A1. An Angioplasty is a way of re-opening a blocked artery by inserting a fine plastic tube, called a catheter, through the blockage and inflating a small balloon on the catheter.

A2. A stent is a small tube, made of a metal mesh framework, which expands in a blocked artery and may help to keep the artery open. It is introduced on a catheter like that used for angioplasty and by the same sort of procedure.

Q3. Why do I need an Angioplasty?

A3. Your doctors have detected a problem in part of your circulation. You may already have had an Angiogram or ultrasound to show the blockage. Whilst surgical treatment is needed in some cases, in your case it is likely that Angioplasty or a Stent will either relieve your symptoms completely or delay the need for surgery.

Q4. Who has made this decision?

A4. The doctors looking after you will have discussed the possible treatment options with the Interventional Radiologist (the X-ray doctor) responsible for performing your Angioplasty. You will also be given the opportunity to discuss the various types of treatment because your 'informed consent' has to be given prior to treatment. If you do not want to undergo this treatment, then the procedure will be taken no further.

Q5. What preparation will I need?

A5. Printed instructions will be given to you with your appointment details. Your doctors may start you on a small dose of Aspirin (or an equivalent drug) at least two days prior to the Angioplasty. You may eat a light meal at least 2 hours prior to the procedure and fluid intake should not be restricted. On admission to the Ward your blood pressure and pulses will be checked and you will be asked to put on a hospital gown. As the Angioplasty is usually done through the artery in the groin (the femoral artery) you may be asked to shave this area.

It is very important that you inform the nursing and medical staff about all allergies. If you have had reactions to intravenous contrast medium, the dye used for kidney X-rays (IVPs) and for CT scanning, then you must also tell your doctor about this.

Q6. If I am diabetic, does this change anything?

Diabetic patients

Diabetic Protocol

A6. Yes. The preparation procedure may change. If you are diabetic and take insulin, you may need a drip to keep your blood sugars controlled. This will be discussed with you on the ward prior to the procedure. Please ring our helpline telephone number, as below:

Freeman Hospital: (0191) 223 1012

and speak to a member of staff, who will be able to advise you. (see next question also).

Q7. I take Metformin (Glucophage, Avandamet) Tablets. Does this change anything?

A7. Yes - Metformin (Glucophage, Avandamet) is most commonly taken by diabetic patients to control blood sugar, but occasionally is taken for other conditions. If you are taking Metformin, your preparation for the procedure may change. Please ring the helpline telephone number, as above, and speak to a member of staff, who will be able to advise you.

Q8. What happens during Angioplasty? How is it performed?

A8. After the admission procedures on the ward, a nurse will accompany you to the X-Ray Department. Here, the radiology nurse will discuss basic details of the procedure with you and the interventional radiologist will answer any further questions you may have. You will be transferred onto the X-ray table, generally flat on your back. The radiologist may place a small needle in a vein in your arm, if sedation is required. We will monitor your blood pressure, heart rate and pulse.

After the radiologist has checked the pulses in your groin, the nurse will clean the skin in this area with antiseptic fluid and cover the rest of your body with a drape. Local anaesthetic will be injected into the tissues around the artery and when the skin in this area is completely 'numb', a needle will be inserted into the artery through a tiny nick in the skin.

A guide wire is passed through this needle and the needle is then removed. The catheter can then be threaded over the wire into the artery and guided into the blocked segment of artery using the X-ray images as a 'road map'. The small balloon on the catheter is then inflated when it has reached the middle of the narrowing.

Local Anaesthetic

Your radiologist will ask you to keep quite still while the injections are given.
You may notice a warm tingling feeling as the anaesthetic begins to take effect.
Your procedure will only go ahead when you and your radiologist are sure that the area is numb.
If you are not having sedation, you will remain alert and aware of your surroundings. A screen shields the operating site, so you will not see the procedure unless you want to.
Your radiologist is always near to you and you can speak to him/her whenever you want to.

Q9. How long will it take?

A9. This varies according to the complexity of the blockage in your artery but expect to spend anything from 45 minutes to 2 hours in X-ray.

Q10. Will I feel anything during the Angioplasty?

A10. You may get a 'tight' sensation during balloon inflation, but it's not usually painful. When the catheter is removed a small hole is left in the artery. Therefore one of the radiology team will have to press on the puncture site firmly for 5 - 10 minutes and this can be uncomfortable.

Q11. What happens afterwards?

A11. You will be taken back to the ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure. They will also check for bleeding or swelling in the groin. You will generally stay in bed for 4-6 hours. You may be allowed home on the same day, or kept in hospital overnight depending on your progress.

Q12. What are the Risks or Complications?

A12. The commonest complication is the development of a deep bruise, called a haematoma, at the puncture site. In about 4% of cases this may require treatment with a blood transfusion or (very rarely) a small operation to stitch the hole in the artery.

In about 1% of angioplasties, either the treated section of artery or the smaller blood vessel just beyond this area, becomes completely blocked with debris loosened by the balloon. This complication may lead to an emergency operation to remove the blockage. Overall, less than 3% of angioplasty or stent procedures will result in an urgent surgical operation to fix a bleeding puncture site or re-open a blocked artery.

Q13. I need an ambulance. Do you arrange one?

A13. If you need an ambulance, you must ask your General Practitioner’s surgery to arrange one. You will need to give them three working days notice. Please inform the department if you are arriving by ambulance as we will arrange your appointment time to fit with ambulance arrivals.

Q14. What if I have any comments, suggestions or questions?

A14. Should you have any suggestions or concerns, please make these known to the person conducting your examination, or by letter addressed to:

The Departmental Manager
Main X-ray
Freeman Hospital
High Heaton
Newcastle upon Tyne
NE7 7DN

Tel: (0191) 223 1012

Should you have any questions regarding this examination, please ring the appointments number, as above (Monday – Friday: 9.00 – 5.00)

All Newcastle Hospitals: Switchboard Tel: (0191) 233 6161

If you need to turn to someone for on-the-spot help, advice and support, please contact the Patient Advice and Liaison Service (PALS) on:

Freephone 0800-032-02-02

How to get to the Freeman Hospital

Freeman Hospital is to the east of the City of Newcastle upon Tyne with public transport services close by. Buses are available to and from the city centre direct to the main hospital entrance. A clearly sign-posted car park is provided for patients and visitors for which a charge applies.

Information produced by Dr John Rose, Clinical Directorate of Radiology

Next Review: November 2009