Patient Information Leaflet
What is ‘atheroma’?
This is the build up of fats and calcium in the wall of the artery. It can lead to narrowing or blockage of the artery (the blood vessel which takes blood from the heart to the tissues). This means that the tissues downstream are deprived of blood. This is also known as ‘furring of the arteries’. For more details, click here.
What is an ‘angiogram’ and why do I need it?
Your consultant will have explained that your symptoms are due to blockages in the arteries. For us to see exactly where and how severe these blockages are, we need to take pictures of the arteries. We do this by injecting a colourless dye (contrast medium) in to the artery and taking X-ray pictures. Only those parts of the artery with contrast medium in it can be seen. In this way any blockages can be seen. This is called an ‘angiogram’. It provides us with a ‘road-map’ of your arteries. Using this ‘road-map’ we can decide on the best treatment for you.
What is a ‘balloon angioplasty’ and why do I need it?
Some of the narrowed or blocked segments of the arteries we can see on the angiogram can be stretched open by expanding a special balloon in the ‘furred-up’ part of the artery. This can help to restore the blood supply to the tissues without having to resort to a bypass operation. Your consultant will discuss this with you once he has seen the angiogram. If the consultant radiologist feels that angioplasty would help you, then he will discuss this with you at the time of the angiogram and may proceed with this procedure to save you from having to come back again.
How long will I be in hospital?
About a week before your procedure (X-ray test) you will be asked to come to the hospital for a check-up. You will be seen by a junior doctor who will take your details. Remember to bring all your tablets to this clinic. Blood tests and a heart tracing (if necessary) will be taken. You will then be allowed home.
The nurses in the clinic will determine if you are suitable to have the procedure as a day case or whether you will have to stay overnight. If you are diabetic on insulin, on blood thinning tablets (warfarin), have kidney failure or have no-one to look after you at home you will have to stay overnight after the procedure.
What will happen when I am admitted to the hospital?
You do not have to starve before the procedure. Take all of your tablets as normal. On the day of your procedure you will be admitted either to a ward or to the day case unit. You will be greeted by a nurse and your details confirmed. At the appropriate time you will be asked to change into a hospital gown before being taken to the X- ray department. There you will be greeted by the consultant radiologist (X-ray doctor), radiographer (the person who takes the pictures) and the X-ray nurse. The procedure will be explained to you and you will be asked to sign a consent form.
How is the procedure carried out?
You will be asked to lie down on a moving table. Please keep as still as possible. The doctor will make sure you are as comfortable as possible. The photograph shows the angiogram room with the table in the middle:
Most often the procedure is carried out through one the arteries (blood vessels that carry blood from the heart to the body organs and limbs) in the groin. Sometimes the doctor may have to use the artery in your arm (usually the left one). The skin will be cleaned and sterile drapes positioned to keep the procedure as clean as possible. Local anaesthetic will be injected into the skin. You will then feel some pushing as a thin tube (cannula) is inserted into the artery. A thin soft wire (guidewire) will then be threaded through this cannula and placed in the appropriate position using the X-ray equipment. You may be able to see the pictures on the video screens. A tube can then be threaded over the guidewire and the contrast medium injected through this tube. As the contrast medium is injected the table may move so that the whole of both legs can be X-rayed. This is an angiogram. During injection of the contrast medium you may experience a hot flush, a metallic taste, nausea (some patients vomit) and the feeling that you are passing water. Do not worry, this is only a feeling.
If you need an angioplasty the procedure will take longer as a balloon is positioned under X-ray control and used to stretch open the narrowed or blocked segment of the artery.
After the procedure the cannula will be removed from the groin and pressure applied for 5-10 minutes or longer if necessary. You will then be taken to the recovery area in the X-ray department before being taken back to the ward.
What are the possible complications of this procedure?
Although most procedures are straightforward and without complication, some problems can arise in 2-4% of cases. These are:
 | Haematoma – this is excessive bruising and a collection of blood at the puncture site. |
| False aneurysm ('pseudoaneurysm') – this is a pulsating clot next to the hole in the artery. It will need treatment either in the form of surgery or the injection of a substance to seal the hole in the artery. |
| Embolism – during the procedures a piece of atheroma may dislodge and travel down the leg. This may be dealt with straight away in the X-ray department. Rarely it may mean having to undergo an emergency operation. |
| Occlusion of the artery – this may make the situation worse requiring surgery to correct the problem. |
| Rupture of the artery – this can rarely happen during angioplasty. It may need an emergency operation to correct. |
| Contrast reaction – this is like an allergic reaction. If you have had problems in the past with a contrast medium you must inform the radiologist. |
| Death – this is a rare possibility. It is usually due to a heart attack or a stroke following the procedure. |
Table of complications
| Complication | Rate after angiogram (%) | Rate after angioplasty (%) |
| Haematoma (requiring surgery, transfusion or delaying discharge) | 3.0 | 4.0 |
| Occlusion of vessel (at puncture site) | 0.5 | 0.5 |
| Pseudoaneurysm | 0.5 | 0.5 |
| Embolism causing tissue damage | 0.5 | 0.5 |
| Unintended occlusion of a selected vessel (not related to puncture site) | 2.0 | 3.0 |
| Vessel rupture/perforation (needing surgery) | - | 0.5 |
| Emergency surgery | - | 3.0 |
Back on the ward
You will be asked to lie still for 2 hours. This will lessen the chances of bleeding from the groin. You will then be allowed to sit for 2 hours before being allowed to walk. During this time you will have your pulse and blood pressure taken every 30 minutes. If you are uncomfortable or in pain let the nursing staff know so that they can give you pain-killers. If you have had an angioplasty, a junior doctor will measure the blood pressure at your ankle. On the day case unit, once the nursing staff are happy with your recovery you will be allowed home. On the other wards you will be allowed home the following morning. An appointment will be made for you meet and discuss the results with your consultant 2 weeks later.
Back at home
For the first day you should rest. From the following day you can resume normal activities. If you have any problems you should consult your GP or come to Casualty at Good Hope Hospital.
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