Full discussion of the risks, benefits, and alternatives to angiography and possible intervention should be conducted to include risks of sedation, arterial access, intravascular trauma, contrast material administration, and closure device use. Risks after leaving the hospital of bleeding, hematoma, or acute arterial occlusion also should be covered. Patients also should be informed of restrictions after the procedure, including physical activity, and treatment of the access site.
Preprocedural laboratory tests are usually limited to assessing renal function and presence of coagulopathy. Abnormal renal function may warrant preoperative hydration and an attempt to minimize contrast material administration. Coagulopathy may necessitate delaying the procedure for investigation or reversal of the coagulation abnormality. An assessment of medications taken by the patient should be completed in order to hold medications at the recommended time to help prevent adverse interactions with iodinated contrast material.
Endovascular procedures can be performed with monitored sedation (angiography, peripheral interventions) or general anesthetic (aortic endografts, hybrid procedures). If monitored sedation is preferred, this can be accomplished with an anesthesiologist or a nurse trained in moderate conscious sedation techniques. Local anesthetics, divided into amides and esters, will be required in addition to sedatives, typically an anxiolytic, and a pain medication. A circulating nurse is also required to record the procedure, document equipment, and provide needed products to the operative field. A surgical scrub technologist or a radiologic technologist (rad tech) is also needed to scrub into the procedure to assist the surgeon. If a rad tech is not at the table, one must be present in the room to help operate the fluoroscopic equipment (FIGURE 1).
Fluoroscopic imaging equipment may include a portable C-arm unit or a fixed or mobile fluoroscopic unit within an angiosuite. A C-arm has advantages of being portable so that it can be used at various sites and for a wider range of nonvascular procedures. Its lower cost and lack of need for specialized construction are also advantageous. A C-arm, however, displays lower-quality images, has a smaller field of view, produces higher radiation exposure, and tends to overheat during prolonged imaging. An angiosuite imaging unit (FIGURE 2), whether floor or ceiling mounted, offers better imaging quality as well as the opportunity to employ advanced techniques, such as rotational angiography and three-dimensional reconstruction with image overlay. Angiosuites tend to integrate all the room components including dimming the lights while in use, linking the power injector to the acquisition of images, and connecting to the hospital’s image storage system (PACS). Angiosuites typically have a steeper learning curve when it comes to mastering the more intricate imaging processes.
The imaging table (FIGURE 3) is crucial to producing adequate images and performing endovascular procedures. The table may be fixed or movable but must be radiolucent. Because of construction, the table ...