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Peripheral Angiography

Peripheral angiography is a type of test that uses contrast dye and x-rays to help the doctor in finding blocked areas or narrow areas in one or more arteries supplying blood to the feet, legs, hands, or arms. 

A peripheral angiography helps the doctor if a surgical procedure is required for opening a blocked artery. An artery is a blood vessel that carries blood away from the heart. The test is also known as extremity angiography.

 

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Causes: An abnormal result in a peripheral angioplasty can occur due to the following reasons:

  • Narrowing and hardening of the arteries in the legs or arms due to the buildup of plaque in the walls of the arteries
  • Blood clot formation
  • Other diseases of the arteries
  • Aneurysms (abnormal ballooning or widening of a part of the artery)
  • Injury to the blood vessels
  • Inflammation of the blood vessels
  • Buerger disease (a rare disease caused by a small blood vessel getting swollen and inflamed)
  • Takayasu disease (inflammation of large arteries like the aorta, which is the main artery of the heart carrying blood from the heart to the rest of the body)

Symptoms: The following symptoms may indicate the need for a peripheral angiography:

  • Weakness in the legs
  • Numbness in the legs
  • Sores or ulcers, which may take a long time to heal
  • Gangrene
  • Erectile dysfunction in men
  • Loss of hair on the legs
  • Slow growth of toenails
  • Brittle toenails
  • Skin on the affected area is pale and bluish, or shiny in appearance

A peripheral angiography can be done in association with other diagnostic tests like:

  1. Ankle-brachial index pressure: This is a quick, non-invasive method to check for the presence of peripheral artery disease.
  2. Magnetic resonance angiography: A powerful magnetic field, radio waves, and a computer is used to evaluate the blood vessels and identify the abnormalities.
  3. CT angiography: A contrast material is injected into the blood vessels and a CT scan is performed to help in diagnosing and evaluating any blood vessel diseases.
  4. Doppler and ultrasound imaging: It is an imaging test that uses sound waves to estimate the blood flow through the blood vessels.

 

  • You will lie on the x-ray table.
  • You may be given a sedative before the procedure, to help you relax.
  • The area of the procedure, which is most often the groin region, is shaved and cleaned.
  • A local anesthesia (a numbing agent) is injected into the skin over an artery.
  • A needle is placed in the above artery.
  • A thin, plastic tube, known as a catheter, is passed through the needle into the artery.
  • The catheter is guided into the area of the body that is being studied. The doctor can view the live images of the area on a monitor, and use them as a guide.
  • A dye is injected through the catheter into the arteries.
  • X-ray images of the arteries are taken.
  • The dye makes the blocked or narrow portion of the arteries appear clearly on the x-rays.
  • It is normal to feel hot or flushed for a few seconds after dye insertion.
  • Some treatments can also be performed during the procedure such as:
  • Injecting a medicine to dissolve the blood clot.
  • Opening a blocked artery using a balloon.
  • Placement of a small tube, known as a stent, into the artery to help it stay open.
  • The catheter is removed once the procedure is completed.

 

The complications of peripheral angiography may include:

  • Blood vessel damage at the site of needle and catheter insertion

  • Injury to the blood vessels that are being tested

  • Nerve injury at the needle puncture site

  • Blood clot formation or excessive bleeding at the site of catheter insertion, causing reduced blood flow to the leg

  • Allergic reaction to the contrast dye used

  • Heart attack

  • Stroke (interrupted blood flow to the brain)

  • Hematoma (blood collection at the site of needle puncture)

  • Damage to the kidneys 

  • Loss of limb

  • Pressure is applied on the puncture site for approximately 10 to 20 minutes after the procedure.

  • A bandage is then applied to the wound.

  • You will be asked to keep the leg that is being used for the catheter straight for at least six hours after the procedure.

  • It is normal to have a small bruise at the site of the puncture.

  • You will be closely monitored for any bleeding or swelling after the procedure.

  • Drink lots of fluids once you go home.

  • Avoid heavy lifting or other strenuous activities for 2 days after the procedure.

  • Normally, you will be able to start with solid food and take your regular medications four to six hours after the angiogram.

  • Avoid driving for at least two days after the procedure.

  • The site of puncture may feel tender for a couple of days after the procedure.

  • You can usually resume your daily activities the next day after the procedure.

  • You can gradually resume your normal activities, allowing the incision to heal.

  • If you notice any bleeding from the site of the puncture, lie flat and then press firmly on the bleeding spot.

  • Contact your doctor immediately if you notice any of the following:

  • The leg with the puncture tingles or becomes numb

  • The foot turns blue or feels cold

  • The puncture site swells up

  • Fluid drainage from the puncture site

  • Bleeding from the site of puncture does not slow down even after firmly pressing on it

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Peripheral Angiography

Peripheral angiography is a type of test that uses contrast dye and x-rays to help the doctor in finding blocked areas or narrow areas in one or more arteries supplying blood to the feet, legs, hands, or arms. 

A peripheral angiography helps the doctor if a surgical procedure is required for opening a blocked artery. An artery is a blood vessel that carries blood away from the heart. The test is also known as extremity angiography.

 

Symptoms

Causes: An abnormal result in a peripheral angioplasty can occur due to the following reasons:

  • Narrowing and hardening of the arteries in the legs or arms due to the buildup of plaque in the walls of the arteries
  • Blood clot formation
  • Other diseases of the arteries
  • Aneurysms (abnormal ballooning or widening of a part of the artery)
  • Injury to the blood vessels
  • Inflammation of the blood vessels
  • Buerger disease (a rare disease caused by a small blood vessel getting swollen and inflamed)
  • Takayasu disease (inflammation of large arteries like the aorta, which is the main artery of the heart carrying blood from the heart to the rest of the body)

Symptoms: The following symptoms may indicate the need for a peripheral angiography:

  • Weakness in the legs
  • Numbness in the legs
  • Sores or ulcers, which may take a long time to heal
  • Gangrene
  • Erectile dysfunction in men
  • Loss of hair on the legs
  • Slow growth of toenails
  • Brittle toenails
  • Skin on the affected area is pale and bluish, or shiny in appearance

Diagnosis

A peripheral angiography can be done in association with other diagnostic tests like:

  1. Ankle-brachial index pressure: This is a quick, non-invasive method to check for the presence of peripheral artery disease.
  2. Magnetic resonance angiography: A powerful magnetic field, radio waves, and a computer is used to evaluate the blood vessels and identify the abnormalities.
  3. CT angiography: A contrast material is injected into the blood vessels and a CT scan is performed to help in diagnosing and evaluating any blood vessel diseases.
  4. Doppler and ultrasound imaging: It is an imaging test that uses sound waves to estimate the blood flow through the blood vessels.

 

Treatment

  • You will lie on the x-ray table.
  • You may be given a sedative before the procedure, to help you relax.
  • The area of the procedure, which is most often the groin region, is shaved and cleaned.
  • A local anesthesia (a numbing agent) is injected into the skin over an artery.
  • A needle is placed in the above artery.
  • A thin, plastic tube, known as a catheter, is passed through the needle into the artery.
  • The catheter is guided into the area of the body that is being studied. The doctor can view the live images of the area on a monitor, and use them as a guide.
  • A dye is injected through the catheter into the arteries.
  • X-ray images of the arteries are taken.
  • The dye makes the blocked or narrow portion of the arteries appear clearly on the x-rays.
  • It is normal to feel hot or flushed for a few seconds after dye insertion.
  • Some treatments can also be performed during the procedure such as:
  • Injecting a medicine to dissolve the blood clot.
  • Opening a blocked artery using a balloon.
  • Placement of a small tube, known as a stent, into the artery to help it stay open.
  • The catheter is removed once the procedure is completed.

 

Risks

The complications of peripheral angiography may include:

  • Blood vessel damage at the site of needle and catheter insertion

  • Injury to the blood vessels that are being tested

  • Nerve injury at the needle puncture site

  • Blood clot formation or excessive bleeding at the site of catheter insertion, causing reduced blood flow to the leg

  • Allergic reaction to the contrast dye used

  • Heart attack

  • Stroke (interrupted blood flow to the brain)

  • Hematoma (blood collection at the site of needle puncture)

  • Damage to the kidneys 

  • Loss of limb

After Procedure

  • Pressure is applied on the puncture site for approximately 10 to 20 minutes after the procedure.

  • A bandage is then applied to the wound.

  • You will be asked to keep the leg that is being used for the catheter straight for at least six hours after the procedure.

  • It is normal to have a small bruise at the site of the puncture.

  • You will be closely monitored for any bleeding or swelling after the procedure.

  • Drink lots of fluids once you go home.

  • Avoid heavy lifting or other strenuous activities for 2 days after the procedure.

  • Normally, you will be able to start with solid food and take your regular medications four to six hours after the angiogram.

  • Avoid driving for at least two days after the procedure.

  • The site of puncture may feel tender for a couple of days after the procedure.

  • You can usually resume your daily activities the next day after the procedure.

  • You can gradually resume your normal activities, allowing the incision to heal.

  • If you notice any bleeding from the site of the puncture, lie flat and then press firmly on the bleeding spot.

  • Contact your doctor immediately if you notice any of the following:

  • The leg with the puncture tingles or becomes numb

  • The foot turns blue or feels cold

  • The puncture site swells up

  • Fluid drainage from the puncture site

  • Bleeding from the site of puncture does not slow down even after firmly pressing on it

FAQ Section

1) What is Peripheral Angiography ?

Peripheral angiography is a test that helps in checking any blockages that may be present in the arteries supplying blood to the legs, feet, arms, and hands.

 

2) What are Peripheral Arteries?

The arteries that move blood away from the heart towards the extremities like the legs, feet, hands, and arms are known as peripheral arteries.

 

3) What is Peripheral Artery Disease (PAD)?

Peripheral artery disease is a circulatory disorder in which the narrowed arteries reduce the flow of blood to the limbs. 

 

4) Why is a Peripheral Angiography performed?

A peripheral angiography may be performed to diagnose the following:

  • A blocked or narrowed blood vessel in the hands, arms, legs, or feet
  • Bleeding blood vessels
  • Swelling of the blood vessels 
  • Vasculitis (inflammation of the blood vessels)
  • Peripheral angiography can also be used for the treatment of:
  • Blood clot, by dissolving it using medications
  • A partially blocked artery can be opened using a balloon
  • A blocked or narrow artery is held open by placing a small tube, known as a stent

 

5) What are the symptoms that indicate the need for a Peripheral Angiography?

The following symptoms may indicate a requirement for peripheral angiography:

  • Pain in the legs or arms
  • Hair loss on the legs
  • Shiny skin on the legs or feet
  • Cold skin
  • Gangrene (dead tissue due to reduced blood flow)
  • Pain 
  • Weakness in the limbs
  • Numbness of limbs
  • Opaque, thick toenails
  • Reddish-blue color in the extremities
  • Trouble in moving around
  • Weak pulse in the foot or leg

 

6) What do abnormal Peripheral Angiography results indicate?

An abnormal result in a peripheral angiogram may indicate the following:

  • Blood clot formation in the arteries
  • Plaque buildup in the arteries
  • Aneurysms (abnormal ballooning of a portion of the artery)
  • Injury to the blood vessels
  • Inflammation of the blood vessels
  • Buerger disease or thromboangiitis obliterans (a disease caused by the swelling and inflammation of a small blood vessel)
  • Takayasu disease (an inflammatory condition of the large arteries like the aorta, which is the main artery of the heart)
  • Other diseases affecting the arteries

 

7) What are the different diagnostic tests done along with a Peripheral Angiography?

The various diagnostic tests that can be done in association with peripheral angiography include:

  1. Ankle-brachial index pressure: This is a non-invasive, rapid test done to check for the presence of peripheral artery disease.
  2. Magnetic resonance angiography and CT angiography: These are imaging tests done to diagnose and evaluate the blood vessel abnormalities.
  3. Doppler and ultrasound imaging: It is a type of imaging test that uses high-frequency sound waves for the estimation of the blood flow through the blood vessels.

 

8) How to prepare for Peripheral Angiography?

The following preparation may be required for peripheral angiography procedure:

  • Tell your doctor if you are currently taking any medications, supplements, or herbs.
  • Tell your doctor if you are suffering from any medical diseases or bleeding problems.
  • Tell your doctor if you are pregnant, or you think that you could be pregnant.
  • Tell your doctor if you are allergic to any medications, anesthetics, iodine, contrast material, or latex.
  • You may be asked to stop taking blood-thinners like warfarin and aspirin a few days before the procedure.
  • You will be asked to not eat or drink anything 6 to 8 hours before the procedure.

 

9) What is the procedure for Peripheral Angiography?

  • The procedure is performed in a hospital. The patient lies on the x-ray table and may be given a sedative before the procedure to help him/her relax.
  • The area of catheter insertion, which is most often the groin area, is shaved and cleaned.
  • A local anesthesia, which numbs the area of the procedure, is injected into the skin over the artery in the leg or arm region.
  • A needle is placed into the artery.
  • A catheter, which is a thin plastic tube, is passed through the needle into the artery.
  • The catheter is then guided to the area of the body that is being studied.
  • Imaging tests are used to make the images of the area visible on the monitor. 
  • A dye is injected by the doctor through the catheter and into the arteries.
  • This dye makes the arteries more apparent on x-rays.
  • Some types of treatment procedures can also be performed using this procedure, which may include:
  • Opening of a partially blocked artery using a balloon
  • Blood clot dissolution by injecting a medicine
  • Placement of a small tube, known as a stent, in the artery to help it stay open
  • The catheter is removed after the completion of the procedure.
  • The procedure takes about one to three hours to complete.

 

10) What are the post-procedure steps after a Peripheral Angiography?

  • You may feel some pressure during catheter removal.
  • Pressure is applied to the area of catheter removal for 10 to 15 minutes to stop bleeding.
  • A bandage is then put on the wound area.
  • It is normal to have some bruising and tenderness at the site of catheter insertion. This normally goes away on its own.
  • The leg or arm where the needle was placed needs to be kept straight for 6 hours after the procedure.
  • Call your doctor immediately if you notice:
  • Severe pain in the leg or arm
  • Swelling
  • Bleeding that does not go away
  • Drink plenty of fluids after the procedure to flush out the dye from the body and rehydrate the body.
  • You can consume your normal diet and medications six hours after the procedure.
  • Avoid strenuous activities like heavy lifting for 1 to 2 days after the procedure.
  • Avoid driving for at least two days after the procedure.

 

11) What are the risks of Peripheral Angiography ?

The complications associated with peripheral angiography are:

  • Bleeding
  • Swelling
  • Bruising
  • Allergy to the contrast dye
  • Infection at the site of catheter insertion
  • Kidney problems due to the dye used
  • Heart attack
  • Stroke (an interrupted blood supply to the brain)
  • Limb loss