Name of the Procedure:

Angiography, Pulmonary, Bilateral, Selective, Radiological Supervision and Interpretation
Common name(s): Pulmonary Angiography

Summary

Pulmonary angiography is a diagnostic imaging procedure used to observe the blood vessels in the lungs. It involves injecting a contrast dye into the pulmonary arteries and using X-rays to capture detailed images of these blood vessels.

Purpose

Pulmonary angiography is primarily used to diagnose and evaluate conditions affecting the pulmonary arteries, such as pulmonary embolism (blood clots in the lungs), arteriovenous malformations, and other structural abnormalities. The goal is to provide clear images that help in diagnosing, planning further treatment, or conducting interventions.

Indications

• Suspected pulmonary embolism
• Unexplained shortness of breath
• Abnormal results from other imaging tests, such as CT scans or V/Q scans
• Persistent chest pain not explained by other tests
• Evaluation of pulmonary hypertension

Preparation

• Fasting for 6-8 hours prior to the procedure
• Discontinuation of certain medications as advised by the doctor
• Pre-procedure blood tests and possibly imaging studies like a chest X-ray or CT scan
• Signing consent forms after risks and benefits are explained
• Placement of an intravenous (IV) line for dye injection

Procedure Description

1. The patient is positioned on an X-ray table.
2. A local anesthetic is administered to numb the insertion site, usually in the groin or arm.
3. A catheter is inserted into a large vein and carefully threaded into the pulmonary arteries.
4. Contrast dye is injected through the catheter to highlight the pulmonary arteries.
5. X-ray images are taken in rapid succession to capture detailed views of the blood flow in the lungs.
6. The catheter is then removed, and pressure is applied to the insertion site to prevent bleeding.

Tools and Equipment: X-ray machine, catheter, contrast dye, IV line

Anesthesia/Sedation: Local anesthesia with possible mild sedatives

Duration

The procedure typically takes 1 to 2 hours.

Setting

Pulmonary angiography is performed in a hospital's radiology or catheterization lab.

Personnel

• Interventional radiologist or cardiologist
• Radiologic technologist
• Nurses
• Anesthesiologist (if sedation is required)

Risks and Complications

• Allergic reaction to contrast dye
• Bleeding or bruising at the catheter insertion site
• Infection
• Kidney damage from the contrast dye
• Rarely, perforation or injury to the blood vessels

Benefits

• Accurate diagnosis of conditions affecting the pulmonary arteries
• Guided treatment planning for identified issues
• Can lead to immediate therapeutic interventions if needed

Recovery

• Monitoring in recovery area for a few hours post-procedure
• Instructions to avoid strenuous activity for 24 hours
• Adequate hydration to help flush out the contrast dye
• Follow-up appointments to discuss results and further care

Alternatives

• Computed Tomography Pulmonary Angiography (CTPA)
• Ventilation/Perfusion (V/Q) scan
• Magnetic Resonance Angiography (MRA)
• Each alternative has its own benefits and limitations compared to selective pulmonary angiography.

Patient Experience

During the procedure, the patient might feel a warm sensation when the dye is injected. Post-procedure, mild discomfort at the catheter insertion site is common. Pain management includes over-the-counter pain relievers and relaxation techniques. Most patients can return to normal activities within a day, following the doctor's instructions.