Angioplasty - A guide for patients

Introduction

This leaflet is for patients booked for Angioplasty and/or a stenting procedure who have been advised to have an angioplasty procedure as part of the treatment for peripheral vascular disease.

What is Angioplasty and/or a stenting procedure?

• An angioplasty is a way of relieving a narrowing or blockage in a blood vessel without having major surgery. A thin plastic tube, called a catheter, is inserted into an artery and passed through the blockage. This is usually done through the groin but occasionally the arm.
• A special balloon on the end of the catheter is placed across the narrowing or blockage. The balloon is briefly inflated from outside the body and then deflated to improve the flow through the blood vessel.
• Normally arteries do not show up on an ordinary x-ray so a special dye, called contrast medium, is injected into the artery through a fine plastic tube called a catheter to make them visible.
• As part of the procedure a stent may be inserted. A stent is a special device made of metal mesh which is placed across a narrowing or blockage to keep the artery open.

Why do I need this procedure?

• Your doctor has identified that there is a narrowing or blockage in one or more of your blood vessels that is causing you a problem.
• If the arteries in your legs are affected, this may be causing pain in your calf or thigh. This may occur after you have walked a certain distance or may be causing more severe symptoms such as severe pain in your foot, especially at night.
• Some patients may develop ulceration due to lack of blood flow.
• Other tests such as a Doppler ultrasound scan, a CT angiogram scan (CTA) or a magnetic resonance scan (MRA) may have already been performed which have identified a narrowing or blockage.

Who has made the decision for me to have this procedure?

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

You will 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.

Who will be performing the procedure and other staff you are likely to meet?

• 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, as well as performing minimally invasive procedures.
• They will look at these images whilst carrying out the procedure.
• The radiologist will be assisted by a radiographer and nurses and/or other Radiology doctors or trainees.

Where will the procedure take place?

You will be taken to the Interventional Radiology Department.

What happens before my procedure?

• You will be admitted to the Radiology Day Unit or a hospital ward on the day of, or the night before, the procedure.
• You may have a small needle/cannula put into a vein to allow for medication to be given if this is necessary.
• Standard blood tests may be carried out.
• You may eat a light meal before the procedure.
• If you have any allergies you must let your doctor know and a red allergy band will be attached to your wrist.
• 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.

What happens during the procedure?

• You will be asked to change 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.
• Your skin near the point of insertion, usually the groin area, will be swabbed with antiseptic and you will be covered with sterile drapes.
• The skin and deeper tissues over the blood vessel will be numbed with local anaesthetic. A needle followed by a wire and catheter (fine plastic tube) will be inserted into the artery and guided to the correct position to obtain the images required.
• Once the narrowing or blockage has been identified, a balloon is inflated to open up the artery and allow more blood to flow.
• Occasionally, the interventional radiologist will decide to place a stent (metal mesh) to keep the artery open. This is placed in exactly the same way as the balloon.
• Occasionally the interventional radiologist will decide to place a special balloon or stent which is coated with a medication to stop the artery narrowing again may be used. The doctor performing the procedure will be able to discuss this in more detail with you.
• Once the procedure is complete, the catheter will be removed.
• The hole in the vessel will then be closed, often with firm pressure applied to the skin entry point for several minutes, to prevent any bleeding. Sometimes a special device may be used to close the hole in the artery.

Will the procedure hurt?

• It may sting a little when the local anaesthetic is injected.
• You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
• You may feel a little discomfort when the balloon is inflated. These symptoms should not last long. Let the nursing staff know about any pain, so that appropriate pain relief can be given.

How long does the procedure take?

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

What happens after the procedure?

• You will be taken back to your ward or the Radiology Day Unit.
• Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need to stay in bed for between two and six hours.
• You may need to stay in hospital overnight.
• You will need someone to pick you up and take you home.
• You must not drive or use public transport to get home.
• You will need a responsible adult at home with you for the night following the procedure (if a day-case procedure).

What are the benefits and possible risks of the procedure?

Benefits

Improving the blood flow in your legs should cause your symptoms to improve.

Risks

Angioplasty is a 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.
• In rare cases if there is significant bleeding or artery damage this may need to be treated with an operation.
• If the blockage is in your leg, there is a small chance of making the leg worse. This could be due to vessel injury or a clot forming in the artery. This may require an emergency operation which very rarely may include the need for amputation.
• Sometimes the angioplasty is not successful in improving the blood flow and further treatments may be needed.

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 see the information on our webpage.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us by email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Can I bring someone with me?

Those accompanying you may be required to stay out of the examination room during the procedure and remain in the waiting area.

Childcare whilst in the department

Staff are unable to look after or supervise children whilst your procedure is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure. If you attend an appointment with children with no one to look after them whilst you have your procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

Patients are advised to bring minimal belongings and not to bring valuable items. Any valuable belongings (mobile phone, wallet etc.) will go with the patient while having their procedure and can be secured in a locked box/safe.

How, when and by whom will my results be communicated?

Imaging examinations are reported in order of clinical priority to ensure those with the highest urgency are reported first.

Your referring team or clinician will be responsible for communicating reports back to you.

Test results are made available via MyChart but there is 3-week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Contacts/Further information

Please call the Radiology Day Unit and speak to the Imaging Nurses, on telephone number 01223 254639 if you have any questions or concerns about this procedure.

Some of your questions about the procedure should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you and you will be able to discuss any questions you have with them.

Require leaflet in a different format or language?

The Recite Me toolbar makes our website digitally inclusive by allowing you to customise the contents so that it works best for you. It features an accessibility tools bar positioned at the top of webpage:

Key functions:

• Screen reader – option for all information on the website to be read aloud
• Translation – option to translate all information into over 100 different languages
• Styling and customisation – option to change the text, font style, size, colour and spacing so that the information is easier to read.
• Reading aids – including a screen mask (tint) and magnifier to help make the information more accessible for all.

Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

More information is available on our website: MyChart (opens in a new tab)

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