Whether you have a diagnostic (catheter) angiogram already scheduled or are still in the treatment planning phase of your care, learning more about your upcoming procedure can help you be more comfortable with your treatment choices. The following information will help answer many questions you may have and give you some direction on how to best prepare for your procedure.
About Angiograms
Learning about what a diagnostic angiogram actually is, how it is performed and why it may be necessary will give you a clearer idea of what to expect, which can help you be more at ease before your procedure.
What is an angiogram?
An angiogram is a diagnostic procedure that allows a doctor to visualize your arterial system of your vasculature to look for any blockages. This is accomplished by injecting iodine dye into your bloodstream, then taking an X-ray. The iodine dye is a special material known as a contrast agent and will show up on the X-ray, providing an image of your blood vessels that couldn’t otherwise be seen. The difference between an angiogram and other imaging tests, is that the angiogram provides information of the speed of blood flow and visualizes smaller blood vessels than other tests do. It is more closely related to a video rather than a photograph.
How long does a brain angiogram take?
The actual procedure takes approximately 30 minutes. However, the total procedure time, prep and immediate aftercare will take approximately one to three hours, during which your loved ones won’t be able to be at your bedside.
Why are angiograms used?
Angiograms are used to identify and/or define:
- Cerebral (Brain) Aneurysms
- Arteriovenous malformations
- Carotid stenosis
- Intracranial stenosis
- Reversible vasoconstrictive syndrome
- Arteriovenous fistulas
- Other vascular malformations
- Blockages in the brain
- Hemorrhagic tumors
- Developmental venous anomalies
- Venous sinus thrombosis
Preparation in the Days Prior to the Procedure
The doctor will be giving you specific instructions about what you should do to prepare for your procedure, but the following information may help answer questions you may have. Remember, follow the instructions from your doctor, should they differ any from the information below, and ask for clarification on any issues you may be unsure about.
Should I take my medications before my diagnostic angiogram?
Your doctor will review all of your medications with you prior to your procedure so you know which ones to take the morning of your surgery. It may be helpful if you write all of your medications, including vitamins and over-the-counter products, or put all of the bottles in a gallon-sized plastic bag to bring to your appointment so you do not have to try and remember everything.
When your doctor gives you instructions about what medications to take or not prior to your surgery, it is of vital importance that you follow them exactly. These instructions are for your safety and comfort, and if you make a mistake and take something you were not supposed to, alert your doctor immediately.
If you take Glucophage (Metformin), it will typically need to be stopped prior to the procedure, and you will need to wait another 48 hours before you can resume taking it. If your doctor tells you differently, be sure to follow the exact instructions he or she has given you. In addition, if you are diagnosed with diabetes, and are taking insulin, you may get further instructions on how to administer the insulin prior to the procedure.
In general, angiograms can be performed safely if you take antiplatelet medication, such as aspirin, clopidogrel Plavix®, Brilinta®, Aggrenox® or Effient® (Prasugrel), and you will not need to discontinue your regular dosage prior to your diagnostic angiogram.
If you take any blood thinners, such as Coumadin® (warfarin) or Lovenox®, you must inform your doctor, as these must be stopped five days before your procedure and could have an effect on bleeding. Other, newer blood thinners, such as Pradaxa® (dabigatran), Xarelto® (rivaroxaban) and Eliquis®(apixaban), also need to be discontinued according to your doctor’s instructions. Never start or stop taking your medications without the advice of your physician.
Can I eat before my procedure?
Your doctor will give you specific instructions, but in general you cannot eat or drink after midnight the evening before your diagnostic angiogram. This includes sips of coffee and chewing gum. Again, this is for your safety and comfort, and it is imperative that you abide by your doctor’s directions. If you need to take medications the night before or morning of your procedure, you may be allowed to take them with a sip of water. If your doctor has not specifically indicated this is okay, be sure to ask him or her in advance for clarification.
I have a contrast allergy. Do I need to do anything special prior to my diagnostic angiogram?
Again, this is a situation where you need to defer to any instructions given by your doctor if they differ. Different places use different protocols, different medications and different medication schedules. However, in our practice, you can expect to take two different medications. The first is Benadryl® (diphenhydramine), which is purchased over the counter and comes in 25 mg tablets. The second is Medrol (methylprednisolone), which requires a prescription and comes in 4 mg tablets. Make sure you pick this up from the pharmacy as soon as possible.
You will need to take a dose of each medication twice before your procedure. The dosing schedule is as follows:
- 12 hours before your procedure, you will need to take:
- Benadryl® (diphenhydramine) – 2 tablets
- Medrol (methylprednisolone) – 8 tablets
- 2 hours before your procedure you will need to take:
- Benadryl® (diphenhydramine) – 2 tablets
- Medrol (methylprednisolone) – 8 tablets
These medications are very important to ensure your body tolerates the contrast dye used in your diagnostic angiogram. If you forget to take them or take them closer to the procedure than scheduled (for example, just one hour before instead of two), let your surgeon know. Remember, this is for your safety and they must be taken exactly when and as directed.
I have kidney impairment. Do I need to do anything special prior to my diagnostic angiogram?
When you meet with your doctor, be sure to let him or her know all the names of the medications you are currently taking. Again, it can be helpful to prepare a list or even place all of your medications into a gallon-sized bag to bring to your appointment. Don’t forget to mention any supplements or other over-the-counter medications you may be taking.
The day before the procedure, take care to drink plenty of fluids. You will be given restrictions for the morning of your surgery, but you can drink as much as you want to until 12 midnight, the day before the procedure.
Your doctor will be ordering a special medication called N-Acetylcysteine or Mucomyst. This prescription is in liquid form and often taken for lung issues, but your doctor will want you to drink it twice daily. The dose is 6 ml and comes with a special dropper. You can also use a medical spoon that measures medication in milliliters, if you prefer. Occasionally, the liquid may be substituted by pills.
For the two days before the procedure, you can mix this medication with diet cola, if it makes it more palatable. However, the morning of your procedure, take the medication with only a small sip of water. You will also need to continue to take this medication for two days following your procedure unless otherwise instructed by your doctor.
The Day of the Procedure
Again, your doctor will likely give you specific instructions, which may differ from the general information that follows. However, these guidelines will be applicable for most patients.
When should I arrive for my diagnostic angiogram?
Patients are asked to arrive two hours before the procedure. If you have never been to the facility before, be sure to leave a little early to account for traffic and navigating to a new place.
Where do I go once I get to the facility?
You can check in at the front desk, which should be easily visible from the main entryway.
What should I wear?
Arrive in comfortable clothing.
Should I take my medications that morning?
Your doctor will give you specific instructions on which medications you should take and whether or not you can take them with a sip of water. Never start or stop medications on your own. If you mistakenly took something you were told not to, or if you forgot to take medication as scheduled, let the surgeon know immediately, for your own comfort and safety.
What happens before the procedure?
You will be taken to the procedural room, where the nurse will start an IV before the procedure begins. Stickers for the heart monitor will be placed on your chest, and a blood pressure cuff will be placed on both your arms unless there are restrictions applicable to your individual condition.
Your Diagnostic Angiogram Procedure
To help you feel more at ease about your upcoming procedure, the following information will give you a better understanding of what the room will be like, who will be there and what happens during the procedure itself.
Where will my procedure take place?
Your diagnostic angiogram will be performed in the procedural room with an Angio Suite. The room will feel cold when you first arrive, so you will be given warming blankets to keep you comfortable.
Who will be in the room during my diagnostic angiogram?
You will see your doctor, nurses, scrub techs, X-ray techs and an anesthesiologist. You may see them all come together for a “time-out” huddle before the procedure and may even overhear them talking about your case.
This is nothing to be alarmed over. In fact, it is a standard safety measure and gives all of the staff a chance to review your pertinent demographics, medical history, lab work, allergies, medications and the details of the procedure out loud to ensure everyone is well informed and on the same page.
Will I be awake during the procedure?
You will be given a medication and sedative to make you comfortable. Based on your medical history, current medications and other factors, your doctor and anesthesiologist will determine what kind of medication you can receive for sedation.
What happens during the procedure?
First, you will be given medication to numb the groin, where the catheter will be placed, to ensure you are comfortable during the procedure. Then a catheter is placed in a blood vessel in the groin and guided into the cerebral arteries by your doctor using dye (contrast material).
It is important to note that you might feel a hot sensation from the dye. Some people also see light flashes or experience a change in taste. This can last a couple seconds and will pass immediately. Knowing that this is a possibility beforehand can help you from being alarmed if you should experience any of these sensations during your procedure.
Next, X-rays are taken as an iodinated contrast material is injected through the catheter. The contrast material flows through the arteries, making them visible on the X-ray when they otherwise would not be. This allows your doctor to visualize your arteries and obtain diagnostic data to assist in making a diagnosis or assessing your condition.
Once your doctor has obtained the necessary data, he or she will remove the catheter and pressure will be held on the sites for 15 to 20 minutes. Alternatively, your doctor may decide to use a “closure device” instead of holding pressure. Should your doctor choose this option, you will be given information about the device and any necessary instructions.
Your Recovery Following Your Diagnostic Angiogram
An Angiogram recovery begins as soon as your procedure is over, while you are in the hospital, and will include transitioning to home care and eventually resuming normal activities. As with the other elements of your procedure, you will receive specific instructions relevant to your individual condition, and your recovery may differ from the next person’s.
How long will I remain in the hospital following my diagnostic angiogram?
Patients typically stay in the hospital for four to six hours. You will also be instructed to keep your leg straight for four to six hours following your procedure.
What do I need to do when I get home from the hospital?
First, you will need to drink plenty of fluids to wash out the dye. You can restart your diet and all previously prescribed medications unless your doctor has indicated otherwise. Remember, specific guidelines from your doctor take precedence over this generalized information.
You will likely want to rest for the remainder of the day after you get home from the hospital. You will need to avoid any strenuous activities and should refrain from climbing any flights of stairs. It can be helpful to plan beforehand to have someone help you with childcare, food preparation or other tasks around the home. You will also need to wait for 24 hours following your discharge to resume driving, so be sure to keep that in mind.
Keep your dressing over the groin area clean and dry. You will likely be sent home with supplies to help you with your incision care, such as adhesive bandages (Band-Aids®) and gauze pads.
How do I care for my incision site? Can I take a shower?
After 24 hours, you may remove the hospital dressing from your groin area. You may take a shower with mild soap, but do not scrub the groin incision site. Pat the area dry with a clean towel and apply a regular adhesive bandage following your shower. It is important to keep the puncture site clean and dry. You will need to avoid taking a bath for five days. This includes whirlpools, spas and swimming pools.
Bruising is common and will resolve within a few weeks. However, if you notice any drainage from the incision site, leg redness, swelling, increasing leg pain or coldness, call your doctor immediately. If you have a fever above 100.4 F, this may be a sign of infection that requires medical attention.
If you have severe bleeding from the incision site, lie down flat and straight. Apply pressure to the area immediately, or ask someone to do it for you. This is a medical emergency, and you need to call 911 or go to the ER immediately.
When can I go back to work?
You may return to work one to two days after your discharge unless your doctor directs otherwise.
When can I return to activities and exercise?
You will need to wait two days before you return to your previous level of physical activity, including gardening, lawn work, sexual activity and exercise. Increase exercise gradually, and avoid lifting any heavy weights (greater than 10 pounds) for the five days following your procedure.
What are the risks or side effects of a diagnostic angiogram?
The most common side effects are from the catheter incision and include:
- Bruising at the incision site
- Swelling
- Discomfort
- Potential infection at the site of the catheter wound
Remember, some degree of bruising is to be expected, but if you experience excessive pain, drainage, swelling, bleeding, coldness or fever, as described above, be sure to contact your doctor immediately.
Putting It Together
It is likely that this information has helped answer many questions you may have had about your upcoming diagnostic brain angiogram. However, you may find you have new questions or still need further clarification. Be sure to bring any concerns up with your doctor at your next appointment, and he or she can help ensure you are at ease before your procedure.
