Peripheral angioplasty

A peripheral angiogram is an imaging test that uses x-ray technology to view your blood vessels in the pelvis, legs, knees, ankles and also, less commonly, the arms and even brain. Specialists often use this test to study narrow, blocked, enlarged or malformed arteries and veins in many areas of the body. 

The x-ray images are created by injecting a liquid x-ray dye (an iodine based contrast media) through a thin flexible tube (catheter) into the desired blood vessel from the access point. The access point is usually an incision in the groin. The x-ray contrast media makes the blood flowing in the blood vessel visible on the x-ray monitor. The contrast will be eliminated from your body via the kidneys. 

A peripheral angiogram is used to diagnose a variety of conditions, including:

• blockages of the arteries, called Peripheral Artery Disease (PAD);
• enlargements of the arteries, called aneurysms;
• kidney artery conditions;
• problems in the arteries that branch off the aorta;
• malformed arteries, known as vascular malformations; 
• problems with your veins, such as deep vein thrombosis (DVT); or
• clots in the lungs, known as pulmonary embolism.

Once your peripheral angiogram has been carried out and a diseased vessel has identified, your specialist will usually proceed to treat the diseased area at the same time. This is referred to as percutaneous transluminal angioplasty (PTA) or intervention.

The PTA is carried out by guiding a balloon catheter (thin flexible tube with a small balloon at the end) to the place where the artery is narrowed. Once in position, the balloon is inflated and the narrowing is gradually widened.

If the narrowing or blockage does not respond to balloon treatment, you specialist may consider placing a stent in the narrowing. A stent is a small expandable mesh tube made from a special metal alloy. Once positioned at the point of narrowing, the stent is opened up to a predetermined width to hold the narrowed artery open. Reclosure (restenosis) of the artery is less likely to occur if a stent is used.

Your procedure will be carried out in an angiography suite (“cath lab”) at Intra within the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your specialist will be assisted by nurses and other highly trained staff. 
 

• You will be awake during the procedure but may be lightly sedated.
• Your groin will be numbed with local anesthetic before a tiny plastic tube called a catheter is introduced the catheter is introduced through a tiny incision (less than 6mm) in the groin. You should not feel pain at the entry site but there still may be some non-painful sensations such as pressure. You cannot feel the catheter moving inside your arteries.
• The specialist watches the catheter on an x-ray screen as he passes the tip of the catheter through your femoral artery guiding it to the arteries supplying your legs or arms.
• Constrast media or dye is injected and a movie picture is recorded as the dye flows into the artery and its branches, making them visible on the fluoroscope's monitor. The contrast media makes the arteries "light up" in comparison with surrounding structures.
• The specialist then carefully studies the recorded images for any disease or narrowing.

 
If you do require angioplasty, it will be done through the same tube that has been placed in your groin for the angiogram:

• The specialist will then insert a catheter through the tiny tube with a small balloon on the end.
• The balloon will be placed where the narrowing or blockage is and inflated to open up the narrowed area. It will then be removed and angiographic pictures will be taken to see whether the balloon treatment worked.
• In some cases the artery is successfully stretched open, but the narrowed portion of the artery can recoil as the balloon is deflated. If the dilation (opening the narrowed vessel) is not entirely satisfactory, your doctor may place a stent at that point of persistent narrowing.
• A stent is made of wire mesh in the shape of a tube or cylinder. This supports the blood vessel, keeping it open and will stay in place for life.

• An intravenous catheter (IV line) for administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.
• Devices to monitor your heart rate and blood pressure will be attached to your body.
• You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anaesthetic is injected through your groin
• You will be given mild sedation through your IV to make you feel relaxed.
• You may feel slight pressure when the catheter is inserted, but no serious discomfort.
• As the contrast material passes through your body, you may get a warm feeling.While you are in the hospital, your pain will be well-controlled with medications given through your IV line.

• Fasting: You may eat until 2 hours before admission then you should not have anything to eat. You may continue to drink clear fluids.
• Allergies or previous reactions to contrast (x-ray dye): Please inform Intra staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
• Diabetes: If you are a diabetic you should tell the Intra staff at the time of booking. You may need to discuss your insulin dose with your cardiologist.
• Warfarin or Coumadin: If you are taking Warfarin (a “blood thinner”) you should make this known to Intra staff at the time of booking. It is likely that you will need to stop this medication temporarily for a few days before angiography.
• Other usual medications: Continue these unless advised otherwise by your specialist. 

Bring an overnight bag in case you need to stay overnight. Please also bring with you any medication and any recent blood test results.

You may bring your favourite music on an iPod or smart phone as this can be played during the procedure.

You are encouraged to bring a friend or family member.

• The catheter is removed and pressure is applied to your groin to stop bleeding.
• Your specialist will discuss the findings with you or at a follow-up appointment.
• Patients are usually monitored for 4 to 6 hours and must remain flat in bed during that time to reduce the likelihood of bleeding from the groin site.
• You should be able to eat, drink, and take your normal medication.
• If an intervention was needed, you may need to stay in hospital overnight.
• Before you leave, a nurse will give you discharge instructions to follow at home.

Upon discharge you will be advised who to contact in case of an emergency after your procedure. 

• A small amount of bruising at the catheter entry point is relatively common. This is not usually clinically important unless it becomes painful.
• As the procedure is carried out through the groin, sometimes a “false aneurysm” or out-pouching of the artery deep under the skin can occur at the puncture site. This shows up as increasing pain at the puncture site. The diagnosis is made by an ultrasound test and treatment is usually by an injection.
• Also, patients with kidney failure or other kidney problems should notify their doctor as contrast can worsen existing kidney disease.
• Damage to artery or arterial wall can occur, which can lead to blood clots. This is not a frequent occurrence