Angiography, angioplasty and sometimes stenting is used to treat narrowings or short blockages in arteries. The most common targets for treatment are the arteries which supply the legs. When atherosclerotic disease in these arteries causes enough restriction of blood flow, patients can experience claudication (pain when walking), rest pain, or tissue loss (ulceration or gangrene).
Angiography refers to injection of dye in to the arteries to reveal precise anatomy under X-ray. This allows location of the lesion to be treated. Angioplasty is 'ballooning' of the lesion, which is used to stretch open the artery and improve blood flow. Sometimes, a stent (metallic tube) is also deployed at the level of the lesion. The procedure is performed under X-ray guidance, usually via ultrasound-guided needle access to the femoral artery in the groin.
Bypass surgery is chosen over endovascular treatment for long blockages in the arteries. For these lesions, bypasses are more durable in the long-term.
Preparing for the Procedure:
Prior to angiography, a duplex ultrasound of the leg arteries is done to locate the lesion in the artery and plan the procedure. A baseline set of blood tests will also be done.
Unless otherwise specified, all regular medications are continued prior to the procedure. Mr Milne will give you specific instructions regarding anti-platelet medications (e.g. aspirin and clopidogrel), anti-coagulant medications (e.g. warfarin and Rivaroxaban), and any medications taken for diabetes (in particular, metformin).Bring a small suitcase with you to the hospital in preparation for an overnight stay. Some patients require intravenous hydration before and after the procedure due to underlying kidney impairment. If this is needed, you will be admitted the night before the procedure and stay for two nights.
Description of the Procedure:
The procedure is performed under local anaesthetic and sedation. Some patients require general anaesthetic.
The procedure is performed under X-ray guidance, usually via ultrasound-guided needle access to the femoral artery in the groin. Once the artery is accessed, a sheath is inserted and angiography (injection of dye in to the arteries) is performed to reveal precise anatomy under X-ray. This allows location of the lesion to be treated. A combination of wires and catheters is then used to cross the lesion. Using the wire as a platform, balloons and stents can then be tracked in to position using X-ray.Typically, an angioplasty is performed first to stretch open the artery and improve blood flow. Another angiogram is then performed to check the result, and if required, a stent is also deployed at the level of the lesion.
After treatment, all wires and catheters are removed, and the sheath is removed from the femoral artery. A closure device may be used to seal off the artery. If not, direct digital pressure will be applied by the assistant surgeon for 10 20 minutes.
Following the Procedure:
You will be transferred to the vascular ward for monitoring after the procedure.It is important to lie still in bed following the procedure. The duration of bed rest depends on the method used to seal the femoral artery, but will be explained to you following the procedure. You can usually get up and walk around after 6 hours.
You may eat and drink after 4 hours.On the first day after the procedure, you may be a little sore in the groin used for access, but this is usually mild and settles quickly
Most patients are discharged home on the morning following the procedure. Occasionally, a longer stay is required.You will be scheduled for a review appointment with Mr Milne 4 6 weeks after the procedure. A duplex ultrasound may be performed at the same visit.
After this, you will be reviewed at 6 months post-operatively. Mr Milne may then elect to see you annually for a check.
Travel:
It is generally advised to wait at least 1 week before driving a motor-vehicle after angiography.You may travel short distances, under 4 hours, 2 weeks following the procedure. It is ideal to avoid flights/train/car travel over 4 hours duration for 4 weeks following the procedure. It is important to stay hydrated and walk around the cabin regularly whenever flying
Possible Complications of the Procedure:
- Discomfort/bruising:
- You may experience some mild discomfort and possibly bruising in the groin after the procedure.
- If it occurs, this usually settles within a few days
- Bleeding:
- Major bleeding can occur from the site of arterial access in the groin. This is uncommon (~1%).
- If it occurs, it requires an urgent trip to theatre to fix.
- Major bleeding at the site of angioplasty is rare (<1%)
- Infection:
- The risk of an infection involving the groin puncture site is ~1%. This type of infection usually resolves with a course of antibiotics.
- Risk of infection involving a stent deployed in the artery is extremely rare.
- Kidney dysfunction:
- In patients with underlying kidney disease (particularly those with diabetes), the use of contrast dye for angiography can worsen kidney function
- To minimise this risk, patients with underlying kidney disease receive intravenous hydration before and after the procedure
- If problems with the kidneys do occur, it usually resolves with hydration, but can prolong hospital stay.
- Thrombosis/embolisation:
- Angioplasty can cause thrombus (clot) to form at the site of treatment, and also clot &/or debris to travel down the leg (embolise) and block smaller arteries.
- If this occurs, in most cases the problem can be rectified during the procedure. Rarely, an urgent open operation is required to fix the problem.
