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.

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

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

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

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

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

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.

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.

• 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.

• 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.

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