Peripheral Vascular Disease | Dr Raghu


Carotid artery disease is a condition that arises when the fat deposits accumulate and block the blood vessels that deliver blood to the brain. People with carotid artery disease are at higher risk of developing stroke. So, to determine the risk and prevent the associated complications, a procedure known as cerebral angiography is recommended.

Cerebral angiography is a diagnostic procedure that uses X-rays to evaluate the blockage or any brain abnormalities in the carotid arteries (blood vessels in the brain and neck).

When is cerebral angiography recommended?

Cerebral angiography is recommended if the doctor suspects any of the following abnormalities within the brain:

  • An aneurysm
  • A dilated blood vessel in the brain
  • Brain tumour
  • Brain clot
  • Stroke

It is also used to evaluate arteries in the head and neck before undergoing any surgery to provide additional information regarding any abnormalities that are not visible on other imaging tests, and as a minimally invasive procedure to treat vessel abnormalities.

In some cases, it is done to determine the underlying cause of the following symptoms:

  • Severe headache
  • Memory loss
  • Dizziness
  • Blurred vision
  • Loss of balance or coordination
  • Weakness or numbness

Before the procedure:

Specific instructions are given before undergoing the procedure. These instructions may include:.

  • Any allergies
  • The use of current medicines, vitamins, and mineral supplement
  • The current medical conditions
  • Any food or dietary restrictions before the procedure.

What happens in the procedure?

Before initiating the procedure, the patient’s head is stabilized by using a strap, tape, or sandbags. Based on the age of the person, either local or general anaesthesia, is administered. Once the anaesthesia sets, the doctor will sterilize the groin region and make an incision. Under the guidance of X-rays, the catheter is passed into an artery in the neck.

Once the catheter is placed in the correct position, the contrast dye is injected to highlight the blockage. After the X-rays are done, the catheter is removed, and the incision is closed.

What to expect after the procedure?

Once the procedure is done, the vitals are monitored in a recovery room. The person would be instructed to keep the leg straight if the catheter is administered through the groin region. Pain and inflammation at the site of incision are common, which can be relieved by applying ice packs and taking the prescribed medicines.

What considerations should be taken after the test?

Cerebral angiography is a diagnostic procedure, so there are not much considerations. However, following the below-given tips may ease the discomfort associated with the test:

  • Have a healthy and well-balanced diet.
  • Do not lift heavy weight for a few days or as suggested by the doctor.
  • Perform normal activities 8 to 12 hours after the procedure.

Talk to the doctor:

Call the doctor immediately on noticing any of the following symptoms:

  • Chest pain
  • Dizziness
  • Infection at the catheter site
  • Shortness of breath
  • Skin rash
  • Slurred speech
  • Vision problems
  • Numbness in the face, arms, or leg muscles

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      Critical limb ischemia occurs due to is a severe blockage of the arteries which leads to reduced blood flow to the extremities (hands, feet and legs). It results in severe pain and even skin ulcers or sores.


      Critical limb ischemia (CLI) is an advanced stage of peripheral artery disease (PAD) which results from progressive thickening of an artery’s lining caused by atherosclerosis (buildup of plaque). This eventually leads to narrowing of the artery which reduces normal blood circulation to the extremities.


      The early symptoms of ischemia of the limbs which can progress to critical limb ischemia involves pain, burning or cramping in the muscles of the limbs, usually after a physical activity or exercise which goes away with rest.

      The following are the symptoms which may be indicative of critical limb ischemia:

      • Severe pain in the limbs or the legs when at rest
      • A noticeable low temperature of the lower leg or foot when compared to rest of the body
      • Toe or foot sores, infections or ulcers which heal slowly
      • Gangrene
      • Shiny, smooth, dry skin in the legs or feet
      • Thickening of the toenails
      • Absent or diminished pulse in the legs or the feet

      Risk factors:

      The risk factors include the following:

      • Age (over 60 years and post-menopausal women)
      • Smoking
      • Diabetes
      • Obesity
      • Sedentary lifestyle
      • High cholesterol
      • High blood pressure
      • Family history of vascular disease


      Diagnosis is dependent on the location of ischemia. A thorough clinical examination is done as the symptoms are the first hint of this severe condition.

      The following are the diagnostic methods which may be considered:

      • Ankle brachial index test: It is suggested when the ischemia is in the lower extremities of the body. It is a noninvasive procedure and helps evaluate the blood pressure in the legs.
      • Duplex ultrasound scanning: It is the most effective non-invasive scanning method of the arteries.
      • Magnetic resonance arteriography (MRA): The blood vessels are visualized based on magnetic resonance which enables the evaluation of stenosis.
      • Arteriogram: It is a contrast-enhanced x-ray of the arteries to help determine stenosis.


      The following measures may help prevent peripheral artery disease:

      • Maintain a healthy active lifestyle.
      • Avoid or quit smoking.
      • Exercise regularly.
      • Maintain a healthy diet of low fat and low cholesterol.
      • Control blood sugar and blood pressure.
      • Manage stress.


      Immediate treatment is required to reestablish the blood flow to the affected areas. The goal of the treatment should be to reduce pain and to improve blood flow to prevent amputation of the leg.

      Treatment options include:

      Prescribed medicines are aimed to prevent further progression of the disease and to reduce the effect of the factors that contribute to the risk factors involved. Medications that prevent clots or infections may also be prescribed.

      Endovascular treatment

      These are the least invasive methods which involves usage of a catheter. Angioplasty may be recommended to open the blockages and improve the blood circulation to the affected part of the limb. Laser atherectomy is a method in which laser is used to vaporize small bits of the plaque, followed by a catheter with rotating blade that physically removes the plaque from the artery.

      Arterial surgery

      It is recommended when the arterial endovascular treatment is not favorable. In this procedure, the diseased arterial part is removed or bypassed with a vein from the patient or with a synthetic graft.


      Amputation of the affected part is done as the last resort, and may be needed in about 25 percent of the CLI cases.

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          Dr. Raghu | Heart Specialist in Hyderabad
          Aster Prime Hospital, Plot No: 2, Mytri Vihar, Satyam Theatre Lane Nearest Metro Station: Ameerpet Metro (100 Mtrs), Telangana 500016

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