• Reference Number: HEY1240/2021
• Departments: Radiology
• Last Updated: 30 June 2021

Introduction

This leaflet has been produced to give you general information about having a peripheral angiogram.  Most of your questions should be answered by this leaflet.  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 any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is an angiogram / angioplasty?

An angiogram is a test of mapping the blood vessels using an X-ray machine.  It is done to find out if your blood vessels are diseased. It is performed in a special X-ray room which looks like an operating theatre by a radiologist who is a doctor that specialises in reading X-rays and performing keyhole treatments under X-ray guidance. An angioplasty is a treatment whereby the doctor uses specialised devices (balloons or stents) to stretch open a narrowing in the artery.

Why do I need an angiogram / angioplasty?

Arteries supply blood to the organs and muscles in your body. An angiogram allows the doctor to see if there is a blockage or narrowing in a blood vessel that may interfere with the normal flow of blood though the body. These arteries can become partly blocked or completely blocked from a build-up of cholesterol cells or other material. This therefore reduces the blood flow to part of your body supplied by those arteries e.g. your legs. An angiogram will provide your doctor with information to see if you need treatment such as angioplasty, bypass surgery or whether you can be treated with tablets.

Your doctor may recommend an angiogram to diagnose a variety of problems with blood vessels including:

• Blockages of the arteries outside of your heart, called peripheral vascular disease
• Enlargement of the arteries, called aneurysms
• Abnormally formed arteries, called vascular malformations
• Conditions of the arteries within the abdomen

Can there be any complications or risks?

An angiogram is generally a safe procedure, however there are some risks and potential complications:

1. Bruise – This can occur around the site where the needle has been inserted into the artery. This is relatively common and is normal. You may also be tender in this region for a couple of days.
2. Haematoma – if there is bleeding from the area where the catheter was placed, you may have a patch where blood collects under the skin called a haematoma. This usually clears up on its own.
3. Pseudoaneurysm – Rarely a pulsating lump develops in the groin at the site of the puncture. This is because bleeding occurred after the catheter was removed. The bleeding caused a small sac on the side of the artery via the hole made in the artery. This lump is connected to the artery and therefore has a pulse. The sac is called a false aneurysm. If the sac is above a certain size it is treated by a simple injection into the sac to block the small hole connecting it to the artery. Occasionally, this might require minor surgery to close the hole.
4. Infection- There is a risk of the puncture wound becoming infected. This can be treated with antibiotics
5. Reactions to the dye – This is very uncommon. Various reactions and allergies can occur. The staff are fully trained and equipped to deal with such reactions. Reactions that can occur include rash, vomiting, asthma, disturbance in heartbeat and kidney damage. If you have had a reaction to the dye in the past please bring it to the notice of the team.
6. Failure to do the procedure – As with any procedure, there is always a risk attempts may fail.
7. Embolism or dissection – Occasionally damage to the artery occurs as a result of the passage of the instruments. This can result in bits of fatty material or blood clot being dislodged and blocking the artery further down the leg, or a splitting of the layers of the artery wall causing a blockage of the artery. These rare complications can normally be resolved by small procedures undertaken through the catheter but rarely a surgical operation will be required to restore blood flow.

How do I prepare for the angiogram / angioplasty?

Please read this information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

The procedure is carried out under local anaesthetic in the Radiology Day Unit at Hull Royal Infirmary, usually via a vein or artery in your groin. There are no specific preparations that you need to undertake and you may eat and drink normally prior to the procedure.

You will need to alert the staff of any allergies you have and they will need to know a list of your current regular medication.  Please inform the staff if you take any medication to thin your blood as this may need to be omitted for a day or two prior to your procedure.

The doctor or nurse may put a small plastic tube (cannula) into your arm in case you need any drugs during the procedure.

What will happen?

You will be asked to attend the Radiology Day Unit on the second floor at Hull Royal Infirmary and the procedure will be performed in the Radiology Theatre.  This is similar to an operating theatre where special X-ray equipment has been installed.

You will have preliminary checks made by a radiology nurse such as blood pressure reading and arrangements for who to contact to take you home.

You will meet the Interventional Radiologist who is a doctor with special expertise in reading X-rays and using these to guide catheters and wires within arteries or veins to aid treatment.  The radiologist will explain the procedure and ask you to sign a consent form.  Please feel free to ask any questions that you may have and remember that, even at this stage, you may decide against going ahead with the procedure if you so wish.

You will be asked to change into a hospital gown. You will lie on your back on the X-ray table and you will be attached to a monitor to check your blood pressure and oxygen levels.

The skin around the groin will be cleaned with antiseptic (this can sometimes feel cold but will not be painful).  The rest of your body will be covered by a large sterile sheet. The radiologist will inject a local anaesthetic into your groin (or sometimes your elbow) to make it numb. The radiologist will then make a small nick in the skin. A needle is then inserted into the artery. A fine plastic tube called a catheter is then placed over the wire and into the artery. The radiologist will watch all of this on a tv-like monitor. A special clear X-ray dye called contrast, is then injected through the catheter.  This dye allows the blood vessels to be visible on the X- ray and will show up any narrowed areas or blockages in the artery. The radiologist will then take the required X-rays. You may be asked to hold your breath for 5 -15 seconds while some of the X-rays are taken. If you wish, you may be able to see the X-ray pictures on the screen during or after the test.

When the radiologist has the information required following the pictures being taken, they may decide to proceed immediately to perform an angioplasty. The radiologist will use equipment through the same entry point in the skin to insert the necessary equipment to stretch open the narrowing’s in the blood vessels.  They will explain this to you as they go along, as each procedure is slightly different. This should not be a painful procedure but you must tell the staff if you feel any pain at all and this will be dealt with accordingly.

When the radiologist is satisfied that your treatment is completed, they will remove the tube from your groin. The radiologist will either press firmly on the skin entry – site for several minutes or place a small plug into the artery where the needle punctured the artery.  This is done to prevent any bleeding from the artery, although you might have a small amount of bruising in the groin.

The radiologist will write a report to your referring doctor detailing all findings and any treatment performed. The report is usually available immediately in urgent cases or within 14 days of the procedure in elective (non-urgent) cases.

Is it painful?

When the local anaesthetic is injected into the skin you may feel some discomfort like a bee sting. After this, the procedure should not be painful but you may have the sensation of gentle pushing and pulling in your groin. There will be a nurse standing nearby looking after you during the procedure. If the procedure becomes painful, please inform the nurse or doctor so that they will be able to give you a pain relief medication. As the dye is injected into the arteries you may feel hot (usually only lasts 20 seconds), a flushed sensation from the dye or the urge to urinate.

What happens afterwards?

You will be taken out of the X-ray theatre onto a trolley in the Day Unit recovery area. The nurses will carry out regular observations such as pulse and blood pressure measurements, to ensure that there are no problems after the procedure. They will also look at the skin entry site in your groin. You will have to stay in bed for a few hours after the procedure. If you need to stay overnight, you will be transported to the hospital ward at this time. During your recovery period, you should keep the leg or arm that was punctured still to reduce bleeding from the puncture site. You will be advised when you can sit up and then walk about.

You will be allowed to leave hospital on the same day if you are a day patient, or the next day if you are kept in overnight. You should not drive immediately after an angiogram.  You should arrange for someone to take you home. You may resume normally activity 2-3 days after the procedure.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to Interventional Radiology Department (01482) 675667

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.