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Leg angiography (lower extremity angiography): why it is needed, how it is done and how to prepare
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Angiography is an X-ray test of the arteries in which a contrast agent is injected directly into an artery through a needle puncture. It shows in the greatest detail where and how severely the leg arteries are narrowed or blocked, down to the small arteries of the lower leg and foot. Angiography is most often performed once the decision to restore blood flow has already been made, and it is frequently combined with angioplasty through the same puncture.
Angiography, ultrasound or CT angiography: how they differ
Duplex ultrasound (vascular ultrasound) is the first test: no puncture, no radiation and no contrast. It shows whether there is a narrowing and exactly where, as well as the speed of blood flow.
CT angiography is computed tomography with contrast injected into a vein in the arm. It gives a three-dimensional image of the arteries from the aorta to the foot and helps to plan treatment.
In angiography (also called contrast or catheter angiography), contrast is injected through a thin catheter directly into the artery, and a series of X-ray images is taken in an angiography suite. It shows the small arteries of the lower leg and foot most accurately and allows a narrowing that is found to be treated straight away. But it is an invasive test — with an arterial puncture, contrast and radiation — so it is not usually ordered as the first test: angiography is done when a procedure is being planned or is already under way.
When angiography is recommended
- Limb-threatening ischemia — foot pain at rest, a wound that does not heal, gangrene: to plan how blood flow will be restored
- Angioplasty or stenting is planned: angiography is the first stage of the procedure
- Ultrasound and CT angiography results are not detailed enough, especially for the arteries of the lower leg and foot in diabetes
- Symptoms have returned after a previous procedure, and the condition of a stent or bypass graft needs to be assessed
Preparing for angiography
- A vascular surgeon's examination and duplex ultrasound of the arteries; CT angiography when indicated
- Blood tests, including kidney function (creatinine), and an ECG — the doctor gives you the list at the consultation
- Tell the doctor about an allergy to iodinated contrast, chronic kidney disease or pregnancy
- Do not stop any medicines on your own: the doctor will tell you whether and when to pause anticoagulants, metformin or other drugs; antiplatelet medicines are usually continued
- Bring previous test results, a disc with your CT angiography, discharge summaries and a list of the medicines you take
- The day before, you will be told when to stop eating and drinking before the test
How angiography is performed
The test is performed in an angiography suite under local anesthesia; you stay awake. After the skin is numbed, an artery is punctured — usually in the groin (femoral artery), sometimes in the arm — and a thin tube (sheath) is placed, through which a catheter is guided to the area to be examined.
When the contrast agent is injected, you may feel warmth in the leg for a few seconds — this is normal. The doctor takes a series of X-ray images of the leg arteries. Patients with kidney disease or an allergy to iodinated contrast may have CO₂ (carbon dioxide) angiography.
Diagnostic angiography usually takes less than an hour. At the end, the puncture is sealed with a closure device, or pressure is held on it and a pressure dressing is applied.
Angiography and treatment in one session
If the test reveals a narrowing or blockage that can be treated endovascularly, and this has been discussed with you in advance, the doctor can perform balloon angioplasty and, if needed, stenting straight away through the same puncture. This avoids a second arterial puncture and a separate procedure. Balloon or stent sizing can be guided by intravascular ultrasound (IVUS).
If open surgery would be the better option, the treatment plan is drawn up together with the vascular surgery department.
After angiography
If the puncture was made in the groin, you need to lie with the leg straight for several hours after the test — the doctor will tell you exactly how long. Drink enough fluids unless the doctor has limited how much you may drink: this helps your kidneys clear the contrast faster. A small bruise at the puncture site is normal and fades within 1–2 weeks. For a few days avoid heavy lifting, baths and saunas.
The doctor decides when you can go home. If angiography was combined with angioplasty, discharge is usually on day 1–2. The doctor will discuss the results of the test and the further treatment plan with you.
Possible complications
- A bruise or hematoma (collection of blood) at the puncture site — usually minor and settles on its own
- Pseudoaneurysm — a pulsating lump at the puncture site; it is usually treated without surgery, under ultrasound guidance
- Bleeding from the puncture site
- An allergic reaction to contrast or worsening kidney function after contrast — the risk is higher with kidney disease, so it is assessed beforehand
- Damage to the artery wall or blockage of the artery — rare; usually detected and treated during the same procedure
When to get emergency help after the test
Sudden pain, coldness, pallor or numbness in a leg: call an ambulance (103 in Ukraine). If these signs appear or sharply worsen over minutes or hours, especially with weakness of the foot or inability to move the toes, this may be acute limb ischemia — a sudden occlusion (blockage) of an artery. Irreversible tissue damage can develop within hours (roughly six), so do not wait until morning, do not warm the leg with a heating pad or hot water, and do not rub it.
Bleeding from the puncture site or a swelling that grows quickly: press on the puncture site and call an ambulance (103 in Ukraine). Lie down and keep pressing firmly on the puncture site with your palm until the ambulance arrives.
Redness, swelling, pus, increasing pain or a pulsating lump at the puncture site, or a fever need a doctor's examination: seek medical care the same day.
Frequently asked questions
Is leg angiography painful?
Usually not: the test is done under local anesthesia, and the most noticeable moment is the anesthetic injection. When the contrast is injected, you may feel warmth in the leg for a few seconds.
How is angiography different from CT angiography?
In CT angiography, contrast is injected into a vein in the arm and the images are taken on a CT scanner, without puncturing an artery. In angiography, contrast is injected through a catheter directly into the artery: this shows the small arteries of the lower leg and foot better, and a narrowing that is found can be treated straight away. That is why CT angiography is more often used for planning, and angiography during the procedure.
Is angiography possible with kidney disease or a contrast allergy?
Yes, but with extra precautions: kidney function is checked beforehand, and the amount of iodinated contrast is reduced or CO₂ (carbon dioxide) angiography is used. Be sure to tell the doctor if you are allergic to contrast.
How long do I need to lie down after angiography?
If the puncture was made in the groin, several hours with the leg straight; the doctor will tell you exactly how long, as it also depends on how the puncture site was closed.
Can a stent be placed straight away during angiography?
Yes, if the narrowing that is found can be treated through the puncture and this has been discussed with you in advance. Angioplasty and, if needed, stenting are then performed through the same puncture.
Book a consultation
Vascular surgeon consultation at the Shalimov Center, 30 Akademika Shalimova St, Kyiv. Booking and questions go through the contact doctor, Yurii Vahis. Patients from other cities and abroad can arrange an online consultation.