aim of the procedure is to be the least risky for both the patient and the staff and to discuss the conditions that will provide the highest quality angio images to be obtained.
One of the basic rules of the application of an invasive procedure with sufficient quality and safety is that the materials, catheters, drugs, and opaque substances to be used in the procedure are closely known and known by both the physician and the angio team. Knowing where, when, and how they should be used is extremely important in terms of imaging quality, procedure time, and prevention of complications. Therefore, taking into account the needs that may arise during the process, it will be possible to keep the necessary materials in reserve.
For a patient, the introduction of coronary angiography, the predetermined patient’s reasons for angiography, and situations where angiography cannot be definitely performed should be determined and done accordingly. For this, the patients and their relatives should be well listened to, and physical examination and basic research should be provided beforehand. Except for some special conditions, the risks and financial burden calculations of patients directly involved in this invasive procedure without creating these basic data are predetermined. The main purpose in this matter should not be considered separate from basic medical rules such as “not to harm the patient first”. As is generally accepted worldwide, this invasive procedure must be performed by a heart specialist. As with other invasive procedures, the success of the procedure and the acceptability of the results depend on the technical knowledge, experience, and skill of the physician performing the procedure. Knowing the basic coronary vessel structure and the heart’s own structure and functioning very well, rapidly evaluating the images that appear during the procedure, and deciding whether new images are required in addition to standard imaging procedures, are dependent on the level of experience of the physician. It is vital for coronary angiography to quickly recognize the bad results that may occur or may occur during or after the procedure and to decide on their treatment if necessary. It is necessary for patient safety to know that bad and undesirable but life-threatening consequences such as kidney disease and blockages in coronary vessels may occur against opaque medication given in the late period (24-48 hours after the procedure) after the procedure.
The physician performing the procedure must know the limits of coronary angiography. If necessary, he/she should also have the experience and equipment to use other auxiliary methods in the laboratory.
HOW IS ANGIOGRAPHY PERFORMED?
It should be fasted for at least 4 hours before the procedure (drugs can be taken with a little water). After the evaluations, your doctor decides which way – inguinal (femoral artery) or arm (radial / brachial artery) – the procedure will be performed. Before the patient is taken to the angiography laboratory, the hairs must be cleaned to ensure good sterilization. After the inguinal or arm area where the procedure will be performed is anesthetized, a cannula is placed in the artery and all operations are performed through this cannula. A thin plastic tube called a catheter is passed through the cannula and the coronary arteries are imaged and film records are taken by giving contrast agents. This process takes 20-30 minutes. After the procedure is completed, the cannula placed in the vein is removed. In the procedures performed in the groin, compression is applied for 15-20 minutes and a sandbag is placed after it is seen that there is no bleeding. In arm angiography, the arm vein is closed with a tight bandage. Generally, the patient is allowed to return to daily activities 24 hours after the procedure.
IS THERE A RISK OF ANGIOGRAPHY PROCEDURE?
Although rare, adverse events (complications) may develop during or after angiography. After the procedure, pain, mild swelling, and bruising may occur, especially in the inguinal region vein along the vein. A ‘vagal’ reaction may develop depending on the pain felt during cannula insertion in the groin area or during withdrawal of the cannula from the groin after the intervention. In this case, there is a temporary low pulse and blood pressure (blood pressure) and cold sweating. If the cannula is withdrawn from the arm, there may be a spasm in the artery.
Kidney failure may develop due to the dye given during the procedure. Although this situation often improves, dialysis may be required in some special cases. Apart from these, although very rarely, stroke (paralysis) may develop in situations that require emergency surgery.
The important point here is to determine the patient’s need for angiography clearly. In this group of patients, sufficient information about the disease is obtained with angiography and a decision is made on what will be the advanced examination or treatment method. If the patient gives consent and the physician approves, coronary therapeutic intervention (balloon angioplasty, which is the expansion of the stenosis in the coronary with a balloon, wire cage ‘stent’ placement in the coronary stenosis, and some other methods) can be performed in the same session with angiography.
Image (1) courtesy of heart foundation