Complications of Angiography and Angiogram Procedure

Complications of Angiography/Angiogram Procedure

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Complications of Angiography/Angiogram Procedure

Overview of Angiography

Coronary Angiography is an invaluable test, used for the detection of coronary artery disease, identification of any existing structural or valvular abnormalities and for measuring hemodynamic parameters (Tavakol et al., 2012). Simply put, Angiography is an X-ray used to check blood vessels, with the help of a special dye injected in the human blood. The dye highlights the blood vessels, allowing the doctors to see any existing coronary problems. These X-Ray images that are created during Angiography, are called Angiograms (NHS, 2020). 

The Angiograms can detect or diagnose conditions related to blood vessels, like atherosclerosis, aneurysms, peripheral artery disease, angina, pulmonary embolism, to name a few (NHS, 2020).  

Complications of Angiogram Procedure

Since Angiography is an invasive procedure, the complications of Angiogram procedure are patient-dependent and procedure-related (Tavakol et al., 2012). The complications may range from minor problems that can have short term sequelae to life threatening conditions that could cause an irreversible damage, if left untreated without giving any urgent care (Tavakol et al., 2012). Below are listed the main complications of Angiogram procedure:

Allergic and Adverse Reactions

Some of the allergic and adverse reactions may arise due to local and general anesthesia. For instance, vasodepressor anesthesia, asthma-like reactions and anesthesia toxicity can occur because of local anesthesia. On the other hand, general anesthesia can lead to anaphylactoid reactions that may happen with conscious sedation agents and more likely occur after contrast media. Such complications can be treated with potential use of oxygen, bronchodilators and histamine blockers, depending upon the severity of the anaphylaxis. In more severe cases, endotracheal intubation and urgent consultation is made with the anesthesia team (Tavakol et al., 2012).

Infections

Although rare, infections can occur after invasive-cardiovascular procedures. The likelihood of catheter-related infections is less than 1% (Munoz et al., 2001). Additionally, it can be seen that the infection is unlikely to occur immediately after the procedure. For instance, in a study of 147 consecutive blood cultures after the complex catheterization procedures, 18% subjects indicated positive blood cultures immediately after procedure and 12% indicated positive blood cultures after 12 hours of procedure, and none of the patients developed clinical signs of infection (Tavakol et al., 2012). 

Other Complications of Angiography

Contrast-Induced Nephropathy (CIN) is one of the serious complications of Angiogram procedure, that can have short- and long-term sequelae. CIN is a condition in which the serum creatinine levels rise ≥ 0.5 mg/dl or 25% above the baseline value, that can have potential long-term outcomes such as renal impairment requiring hemodialysis, and even death (Tavakol et al., 2012). 

The pathogenesis of CIN is quite multifactorial. The Contrast media has an effect on a wide range of vasoactive substances like adenosine, nitrous oxide, along with direct cytotoxicity through the free radicals (Barrett & Carlisle, 1993; R. Solomon, 2005) that have been implicated as the potential causes of Nephropathy (Tavakol et al., 2012). 

There are some other complications of Angiography, including but not limited to Cholesterol Emboli, Local Vascular Injury leading to problems like Thrombosis and Embolism, and Conduction disturbances like bradyarrhythmia, tachyarrhythmia, Myocardial Infarction, Cerebrovascular complications, to name a few. 

Conclusion

Concludingly, Angiography is a diagnostic procedure, that is used to detect coronary artery diseases and for the detection of likelihood of any structural and vascular abnormalities. It can detect various cardiac abnormalities and is thus, an invaluable procedure. However, there occur few complications ranging from Infections, Nephropathy, Anaphylaxis, and other complications like Local vascular injury, Conduction disturbances, to name a few. Although, the risk factors are patient-dependent and procedure-related, for each individual, the potential benefits should be weighed against the risk factors, including the morbidity and mortality, basis which the procedure of Angiography should be performed.

References

Barrett B. J, Carlisle E. J. (1993) Metaanalysis of the relative nephrotoxicity of high- and 

low-osmolality iodinated contrast media. Radiology. 188(1):171–178. [PubMed] [Google Scholar]

Munoz P, Blanco J. R, Rodriguez-Creixems M, et al. (2001) Bloodstream infections after 

invasive nonsurgical cardiologic procedures. Arch Intern Med. 161(17):2110–2115. [PubMed] [Google Scholar]

NHS (2020) Angiography Overview. National Health Service. Available at 

https://www.nhs.uk/conditions/angiography/ Accessed: 10 June, 2021

Tavakol, M., Ashraf, S. and Brener, S.J. (2012) Risks and Complications of Coronary --

Angiography: A Comprehensive Review. Glob J Health Sci. doi: 10.5539/gjhs.v4n1p65 Available at

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777042/ Accessed: 10 June, 2021