Digital Subtraction Angiography

Digital Subtraction Angiography involves taking images of arteries, veins & organs of the body using a complex computerized X-ray equipment. A special dye is injected to show the blood supply in the body on the X-ray.

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A digital subtraciton angiography should be carried out in the following cases:

  • Pain in specific areas
  • Back or leg pain
  • Hypertension
  • Rapid onset of headache
  • Cranial nerve deficits

Digital Subtraction Angiography is a diagnosis for blood vessel imaging.

A contrast medium is injected to obtain images of an area of interest by time-controlled exposure to X-rays. It is usually helpful in determining the anatomical positions & the variations. Blood vessels appear dark grey in the image produced.

The risks involved in a Digital Subtraction Angiography are:

  • Haematoma 
  • Vessel laceration
  • AV fistula 
  • Fever
  • Sepsis
  • Allergic reaction to contrast medium

After a Digital Subtraction Angiography, it is advised to:

  • Apply compression on the puncture site
  • Ensure minimum 4 hours of bed rest 
  • Check for symptoms such as swelling and numbness at the puncture site

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Digital Subtraction Angiography

Digital Subtraction Angiography involves taking images of arteries, veins & organs of the body using a complex computerized X-ray equipment. A special dye is injected to show the blood supply in the body on the X-ray.

Symptoms

A digital subtraciton angiography should be carried out in the following cases:

  • Pain in specific areas
  • Back or leg pain
  • Hypertension
  • Rapid onset of headache
  • Cranial nerve deficits

Diagnosis

Digital Subtraction Angiography is a diagnosis for blood vessel imaging.

Treatment

A contrast medium is injected to obtain images of an area of interest by time-controlled exposure to X-rays. It is usually helpful in determining the anatomical positions & the variations. Blood vessels appear dark grey in the image produced.

Risks

The risks involved in a Digital Subtraction Angiography are:

  • Haematoma 
  • Vessel laceration
  • AV fistula 
  • Fever
  • Sepsis
  • Allergic reaction to contrast medium

After Procedure

After a Digital Subtraction Angiography, it is advised to:

  • Apply compression on the puncture site
  • Ensure minimum 4 hours of bed rest 
  • Check for symptoms such as swelling and numbness at the puncture site

FAQ Section

1) What is digital subtraction angiography?

DSA provides an image of the blood vessels in your brain to detect a problem with your blood flow. The digital subtraction angiography involves inserting a catheter (a small, thin tube) into an artery in your leg and passing it up to the blood vessels in your brain. A contrast dye is injected through the small, thin tube. The X-ray images are taken of the blood vessels.

 

2) What is the difference between angiography and angioplasty?

Angiography is a procedure that allows physicians to look at blood vessels in great detail using X-rays. If the physicians identify a narrowed portion (a condition called stenosis) of a blood vessel during the angiography procedure, they may stretch or widen it straightaway using a procedure called an angioplasty. So, An angiogram is a test that is used to find out which arteries supplying the heart have become narrowed and angioplasty is a procedure to expand narrow arteries that may follow on from an angiogram.

 

3) What are some common uses of the procedure?

Physicians use DSA to detect or confirm abnormalities within the blood vessels in the patient's brain, including:

  • an aneurysm, a bulge or sac that develops in artery
  • atherosclerosis, a narrowing of the arteries.
  • arteriovenous malformation, a tangle of dilated blood vessels vasculitis, an inflammation of the blood vessels, 
  • a brain tumor.
  • a blood clot.
  •  vascular dissection, tear in the wall of an artery.
  • a stroke.

4) Is digital subtraction angiography a painful procedure?

Like any blood-related procedure, an angiogram involves the use of needles and some poking and prodding, but any discomfort from the procedure is usually minor. 

 

5) What Are the Benefits of digital subtraction angiography?

It is primarily used to image blood vessels. DSA is useful in the diagnosis and treatment of arterial and venous occlusions, including pulmonary embolisms, carotid artery stenosis, and acute limb ischemia and arterial stenosis. DSA is the gold standard investigation for cerebral aneurysms, renal artery stenosis, and arteriovenous malformations (AVM).

6) What dye is used for a digital subtraction angiography?

Contrast dye is used for an angiogram. It allows doctors to see the exact site of blocked blood vessels and also to see certain problems with organs more clearly.

7) How long does the procedure take?

An angiogram typically takes from forty-five minutes to one hour. You will lie on a table, awake but mildly sedated, with a local anesthetic will be applied to numb an area on your upper leg or on your arm or wrist, and this initial needle prick will probably be the only pain you will feel throughout the procedure.

8) What happens during the digital subtraction angiogram?

The patient will feel a slight pin prick when the needle is inserted into his or her vein for the intravenous line (IV) and when the local anesthetic is injected. Most of the sensation is at the skin incision site, which is numbed using a local anesthetic. The patient may feel pressure when the catheter is inserted into the vein or artery.

If the procedure is done with sedation, the intravenous (IV) sedative will make the patient feel relaxed, sleepy and comfortable for the procedure. The patient may or may not stay awake, depending on how deeply he or she is sedated and may feel slight pressure when the catheter is inserted, but no serious discomfort. As the contrast material passes through their body, they may experience a warm feeling which quickly subsides. They will be asked to remain very still while the x-ray images are taken. The most difficult part of the procedure for many patients is lying flat for several hours.

9) What happens after the digital subtraction angiogram?

Once the procedure is complete, the catheter is removed by the radiologist. To prevent any bleeding from the puncture site, in some patients, a special plug called Angioseal is inserted at the end of the angiogram.  If this is used you the patients are able to sit up immediately and get out of bed in two hours. If this cannot be used they are moved out of the lab and the sheath is removed from their groin.  Pressure is applied for 10-15 minutes to stop bleeding from the artery or vein, and after they are returned to the ward, they are made to stay lying flat for 4 hours and in bed for 6 hours. The patient is allowed to apply ice to the site where the catheter was inserted to relieve pain and swelling and may be able to resume his or her normal diet immediately after the exam. 

10) What are the risks of brain angiogram?

As with most procedures done on the heart and blood vessels, a brain angiogram has some risks, such as radiation exposure from the X-rays used. Though major complications are rare, potential risks and complications include:

  • Chance of cancer from excessive exposure to radiation. 
  • Allergic reaction
  • Injury to Kidneys
  • Damage to blood vessels
  • Bruising or bleeding at the puncture site
  • Stroke
  • Internal Bleeding 

11) How much does a brain angiogram cost in India?

In India, a brain angiogram can cost INR 7000 to INR 12000.