Angiogram using image guidance

Kidney angiogram
 

What is an angiogram?

An angiogram is a procedure that uses a special dye, called contrast, and X-rays to see the arteries inside your child’s body. An artery is a blood vessel, which carries blood away from the heart to the tissues in the body. Angiograms are done by interventional radiologists.

Reasons for an angiogram

  • help doctors identify narrowed, enlarged and blocked blood vessels.
  • determine if there is blood leaking out of the vessels and into other parts of the body.
  • help doctors diagnose different diseases that involve blood vessels.

How an angiogram is done

The interventional radiologist will insert a tiny tube, called a catheter, into an artery in the groin (the area at the top of the leg) or in the arm. The catheter is then directed into the area that requires imaging. Next, a special dye, called contrast, is injected into the catheter. The dye is a clear, colourless liquid that helps to outline the arteries so they will show up on an X-ray. The doctor then uses X-rays to take pictures of the arteries.

Some children will be given blood thinners during the procedure to help keep the artery from clotting (blocking).

When the procedure is finished, the catheter is taken out of the artery. The radiologist presses on the artery in the groin or arm to stop any bleeding.

An angiogram can take from 45 minutes to two hours, depending on how complex the arteries being examined are. It can also take longer if any additional treatments are done to the arteries.

Risks of an angiogram

Angiograms are usually low-risk procedures. Major complications are extremely rare. The risk may increase depending on your child’s condition, age and health.

The risks of an angiogram include:

  • pain, bruising or bleeding in the groin or arm where the catheter was inserted
  • infection
  • a bulge or weakness in the artery wall (pseudoaneurysm)
  • poor circulation to the leg or arm where the catheter was inserted
  • clotting (blockage) of the artery
  • damage to the arteries examined (dissection, rupture)
  • bleeding inside the body in the area examined
  • allergy to X-ray dye or contrast
  • stroke (very, very rare)

Visiting the clinic before the procedure

Your child may have a clinic visit with the interventional radiologist before the procedure. During the visit, you should expect:

  • A health assessment to make sure your child is healthy and that it is safe to have general anaesthesia and to go ahead with the procedure.
  • An overview of the procedure, and a review of the consent form with an interventional radiologist.
  • Blood work, if needed.

Giving consent before the procedure

Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the angiogram and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.

How to prepare your child for the procedure

Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.

Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.

If your child becomes ill within two days before the procedure

It is important that your child is healthy on the day of their procedure. If your child starts to feel unwell or has a fever within two days before the angiogram, let your doctor know. Your child’s procedure may need to be rebooked.

Food, drink and medicines before the procedure

  • Your child’s stomach must be empty before general anaesthetic.
  • If your child has special needs during fasting, talk to your doctor to make a plan.
  • Your child can take their regular morning medicine with a sip of water two hours before the procedure.
  • Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor and the interventional radiologist.

Your child will have medicine for pain

Children are given medicine for treatments that may be frightening, uncomfortable or painful. For angiograms, most children are given general anaesthesia and local anaesthesia at the groin or arm where the catheter is inserted to make sure they are comfortable. Occasionally, in older children, angiograms are done with local anesthesia only.

On the day of the angiogram

Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will be dressed in a hospital gown, weighed and assessed by a nurse. You will also be able to speak to the interventional radiologist who will be doing the angiogram, and the anesthetist who will be giving your child medication to make them comfortable during the procedure.

During the angiogram, you will be asked to wait in the surgical waiting area.

After the angiogram

Once the angiogram is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.

Your child should remain on their back with their leg or arm kept straight while in the recovery area and for six hours after the procedure. Some pressure may be applied at the insertion site in the groin or arm to prevent further bleeding.

Going home

In most cases, children go home the same day as the procedure. This usually occurs about six hours after the procedure. Your child’s nurse will let you know when they are well enough to go home.

For more details on how to care for your child after an angiogram, please see Angiogram: Caring for your child at home after the procedure.

Results

Your referring doctor will receive the results of your child’s angiogram. You will need to make an appointment with them to discuss the results.

Key points

  • An angiogram uses medical imaging to create a map of the arteries so they can be seen on an X-ray. Contrast dye is injected through an artery to outline the artery shape.
  • Angiograms are usually low-risk procedures.
  • You will be asked to sign a consent form before the procedure.
  • Be calm, honest and tell your child what to expect. Children feel less nervous and scared when they are given information about what will happen to them.
  • Your child will most likely be given a general anaesthetic.

Candice Sockett, RN(EC), MN:APN

Michelle Cote, BScN, RN

Joao Amaral, MD

2/9/2016

At SickKids

At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT). You can call the IGT clinic at (416) 813-6054 and speak to the clinic nurse during working hours (8:00 to 15:00) or leave a message with the IGT clinic nurse.

For more information on fasting see Eating and drinking before surgery.

For more information on preparing your child for their procedure see Coming for surgery.





Notes: