Angioplasty - A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have an angioplasty procedure as part of the treatment for peripheral vascular disease.

Contents

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

What is an angioplasty?

• 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 an angioplasty?

• 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 computed tomography 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 an angioplasty?

• The consultant in charge of your case and the radiologist performing the angioplasty 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.

What are the benefits?

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

What happens before the procedure?

• You will be admitted to the Radiology Day Unit or a hospital ward on the day of, or the night before, the angioplasty.
• You may have a small needle 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.
• 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 angioplasty?

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

What happens during the angioplasty?

• 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 angioplasty 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 angioplasty take?

• Every patient is different, and it is not always easy to predict. However you should expect to be in the department for about an hour.

What will happen after the angioplasty?

• 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 possible 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 the CUH Imaging webpage.

Conclusion

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.

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.