Digital Subtraction Angiography

Digital subtraction angiography (DSA) is an examination form to obtain the images of the inner surface (lumen) of the blood vessels including the arteries, veins, and chambers of the heart. 
Complex, computerized x-ray machines are used to obtain the images in DSA. A special dye (high-density, clear liquid) is normally injected to make the blood supply to the heart, legs, or other organs easier to visualize.

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Purpose:
Digital subtraction angiography may be done for diagnostic purposes, and also as a visual guide during interventional procedures. It may be indicated in the following cases:

1. Diagnosis of several blood vessel diseases, like:

  • Obstructive vascular diseases (blockage or narrowing of arteries and veins)

  • Brain aneurysm (a weakness in the wall of a blood vessel in the brain, causing it to bulge and fill with blood)

  • Bleeding blood vessels

  • Arteriovenous malformations (abnormal connections between the veins and arteries)

  • Study of blood vessel system in cancerous tumors

2. Arterial stenting: An arterial stent, which is a small, metal mesh tube, is usually placed inside a coronary artery (the main artery of the heart) to open the artery for better blood flow, and prevent it from closing again.

3. Arterial balloon angioplasty: It is a procedure done to open the blocked or narrowed arteries. A balloon is attached to a flexible tube, known as a catheter, and inserted into a blocked artery, and the balloon is inflated to open the artery.

4. Thrombectomy: This is a surgical procedure done to remove a blood clot from inside a vein or artery.

5. Endovascular embolization: This is a procedure done to treat the abnormal blood vessels in the brain, and other body parts by cutting off the blood supply to a certain part of the body.

6. Endovascular aneurysm repair: This is a minimally invasive surgery that is used to treat an aortic aneurysm, which is a balloon-like bulge in the aorta (a large artery carrying blood from the heart through the chest and torso region).

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.

  • The hospital room should be equipped with monitoring equipment and a crash cart.
  • The patient’s heart rate and blood oxygenation are monitored continuously, and the blood pressure is measured intermittently during the procedure.
  • The procedure is performed in aseptic (sterile) conditions.
  • The procedure is performed under conscious sedation (a combination of medications given to block pain and help the patient relax), local anesthesia (the area of the procedure is numbed), or general anesthesia (the patient is asleep during the procedure), depending on the condition of the patient and the type of procedure being performed.
  • The patient is placed comfortably on the treatment bed, with the head on one end of the bed.
  • A radiographic dye is injected into either the arterial or venous circulation. Less dye is required for arterial angiography.
  • X-ray film is taken before and after dye injection is superimposed on one another, all matching images are subtracted.
  • Therefore, only the dye-enhanced cerebral vessels are left for studying and evaluation.
  • This procedure eliminates the distortions and shadows of the bone or other material that sometimes blocks the viewing of the cerebral vessels.
  • After the completion of the procedure, the catheter will be removed.
  • Pressure is applied to the puncture site for many minutes and a sterile dressing is applied.

 

The risks involved in a Digital Subtraction Angiography are:

  • Bleeding from the site of puncture
  • Damage to the nearby tissues
  • Blood clot (a mass of blood) formation
  • Pseudoaneurysm (when the wall of the blood vessel is injured and the blood leaks in the surrounding tissue)
  • Arteriovenous fistula (an abnormal connection between an artery and a vein)
  • Air embolism (blockage of an artery or a vein when one or more air bubbles enter inside)
  • Thromboembolism (the obstruction of a blood vessel by a blood clot that becomes dislodged from another site in the circulation)
  • Blood vessel dissection (a tear inside the wall of a blood vessel)
  • Contrast mediated nephrotoxicity (worsening of the kidney function due to the administration of iodinated contrast material)

 

After a Digital Subtraction Angiography, it is advised to:

  • Post-procedure care depends on the nature of the procedure performed, and whether it was performed as an outpatient procedure (the patient goes home on the day of the procedure) or inpatient procedure (the patient stays in the hospital following the procedure).
  • The patient is immobilized for four to six hours after the procedure and kept in a supine position (lying on the back).
  • The patient’s vital signs and neurological (nerve-related) status are monitored after the procedure.
  • Frequent observations are needed after the procedure to look for puncture site hematoma (bleeding from the puncture site), which is the most common complication after the procedure.
  • The patient is instructed to increase the intake of fluids for the first 24 hours after the procedure.
  • The patient should be observed for any allergic reactions like nausea, vomiting, or urticaria (rashes on the skin) after the procedure.

 

Digital Subtraction Angiography Cost in Mumbai

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Digital Subtraction Angiography

Digital subtraction angiography (DSA) is an examination form to obtain the images of the inner surface (lumen) of the blood vessels including the arteries, veins, and chambers of the heart. 
Complex, computerized x-ray machines are used to obtain the images in DSA. A special dye (high-density, clear liquid) is normally injected to make the blood supply to the heart, legs, or other organs easier to visualize.

Symptoms

Purpose:
Digital subtraction angiography may be done for diagnostic purposes, and also as a visual guide during interventional procedures. It may be indicated in the following cases:

1. Diagnosis of several blood vessel diseases, like:

  • Obstructive vascular diseases (blockage or narrowing of arteries and veins)

  • Brain aneurysm (a weakness in the wall of a blood vessel in the brain, causing it to bulge and fill with blood)

  • Bleeding blood vessels

  • Arteriovenous malformations (abnormal connections between the veins and arteries)

  • Study of blood vessel system in cancerous tumors

2. Arterial stenting: An arterial stent, which is a small, metal mesh tube, is usually placed inside a coronary artery (the main artery of the heart) to open the artery for better blood flow, and prevent it from closing again.

3. Arterial balloon angioplasty: It is a procedure done to open the blocked or narrowed arteries. A balloon is attached to a flexible tube, known as a catheter, and inserted into a blocked artery, and the balloon is inflated to open the artery.

4. Thrombectomy: This is a surgical procedure done to remove a blood clot from inside a vein or artery.

5. Endovascular embolization: This is a procedure done to treat the abnormal blood vessels in the brain, and other body parts by cutting off the blood supply to a certain part of the body.

6. Endovascular aneurysm repair: This is a minimally invasive surgery that is used to treat an aortic aneurysm, which is a balloon-like bulge in the aorta (a large artery carrying blood from the heart through the chest and torso region).

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

  • The hospital room should be equipped with monitoring equipment and a crash cart.
  • The patient’s heart rate and blood oxygenation are monitored continuously, and the blood pressure is measured intermittently during the procedure.
  • The procedure is performed in aseptic (sterile) conditions.
  • The procedure is performed under conscious sedation (a combination of medications given to block pain and help the patient relax), local anesthesia (the area of the procedure is numbed), or general anesthesia (the patient is asleep during the procedure), depending on the condition of the patient and the type of procedure being performed.
  • The patient is placed comfortably on the treatment bed, with the head on one end of the bed.
  • A radiographic dye is injected into either the arterial or venous circulation. Less dye is required for arterial angiography.
  • X-ray film is taken before and after dye injection is superimposed on one another, all matching images are subtracted.
  • Therefore, only the dye-enhanced cerebral vessels are left for studying and evaluation.
  • This procedure eliminates the distortions and shadows of the bone or other material that sometimes blocks the viewing of the cerebral vessels.
  • After the completion of the procedure, the catheter will be removed.
  • Pressure is applied to the puncture site for many minutes and a sterile dressing is applied.

 

Risks

The risks involved in a Digital Subtraction Angiography are:

  • Bleeding from the site of puncture
  • Damage to the nearby tissues
  • Blood clot (a mass of blood) formation
  • Pseudoaneurysm (when the wall of the blood vessel is injured and the blood leaks in the surrounding tissue)
  • Arteriovenous fistula (an abnormal connection between an artery and a vein)
  • Air embolism (blockage of an artery or a vein when one or more air bubbles enter inside)
  • Thromboembolism (the obstruction of a blood vessel by a blood clot that becomes dislodged from another site in the circulation)
  • Blood vessel dissection (a tear inside the wall of a blood vessel)
  • Contrast mediated nephrotoxicity (worsening of the kidney function due to the administration of iodinated contrast material)

 

After Procedure

After a Digital Subtraction Angiography, it is advised to:

  • Post-procedure care depends on the nature of the procedure performed, and whether it was performed as an outpatient procedure (the patient goes home on the day of the procedure) or inpatient procedure (the patient stays in the hospital following the procedure).
  • The patient is immobilized for four to six hours after the procedure and kept in a supine position (lying on the back).
  • The patient’s vital signs and neurological (nerve-related) status are monitored after the procedure.
  • Frequent observations are needed after the procedure to look for puncture site hematoma (bleeding from the puncture site), which is the most common complication after the procedure.
  • The patient is instructed to increase the intake of fluids for the first 24 hours after the procedure.
  • The patient should be observed for any allergic reactions like nausea, vomiting, or urticaria (rashes on the skin) after the procedure.

 

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) What is the cost of Digital Subtraction Angiography in India ?

The cost of Digital Subtraction Angiography in India varies across different cities and hospitals.

Cost of Digital Subtraction Angiography in India
CITY COST
Cost of Digital Subtraction Angiography in Mumbai INR 70000- INR 80000
Cost of Digital Subtraction Angiography in Delhi INR 68000- INR 78000
Cost of Digital Subtraction Angiography in Bangalore INR 68000- INR 78000
Cost of Digital Subtraction Angiography in Chennai INR 65000- INR 75000