Hey everyone! I’m happy to report I’m coming up on my year mark and haven’t had really many complications. I have my year angiogram follow-up and seem more anxious and nervous for this procedure than when they put the web in. Any suggestions/experiences?
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Good morning! An angiogram is the same procedure but without the device your surgeon used to install the device! Important to be hydrated so the needles and catheter can go in easily. They will provide you with some rules you need to follow like when you have to stop eating and drinking anything. It makes life easier for them and more importantly you. You’ll arrive at the hospital, get checked in. The pre-Op RN comes and takes you to Pre-Op where you get to change into one of their less than fashionable gowns. Gown can only be tied at the neck. Once changed or perhaps before changing the RN asks if you’ve eaten or drank anything in the last x amount of hours, meds taken and the like.
The RN Anesthetist comes in and starts prepping you for the IV, either they or the actual Anesthesiologist is supposed to go over the what can happen whilst under anesthesia. If your at a teaching hospital it could be one of the Anesthesiology Residents. You will have to sign off that you understand all the risks which sometimes they don’t tell you every one. They are supposed to though so make sure to ask if you’re not sure or want everything covered. And yes I do have a funny story about one, thanks for asking😂. Dr. Q-W and Dr. Shaw made sure I knew all the risks, every one of them. Not only from their end but the anesthesia end as well. It was like taking a class and having to take a verbal test. On one angiogram the Resident came in after Dr. Shaw (lovely, smart young neurosurgeon) Resident starts going over the list, I thought it hilarious to interrupt him repeatedly. Poor guy had memorized the list and kept having to start over again. Sometimes I’d say he forgot such and such, or I’d ask him exactly what happens or how would he know when he’d mention a risk. He had memorized them alphabetically. Dr. Shaw who knew me quite well finally asked me to give the Fellow a break after the 4th or 5th time. I said I’d rather have a B student who knew them than one who was good at taking tests, what if he had to go through the whole list until he got to a risk I decided to try?
The Anesthesiologist will come by and introduce themselves usually. In my experience, they walk the floors and the RNA is the one who does the work. I’ve known maybe a handful of members actually get the anesthesiologist in the room during a procedure. I imagine it’s either because of the type of procedure or something else, truthfully I’m not sure.
You’ll get wheeled into the procedure room, transferred from the gurney to the table. The surgical team will be very busy until the surgeon comes in. I used to have a team that was great and we’d joke around, play music I liked, etc.
Surgeon comes in says hey and will commence inserting the catheter either in the groin (femoral) or wrist (radial). He/She will follow your external carotid artery once they get there to the internal and wherever they need to go. Usually mine looks at both sides to make sure I’ve not got another aneurysm. The last time she couldn’t do a full look because I opted to try out one of the risks. He or she will have you breathe and ask you to hold your breath and tell you to breathe again I presume so the pictures can be taken better, not sure on that either. It could be because they’re navigating to a different artery. Hopefully someone knows better than I do and can enlighten us. Sometimes I fall asleep but since I talk in my sleep, I can also follow directions in my sleep so not a problem for Dr. Q-W, so she has said.
When you get home remember to hydrate, eat protein, rest as needed. Hydration and protein are to help your brain, hydration also helps your body get rid of the contrast dye faster. You will have weight limits and other rules to follow on your discharge papers. So make sure you understand them and follow them! Good luck with your procedure, I will keep you in my thoughts. Don’t forget to let us know how it went when you’re able.
When they’re done, they wheel you to post op until you’re awake and lucid. Once awake, they’ll transfer you to a regular hospital room and you get another RN and maybe a CMA or CNA who assist the assigned RN. If the doc went through your femoral artery you would be given a weight on the entry site when they were done and you’ll have to lay flat for a rather long time. The RN will check that site pretty regularly. If it’s through the radial artery, you’ll get a rather neat contraption that keeps pressure on the site and slowly releases the air. You get to be inclined and can sit up quicker than the femoral site. The RN will remove the IV once everything is good and of course according to the doctor’s orders. I’ve always had to urinate and eat before they release me and get to head home!
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thank you very much for the very descriptive response! I think I am anxious over not being completely knocked out for the procedure and in more of a twilight.. it definitely has me more freaked out, I’m guessing they will go through my femoral because they say I have bad “arteries/veins” and had no luck with radial last time.
Thanks again!!
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If it is any help @tahara05 I never remember any of my angiograms! I have funny dreams instead especially when they start to wake me up. The meds they run in the IV will probably prevent you from being afraid even if you are “awake”. Remember the last thing your care team wants is for you to panic during the procedure. I hope the results are excellent - we’ll be thinking of you!
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Thank you so much for this! It’s weird that I’ve had this much anxiety over this part but the actual procedure last year I felt pretty calm. Thanks again and happy holidays!
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I think your guess is spot on if they’ve already determined they can’t use your radial arteries. Mine are all tortuous, there’s not a straight one to be found. The last angiogram I had, Dr.Q-W allowed one of her Residents to do it. I was my usual over talkative self and one guy told me to be quiet, I informed him she needed to be able to multi task so no, in fact, I want going to be quiet, thank you kindly. It was a new team who didn’t know me. The old team would have engaged with me to draw conversation away from the Resident. She stopped and said she was going to wait for Dr. Q-W because of a bend she got to. I tried to encourage her to go ahead, gave her permission to try, saying she had to learn sometime, might as well be now. I also told her I was squiggly which meant the same as tortuous. Squiggly is what Dr. Q-W used when she explained my arteries to us. I was very proud of myself for sharing that information, I was on drugs. But she stopped and waited for Dr. Q-W who doesn’t mind the squiggles, she’s done many procedures on AVM patients!
When you feel yourself getting freaked, do some relaxation breathing immediately. In fact, I like to tell folks to do it all the time so that it just becomes the way you breathe. That way when you need it, you don’t have to remind yourself much if at all.
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I had an unruptured aneurysm and had a WEB device put in last year. Since i had two cervical fusions in the two years previously and it was done under fluoroscopy, which is constant x-rays, i did not want more radiation with the follow up angiogram so my doctor said i could get an MRA instead. No radiation and faster than a MRI. Took about 15 minutes. See if you can have an MRA instead. 
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Hi @tahara05!
My apologies, I have wanted to get back to you, but yes, was caught up in the holiday madness. You are one of my top priorities for Boxing Day though!
Of course, everyone has given great details on the procedure itself, so I have nothing to add to that.
What I did want to add from my own experience is that - anecdotally - my experience in the procedure very much seems to depend on the anesthesiologist I get. [I know, it is crazy, but I almost started to know my “usual” guy with all the angiograms, surgeries, etc. I was having!] I say that because for some angiograms, it wasn’t twilight at all, and like @Shinykai I have no memory of them whatsoever.
However, other angiograms - most particularly my last one - I honestly don’t think I fell asleep at all, and I remember the whole thing. I suspect that may be due that to the different types of anesthesia that can be used, and how the “cocktail of the day” impacted my experience.
I know, I am a broken record at this point, but this last time I spent the whole time Box Breathing. 
For me, it is super helpful as it gave my brain something to focus on so I could tune out all that was going on around me, and literally I can just think about breathing. What was WONDERFUL about being under twilight and being awake is a very distinct memory I have is hearing in a loud, booming voice my neuroradiologist say “GREAT!” and I knew that meant my aneurysm was occluded, and it was a thing of the past! No waiting to read notes or a follow-up appointment or get out of the procedure to have a nurse tell me, I knew right then and there, and it is one of my very favorite memories of all time, so there are definitely pros to being under twilight! 
I have had both radial and femoral entries. I asked him one time why it was femoral on one occasion, when it was a planned radial, and he said it was too twisty - fair enough, why make it harder on him then need be? I haven’t asked, but I also wonder if it matters if - e.g. - they are trying to install a piece of equipment (e.g. stent) v. just using a camera so less stuff needs to get through the arteries/veins if that can impact. Sorry that may not be clear, so to analogize if you are moving and need to get a large sofa around a corner, you may have to move the couch out through the window. If, however, you only need to move some boxes, you can go around the corner. So, I still come out of the procedure not knowing whether he will have decided femoral v. radial, so I am going to still hope you have a radial this time around.
Sending good thoughts to you! Please let us know how you are doing, and what we can do to support you!!!
Fin Whale Fan 
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