Coronary angiography is a procedure used to diagnose and treat cardiovascular conditions. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart. A special dye (contrast material) and X-rays are then used to see how the blood flows through the arteries of you heart.
In a right-heart catheterization, your doctor guides a special catheter (a small, hollow tube) called a pulmonary artery (PA) catheter to the right side of your heart. This is then passed into your pulmonary artery. This is the main artery that carries blood to your lungs. As the catheter is advanced; pressures are measured in various locations allowing your physician to diagnose various heart conditions and determining the best treatment for you.
Your heart’s arteries can become blocked or narrowed from a buildup of cholesterol, cells or other substances (plaque). This can reduce blood flow to your heart and cause chest discomfort. Sometimes a blood clot can suddenly form or get worse and completely block blood flow, leading to a heart attack. Angioplasty opens blocked arteries and restores normal blood flow to your heart muscle. It is not major surgery. It is done by threading a catheter (thin tube) through a small puncture in a leg or arm artery to the heart. The blocked artery is opened by inflating a tiny balloon in it.
A stent is a tiny wire mesh tube. It props open an artery and is left there permanently. When a coronary artery (an artery feeding the heart muscle) is narrowed by a buildup of fatty deposits called plaque, it can reduce blood flow. If blood flow is reduced to the heart muscle, chest pain can result. If a clot forms and completely blocks the blood flow to part of the heart muscle, a heart attack results. Stents help keep coronary arteries open and reduce the chance of a heart attack.
Rotational atherectomy uses a tiny rotating cutting blade to open a narrowed artery and improve blood flow to or from the heart. Often a stent — a small tube made of metal mes— is put in the artery to prevent it from re-narrowing.
A pacemaker is a small device that’s placed in the chest or abdomen to help control abnormal heart rhythms. This device uses low-energy electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are used to treat arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat.
An implantable loop recorder is a type of heart-monitoring device that records your heart rhythm continuously for up to three years. It records the electrical signals of your heart and allows remote monitoring by way of a small device inserted just beneath the skin of the chest.
Why it’s done
An implantable loop recorder can help answer questions about your heart that other heart-monitoring devices don’t provide. It allows for long-term heart rhythm monitoring. It can capture information that a standard electrocardiogram (ECG or EKG) or Holter monitor misses because some heart rhythm abnormalities occur infrequently.
For example, if you have a standard ECG to help figure out why you’re having fainting spells, it will only record any related heart rhythm abnormalities during the few minutes of the monitoring period — usually about five minutes. Because an implantable loop recorder monitors your heart signals for a much longer time, it’s more likely to capture what your heart is doing during your next fainting spell. This information may help your doctor make a definite diagnosis and develop a treatment plan.
Implantable loop recorders are one of the newer heart-monitoring devices. Researchers have evaluated their safety and benefit over the last 10 years. A study of 579 people with fainting spells showed that implantable loop recorders had a higher rate of diagnosis of heart rhythm problems than did other monitoring devices.
Researchers also examined the value of implantable loop recorders in people who had a stroke. Long-term heart monitoring uncovered heart rhythm problems that caused the stroke better than 24-hour monitoring did. Doctors used these results to guide treatment with blood-thinning drugs (anti-coagulation therapy) to prevent another stroke.
An angiogram is an imaging test that uses X-rays to look at your blood vessels. It is done to check for conditions such as:
- Weak, stretched or enlarged portion of a blood vessel (aneurysm)
- Narrowing of a blood vessel (stenosis)
An abdominal angiogram looks at the blood vessels in your belly (abdomen). It may be used to check blood flow to the organs of the abdomen, such as the liver and spleen. It may also be used to guide in the placement of medicine or other materials to treat cancer or bleeding in the abdomen.
Fluoroscopy is often used during an abdominal angiogram. This is a kind of X-ray “movie” with continuous X-rays showing the provider real time images of the test procedure.
Contrast dye is used to cause the blood vessels to appear solid on the X-ray image. This lets the radiologist see the blood vessels more clearly. Dye is injected into specific blood vessels to look at a certain area of blood flow more closely.
For an abdominal angiogram, a catheter (small tube) is placed into a large artery in your groin and then placed into the specific artery of interest. Contrast is injected through this tube. Next, the radiologist takes a series of X-ray pictures. These X-ray images show the blood flow in the abdomen. You may also have a CT (computed tomography) scan or MRI (magnetic resonance imaging) scan with your angiogram.
Why might I need an abdominal angiogram?
You may need an abdominal angiogram to find problems of the blood vessels in the abdomen. Problems include:
- Stenosis or spasms of the blood vessel (vasospasm)
- A connection between the arteries and veins that isn’t normal (arteriovenous malformation)
- A blood clot within a blood vessel or blockage of a blood vessel
Other conditions that may be found by include tumors, or bleeding. Angiography may be used to deliver medicine directly into tissue or an organ. This might include clotting medicine to the site of bleeding or cancer medicine into a tumor.
Carotid Angiogram is usually performed when your doctor suspects that you may have a significant blockage in one or more of your carotid arteries. It is a common, relatively painless, nonsurgical procedure performed by an interventional cardiologist.
The information provided by this procedure provides details about the function and patency of the carotid arteries.
During the procedure a thin flexible tube (catheter) is inserted through an artery in your groin (femoral artery). To make the arteries visible on x-ray, dye is injected through the tube into the target arteries. An x-ray camera films the arteries as they pump blood. These x-ray images can be viewed right away so treatment decisions can be made quickly.
A Peripheral Angiogram is a broad term used to describe a study of the peripheral circulation. This test is usually performed when your doctor suspects that you may have a significant blockage in one or more of the arteries of your peripheral circulation. Specifically, the arteries of the aorta (Aortogram), renal arteries (Renal angiogram), legs (Lower Extremity Angiogram), or arms (Upper Extremity or Subclavian Angiograms) may be studied. Venous angiography is used to assess for venous narrowing or occlusion. It is a common, relatively painless, nonsurgical procedure.
The information provided by this procedure provides details about the function and patency of the specific arteries or veins being studied. It is used to diagnose and treat Peripheral Artery Disease (PAD), May-Thurners, and may also diagnose thoracic (TAA) and abdominal aortic aneurysms (AAA).
How Is a Peripheral Angiogram Performed?
A thin flexible tube (catheter) is inserted through an artery in your groin (femoral artery), wrist (radial artery) or arm (brachial artery). To make the arteries visible on x-ray, dye is injected through the tube into the target arteries. An x-ray camera films the arteries as they pump blood. These x-ray images can be viewed right away so treatment decisions can be made quickly.
Percutaneous closure is a surgical procedure used to treat patients with patent foramen ovale (PFO) and atrial septal defect (ASD). Advancements in device technology and image guidance now permit the safe and effective catheter-based closure of numerous intracardiac defects, including PFO and ASD.
An implantable cardioverter defibrillator (ICD) is a device that is inserted just below the collarbone it is used to help regulate potentially fast and life-threatening electrical problems with the heart. An ICD monitors the heart’s electrical activity using wires with electrodes on the end that are placed in specific areas of the heart. The ICD responds to irregular life-threatening heart rhythms from the lower chambers of the heart with either anti-tachycardia pacing (ATP) consisting of low energy impulses to promote a normal heartbeat, or shock therapy with high energy impulses, to prevent sudden cardiac arrest. .
Cardiac resynchronization therapy (CRT), also called biventricular pacing, uses a special kind of pacemaker, called a biventricular pacemaker, designed to treat the delay in heart ventricle contractions that can occur in some patients with advance heart failure. It keeps the right and left ventricles pumping together by sending small electrical impulses through the leads. CRT has been shown to improve symptoms of heart failure in patients who have been treated maximally with medications but still have severe or moderately severe heart failure symptoms.
Dorsal Column Spinal cord stimulation (DCS) is a technique used in the management of certain chronic pain syndromes. Through an implanted electronic device, low level electric current is delivered to the posterior elements of the spinal cord in order to relieve the pain associated with failed-back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS).
Kyphoplasty is a surgical procedure designed to stop the pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to a compression fracture. This involves making a small incision in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae. A special balloon is then inserted through the tube and into the vertebrae. This is then gently and carefully inflated. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae. The balloon is then removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material. After being injected, the material hardens quickly, stabilizing the bone.
Lumbar laminectomy is a surgical procedure that removes part of the bone in the back of the spine along with overgrown ligaments and bone spurs in order to reduce pressure on the spinal nerves. With Minimally invasive laminectomy a small incision (about 1 inch long) is made over the level of spinal stenosis. Without cutting through the muscles, a series of dilators are used to separate muscle fibers and provide access to the spine. A retractor is placed over the dilators and provides a working channel to perform the surgery. A microscope is brought in to provide a close-up view during the procedure.
Overgrown bone, ligament and bone spurs are then removed with special instruments in order to open up more room for the spinal nerves. If more than one level needs to be treated, the incision is slightly extended and the procedure is repeated in the same manner. The incision is then closed with sutures that stay under the skin and dissolve over time.