This information leaflet has been produced to give you general information and hopes to answer most of your questions prior to attending for an Arterial Stent insertion. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have concerns or require further explanation, please discuss this with a member of the healthcare team.
Why do I need this procedure?
You may have had a Magnetic Resonance (MR) Angiogram or an ultrasound of your arteries which shows that there is a blockage in an artery in your pelvis or upper leg. A stent is a metal tube used to open a blocked artery. It acts like a piece of scaffolding supporting the inside of your artery.
What are the benefits of the procedure?
A stent will open a blockage and allow blood to flow more easily. It may also help to relieve any pain or discomfort you are experiencing.
How do I know if it is a suitable procedure for me?
Your doctor has suggested this as the most suitable treatment for your legs. You will need to attend the radiology pre-assessment clinic to establish your general health. At this appointment you will need to have your blood pressure measured, blood samples taken and a tracing of your heart may be performed. A nurse will talk with you about these investigations. You will also be given the opportunity to talk through the procedure with a Vascular Consultant (a doctor who specialises in operations on blood vessels) or senior nurse to discuss the risks and benefits of the procedure. There will be plenty of time during this appointment to answer any questions you may have.
Can I take my medication as normal?
Most medication can be taken as normal. If you are taking Metformin or any blood thinning medication such as Aspirin, Warfarin, Clopidogrel or Rivaroxiban, it is important that you let us know at your pre-assessment appointment.
What happens during the procedure?
On the ward
The procedure is usually a day case, but occasionally an overnight stay is required. If you require an overnight stay post procedure then you will be transferred to Freeman Hospital. On the day of your procedure you will be asked to go to a ward for a couple of hours to prepare before the procedure. On the ward you will be asked to put a hospital gown on and a cannula (plastic needle) will be inserted into one of your veins. You can continue to eat and drink normally but avoid fizzy drinks.
In the x-ray department
A nurse will complete a checklist with you before leaving the ward. The procedure is performed in the x-ray department. On entering the x-ray room a Vascular Surgeon (doctor performing the procedure), radiographer (person who takes the x-ray pictures) and a nurse will greet you. They will check your personal details and discuss the procedure with you, including where they will access the artery. At this time the surgeon will ask for your written consent to go ahead with the procedure.
You will be asked to lie flat on the x-ray table with a pillow under your head. You will be awake during the procedure and there will be a member of staff nearby at all times to support you. Your blood pressure, oxygen levels and heart rate will be measured regularly.
During the procedure
The skin over the access site to the artery will be cleaned (this can be groin, arm or lower leg and will have been discussed with you at your pre assessment appointment) and some local anaesthetic will be injected into the skin. The local anaesthetic will make this part of your body go numb. You may feel a little pressure as a thin catheter (tube) is placed into the artery. The surgeon will then use x-rays to see the position of this catheter. Contrast (x-ray dye) is injected through the catheter. X-rays will be taken at the same time and will show any narrowed or blocked areas inside your arteries.
As the x-ray dye enters the arteries, you may feel a warm sensation. It may feel as if you urgently need to pass urine, but this is only a feeling, it is normal and will pass quickly.
The Surgeon will now position a catheter with the stent inside into the blocked area. As the stent is released, it will hold open the artery allowing blood to flow more easily through it. The radiologist may then decide to position a catheter with a balloon into the stent. As the balloon is inflated, it widens the artery further. The balloon is then deflated and removed. The radiologist will decide if this needs to be repeated to complete the procedure.
At the end of the procedure
For most patients, at the end of the procedure a closure device (a metal clip or stitch) will be used to seal the access site. When the bleeding has stopped only two hours of bed rest are required. Sometimes there will be a small amount of bleeding, if this happens the radiologist will press on the access site and longer bed rest is needed.
In a small number of patients the devices cannot be used or do not open correctly. In those circumstances, the artery is normally compressed for about 10 minutes or until staff are satisfied that bleeding is controlled. A longer period of bed rest is needed, usually four to six hours.
What happens after the procedure?
You will be helped back onto a trolley. There will be someone with you until the ward nurse arrives to escort you back to the ward.
A nurse will observe your access site regularly and continue to measure your blood pressure, oxygen levels and heart rate. If you feel any swelling, oozing or pain in the area of the access site, please inform the nurse immediately.
You will be allowed to eat and drink after this procedure, although this will need to be lying flat for the recovery period. It is important to drink plenty of fluids after this procedure to help your kidneys flush the x-ray dye from your body.
If you need to use the toilet during this time, please ask for a bedpan or bottle.
It is important to put pressure on your access site when moving, coughing, laughing or sneezing. This can be done by gently putting your hand over the area for the rest of the day.
Are there any risks?
The most common complication is the development of a bruise called a haematoma at the access site. This happens in about 2% of cases.
There is a very small risk that you may be allergic to the x-ray dye used during the procedure and also that the x-ray dye may affect how well your kidneys function. As this risk varies it will need to be discussed with you at your pre-assessment appointment.
There is also a 1 to 2% risk that during a stent insertion a plaque (area of fatty deposit) could become dislodged or that a clot could form at the site of the angioplasty and cause your symptoms to become worse. This may require an operation to resolve it. In a rare case (less than 1 in 100) this could result in the loss of a limb (amputation).
There is a small risk that the lining of the artery is damaged during the procedure (this is called dissection). This may require further treatment to resolve it.
There is a small chance that the artery could rupture; this could be treated either in the x-ray department or it may need an operation to repair it.
Please feel free to ask any questions at your pre assessment appointment.
How soon will I be back to normal?
Most patients can go home the same day, but you may be required to stay in hospital overnight following the procedure. We advise you to bring an overnight bag just in case. This will be discussed with you at your pre-assessment appointment. You must have another adult with you for 24 hours after the procedure.
You cannot drive on the same day as the procedure, if you have any bruising/ swelling in your groin you should avoid driving until after this is resolved. There are no restrictions for driving once you have recovered.
The day after your angioplasty it is important to start some gentle exercise such as walking and avoid heavy lifting for three days.
Angioplasty on its own does not stop peripheral vascular disease. If you have peripheral vascular disease, you should make changes in your lifestyle. These changes include:
- Stop smoking
- Eating foods low in fat, cholesterol and calories
- Maintaining your ideal body weight
- Exercising aerobically, such as brisk walking, for 20 to 30 minutes at least five times per week
If you have any concerns do not hesitate to contact your GP, the radiology nurse or the vascular nurse specialist on the number below.
What happens if I decide not to have the procedure?
You will be referred back to the doctor who recommended the arterial stent insertion to discuss it further.
What if I have any special requirements?
If you have any special needs or requirements please discuss this with the nurse or doctor at your pre assessment visit or contact the x-ray staff on the number below.
Where can I get more information?
Radiology nurses can be contacted on:
0191 445 3260. Monday to Friday 9am to 5pm.
NHS 111
Vascular Surgical Society of Great Britain and Ireland at www.vascularsociety.org.uk
Reference
British Society of Interventional Radiology (2008) Iliac Angioplasty and Stenting Report (BIAS 2008). Dendrite Clinical Systems Ltd
Data Protection
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.
Further information is available via Gateshead Health NHS Foundation Trust or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].