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)

Source: http://andy-mckay.co.uk/work/gpapp/docs/ArteriogramandAngioplastyStent.pdf