Extremes

Answer 1

Definition

Extremity angiography, or peripheral angiography is a test used to see the arteries in the hands, arms, feet, or legs.

Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. Arteries are blood vessels that carry blood away from the heart.

Alternative Names

Angiography/arteriography of the extremity; Peripheral angiography; Lower extremity angiogram; Peripheral angiogram

How the test is performed

Extremity angiography is done in a special unit of a hospital. You will lie on an x-ray table. You may ask for a sedative if you are anxious about the test.

The health care provider will shave and clean an area, usually in the groin.

• A numbing medicine (anesthetic) is injected into the skin over an artery, and a needle is inserted into that artery.
• A thin plastic tube called a catheter is passed through the needle, into the artery. It is guided up into the area of the body being studied. The doctor can see live images of the area on a TV-like monitor, and uses them as a guide.
• The dye flows through the catheter. X-ray images are taken of the artery.

Certain treatments can be done during this procedure. Items are passed through the catheter to the area in the artery that needs treatment. These treatments include:

• Dissolving a blood clot with medicine
• Opening a partially blocked artery with a balloon
• Placing a small tube called a stent into an artery to help hold it open

The health care team will check your pulse (heart rate), blood pressure, and breathing during the procedure.

After the x-rays are taken, the catheter is removed. Pressure is immediately applied at the site of insertion for 10 - 15 minutes to stop the bleeding. After that time, the area is checked and a bandage is applied.

The arm or leg where the needle was placed should be kept straight for 6 hours after the procedure. You should avoid strenuous activity, such as heavy lifting, for 24 - 48 hours.

How to prepare for the test

You should not eat or drink anything for 6 - 8 hours before the test.

You may be told to stop taking certain medications such as aspirin or other blood thinners for a short while before the test. However, do NOT stop taking any medicines unless told to do so by your health care provider. Make sure your health care provider knows about all medications you are taking, including all over-the-counter and herbal preparations.

You will be asked to wear a hospital gown and sign a consent form. Remove jewelry from the area being studied.

Tell your health care provider:

• If you are pregnant
• If you are allergic to any medications
• If you have ever had an allergic reaction to x-ray contrast material or iodine substances
• If you have ever had any bleeding problems
• Which medications you are taking (including any herbal preparations)

How the test will feel

The x-ray table is hard and cold, so you may want to ask for a blanket or pillow. There is a sting when the numbing medicine is injected. You may also feel some pressure as the catheter is positioned.

The dye can cause a feeling of warmth and flushing. This is normal and usually goes away in a few seconds.

You may have tenderness and bruising at the site of the catheter insertion after the test. If you have swelling, bleeding that doesn't go away, or severe pain in an arm or leg, seek immediate medical care.

Why the test is performed

The test is done when someone has symptoms of a narrowed or blocked blood vessel in the arms, hands, legs, or feet.

The test may also be done to diagnose:

• Bleeding
• Swelling or inflammation of the blood vessels (angiitis)

Normal Values

The x-ray shows normal structures for the age of the patient.

What abnormal results mean

The most common abnormal finding is narrowing and hardening of the arteries in the arms or legs due to plaque build-up (hardening of the arteries) in the artery walls.

The x-ray may show a blockage in the vessels caused by the following:

• Aneurysms(abnormal widening or ballooning of part of an artery)
• Blood clots
• Other diseases of the arteries

Abnormal results may also be due to:

• Inflammation of the blood vessels
• Injury to the blood vessels
• Thromboangiitis obliterans (Buerger's disease)
• Takayasu's disease

What the risks are

Complications may include:

• Allergic reaction to the contrast dye
• Blood clot that travels to the lungs
• Damage to the blood vessel as the needle and catheter are inserted
• Excessive bleeding or a blood clot where the catheter is inserted, which can reduce blood flow to the leg
• Heart attack or stroke
• Hematoma -- a collection of blood at the site of the needle puncture
• Injury to the nerves at the needle puncture site
• Kidney damage from the dye

There is low-level radiation exposure. However, most experts feel that the risk of most x-rays is smaller than other risks we take every day. Pregnant women and children are more sensitive to the risks of the x-ray.

References

Jackson JE, Allison DJ, Meaney J. Angiography: Principles, techniques (including CTA and MRA) and complications. In: Grainger RC, Allison D, Dixon AK, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 6.

Morgan RA, Belli A-M, Munneke G. Peripheral vascular disease. In: In: Grainger RC, Allison D, Dixon AK, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 28.

Reviewed By

Review Date: 11/18/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.