Vascular Imaging

Is this an operation, and will I be awake?

It is not an operation in the way most people mean the word. There is no cut in the chest and no stitches. The work is done through a puncture in an artery at the wrist or the groin, in the catheterisation lab, which is an imaging room rather than an operating theatre. The hospital has two catheterisation labs.

You lie on a narrow table. A nurse cleans and covers the wrist or the groin, and the doctor numbs a small patch of skin with a local anaesthetic injection. The injection stings for a few seconds. After that you should feel pressing and pushing, but not pain.

A thin flexible tube is then passed along the artery up to the heart. You cannot feel it travelling, because the inside of an artery has no nerves that sense it. When the dye goes in you may feel a warm flush through your body, and you may be asked to hold your breath or to cough. You are awake and the team talks to you throughout. Tell them at once if anything hurts.

Whether you are also given something to make you drowsy is a decision for your cardiologist. Ask beforehand if it worries you.

An angiogram, an angioplasty and a stent are three different things

An angiogram is a test. Dye is injected through the tube and X-ray pictures are taken, which show where the heart arteries are narrowed and by how much. The pictures appear as they are taken, so the cardiologist knows the result at the end of the procedure and can tell you then.

An angioplasty is the treatment. A small balloon is passed to the narrowed part and opened, which pushes the narrowing aside. A stent, a small metal mesh tube, is usually left behind to hold the artery open. It stays there for life and is not taken out later.

The two are often done in one sitting, so that a narrowing found on the test can be treated without a second procedure on another day. You will usually be asked to consent to both before you go in. If the plan changes, the team explains it where there is time.

If the pattern of narrowings is not suitable for stenting, your cardiologist may advise bypass surgery instead. That is done by the cardiothoracic surgery team in the same hospital, and it is a different kind of operation, with a chest incision and a longer recovery.

How long it takes, and how long you will stay

The picture taking is the short part of the day. The waiting before it and the lying still after it take longer than the procedure itself, so plan for a day rather than for an hour.

When it is over the tube is pulled out and the puncture is pressed, or held with a band, until it stops bleeding. If the wrist was used you can usually sit up sooner. If the groin was used you are asked to lie flat for some hours, and during that time you will need help to eat and to use a bedpan.

A coronary angiogram on its own can be done as a day-care procedure, where you come in early and go home the same day. An angioplasty with a stent is planned as an admission, and you are kept in afterwards so the heart and the puncture site can be watched.

Ask your cardiologist how many hours and how many nights to plan for in your case. It depends on which artery was used, on what was found, and on your other health problems. This page does not print a standard figure, because there is none to print.

Before you come in

These are the usual instructions. Where they differ from what your own cardiologist tells you, follow your cardiologist.

• Follow the instructions you are given about eating and drinking. Fasting for a few hours before a planned procedure is usual.
• Do not stop any medicine on your own. Blood thinners, diabetes tablets including metformin, and water tablets sometimes have to be adjusted before a procedure, and only your doctor can say which and when.
• Tell the team if you have kidney trouble, diabetes, asthma, or have ever reacted to X-ray dye, to iodine or to any medicine.
• Tell the team if you are pregnant or might be. X-rays are used.
• Bring your medicines in their strips or boxes, and your earlier reports, ECGs and any angiogram CD.
• Bring one attendant who can stay with you, wait for the result and handle the paperwork.

What can go wrong

Bruising around the puncture is common and fades over a week or two. Bleeding or a swelling at the site is less common and can be treated, and it is the main thing to watch for after you go home.

The dye leaves the body through the kidneys and can upset how they work, more so if you already have kidney disease or diabetes. That is why your kidney blood tests are checked before the procedure and why you are usually encouraged to drink afterwards. An allergic reaction to the dye is uncommon, and the team watches for it throughout.

Serious complications, including damage to the artery, a heart attack, a stroke and in rare cases death, are uncommon. They are not impossible, which is why consent is taken in writing first. Ask your cardiologist what the risk is in your own case, because it depends on your heart, your kidneys, your age, and on whether the procedure is planned or an emergency.

After a stent you will be given blood thinning tablets. Do not stop them, and do not let another doctor or dentist stop them, without asking the cardiologist who put the stent in. Stopping them early can block the stent, and that is dangerous.

What it costs

No prices are published on this page. What you pay depends on what is done, on whether a stent is used and how many, on the type of stent, and on the room you stay in.

For a planned procedure you are given a written estimate before it, at financial counselling with the guest relation executive. The same person collects your insurance documents and sends them for pre-authorisation, handles the credit letter if you are covered by a public sector employer, and applies for Aarogyasri where that applies. Treatment packages and their prices are listed on the hospital's portal and mobile app.

Ask the estimate to say what happens to the cost if more than one stent turns out to be needed, since that is where the figure moves most.

How admission, estimates, insurance and the final bill work is set out in full on the IP processes page at /ip-processes/. In an emergency, treatment starts first and the paperwork is done alongside it.

If your relative has just been taken to the cath lab

In most cases the patient is awake, under local anaesthetic, not under general anaesthesia, and is with a team of doctors, nurses and technicians the whole time.

Consent is taken before the procedure, from the patient where possible and from the family where it is not. If a test turns into a treatment in the same sitting, that is a normal course of events and not a sign that something has gone wrong.

Stay where the team can find you and keep one attendant with a phone switched on. The cardiologist comes out to speak to the family after the procedure. If you are not sure where to wait, ask the guest relation executive or the ward nurse before the patient is taken in.

If this is a heart attack, the thing that matters most is time. Opening the blocked artery quickly is what limits the damage to the heart muscle, so the team will act first and explain as they go.

After you go home

Keep the puncture site clean and dry for as long as your team tells you, and do not lift heavy things or drive until they say you can. Your follow-up appointment is booked before you leave. Keep the discharge summary, which records what was found and which stent was used, and show it to any doctor who treats you later.

• Bleeding at the wrist or groin, or a swelling there that is getting bigger: press on it and come in straight away.
• The hand or the leg below the puncture turning cold, pale or numb: come in straight away.
• Chest pain like the pain that brought you in: this is an emergency. Come to the emergency department or call 040 4699 9999.
• Fever, or the puncture site turning red and painful: call the hospital the same day.
• Do not wait for your follow-up appointment for any of these.

Other catheter tests and treatments done in this lab

These are arranged by your cardiologist, and the day follows the same pattern as an angiogram.

• Coronary angiography, and angioplasty with stenting of one or more arteries
• Carotid angiography and stenting, for the arteries in the neck that supply the brain
• Renal angiography and stenting, for the arteries that supply the kidneys
• Peripheral angiography and angioplasty, for the arteries of the legs
• Right heart catheterisation, and pulmonary angiography and screening for pulmonary hypertension
• Intravascular ultrasound (IVUS), which looks at the artery wall from the inside
• Fractional flow reserve (FFR), which measures whether a narrowing is actually restricting blood flow