Spinal angiogram

Introduction

This leaflet is for patients scheduled to undergo a spinal angiogram.

About spinal angiograms

An angiogram is an x-ray test used to produce pictures of blood vessels. A spinal angiogram shows the blood vessels around your spinal cord.

Intended benefits

Spinal angiograms provide more detailed images than other non-invasive techniques such as CT angiography and MR angiography. The extra detail helps to make a more accurate diagnosis.

Who will perform my procedure?

This procedure will be performed by a Consultant or Specialist registrar in radiology.

What happens before the test?

A doctor will ask you about your medical history and any medication you are taking, and will explain the test to you. Please bring all your medications and any packaging (if available) with you. You will be asked for your consent. If you are too unwell to give your consent, the procedure will be discussed with your family. If you are coming to us as a day case, you will be allowed to eat or drink before the test.

You will need to arrange a lift to and from hospital as you will not be allowed to drive after the procedure for 24 hours.

Medications

If you are taking blood thinning drugs (also known as anticoagulant or antiplatelet drugs) then please inform the Radiology Day Unit on 01223 274287 as soon as you get the appointment. Examples include: warfarin, rivaroxaban, apixaban, edoxaban, aspirin, clopidogrel, prasugrel, ticagrelor, dabigatran, dipyridamole and acenocoumarol.

If you are taking metformin please ask your GP to check your creatinine levels and inform us of the result a week before your angiogram; you may be asked to stop taking your metformin for 24 hours following the procedure.

What happens during the procedure?

• The procedure is carried out in the radiology department in a room with large, high-technology computerised equipment.
• There will usually be at least three people in the room during the procedure: a radiologist, a radiographer, and a nurse.
• You will be asked to lie on an x-ray table in the room. The doctor or nurse will shave a small area in your groin and clean the area with an antiseptic solution; they will then put a large sterile drape over the area.
• The radiologist will use local anaesthetic; this may be a little uncomfortable to begin with.

The radiologist will put a very small tube (catheter) into the blood vessel in your groin (the femoral artery). This is passed through other blood vessels in your body until it reaches the site of interest. You will not feel it moving inside you. The radiologist will position the tube into various different blood vessels adjacent to the spinal cord. While this happens, you will receive injections of a special dye (called contrast agent) to produce the radiological images required.

The injections may give you a localised hot feeling in your back, but this goes away quickly. This is a normal reaction.

Before taking the first picture, the radiographer will move the equipment around you into the correct position. More pictures are taken with further injections.

It is very important that you remain still throughout the procedure to ensure the pictures taken are as clear as possible.

The whole procedure is likely to take between one and two hours.

We want you to be informed about your choices to help you to be fully involved in making any decisions so please ask about anything you do not fully understand or wish to have explained in more detail before the procedure.

What happens after the procedure?

Once your angiogram is completed you will usually be transferred to the Radiology Day Unit where you will be looked after by specially trained nurses, under the direction of your radiologist.

Most people who have this type of procedure will need to stay in hospital for four hours after the procedure.

The nurses will monitor you closely and regularly check on the arterial puncture site in your groin. Please be aware of the following

• Bruising at the top of the leg is common following an angiogram. This should go after a few days. If the bruising is excessive or a lump develops after you have been discharged please contact your GP.
• If you feel unwell, dizzy or light headed or there is active bleeding, press firmly on the puncture site and go to the nearest Accident and Emergency department.
• You will be advised on when to restart any medication that was stopped prior to the procedure.

Significant, unavoidable or frequently occurring risks of this procedure

• 1 in 100 patients
  • Transient neurological symptoms (headache, limb weakness, difficulty with speech or loss of vision). This will usually last for a few hours (although in some cases there is a permanent disability, 1 in 200 patients or less).
• 1 in 200 patients
  • Circulatory problems in the leg because of the damage to the femoral artery (e.g. painful swelling of the artery). These problems usually settle with simple treatment like compression of the artery but may require a day in hospital.
  • Damage to the femoral nerve which lies next to the artery in the groin.
• 1 in 500 patients
  • Loss of circulation to the leg from blockage of the artery requiring further treatment.
  • Serious blood loss.
  • Allergic reaction to contrast agent, latex or local anaesthetic. Please let us know if you have any allergies.

Alternative procedures that are available

Other tests to demonstrate blood vessels, for example CT or MR angiography, do not give as much detail. You may have had these other tests already.

You may decide not to have this test or to delay it whilst you make up your mind. For some conditions, delaying may carry additional risk.

Discuss this with the doctor who referred you for your angiogram.

An alternative to this procedure is a decision not to have the angiogram. We will discuss with you the implications of deciding not to have the angiogram.

Local anaesthesia

In local anaesthesia the anaesthetic drug is injected into the skin and tissues at the site of the blood vessel in the groin. The area of numbness will be restricted and some sensation of pressure may be present, but there should be no pain. Local anaesthesia is used for minor procedures such as stitching a cut and a local anaesthetic will be given by the doctor doing the procedure.

Important things you need to know

Patient choice is an important part of your care. You have the right to change your mind at any time - even after you have given consent and the procedure has started - as long as it is safe and practical to do so.

We will only carry out the procedure on your consent form unless, in the opinion of the health professional responsible for your care, a further procedure is needed in order to save your life or prevent serious harm to your health. However, there may be procedures you do not wish us to carry out and these can be recorded on the consent form.

We are unable to guarantee that a particular person will perform the procedure. However the person undertaking the procedure will have the relevant experience.

All information we hold about you is stored according to the Data Protection Act 1998.

Key points for you to note

• Please read your admission letter carefully. It is important to follow the instructions we give you about not eating or drinking or we may have to postpone or cancel your operation.
• Please read this information carefully, you and your health professional will sign a consent form to document your agreement to the procedure. You will have an opportunity to ask any questions of the radiologist when you are admitted. The radiologist will explain the procedure and you will be asked to sign the consent form.
• Please bring with you all of your medications and its packaging (including inhalers, injections, creams, eye drops, patches, insulin and herbal remedies), a current repeat prescription from your GP, any cards about your treatment and any information that you have been given relevant to your care in hospital, such as x rays or test results.
• Simple painkillers such as paracetamol and ibuprofen may be required after surgery. It is suggested that you discuss with your pharmacist and have a seven day supply of these medications at home to take as you need according to the instructions.
• Take your medications as normal on the day of the procedure unless you have been specifically told not to take a drug or drugs before or on the day by a member of your medical team. If you have diabetes please ask for specific individual advice to be given on your medication at your pre-operative assessment appointment.
• Please call the nurses on the Radiology Day Unit on telephone number 01223 274287 if you have any questions or concerns about this procedure or your appointment.

After the procedure we will file the consent form in your medical notes.

Contacts / Further information

Please call the nurses on the Radiology Day Unit on telephone number 01223 274287 if you have any questions or concerns about this procedure or your appointment.