Digital Subtraction Angiography (DSA) is a procedure using X-rays and digital technology to produce clear, detailed images of the human vascular system. In this exam, radiopaque structures, such as bone, can be removed from the image so that the depiction of blood vessels will be more accurate.
There are many diseases that can be diagnosed using Digital Subtraction Angiography . Before carrying out this examination, the medical team will ask for information about your medical history so that the examination can go well. Come on, have a look at the examination process using the following Digital Subtraction A ngiography !
Digital Subtraction Angiography Process
In this procedure, images are produced using X-rays by digitally removing or reducing radiopaque structures, resulting in a detailed and accurate picture of blood vessels .
This procedure allows early detection and evaluation of a wide range of conditions including stroke, tumors, assessment of blood flow , narrowed or blocked arteries, aneurysms, arteriovenous malformations and other vascular disorders.
Then, what is the procedure to be carried out when performing Digital Subtraction Angiography ? Here's the process:
Health History Evaluation
The first stage as an examination procedure is to evaluate the patient's medical history as a whole. There are several health conditions that need attention, such as:
- Diabetes
- Atherosclerosis
- Kidney function
- History of taking certain drugs
- History of allergies, especially with contrast fluid
- Surgical history
- Results of previous blood vessel examination (angiogram), if any
DSA goals
There are two objectives of DSA, namely:
- Diagnostic, namely to detect blood vessel abnormalities, tumor vascularization, etc. Patients only need to make preparations in the form of four hours of fasting and blood tests, including checking Hb and leukocytes, kidney and liver function. Patients with diabetes mellitus should stop taking the drug the day before the DSA procedure.
- Therapeutic, namely for the treatment of abnormalities in the blood vessels, by inserting drugs, devices, or implants into the intended blood vessels. DSA is also used as a complementary therapy before undergoing surgery.
When a patient undergoes DSA for diagnostic purposes , it is possible that immediate therapeutic intervention is needed during the procedure . The action of DSA on the human nervous system is known as neurointervention, and is a technique that is more widely used in cases of aneurysms and strokes, because the use of drugs is more targeted.
Ischemic stroke patients who can undergo neurointervention must meet several neurointervention criteria, namely not older than 86 years, must not experience bleeding, relatively normal blood pressure, and are still in the golden period, which is less than 8 hours since the stroke occurred . In stroke treatment, the focus is on saving surviving brain cells . If the brain cells are damaged , the blood flow that is launched will no longer be useful.
Examination Process
The patient will lie down on the angiography examination table and receive local anesthesia to reduce pain, so that the patient can be comfortable during the examination . In certain conditions , doctors can also give general anesthesia .
Heart rate , blood oxygen levels and blood pressure will be monitored continuously by the medical team during the procedure.
After confirming that all equipment is ready and sterile for use, the examination can be carried out. Here are the steps:
- The doctor will inject contrast fluid into the patient's body part which will be examined using an injection device specifically used in the DSA procedure.
- The doctor will continue to monitor the contrast fluid that enters the body using X-rays to determine the condition of the blood vessels directly.
- When the examination is declared complete, the doctor will immediately perform hemostasis at the site of the disease. Hemostasis is carried out with the aim of stopping bleeding .
After the examination process is complete, the patient is required to rest in a supine position for 4 to 6 hours. The medical team will observe the patient's health condition, especially complications at the injection site.
Side effects
DSA is a minimally invasive procedure, so it has a much smaller risk compared to surgery, where the patient has to undergo major surgery such as opening the skull . The risks involved are friction between the blood vessels and the catheter, or tearing of the blood vessels , so that DSA is a relatively safe and effective diagnostic and therapeutic option.
Article written by dr. Pramlim Gunawan, Sp.Rad (K) RI (Intervention Radiology Specialist at EMC Alam Sutera Hospital).