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Angiography
Your physician has referred you to Johns
Hopkins Neuroangiography so that we may examine or treat the blood
vessels which supply your head, neck or spine. You will be under the
care of a Johns Hopkins neuroradiologist (a physician trained and
experienced in this specialty) and a dedicated team of health care
professionals. We are leaders in the prevention, diagnosis, and treatment
of neurovascular problems, and utilize state of the art equipment
in performing these procedures. Our goal is to make you as comfortable
as possible. We welcome your questions, concerns, and comments, and
are ready to assist with your special needs at all times
How to Prepare: A Checklist
If you are an outpatient, one of our staff will call you several days
before your procedure to review your preparations and answer any questions.
You may also call (410) 955-8525 at any time. If you are an inpatient,
one of our staff will visit you the night before your procedure.
Please notify us several days prior to your procedure if:
You have allergies to x-ray contrast (“dye”) or iodine.
You have a history of asthma or kidney disease
You take insulin, oral hypoglycemics (for diabetes) such as glucophage,
or blood thinners such as Coumadin, Persantine or Aspirin.
You are, or suspect you are, pregnant.
Take your medications as usual, unless told not to do so by your physician.
Take liquids as desired up to the time of your procedure. Take no
solid food within eight hours of your procedure. If you are to receive
general anesthesia for your procedure you must have no food or drink
after midnight the night before your procedure. If you are an outpatient
and you are to receive general anesthesia, you will be scheduled to
come to Johns Hopkins within a 2-week period prior to your procedure
for a “pre-anesthesia’ physical. If you are an inpatient, the anesthesiologist
will visit you the evening before your procedure.
Do not bring jewelry or other valuables with you.
If you are an outpatient, arrange for someone to drive you home after
the procedure.
What to bring:
1. Bring any existing CT, MRI, myelogram, and angiogram films and
reports. If you have had a prior arteriogram bring those films or
arrange to have them sent to us in advance of your test.
2. Bring information about existing conditions and medications.
3. Bring appropriate medical insurance materials.
What to Expect:
Prior to Your Procedure
When you arrive, you will be greeted by a member of our staff and
registered for your procedure. A physician will explain your procedure,
answer any questions, and have you sign a consent form. An intravenous
line will be started in your arm to give you fluids and medications
to relax you if you require them. You will be taken to the procedure
room, where you will lie on your back during your angiogram. Cushions
and pillows will be used to make you comfortable. The skin where the
catheter will be inserted, which is usually in the upper thigh-groin
region, will be cleansed, and you will be covered from the shoulders
down with a sterile drape.
During your Procedure
The neuroradiologist will give you local anesthetic in your groin
which may cause slight discomfort for a few seconds before going numb.
A catheter will be inserted through a small incision in the skin.
You will feel minimal pressure in the area. The catheter will be guided
into the vessels to be examined.
When the neuroradiologist has placed the catheter in the correct position,
contrast dye will be injected which may cause a warm, but not painful,
feeling for a few seconds. During this time, you will also hear an
x-ray machine taking pictures. It is important to remain still, without
breathing or swallowing, while the dye is injected and the pictures
are taken. A nurse will be with you at all times. Please tell us if
you become uncomfortable.
After your Procedure
In general, diagnostic procedures require about two hours; therapeutic
procedures typically require more. When your procedure is completed,
pressure will be applied to the incision site for 10-20 minutes, after
which a small bandage will be placed over the incision. No stitches
are required. You will then need to lie on your back with your leg
straight and still for four to six hours. A meal will be provided
during this time.
If you are an outpatient, you will be observed in the Neuroangiography
area. You may bring reading material or other items to pass the time.
Friends or family members may visit as desired. You will be discharged
by us when it is safe for you to leave, usually between 6 and 8 hours
after your study. Written instructions for home care will be provided.
If necessary, you may be admitted to the hospital after your procedure.
If you are an inpatient, you will be returned to your room for observation
by your floor nurse.
The neuroradiologist will communicate the results of your examination
to your physician, who will discuss the results with you at an appropriate
time. The referring physicians often prefer that we refrain from discussing
the findings with the patients, particularly before they have been
notified.
After you Leave
You may resume your usual diet after the procedure. Fluid intake of
48-64 ounces during the next 24 hours is recommended as this aids
in x-ray dye elimination.
Do not exert yourself for 24 hours following the procedure, after
which normal activity may be resumed. If you are an outpatient, a
family member or friend should drive you home and stay with you during
the 24-hour period.
It is not unusual to have minor bruising around the incision, but
if you experience bleeding or swelling there, or develop a cold or
painful leg, contact us immediately.
We try to call our patients (outpatients) or visit them (inpatients)
the day after the procedure. Please contact us at any time if you
have concerns.
Neuroangiography is Safe
Neuroangiography procedures are very safe. However, very rarely one
may experience an allergic reaction to the dye, damage or blockage
to a blood vessel, or bleeding. We will review these risks in detail
before your procedure. Because we must tell you every possible thing
that could go wrong during your angiogram, the list of risks is long.
Nonetheless, your doctor has felt that the benefit of the information
we obtain from this procedure outweighs the risks.
X-Rays
We are trained in the use of x-rays and every effort is taken to use
the minimum of radiation. The small amount of x-rays used during routine
neuroangiography will not be harmful to you. If you notice that the
staff wear leaded aprons, it is because they work with x-rays everyday
and their occupational exposure is high.
Additional Information
For additional
information on the web, we recommend you click on the link below to
visit the ACR and RSNA patient information site:
Billing
If you are a self-pay patient, a bill will be issued at time of service
and mailed to your home.
If you are covered by a commercial health insurance carrier, please
bring your cards or proof of coverage should be brought with you the
day of your study. We will file your claim for you. If you are covered
by Blue Shield of Maryland Major Medical or Medicare Part B, we will
also file your claim for you. Please note that you will be billed
for any balance not covered by your plan. If you are covered by Maryland
Medical Assistance, we will verify your eligibility and bill them
directly. If you belong to a Health Maintenance Organization (HMO)
or Preferred Provider Organization (PPO) with which we have a contract,
you must bring the referral and authorization form for the procedure
to be covered.
If your visit is due to an accident (work-related, automobile, etc.),
you must provide us with an authorization from the guarantor of your
bill.
Note that separate bills are issued by the Johns Hopkins Hospital
(to cover facilities, equipment, and support personnel) and the Johns
Hopkins University School of Medicine (to cover the services of the
physician neuroradiologists). So expect to see two bills for your
study.
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