Angiography/arteriography of the extremity

Alternative names 
Extremity arteriography

Definition

Extremity arteriography is a test to visualize the arteries in any of the extremities (hands, arms, feet, and legs). The arteries are not normally seen in an X-ray, so a contrast material is injected into one or more arteries to make them visible. X-ray images are then taken of the blood flow through the area of interest.

X-rays are a form of electromagnetic radiation like light, but of higher energy, so they can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray.

How the test is performed

This test is done in a hospital or outpatient facility. You will be asked to lie on an X-ray table. You may ask for a sedative if you are anxious about the test.

The area where the catheter will be inserted will be shaved and cleansed. (The site is usually in the groin area.) Local anesthetic is used, and a needle is used to puncture the artery so that an intravenous catheter (a flexible tube) can be inserted.

The catheter is inserted through the needle and into the artery. It is then threaded until it is in the artery of interest. This procedure is monitored by fluoroscopy (a type X-ray that projects moving images on a TV monitor).

Contrast material is injected and X-ray images are taken. The catheter is flushed periodically with a saline solution, which will keep the blood in the catheter from clotting.

Your pulse (heart rate), blood pressure, and breathing are monitored during the procedure. After the X-rays are taken, the needle and catheter are withdrawn. Pressure is immediately applied on the leg at the site of insertion for 10 to 15 minutes to stop the bleeding. After that time, the area is checked and a bandage is applied.

The leg should be kept straight for 6 hours after the procedure, and strenuous activity, such as heavy lifting, should be avoided for 24 to 48 hours.

How to prepare for the test

Food and fluids will be restricted 8 hours before the test. Some medications, such as aspirin or other blood thinners, may need to be stopped before the examination. Do not discontinue any medications unless you are advised to do so by your health care provider.

You will wear hospital clothing during this procedure. You will be asked to sign a consent form for the procedure. Remove all jewelry from the area being imaged.

Inform the health care provider if you are pregnant, if you have allergies to any medication, which medications you are taking (including any herbal preparations), and if you have ever had any allergic reactions to X-ray contrast material or iodine substance. Also inform the health care provider if you have ever had any bleeding problems.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

     
  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

The X-ray table is hard and cold; you may want to ask for a blanket or pillow. There is a sting when the anesthetic is given. This does not numb the artery, so you will feel a brief, sharp pain as the catheter is inserted. There is a feeling of pressure as the catheter is advanced. As the dye is injected, you may experience a burning sensation.

There may be tenderness and bruising at the site of the injection after the test. If you experience an enlarging mass, recurrent bleeding, or significant pain in the extremity, seek immediate medical attention.

Why the test is performed
The extremities arteriogram helps identify and locate occlusions (closure of the vessel), stenoses (areas of narrowing) or sites of bleeding. The test is done for persons with symptoms of vascular disease in the extremity (acute or chronic) or after trauma.

Normal Values
The X-ray shows normal structures for the age of the patient.

What abnormal results mean

The X-ray may show blockage in the vessels caused by the following:

     
  • Hardening of the arteries (arteriosclerosis) or other diseases of the arteries  
  • Blood clots  
  • Aneurysms (sacs filled with blood that have formed because of an abnormal widening in the artery)

Additional conditions under which the test may be performed include the following:

     
  • Deep venous thrombosis  
  • Thromboangiitis obliterans  
  • Vasculitis  
  • Trauma

Extremity arteriography may also be used before surgery.

What the risks are

Significant complications may occur:

     
  • There is a chance of a reaction to the contrast medium.  
  • There is some risk of the catheter damaging the artery or knocking loose a piece of a clot which can block the blood flow and cause tissue damage or even a stroke; however, this is rare.  
  • A clot or bleeding at the puncture site may result in a partial blockage of the flow of blood to the leg.

There is low radiation exposure; however, most experts feel that the risk of most X-rays is smaller than other risks we take every day. Pregnant women and children are more sensitive to the risks of the X-ray.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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