Femoral angiography is a specialized X-ray procedure that uses contrast material and X-ray imaging to visualize blood vessels and blood flow. The term “femoral” refers to the access point, typically the femoral artery in the groin. This approach allows medical professionals to examine arteries and veins throughout the body.
Purpose of the Procedure
Doctors order a femoral angiogram to diagnose and evaluate conditions affecting blood vessels. It helps identify issues such as peripheral artery disease (PAD), where arteries in the legs and feet narrow due to plaque buildup, causing symptoms like leg pain during walking or non-healing ulcers. The procedure can also detect atherosclerosis, a broader condition involving the hardening and narrowing of arteries.
The angiogram is also valuable for identifying aneurysms, which are abnormal bulges or weakened areas in an artery wall that could potentially rupture. Additionally, it helps locate vascular malformations, which are abnormal clusters of blood vessels. The test assists healthcare providers in determining the problem’s source and extent, guiding treatment plans.
The Angiography Process
Before femoral angiography, patients typically receive specific instructions, often including fasting for a few hours (usually around 4 hours). Patients should also discuss current medications with their doctor, especially blood thinners, as adjustments might be necessary. Blood pressure medication is generally continued with a small sip of water. Upon arrival at the hospital or clinic, nurses will complete admission paperwork and may perform additional tests like blood work.
During the procedure, a local anesthetic is injected into the skin in the groin area, causing a brief stinging sensation. After the area is numb, a small incision is made, and a thin, flexible tube called a catheter is inserted into the femoral artery, often over a guidewire. Patients may feel pressure as the catheter is inserted, but typically no pain as it moves inside the artery.
Once the catheter is in place, a special contrast dye is injected through it into the blood vessels. This dye makes blood vessels visible on X-ray images, highlighting any blockages or narrow areas. Patients commonly experience a sensation of warmth or flushing throughout their body as the dye is injected. X-ray images, often using fluoroscopy, are continuously taken to capture blood flow and vessel structure. The entire procedure can take between 20 to 60 minutes.
Immediately after the procedure, the catheter is removed, and firm pressure is applied to the puncture site for at least 10 minutes to prevent bleeding. Patients are then required to lie flat for a minimum of 1-4 hours in a recovery area, with nurses monitoring blood pressure, heart rate, and the puncture site for any signs of bleeding. Once able to sit up, patients are typically offered something to eat and drink.
Recovery and Aftercare
After discharge, home care focuses on the puncture site and activity restrictions. It is generally advised to rest quietly for the first 24-48 hours and avoid strenuous activities like heavy lifting or repetitive bending. The dressing over the puncture site can usually be removed the day after the procedure, and the area can be left uncovered. It is recommended to avoid swimming, spas, and baths for about 7 days to prevent infection.
Staying well-hydrated by drinking plenty of fluids is important, as this helps the body flush out the contrast dye. Bruising at the insertion site is common and typically resolves within one to three weeks. While some oozing from the puncture site might occur, increasing swelling, pain, or significant bruising should prompt immediate medical attention.
Potential Complications
While generally safe, femoral angiography carries some potential complications. The most common issues occur at the catheter insertion site and include bleeding, bruising, or the formation of a hematoma (a collection of blood under the skin). Improper puncture site location can increase the risk of these complications.
Less common but more serious complications can include an allergic reaction to the contrast dye, such as a rash or difficulty breathing. There is also a temporary strain on the kidneys due to the contrast dye, particularly for individuals with pre-existing kidney issues. Rarely, damage to the blood vessel itself, such as a tear or a blood clot, or an abnormal heart rhythm, can occur. Any signs of significant bleeding, severe pain, numbness in the leg, or persistent swelling at the puncture site warrant immediate contact with a healthcare provider or emergency services.