Angiography / angioplasty / stent and stent graft of mesenteric and transplant vessels - A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have an angiogram procedure / angioplasty / stent as part of the investigation and treatment of various vascular and other pathologies.

Contents

• What is an angiogram / angioplasty / stent?
• Why do I need an angiogram / angioplasty / stent?
• Who has made the decision for me to have an angiogram?
• What are the benefits?
• What happens before the procedure?
• Who will be performing the procedure?
• What happens during the procedure?
• Will the angiogram / angioplasty / stent hurt?
• How long will the procedure take?
• What will happen after the procedure?
• What are the possible risks?
• Radiation
• Conclusion
• Privacy and dignity

What is an angiogram / angioplasty / stent?

An angiogram is a special x-ray examination procedure where the arteries in the body relevant to your problem are shown.

Usually vessels do not show up on an ordinary x-ray, so a special dye called contrast medium, is injected into the vessels through a fine plastic tube called a catheter to make them visible.

X-rays are taken during the procedure. These images will assist the doctors in performing the procedure and obtaining diagnostic information.

An angioplasty is a way of relieving a narrowing or blockage in a blood vessel without having an operation.

A stent is a special device made of metal mesh that is placed across a narrowing or blockage to keep the artery / vein open.

Why do I need an angiogram / angioplasty / stent?

This is usually because you may have a problem with your circulation causing pain or a reduced blood supply to your gut or other organs.

Your doctor needs detailed images of the arteries to determine the most appropriate treatment for you. Often you will have already had either a CT or MRI scan.

Angiograms are most commonly performed to investigate blockages, areas of bleeding and to depict the blood supply to abnormal areas.

An angioplasty / stent may be needed if your doctor had identified that there is a narrowing or blockage in one of your blood vessels which is causing you a problem.

If the arteries supplying your gut or organs are affected, you may experience pain or a reduction in function of those organs.

Who has made the decision for me to have an angiogram / angioplasty / stent?

The Consultant in charge of your case and the Interventional Radiologist performing the procedure will have discussed the situation and come to the conclusion that this is the best way of treating your condition.

However, you will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What are the benefits?

These images will assist the doctors in performing the procedure and obtaining diagnostic information.

An angioplasty is a way of relieving a narrowing or blockage in a blood vessel without having an operation.

A stent is a special device made of metal mesh that is placed across a narrowing or blockage to keep the artery / vein open.

What happens before the procedure?

• You may be admitted to hospital on the day of, or the night before, the procedure.
• A doctor will take a history from you.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• You may eat a light meal and drink as normal unless otherwise informed – in which case you may be fasting for four to six hours prior to the procedure.
• You may be given antibiotics or other pre-medication on the morning of the procedure if required.
• If you have any allergies you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue.
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Who will be performing the procedure?

A specially trained doctor called an interventional radiologist will be performing your procedure.

Radiologists have special expertise in using x-ray equipment and in interpreting the images produced.

They will look at these images while carrying out the procedure to guide treatment.

The Interventional Radiologist will be assisted by a radiographer and nurses and / or other Radiology doctors or trainees.

What happens during the procedure?

• You will get dressed into a hospital gown.
• You will lie on the x-ray table, generally flat on your back.
• You will have a monitoring device attached to your finger and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions and the Radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Most often an artery in the groin is used, but occasionally an arm or wrist artery will be chosen. Your doctor will tell you beforehand which artery will be used. Your skin will be cleaned and local anaesthetic given to numb the area and prevent any pain. A small tube is then placed into the artery.
• Small catheters (plastic tubes) will then be guided into the arteries that are blocked or narrowed.
• When pictures need to be taken some iodine dye will be injected; you will be asked to hold your breath for a short time at these points. You may feel a hot feeling from the dye and it can make your bladder feel full.
• If a vessel narrowing or blockage is identified a balloon is inflated to open up the vessel (angioplasty). This may be done more than once in order to open up the vessel sufficiently.
• Occasionally, the interventional radiologist will decide to place a stent (metal mesh tube) in the vessel to keep it open. This is placed in exactly the same way as the balloon.
• Once the procedure is completed you will be moved back onto your hospital bed.
• The tube in the artery will then be removed and pressure applied on the site for several minutes.

Will the procedure hurt?

Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic.

You may feel a warm sensation for a few seconds when the x-ray dye is injected and some people report a metallic taste in the mouth. You may also feel like you are passing urine; this is normal.

Angioplasty is not painful although you may feel a little discomfort when the balloon is inflated / angioplasty is being performed.

There will be a nurse, or another member of the clinical staff, in the room looking after you.

If the procedure does become uncomfortable, please let a member of staff know.

How long does the procedure take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be.

Generally, the procedure will last approximately 1 – 1.5 hours.

Some procedures can be performed as a day case (we would have informed you prior to your appointment) and you will be observed in the x-ray department for around four hours to ensure it is safe for you to go home.

What will happen after the angiogram / angioplasty / stent?

You will be taken back to your ward for observations and a period of bed rest, before to being sent home. You may also need to stay for further treatment or investigations.

Nursing staff will carry out routine observations including taking your pulse and blood pressure readings and will also check the treatment site.

If you experience pain, sickness, abnormal swellings or are generally feeling unwell, please let the nursing staff know.

You will need to stay in bed for a few hours, approximately four to six hours, until you have recovered and are ready to be sent home.

Occasionally, you may need to stay in hospital overnight.

What are the possible risks?

Angiography / angioplasty is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise:

• Bleeding or bruising at the artery puncture site is a relatively common problem.
• Rarely significant bleeding or artery damage may need to be treated with an operation.
• Rarely, damage can be caused to the treated artery by the catheter, balloon or wire. This may result in reduced blood flow to the treated organ which can be serious or life-threatening. This may require further treatment with surgery or another radiological procedure.
• Sometimes it is not possible to successfully cross or open the blockage. If this happens your clinical team will discuss with you other management options.

Radiation

You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.

The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.

Ionising radiation can cause cell damage that may turn cancerous. However the risk of this happening from your examination is considered low.

Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short-term and long-term effects (e.g. reddening of the skin and burns).

If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.

For further information please visit our Imaging (Radiology) page.

Conclusion

Some of your questions about your procedure should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).

Privacy and dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. This means, with a few exceptions, we will care for you in same sex bays in wards with separate sanitary facilities for men and women.

In some areas, due to the nature of the equipment or specialist care involved, we may not be able to care for you in same sex bays. In these cases staff will always do their best to respect your privacy and dignity, for example with the use of curtains or, where possible, moving you next to a patient of the same sex. If you have any concerns, please speak to a member of the radiology team, ward sister or charge nurse.