What is a peripheral angiogram?
A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. The test is also called a peripheral arteriogram.
Why do people have peripheral angiograms?
Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries.
What are the risks of peripheral angiograms?
Serious risks and complications from peripheral angiograms are very unlikely. But in rare cases:
- A thin tube (catheter) that doctors insert into your artery during a peripheral angiogram damages the artery.
- Some people may have allergic reactions to the dye used in the test. Tell your doctor if you have ever had an allergic reaction to x-ray contrast dye or to iodine substances.
How do I prepare for a peripheral angiogram?
- Your doctor will give you instructions about what you can eat or drink during the 24 hours before the test.
- Usually you’ll be asked not to eat or drink anything for 6 to 8 hours before your peripheral angiogram.
- Tell your doctor about any medicines (including over-the-counter, herbs and vitamins) you take. He or she may ask you not to take them before your test. Don’t stop taking your medicines until your doctor tells you to.
- Tell your doctor or nurse if you are allergic to anything, especially iodine, latex or rubber products, medicines like penicillin, or X-ray dye.
- Leave all of your jewelry at home.
- Arrange for someone to drive you home after your angiogram.
What happens during the peripheral angiogram?
A doctor with special training performs the test with a team of nurses and technicians. The test is performed in a hospital or outpatient clinic.
- Before the test, a nurse will put an IV (intravenous line) into a vein in your arm so you can get medicine and fluids. You’ll be awake during the test.
- A nurse will clean and shave the area where the doctor will be working. This is usually an artery in your groin.
- A local anesthetic will be given to numb the needle puncture site.
- The doctor will make a needle puncture through your skin and into your artery, and insert a long, thin tube called a catheter into the artery. You may feel some pressure, but you shouldn’t feel any pain.
- The doctor will inject a small amount of dye into the catheter. This makes the narrowed or blocked sections of your arteries show up clearly on X-rays. The dye may cause you to feel flushed or hot for a few seconds.
“I watched the whole thing on the screen. It was a pretty easy procedure.” Shirley, age 77
What happens after the peripheral angiogram?
- You will go to a recovery room for a few hours.
- To prevent bleeding, the nurse will put pressure on the puncture site. After about 45 minutes, the nurse will remove the pressure and check for bleeding.
- The nurse will ask you not to move the leg used for the catheter.
- The nurse will continue to check often for bleeding or swelling.
- Before you leave, the nurse will give you written instructions about what to do at home.
What happens after I get home?
- Drink lots of liquids to make up for what you missed while you were preparing for the angiogram and to help flush the dye from your body. For most people, this means drinking at least 6 glasses of water, juice or tea.
- You can start eating solid food and taking your regular medicines 4 to 6 hours after your angiogram.
- Don’t drive for at least 24 hours.
- The puncture site may be tender for several days, but you can probably return to your normal activities the next day.
- Your doctor will get a written report of the test results to discuss with you.
What should I watch for?
A small bruise at the puncture site is common. If you start bleeding from the puncture site, lie flat and press firmly on that spot. Ask someone to call the doctor who did your peripheral angiogram.
Call your doctor if:
- Your leg with the puncture becomes numb or tingles, or your foot feels cold or turns blue.
- The area around the puncture site looks more bruised.
- The puncture site swells or fluids drain from it.
Call 911 if you notice:
- The puncture site swells up very fast.
- Bleeding from the puncture site does not slow down when you press on it firmly.
What can I do to help myself?
The most important steps you can take are:
- Quit smoking. Avoid secondhand smoke.
- Be physically active. Follow your provider’s recommendation for your appropriate level of physical activity. For most adults, walk, ride a bicycle, or do other types of moderate physical activity for at least 150 minutes per week.
- Know your blood pressure numbers. Work with your doctor to reach a blood pressure of less than 120/80 mm Hg.
- Lower your blood cholesterol levels by eating healthy foods (high in fiber and low in saturated fat andtrans fat) and taking your cholesterol lowering medicine.
- If you have diabetes, work with your doctor to keep your blood sugar under control and reach and maintain an HbA1c of less than 7 percent. HbA1c (hemoglobin A1c) is a blood test that measures your average blood sugar level for the previous 2 to 3 months.
- If you are overweight, set your initial goal at a loss of 5 to 10 pounds. If you need to lose more, a weight loss of 1 to 2 pounds per week is recommended until you reach a healthy weight. Visit our Losing Weight section for more information.
- If you drink alcohol, have only 1 drink a day if you’re a woman, 2 if you’re a man. Learn more about alcohol and heart disease.
How can I learn more about peripheral angiograms?
Talk with your doctor. Here are some good questions to ask:
- Why do I need a peripheral angiogram?
- Should I take my medicines on the day of my peripheral angiogram?
- How do the results of the peripheral angiogram affect my treatment?
- Do I need a procedure to open up or bypass any blocked arteries?
Angioplasty and stent placement – peripheral arteries
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. Fatty deposits can build up inside the arteries and block blood flow.
A stent is a small, metal mesh tube that keeps the artery open.
Angioplasty and stent placement are two ways to open blocked peripheral arteries.
Angioplasty uses a medical “balloon” to widen blocked arteries. The balloon presses against the inside wall of the artery to open the space and improve blood flow. A metal stent is often placed across the artery wall to keep the artery from narrowing again.
To treat a blockage in your leg, angioplasty can be done in the following:
- Aorta, the main artery that comes from your heart
- Artery in your hip or pelvis
- Artery in your thigh
- Artery behind your knee
- Artery in your lower leg
Before the procedure:
- You will be given medicine to help you relax. You will be awake, but sleepy.
- You may also be given blood-thinning medicine to keep a blood clot from forming.
- You will lie down on your back on a padded operating table. Your surgeon will inject some numbing medicine into the area that will be treated, so that you do not feel pain. This is called local anesthesia.
Your surgeon will then place a tiny needle into the blood vessel in your groin. A tiny flexible wire will be inserted through this needle.
- Your surgeon will be able to see your artery with live x-ray pictures. Dye will be injected into your body to show blood flow through your arteries. The dye will make it easier to see the blocked area.
- Your surgeon will guide a thin tube called a catheter through your artery to the blocked area.
- Next, your surgeon will pass a guide wire through the catheter to the blockage.
- The surgeon will push another catheter with a very small balloon on the end over the guide wire and into the blocked area.
- The balloon is then filled with contrast fluid to inflate the balloon. This opens the blocked vessel and restores blood flow to your heart.
A stent may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands when the balloon is blown up. The stent is left in place to help keep the artery open. The balloon and all the wires are then removed.
Atherectomy is a procedure performed to remove or “debulk” the atherosclerotic plaque from diseased arteries. It is usually combined with low-pressure balloon angioplasty with the goal of minimizing plaque shift while avoiding stent placement. In densely calcified vessels, atherectomy has been used to better “prepare” the vessel prior to stenting in order to prevent incomplete and/or eccentric stent expansion. There are different atherectomy devices designed to cut, shave, sand, or vaporize atherosclerotic or calcified plaques, and they have slightly different indications that depend on the lesion characteristics. Four different methods of atherectomy have been utilized for treatment of femoropopliteal or small-vessel infrapopliteal disease: plaque excision (directional) atherectomy, rotational atherectomy/aspiration, laser atheroablation, and orbital atherectomy.