Your physician has referred you to UVa Neuroradiology so that we may examine and/or treat the blood vessels which supply your head, neck or spine. You will be under the care of an UVa Neuroradiologist (a physician trained and experienced in the 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 comment and are ready to assist with you special needs at all times.
How to Prepare:
You will be seen by a Neuroradiologist prior to your procedure, either in our clinic or on the day of the procedure. We will perform a thorough history and physical and review medications and any allergies you might have. Films such as CT scans and MRIs will be reviewed as well. A plan of treatment will be established and the details will be discussed with you. At that time, you will be given instructions for your procedure. We will need to have current labs. We will go over your medications and tell you which to take the morning of your procedure. You may be put on additional medications specific for the type of procedure you are having. If the Neuroradiologist orders the procedure to be done under General Anesthesia, you will be sent to the Pre Anesthesia Evaluation Center for part of the work-up. If your procedure can be done with nursing sedation, you will not need an anesthesia evaluation.
When your appointment is made, you will be given instructions as to where and when to come in for the procedure. You will also be given a phone number to call with questions. We ask that you follow medication instructions carefully. You will not be allowed to eat anything after midnight but you may drink clear liquids up until 2 hours before your procedure. Leave jewelry and other valuables at home. You must have someone to drive you home after your procedure. If your condition is treated during the angiogram, you will stay overnight in an ICU to be monitored, and go home the following day.
Where to go the day of the procedure:
You will need to check in at Radiology Reception one hour prior to your scheduled procedure time. This will give us time to get you ready. One of the staff will pick you up after you have registered.
Prior to your procedure:
The nurse will do an assessment and start an IV. If your procedure is being done with anesthesia, someone from the anesthesia team will see you. The neuroradiologist will explain your procedure, answer any questions and have you sign a consent form. A pre-procedure assessment will be performed. 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 usual in the upper thigh-groin area will be shaved and 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 area 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 in to the vessels to be examined. When the neuroradilogist has placed the catheter in the correct position, contras 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. The cameras will be close to you but not touching you. It is important to remain still, without breathing or swallowing, while the dye in injected and the pictures are taken. The neuroradiologist will instruct you when to hold your breath. A nurse or anesthesiologist will be with you at all times.
After your procedure:
In general, diagnostic procedures take 1 to 2 hours; interventional procedures typically require more time. When your procedure is completed, the catheter is removed from your groin area. There are 2 ways to seal the artery after the catheter is removed. One way is for the physician to hold firm pressure for 15 to 20 minutes until the bleeding has stopped. You will then be required to lie flat for 6 hours with your leg straight. The second option for sealing the artery is called angioseal.. This is a commonly used device which is inserted into the femoral artery to close the hole. The practitioner will explain this device to you when they are getting your consent for the procedure. If you consent for an angioseal, and they are able to use it, you will need to lie flat with your leg straight for 2 hours. Once the artery is sealed, you will be taken to an area for recovery. If no treatment was done, you will be discharged by us when it is safe for you to leave, usually between 2 and 6 hours. Depending on your location, 2 family members may be able to stay with you until discharge. If treatment of your blood vessels is necessary, you will be admitted to an intensive care unit for overnight observation. Visiting hours vary depending on the unit. The neuroradiologist will communicate the results of you examination to you, your family and the referring physician.
After you leave:
You will be given detailed discharge instructions prior to your discharge. Generally, you need to increase your fluid intake immediately after the procedure to help eliminate the contrast dye. You will not be allowed to drive yourself home. Do not exert yourself for several days after the procedure. If you experience any bleeding from your groin site or any color changes, pain or coolness in that leg you will need to be seen immediately. Again, you will get a copy of more specific instructions along with phone numbers to contact us with any questions or 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. Every effort is made to use the minimum amount of radiation. The small amount of radiation used will not be harmful to you. The staff wear leaded aprons because they work with radiation everyday and their occupational exposure is high. We will do everything to keep you safe and comfortable.
Billing and Insurance
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. Please note that you will be billed for any balance not covered by your plan. 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 UVA (to cover facilities, equipment, and support personnel) and the Health Science Foundation (to cover the services of the physician neuroradiologists). So expect to see two bills for your study.