Abdominal Aortogram Procedure Guide

 

What is an abdominal aortogram with bilateral leg run off?

This procedure finds areas in your blood vessels where they are narrowing or closing due to plaque. This is called PERIPHERAL ARTERY DISEASE or PAD. 
An aortogram may also be used to evaluate an abdominal aneurysm.

Why is it necessary?

  • Patients who have pain in their legs when they walk often have a blocked or narrowed blood vessel.
    Fatty deposits can build up in your blood vessels, reducing blood flow, and in some cases, blocking it completely.
  • Patients who have an abdominal aneurysm may need this evaluation prior to a surgery.

How is it done?

  • The doctor will thread a narrow, flexible plastic tube, called a catheter, through the arteries suspected of having the narrowing or blockage.
  • The tube will be hooked to a pump that injects X-ray dye which flows down the arteries of your legs and the doctor can visualize any blockages, if present.
  • Once the X-ray pictures show where the blockages are, your doctor will be able to tell the best way to open the blocked blood vessels, such as with a small balloon on a catheter. This is inflated and compresses the plaque to open the artery
  • You may need a stent in the artery in your leg to keep it open.  Either treatment should stop the pain and reduce the risk of blood clots.
  • We typically can only treat one leg during this procedure due to the amount of contrast dye and radiation exposure. The first leg we treat is usually the leg that hurts the most or has ulcers/open wounds that are not healing well.
  • If your other leg has blockages we will allow for 2 a week interval and schedule you for your other procedure

What should you expect?  Before the procedure:

  • You must not to eat or drink anything after midnight the night before the study except for your normal medications. Your doctor or nurse will tell you if you should stop taking any of your medications prior to the procedure. 

IF YOU ARE ON METFORMIN – DO NOT TAKE THIS DRUG FOR 24 HOURS BEFORE YOUR PROCEDURE AND CONTINUE TO HOLD THIS MEDICATION FOR 48 HOURS AFTER YOUR PROCEDURE AS IT CAN REACT WITH THE DYE AND HARM YOUR KIDNEYS

NOTIFY OUR OFFICE IF YOU ARE ON BLOOD THINNERS SUCH AS:

  • COUMADIN (WARFARIN)
  • ELIQUIS (APIXABAN)
  • XARELTO (RIVAROXABAN)
  • PRADAXA (DABIGATRAN)
  • OR IF YOU ARE ON ANTIPLATELET MEDICATIONS SUCH AS:
  • PLAVIX (CLOPIDOGREL)
  • PLETAL (CILOSTAZOL)
  • BRILLINTA (TICAGRELOR)

You MUST have someone drive you to the hospital and drive you home after the procedure is completed.

  • You need to bring a list of all your medications with you to the hospital.
  • Please tell the doctor if you think you may be pregnant. 
  • A nurse will place an IV in your hand or arm so that you can receive fluids and medications. 
  • Your doctor will answer any additional questions and ask you to sign a consent form.

During the procedure:

  • You will lie on an x-ray table with machines all around you. You will have a blood pressure cuff on your arm, a clip on your finger to make sure you are getting enough oxygen and wires on your legs and arms to check your heart rate.
  • The nurse will give you pain medication and a sedative, which will help you relax, before the procedure. The nurse will give you more medication if needed. You will feel relaxed, but you will be awake so that you can follow instructions.
  • The area where the doctor will be working (the groin) will be cleaned and shaved. You will be covered with sterile drapes from your shoulders to your feet.
  • The doctor will numb the area in the groin or the arm and insert a tiny, flexible tube called a catheter.
  • He or she will guide the tube in to a large artery in your stomach and inject X-ray dye.  The dye may cause a burning feeling in your legs, but it will pass in 20 to 30 seconds.  It is important to hold still during this time. You will not feel the tube move inside your artery.
  • The technologist will tell you to hold your breath and stay still during the pictures (about 10 seconds for each picture).

After the procedure:

    • The doctor or a nurse will remove the catheter and hold the site for 15 to 20 minutes to prevent bleeding. If the catheter was in your groin, you will need to lie flat without raising your leg for about four hours.
    • The head of the bed may be tilted a little to help you rest. You will be able to bend the other leg to relieve pressure on your back, or the nurse may roll you on your side. If you develop back pain, the doctor can give you medication to help you feel better. Your nurse will help you with any personal needs.
    • Call the nurse right away if you feel any chest discomfort, back pain, or wetness in the area where the catheter was.
    • Your nurse will check your blood pressure, heart rate, heart rhythm, and pulse in the area near the catheter insertion.
    • You will receive IV fluids to flush the dye from your system.
    • You may eat one hour after the procedure if you have had no problem drinking fluids. 
    • If you need to cough or sneeze, apply pressure to the catheter site first to protect it.
    • If you are an outpatient, you may leave after a 5 hour recovery period. REMEMBER! You will need someone to drive you home.

The hospital cannot release you to Uber drivers or a cab service after receiving sedation so please have someone here to drive you home.

What You Can Expect:

    • It is very common for the groin site to be sore for a few days following this procedure.  At home, it is generally recommended that you take acetaminophen (Tylenol) or aspirin for the minor pain you might experience.  Pain occurring more than a few days following the procedure is uncommon and if associated with redness in the area, fever, or other symptoms may indicate an infection and is reason for you to contact your doctor.
    • It is very common to develop a black and blue area (bruise) around the groin site following abdominal aortogram catheterization. This is not from bleeding following the procedure, but rather from blood that seeped into the area during the procedure and which migrates to the skin and causes the discoloration afterwards.
    • In some cases the bruised area may extend quite a ways down the leg, sometimes reaching the knee or even lower. It may continue to enlarge for several days or even a week or two following the procedure, but thereafter will start to gradually fade and disappear over a few weeks.  
  • If the area is painful and you are concerned, call our office and we will make an appointment for you to be seen by the surgeon or the Nurse Practitioner (whichever one is available to ensure you are seen quickly)  
  • It is very common to feel a small lump or knot at the groin puncture site. This is normal and related to the collagen plug/closure device at the puncture site and may also be due to minor inflammation and repair resulting from trauma to the area. This generally decreases in size over the weeks following the procedure. You should avoid touching the skin puncture area during the first few days following the procedure.

What Can Go Wrong?

Bleeding: The complication we work the hardest to avoid is bleeding from the arterial puncture site. This occurs only rarely and generally in the first hour or two following the procedure (while you’re still being observed in the hospital).  When it does occur, it usually does not involve visible bleeding, but rather bleeding under the surface of the skin and which leads to a painful and rapidly growing “mound” in the groin area.

  • REMEMBER! There will be a small knot in your groin about the size of an acorn or walnut – this is normal and due to our collagen plug.

If the knot grows to the size of an egg or larger it may indicate blood is leaking around the plug or puncture site. Although rare, such bleeding is considered an emergency and should be treated by:

  • Putting firm steady pressure on the area with your fingers or the palm of your hand (or preferably by a spouse or family member ) and notify our office OR
  • Seek emergency medical attention by calling 9-1-1 if you feel it is growing rapidly!
  • Infection: This is exceedingly rare but happens once in a while, so you should be aware of this and monitor for it. Infection at the groin puncture site is manifested in the same way an infection of the skin and related tissues does anywhere:     Redness       Increasing pain       Production of pus Fever
  • If you have reason to suspect an infection following aortogram, you should call your doctor’s office and ask to be seen immediately, or, alternatively, stop by your local Emergency Room.
  • The treatment is antibiotics and recovery is usually quite rapid.

Kidney damage: in rare cases, the iodine-containing x-ray dye can cause damage to the kidneys. The outward sign of this is reduction in urine output during the day or two following the procedure. While in most cases this problem will resolve over a few days, in rare cases it does not and such cases can lead to a dangerous fluid build-up in the body.  For this reason it is important to keep an eye on your urine output. If you notice that the quantity of urine you produce drops inappropriately or stops, you should bring this to your doctor’s attention immediately

Vascular Complications: there are several complications which can occur following catheterization and which are related to manipulation of the artery at the groin where the catheter is inserted.
You should be on guard for these general types of signs or symptoms:

      • loss of usual color of the toes or foot
      • pain in the toes or feet
      • a pulsatile swelling at the catheter insertion site at the groin
  • If you notice either of these signs, you should contact your physician immediately

Steps to Minimize Problems Following Abdominal Aortogram

    • Limit your activity on the day of your procedure. Upon arrival home, you should find a comfortable chair or couch and literally plant yourself. You should be on your feet for only three things:
      • To use the bathroom
      • Walking to the dinner table
      • Going to bed
  • During the first two days following the procedure you should avoid activities that will pull or stress the groin area.  In particular you should avoid lifting objects more than 20 pounds, other activities that cause you to strain your belly, and excessive crouching (deep knee bends).
  • Patients are generally advised not to drive during the two days following the procedure, although being a passenger in a car is OK.
  • Keep the groin site clean and dry.   It is generally fine to bathe or shower.
  • Drink plenty of fluid during the first two days following your procedure to help your kidneys flush out the contrast dye.
  • You will be seen in our clinic 2 weeks after your procedure and we can answer any questions at that time.