A spinal angiogram is an x-ray study of the blood vessels of the spine. It is usually performed to look for abnormality of the vessels or to treat a vascular tumor or a vascular malformation. With this information your physicians can recommend a course of treatment you need and how it should be performed. The angiogram is a minimally invasive procedure. A catheter (long thin flexible plastic tube) is placed into your leg and is guided through the blood vessels of the body to reach the blood vessels of the spine. An x-ray dye is injected to highlight the vessels simultaneously when films are taken from several angles. The procedure is done in the angiography suite with a special team of physicians, physician assistants, nurses and technologists.
Why Do I Need to Have This Procedure?
Common reasons to do a spinal angiogram include the following:
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show narrowing or blockages of blood vessels
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show abnormally dilated blood vessels
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show bleeding sites
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display atherosclerotic disease (hardening of blood vessels) within the spine
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to find intraspinal aneurysms (abnormal outpouchings of the vessel wall ) or other disorders of the blood vessels inside the spine
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planning for a future operation to decide on the best surgical procedure
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allow interventional neuroradiologists to plan for future procedures
Preparing For The Procedure
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Do not eat or drink anything after midnight the day before your procedure except for small sips of water to take your pills.
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Prior to the procedure, you must put on a hospital gown and remove any jewelry around your head and neck that would interfere with the x-ray beam.
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A small amount of blood will be drawn to make sure your kidneys are working and your blood is clotting normally. (If you are a female of childbearing age, a blood pregnancy test will be done to make sure you are not pregnant as x-rays and x-ray dye could be harmful.)
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You should not drive for 24 hours after the study.
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As most people go home the same day, you should arrange transportation.
Prior to the procedure you will need to give your informed consent. This means you will speak face-to-face with the physician or physician assistant and acknowledge the potential risks and benefits of the procedure. This is also your opportunity to have any questions answered about the procedure. Your physician or physician assistant will explain the risks of spinal angiography in order to investigate your symptoms and plan appropriate treatment.
What Will I Experience During The Procedure?
First the area of your access site (usually the right groin) will be cleaned and shaved. Then you will receive a small dose of pain medication through the IV line during the procedure.
The area where the catheter will be inserted will be numbed. (You may feel a stinging sensation briefly, and numbing the area usually makes the rest of the procedure pain free.) The neuroradiologist then threads the catheter (long flexible plastic tube) through the arterial system to the desired location and then injects the x-ray dye contrast. During your procedure you will not feel the catheter in the artery but as the contrast material is injected, you may have a sense of warmth.
X-rays are taken when the contrast is injected.
After the angiogram is completed, the catheter is removed and the puncture site closed. The incision site can be closed either by manual compression or by using a special closure device.
You will have to lie flat for two to six hours after angiography, depending on the reason for the test, the catheter size, and the type of device used to close up the artery. During this time, you should inform the nurse if you notice any bleeding, bruising, swelling or pain at the site where the catheter entered the skin. Your entire procedure may take between one hour to several hours long.
Benefits
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Spinal angiography is a very detailed, clear and accurate picture of the blood vessels in the spine. This is especially helpful when a surgical procedure or a neuroradiologic intervention is being considered.
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By selecting the arteries using a catheter, it allows physicians to assess only the blood vessels.
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Unlike computed tomography (CT) or magnetic resonance (MR) angiography, the use of a catheter makes it possible to combine diagnosis and treatment into one procedure. An example is finding an area of severe arterial narrowing, followed by angioplasty and placement of a stent.
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The degree of detail displayed by catheter angiography cannot be obtained with any other noninvasive procedure.
Risks
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Some patients can have an unusual allergic reaction to the contrast. Reactions range from mild skin irritation, itching, a drop in blood pressure, difficulty breathing, loss of consciousness or death. These reactions only happen in approximately 1/50,000 to 1/150,000 people. You should tell your doctor of a previous allergy history prior to the test.
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There is a very tiny risk that blood will form a clot around the tip of the catheter, blocking the artery and causing a stroke. The chance of developing a permanent stroke (weakness, numbness or paralysis) as the result of a spinal angiogram is approximately 0.5%.
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If you have diabetes or kidney disease, the kidneys could be injured when contrast material is eliminated through the urine.
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Very rarely, the catheter can injure the vessel wall.
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Very rarely, the blood vessel the catheter was inserted into becomes blocked and prevents blood from going to your lower leg and foot. This requires an emergency operation to reopen the blocked blood vessel.
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Delayed bleeding at the site of catheter insertion is very uncommon but it is the major reason that you are observed for four to six hours after your test is completed.
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With interventional radiology procedures using x-rays, the level of risk depends on the type of procedure because some use very little radiation, while complex procedures use more.
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Women should always inform their doctor if there is any possibility that they are pregnant.