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A guide to your arteriogram and angioplasty/stent
A guide to your arteriogram and angioplasty/stent Your consultant has asked for you to have an arteriogram, which is a special procedure to show up the arteries in your pelvis and legs. Narrowing or blockages of the arteries can easily be shown on x-rays.
If you are taking Warfarin, Metformin (Glucophage), Clopidogrel (Plavix)or Cilostazol (Pletal) tablets, please telephone the Royal Derby Hospital on 01332 783215 for further advice. What are the benefits of having an arteriogram? Your consultant will be able to see any narrowing or blockages in the arteries and using this information decide the best way to treat the arterial disease. What are the risks, consequences and alternatives associated with having an arteriogram? Most procedures are straightforward, however as with any procedure there is a small chance of side-effects or complications and these include:
• Severe allergy to the dye injected into the arteries (this occurs in less than 0.1% of
• Bruising around the puncture site in the artery after the procedure. This is common.
• Severe bleeding from the puncture wound can occur in about 1% of patients and may
If you require further details about these or other possible complications, please contact the radiologist (x-ray doctor) at the Royal Derby Hospital (telephone numbers as above) before your arteriogram, or the ward doctor during your stay. Radiation risks All x-ray procedures involve some exposure to radiation and so pose a degree of risk. Everyone is exposed to natural background radiation from the environment throughout their lives. One in 3 people will develop cancer at some point in their lives due to many various causes including environmental radiation. Radiation from a medical procedure involving x-rays can add very slightly to this risk. The length and level of exposure to radiation from x-rays in medical procedures is very strictly controlled and is kept to the minimum amount possible. The added risk of cancer due to this radiation is extremely small. Your doctor has determined that the risk to your health of not having this procedure is considerably greater than the risk from the radiation used. Alternatives Your consultant has recommended this procedure as being the best option. A possible alternative to having an arteriogram is an ultrasound or MRI of your arteries, which you may have already had done. If you would like more information, please speak to your consultant. What happens when I come into hospital? You will be admitted to a ward in the Royal Derby Hospital either the day before or on the morning of your arteriogram. Afterwards you may be allowed home the same day after a period of observation. However, if your arteries are narrowed or blocked we will discuss this with you and may proceed immediately with an angioplasty/stent. This procedure will open up your diseased artery and you may have to stay in overnight for more observation. Before your arteriogram, the nursing staff may wish to shave both groins. A member of the consultant’s team may see you before the arteriogram. You may be asked to sign a consent form, if you haven’t already signed one, usually for an arteriogram, which may proceed to angioplasty/stenting. Please do not hesitate to ask the doctor or nursing staff any questions you may have. You will be able to have a light breakfast or lunch before your arteriogram. If you are diabetic, please continue with your normal routine and diet. What happens during my arteriogram? You will be brought to the X-Ray Department from your ward in a wheelchair. An arteriogram takes about an hour, and if an angioplasty/stent is done after, this will take another 30 - 60 minutes. A nurse will be with you all the time and can give you any assistance you require. If you have any further questions, please ask the nurse, radiographer or x-ray doctor. You will be asked to lie flat throughout the procedure. If you have any breathing problems or problems with lying flat, please discuss this with the doctor on the ward. You will be awake during the procedure. Your groin will be numbed with local anaesthetic. A fine tube will then be inserted into your artery in the groin. After this, dye is injected into the tube, which shows up the arteries. We record this by taking x-rays. You may feel hot ‘flushes’ when the dye is injected, this is a normal reaction. After the arteriogram we may perform an angioplasty/stent. If we do not, the tube in the artery is taken out and the x-ray doctor will press on your groin for 10 minutes. Once the bleeding has stopped you will be taken back to your ward. What happens after my arteriogram? You will be taken back to your ward on a trolley. You must lie flat for 3 hours to prevent re- bleeding from your artery puncture site in your groin. The ward nurse will check your groin at regular intervals for bleeding/bruising. You may eat and drink as normal on the ward. If your groin is painful, please ask your nurse for painkillers. DISCHARGE INFORMATION AND AT HOME ADVICE Whilst at home, you may wash as normal, but avoid strenuous exercise and driving. You may return to your normal activities after 48 hours. You may need to take painkillers for a few days if your groin is painful. IF YOU NOTICE ANY INCREASED SWELLING OR BLEEDING FROM YOUR GROIN, OR IF YOUR FOOT TURNS VERY COLD AND/OR WHITE YOU SHOULD IMMEDIATELY GO TO THE EMERGENCY DEPARTMENT.
An outpatient appointment with your consultant will be arranged by the ward staff before you leave hospital.
A guide to your angioplasty/stent An angioplasty is a procedure for widening a narrowed part of an artery, or opening up a new channel through a blocked artery. It may be performed immediately after your arteriogram and may involve the puncturing of the artery in the other groin as well.
A stent is a short metal tube placed in the artery to keep it open. It may be used instead of an angioplasty, or if the results of the angioplasty are unsatisfactory.
What are the benefits of having an angioplasty or stent? If the angioplasty/stent procedure is successful, it will improve the blood supply to your buttocks and/or legs, and hopefully improve your symptoms. What are the risks, consequences and alternatives associated with having an angioplasty or stent? Most procedures are straightforward, however as with any procedure there is a small chance of side-effects or complications and these include:
• Bruising around the puncture site in the artery. This is common. However, severe
bleeding from the puncture wound occurs in about 4% of patients, and at the angioplasty site in less than 0.5% of patients. This may require surgical treatment or stenting.
• Blockage of the artery after angioplasty, because of clot formation or collapse of the artery walls (1 - 2% of patients). This may be treated by stenting.
• Emboli this is where bits of diseased inner walls of the artery break off during the
procedure and can block off smaller arteries in the thigh or lower legs. If this occurs, we can sometimes suck out the bits causing the blockage, or you may need to have surgery (1 - 2% of patients).
• Poor kidney function. The dye that is injected into the arteries can rarely damage the
kidneys. This damage maybe temporary. The risk of kidney damage is much higher in patients who already have kidney disease (25% of patients). If this kidney damage, caused by the dye, is bad enough it may have to be treated by dialysis.
• Amputation (loss of limb). The risk of this occurring as a complication of the procedure
varies according to how bad the artery disease is in each individual patient and is about 0.5% (1 in 200 patients).
• Death as a result of the procedure is rare (1 in 1000 patients), but as a result of other
illness eg. heart disease or a stroke, which may occur whilst the patient is in hospital, is higher, about 1% of patients.
Please note that the surgical alternatives to angioplasty/stenting eg. bypass surgery also carries significant risks of complications. These can be explained in more detail by your surgical team.
If you require further details about these or other possible complications, please contact the radiologist (x-ray doctor) at the Royal Derby Hospital before your angioplasty/stent, or the ward doctor during your stay.
Alternatives Your consultant has recommended this procedure as being the best option. An alternative to having an angioplasty may include surgery. If you would like more information about this, please discuss this with your consultant or doctor on the ward. What happens after my angioplasty/stent? You will be taken back to your ward on a trolley. You must lie flat for 6 - 12 hours to prevent re-bleeding from your artery puncture site in your groin. If you need the toilet, a bedpan/bottle will be provided. If you still have difficulty emptying your bladder, please inform the nursing staff. You may eat and drink as normal on the ward. A nurse will regularly check your blood pressure, pulse and groin area for signs of bleeding. If you have any pain or discomfort, please ask your nurse for painkillers. DISCHARGE INFORMATION AND AT HOME ADVICE Whilst at home, you may wash as normal, but avoid strenuous exercise and driving. You may return to your normal activities after 48 hours. You may need to take painkillers for a few days if your groin is painful. IF YOU NOTICE ANY INCREASED SWELLING OR BLEEDING FROM YOUR GROIN, OR IF YOUR FOOT TURNS VERY COLD AND/OR WHITE YOU SHOULD IMMEDIATELY GO TO THE EMERGENCY DEPARTMENT.
An outpatient appointment with your consultant will be arranged by the ward staff before you leave hospital. References Standards in Vascular Radiology. Royal College of Radiologists (1999) Belli, A, M. et al. Complication Rate of Percutaneous Peripheral Balloon Angioplasty. Clin Rad (1990) 41; 380-383 Axisa, B. et al. Complications Following Peripheral Angioplasty. Ann R Coll Engl (2002) 84; 39-42 Matsi, P. et al. Complications of Lower Limb Percutaneous Transluminal Angioplasty. Cardiovasc Intervent Radiology (1998) 21; 361-366 Aspelin, P. et al. Nephrotoxic Effects in High Risk Patients Undergoing Angiography. N Engl J Med (2003) 348; 491-499 Standards for Iodinated Intravascular Contrast Agent Administration to Adult Patients. Royal College of Radiologist (2005) I have read and understood the information provided. Patient’s signature: _______________________
If you have any queries, or require further information
please contact the ward doctor during your stay
or a radiologist at the Royal Derby Hospital on 01332 783215.
Reference Code: P1311/0271/03.2013/VERSION6 Copyright 2013 All rights reserved. No part of this publication may be reproduced in any form or by any means without prior permission in writing from the Patient Information Service, Derby Hospitals NHS Foundation Trust. (P0728/06.2010/V5)
DETAILED SCIENTIFIC PROGRAM Monday 25 November, 2013 Vice-Chancellor, University of the Punjab, Lahore M. Iqbal Choudhary H. E. J. Research Institute of Chemistry, University of Karachi, Karachi Concurrent Sessions Concurrent Session I (Venue: Al-Razi Hall) Clinical Genetics and RNA Interference School of Healthcare Science, Manchester Metropolitan University, Shool of Biological
Adjudication Report Lissycasey 09/07/2009 TOTAL MARK Overall Development Approach: The adjudicator would like to welcome Lissycasey to the 2009 Tidy Towns Competition. Thank you for your very detailed entry form and map. However the scale of the map provided was too small and a slightly larger scale might be considered for next year. The adjudicator noted that a copy of the 3 Year