What is Digital Subtraction Angiography ?

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What is the meaning of digital subtraction angiography? 

Digital subtraction angiography (DSA) is a procedure that uses advanced X-ray machines to capture clearer images of the inner surface of the blood vessels, also known as the lumen of the blood vessels. This technique is also used to get clearer images of the four chambers of the heart along with the arteries and veins. It can also be used to detect any blood flow related problems of the blood vessels of the brain.

This procedure is performed by using a catheter. A catheter is a small, flexible, narrow tube which is inserted into an artery of the leg. This tube is allowed to reach up to the blood vessels of the various organs. Then a contrasting medium (high density clear liquid) is injected into the catheter which gives a clear picture of the blood vessels in the legs, heart, or other organs of the body. Images are taken before and after the contrast medium is injected. Following this, the first image is ‘subtracted’ from the second image in order to highlight the blood vessels. This entire procedure is called digital subtraction angiography (DSA). 

Let us tell you in detail about digital subtraction angiography in today’s article.

• When is digital subtraction angiography needed?
• What are the steps done before digital subtraction angiography?
• How is digital subtraction angiography done?
• What is the care to be taken after digital subtraction angiography? 
• What are the risks of digital subtraction angiography?
• What is the cost of digital subtraction angiography in India?

When is digital subtraction angiography needed?

Your doctor may recommend you digital subtraction angiography based on your health condition and symptoms. Here are the conditions/procedures where a person might need digital subtraction angiography.

• Obstructive vascular diseases– This is the condition where there is blockage and narrowing of the arteries and veins. Digital subtraction angiography helps in better visualization of the blocked blood vessels.
• Brain aneurysms– In this condition, the weak blood vessels of the brain fill with blood and swell. ( Know more about- What is Brain Aneurysm Surgery? )
• Bleeding blood vessels– This happens due to weak or abnormal blood vessels. This causes bleeding spots under the skin, bruising, etc.
• Analysis of the blood vessels of the tumor– Any tumor in the body can make new blood vessels around it. Digital subtraction angiography can be used to analyze these blood vessels.  
• Arterial stent placement– In this procedure, a small, metal stent is placed in the narrow or blocked blood vessels.
• Arterial balloon angioplasty– In this procedure, a balloon attached to the catheter tube is inserted inside the blocked or narrowed artery. Digital subtraction angiography helps in better view of these blocked arteries during the procedure. ( Know more about- What is Peripheral Angiography ? ) 

What are the steps done before digital subtraction angiography?

Before performing digital subtraction angiography, the doctor usually examines and evaluates the patient on the basis of certain factors or conditions and may ask for some tests, which are as follows-

• Blood glucose levels
• Kidney function tests
• Ongoing medications
• Allergies or any allergy to iodinated contrast media(liquid used in the procedure)
• Previous surgeries, especially vascular surgeries ( Know more about- What is Aortic Aneurysm Repair Surgery ? )
• Reports of previously performed angiograms
• Reports of previous vascular imaging studies like pre-procedural CT angiograms, etc.
•  Myocardial infarction- This is done to evaluate any previous history of heart attacks.

The doctor will consider all the above information and recommend digital subtraction angiography, if necessary.

How is digital subtraction angiography done?

The steps of the procedure of digital subtraction angiography are-

• Patient is resting on the table. Position of the patient depends on the ease of vascular access required and convenience of the interventional radiologist.
• Local anesthesia (numbing agent) is injected at the site of puncture (site where the catheter tube will be inserted).
• Sometimes general anesthesia may be given. Example- in a child patient undergoing the treatment of cerebral angiography.
• Ultrasound is used to gain access to the blood vessel to insert the catheter tube.
• Before injecting the contrast medium liquid, a mask X-ray image of the area is captured which is used later.
• The radiologist then injects the contrast medium through the catheter tube. 
• Subsequent X-ray images are then taken which show high contrast of the blood vessels that appear dark gray. ( Know more about- What is Cardiac Catheterization? )

These images are produced by the computer in real time and helps the doctors to diagnose the disease of the blood vessels, due to the high contrast of the images.

What is the care to be taken after digital subtraction angiography? 

After digital subtraction angiography, the patient needs proper care. The doctor may give the following instructions-

• Apply compression to the puncture site.
• At least 4 hours of bed rest is necessary.
• Avoid lifting weights and stretching exercises for a few days after the procedure.
• Look for symptoms such as swelling and numbness at the puncture site.
• Talk to the doctor if the patient experiences any health abnormalities 

What are the risks of digital subtraction angiography?

Digital subtraction angiography may have the following risks:

• Hematoma- This is the localized swelling caused due to leakage from the blood vessels.
• Vessel laceration- This is injury to the blood vessels that leads to leaking of blood vessels in the tissues.
• AV fistula- This is an abnormal connection between the artery and the vein.
• Fever
• Sepsis- This is a serious health condition that is caused by the microorganisms in the blood.
• Allergic reaction to the contrast medium

What is the cost of digital subtraction angiography in India?

The total cost of digital subtraction angiography in India can range from around INR 70,000 to INR 80,000. There are many large hospitals and specialist doctors in India who perform digital subtraction angiography. But the cost of digital subtraction angiography may vary across different hospitals.

If you are coming from abroad, apart from the cost of digital subtraction angiography procedure, there will be additional expenses for hotel accommodation and local travel. The patient is advised to stay in the hotel for 1 day for recovery. So, the total cost of digital subtraction angiography in India will be around INR 1,00,000 to INR 1,20,000.

We hope that we could answer your questions regarding digital subtraction angiography through this article.

If you have any further queries regarding digital subtraction angiography, you may contact the Vascular and Endovascular Surgeon.

We only aim to provide you with information through this article. We do not recommend any medicine or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan.