Pulmonary Angiography
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What is the
test?
An angiogram is an x-ray of your blood vessels
that shows blockages or other abnormalities in
veins or arteries. It uses a contrast dye (usually
iodine dye), a liquid that helps blood vessels
show up clearly on x-rays. The dye is injected
into the body, and its movement is tracked by
a series of x-rays. Two common types of angiography
are cardiac catheterization with an angiogram
of the coronary arteries, which supply blood
to the heart, and pulmonary angiography, which
examines arteries supplying blood to the lungs.
Most often, a pulmonary angiogram is performed
to see whether a pulmonary embolus, or blood
clot, has traveled through the veins from the
legs or pelvis into the lungs, blocking blood
flow to a part of your lungs. A pulmonary angiogram
is used if a less invasive test such as a ventilation-perfusion
(V-Q) scan or a chest CT scan is inconclusive.
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How
do I prepare for the test?
During this procedure, local anesthetics (numbing
agents) are used to minimize pain. Tell the cardiologist
if you have ever had an allergic reaction to
a local anesthetic or to contrast dyes. Also
let your doctor know if you could be pregnant,
since the x-rays used during this procedure can
damage a fetus.
You might be asked not to eat anything for six
to eight hours before the test, to reduce the
risk that you might become nauseated and vomit
during the procedure. Tell the cardiologist if
you're taking a nonsteroidal anti-inflammatory
drug (NSAID) or other medicines that affect blood
clotting and could increase the chance of bleeding
from the procedure. You should also tell your
doctor if you take insulin shots or blood sugar-lowering
pills so that you can take steps to avoid dangerously
low blood sugar, or hypoglycemia.
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What
happens when the test is performed?
You lie on your back as a medical technician
connects you to a heart monitor and places an
intravenous (IV) line in your arm. You may be
given a sedative through the IV so that you are
relaxed during the test.
First, the doctor injects a local anesthetic
into the skin. This might sting momentarily.
After the skin is numb, the cardiologist inserts
a catheter (a thin, hollow plastic tube) into
a large vein-usually in your groin.
Using live x-rays displayed on a video monitor
as a guide, your doctor moves the catheter along
the vein until it reaches your vena cava (the
large blood vessel that carries blood to your
heart from the rest of your body). then into
the right side of your heart and finally into
the pulmonary arteries that carry blood from
the heart to your lungs. When the tip of the
catheter is pointed into the pulmonary arteries,
the doctor injects contrast dye, illuminating
the arteries on an x-ray. If there is a blood
clot in the lung arteries, it will show up on
the x-ray. The procedure is repeated to visualize
the other pulmonary arteries.
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What
risks are there from the test?
There are several potential risks. First, the
catheter can irritate the heart, in rare cases
causing a disturbance in the heart rhythm. Should
this happen, the doctor can immediately use devices
and medicines to restore a normal heart rhythm.
Alert the doctors and nurses if you develop any
chest discomfort, trouble breathing, or any other
problem during the test.
In addition, the contrast medium can sometimes
impair kidney function. This effect is almost
always temporary, but some people have permanent
damage. Another possible complication is bleeding
at the place where the catheter was inserted.
If blood collects under the skin, it can form
a large painful bruise called a hematoma. This
usually resolves on its own, without requiring
additional treatment. Occasionally, people are
allergic to the contrast dye and develop a rash,
hives, or difficulty breathing after the dye
is injected. If this should occur, the medical
staff in the catheterization laboratory have
medicines available to treat the allergic reaction.
The amount of radiation from this test is too
small to be likely to cause harm.
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Must
I do anything special after the test is over?
Your doctor may ask you to lie flat for a few
hours following the procedure or just keep your
leg straight for up to 12 hours after the procedure.
Often, a small plug or stitch is used to prevent
bleeding from the artery that was entered to
perform the catheterization. If you received
a sedative, you might feel sleepy and shouldn’t
drive or drink alcohol for one day after the
catheterization.
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How
long is it before the result of the test is
known?
As soon as the test is completed, your doctor
will be able to look at the x-rays and determine
whether there is a blood clot in your lungs.
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