What is angiography?
Angiography is a procedure that uses contrast dye 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. Angiography is performed by interventional radiologists either through the radial artery (wrist) or femoral artery (groin).
The X-ray images provided by an angiography are called angiograms.
Reasons for an angiography
- To help health-care providers identify narrowed, enlarged and blocked blood vessels and plan treatment.
- To determine if there is blood leaking out of the vessels and into other parts of the body.
- To help health-care providers diagnose different diseases that involve blood vessels.
Risks of an angiography
Angiography is usually a low-risk procedure. Major complications are extremely rare in experienced centres. The risk may increase depending on your child’s condition, age and health.
The risks of angiography 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) where the catheter was inserted
- poor circulation to the leg or arm where the catheter was inserted
- clotting (blockage) of the arteries examined
- damage to the arteries examined (dissection, rupture, blockage)
- bleeding inside the body in the area examined
- allergy to X-ray contrast dye
- reduced function of organ and tissue (stroke, paralysis, organ loss), which is rare
Visiting the clinic before the procedure
Your child may have a clinic visit with the interventional radiology team 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 anesthesia and to go ahead with the procedure.
- An overview of the procedure and a review of the consent form.
Giving consent before the procedure
Before the procedure, the interventional radiology team 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 benefits against the risks. It is important that you understand all potential risks and benefits of the angiography and that all your questions are answered. If you agree to the procedure, you can give consent for the angiography by signing the consent form. 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 angiography, let their health-care provider know. Your child’s procedure may need to be rescheduled.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty before general anesthetic.
- If your child has special needs during fasting, talk to their health-care provider to make a plan.
- Your child can take their regular morning medicines with a sip of water up to two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. If your child is on any of these medications, consult with your child’s health-care provider and interventional radiology team before the procedure to create a plan of care.
On the day of the angiography
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. You will also be able to speak to the interventional radiologist who will be doing the angiography, and the anesthesiologist who will be giving your child medication to make them comfortable during the procedure.
During the angiography, you will be asked to wait in the surgical waiting area.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. For angiography, most children are given general anesthesia as well as local anesthesia at the groin or arm where the catheter is inserted to make sure they are comfortable. Occasionally, in older children, angiography is done with local anesthesia only.
How an angiography is done
The interventional radiologist will insert a flexible tube, called a catheter, into an artery in the groin (the femoral artery) or in the arm (the radial, brachial or axillary artery). The catheter is then directed into the area that requires imaging. Next, contrast dye is injected through the catheter. The dye is a clear, colourless liquid that helps to outline the arteries, so they show up on X-rays, which are used to take pictures of the arteries.
Some children will be given blood thinners during the procedure to prevent the blood in the artery from clotting and blocking the artery.
When the procedure is finished, the catheter is taken out, and the radiologist presses on the artery in the groin or arm to stop any bleeding. If done through the groin, the insertion site will have a small clear dressing. If done through the wrist, your child will have a compression wrist band specifically designed to stop bleeding at the wrist access site.
An angiography can take between one 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.
After the angiography
Once the angiography 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, you will be notified and taken to be with your child.
If the angiography was performed through the groin, your child should remain on bedrest for four hours. They should not get up out of bed for any reason, even to go to the bathroom. Some pressure may be applied at the insertion site in the groin to prevent further bleeding. Slow ambulation can begin after four hours if there are no concerns at the accessed groin site.
If the angiography was performed through the wrist, your child should remain on bedrest for 30 min after the procedure on their back with their arm kept straight with the provided splint. Your child will also have a compression wrist band specifically designed to stop bleeding at the access site. The band will be removed before your child is discharge home.
Your child’s upper limb/wrist should be immobilized with the provided splint overnight. Your child should not lift anything greater than 2 kg for 72 hours. They should not text, flex or bend with the procedure-site hand for 12 hours. They should also avoid any physical activity for one week after the angiography.
Going home
In most cases, children go home the same day as the procedure. This usually occurs about six hours after an angiography through the groin, and about 3-4 hours after an angiography through the wrist. The health-care team will let you know when they are well enough to go home.
For more details on how to care for your child after an angiography, please see Angiography through the radial artery (wrist): Caring for your child at home after the procedure or Angiography through the femoral artery (groin): Caring for your child at home after the procedure.
Results
The health-care provider who ordered the procedure will receive the results of your child’s angiography. You will need to make an appointment with them to discuss your child’s results.
At SickKids
If you have any questions or concerns regarding your child after discharge, please contact the Image Guided Therapy (IGT) clinic at (416) 813-7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message. Alternatively, you can email the IGT clinic nurse at igt.clinicnurse@sickkids.ca.
If you have concerns and it is after working hours, see your child’s primary care provider or go to the nearest Emergency Department. You can also contact the Hospital for Sick Children switchboard at (416) 813-7500 and ask them to page a member of your child’s health-care team or the interventional radiology fellow on call.
For more information on preparing your child for their procedure see Coming for surgery.