Download Angioplasty and stent insertion to leg arteries

Angioplasty and stent insertion to leg arteries
What is an angioplasty and stent insertion?
An angioplasty is a minimally invasive X-ray guided procedure to relieving a blockage or
narrowing in an artery, without having an operation. A fine plastic tube, called a catheter, is
inserted through the blockage in the artery and a special balloon is then inflated to open it
up and allow more blood to flow. The balloon is then removed. Sometimes a “stent” (a
small metal mesh tube) is used in addition to the balloon. The stent is inserted into the
artery to hold it open after it has been dilated with the balloon. This stent will remain in
place permanently.
Why do I need an angioplasty?
This procedure is necessary to improve the blood flow to your leg. You may be
experiencing claudication, pain in the legs on walking a certain distance that is relieved by
rest or you may have more serious problems such as continuous pain in your foot or
ulceration of the skin in the toes or feet. You will already have had a CT, MRI or
Ultrasound scan, which has shown a blockage in an artery considered likely to be causing
your symptoms and your specialists have decided that an angioplasty is the best way of
treating this blockage.
Who will be doing the angioplasty and where will the procedure take place?
A Consultant Interventional Radiologist, a specially trained doctor with expertise in using xray equipment, catheters, guide wires, balloons and stents will perform the procedure in a
dedicated angiography suite within the Radiology Department of the Royal Berkshire
Hospital.
How do I prepare for an angioplasty?
Most angioplasties will be performed as a day case with between 4-6 hours observation in
the recovery unit afterwards. Some patients however will need to stay overnight. You will
have a consultation with the Interventional Radiologist prior to the procedure to identify
your suitability for a day case procedure, or whether you will need to stay overnight. If you
are taking warfarin or any other anticoagulants, these may need to be temporarily
discontinued for the angioplasty. Routine blood tests will be performed to check your
kidney function and clotting status.
What happens on the day of the angioplasty?
Please take all your normal medications including aspiring and clopidogrel unless
instructed otherwise. Do not to eat anything for at least 4 hours before the procedure,
although you will be able to drink water up to 1 hour before. The Interventional Radiologist
carrying out your procedure will have a final discussion with you. This is an opportunity to
ask any outstanding questions you may have. You will then be asked to sign a consent
form if you agree to go ahead. A cannula (a plastic device) will be inserted into a vein in
your arm so that sedation and/or painkillers can be administered if necessary.
What actually happens during an angioplasty?
You will lie on an X-ray table within the angiography suite. You will have monitors attached
to your chest and finger, as well as a blood pressure cuff. If you receive sedation and/or
painkillers you will be given oxygen through small tubes in your nose.
The skin and deeper tissues over the artery will be anaesthetised with local anaesthetic
and then a needle will be inserted into the artery. Through this a guidewire wire will be
inserted and then a series of catheters (fine plastic tubes) will be used to navigate through
the narrowing or blockage. Balloons are inflated inside the narrowings and occasionally a
stent is deployed.
Once a good result has been achieved, the wires and balloons are removed and the hole
in the artery in the groin is closed with a special closure device as well as pressure for
several minutes to stop any bleeding.
Will it hurt?
If you choose to have sedation, then whole procedure should not be uncomfortable.
Even without sedation, once the initial sting of the local anaesthetic has passed the deeper
tissues should then feel numb and following this the procedure should not be painful.
There will be a nurse monitoring your progress throughout the procedure and should you
become uncomfortable, then you will will be given sedation through the cannular in your
arm.
During the procedure, contrast medium (xray dye) is injected to help visualise the
blockage. When this happens you may get a warm feeling, which some people can find a
little unpleasant. However, this soon passes off and should not concern you.
How long will it take?
Every patient’s situation is different and it is not always easy to predict how complex or
how straightforward the procedure will be. Some angioplasties take about half an hour,
while others may be more involved and take rather longer, sometimes up to 2 hours.
What happens afterwards?
You will be monitored in the recovery area and asked to lie completely flat for 2 hours and
then remaining in bed sitting up for a further 2 hours to allow the hole in the artery in the
groin to firmly seal. If you are an inpatient you will be taken back to the ward. If you are a
day case you will stay for approximately 4-6 hours in X-ray recovery unit and will need to
be accompanied home with a responsible adult who will need to stay with you for 24
hours.
Are there any risks or complications?
Angioplasty is generally a very safe procedure, however there are some risks and
complications that may arise:
- There may occasionally be a small bruise, called a haematoma, around the site where
the needle has been inserted in the groin. Rarely, the haematoma may be more
pronounced and associated with a hard painful lump indicating there is a small persistent
leak. This is usually corrected with a minor procedure.
- The balloon or catheter may worsen the blood flow in the leg by damaging the artery wall
or causing some blood clot to form and blocking the artery. This is invariably corrected
during the procedure, but rarely may also necessitate an emergency operation. It is
possible that this could result in loss of your leg – but this is extremely rare.
- Very occasionally, the artery ruptures during ballooning which can be very serious and it
usually treated by the immediate deployment of a special stent, and rarely requires
surgery.
- During the angioplasty contrast (X-ray dye) is administered. For the vast majority of
patients this has no untoward affect. For patients with known kidney disease however,
there is a small risk that the kidney function may be worsened. To minimise this risk these
patients are given intravenous fluids around the time of the procedure.
Despite these possible complications angioplasty is normally very safe and in the majority
of cases carried out with no significant side effect.
Further information
Please contact Berkshire imaging if you have any further questions