There are several non-invasive techniques to investigate the arterial system, but in many cases an angiography will be required to gather all the information required to make an accurate diagnosis and treatment plan.

Angiography is a process which allows pictures of the blood flow channel to be taken with great accuracy. This allows a picture of where the blood is flowing and importantly, where it is not flowing, to be taken. It therefore shows areas of narrowing (stenosis) and complete blockages (occlusions) in the arterial system in great detail, including their severity, and length.

Angiography involves placing a needle into an artery under local anaesthetic. Sometimes this is done with the assistance of ultrasound. This is usually done using one of the femoral arteries in the groin, but occasionally, other arteries are used. A general anaesthetic is not usually required. Through the needle in the artery a wire is placed, and then over the wire a small tube (called a catheter) is placed. The catheter allows contrast to be injected into the blood system. The contrast shows up on X-Ray and is injected simultaneously when an X-Ray is taken to generate the angiogram. Computers then allow the bones to be subtracted from the picture, leaving only the picture of the arterial system – called digital subtraction angiography.

Angiography and angioplasty is usually safe, but there are potential complications which occur approximately 5% of the time. These potential complications include allergy to the contrast agent, decreased renal function due to the contrast agent, bleeding and damage to the artery at the site of puncture, emboli, vessel rupture and damage (especially in angioplasty), damage to vessel branches and occasionally worsening the degree of ischaemia. These will be discussed more if you need to have an angiogram.

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