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Date issued: November 2023

Review date: November 2025

Ref: A-89/S/V/CC/Angioplasty v4

PDF:  Angioplasty and stent.pdf [pdf] 159KB

Angioplasty/stenting is a procedure to treat narrowing or blockage of a blood vessel (artery). This uses either a balloon to stretch the artery (angioplasty) or an expandable metal mesh (stent) to hold the artery open.

Why do I need an angioplasty/stent?

Patients who have been referred for this procedure generally have symptoms due to narrowing or blockage of the arteries.

The purpose of the procedure is to improve the blood flow to help relieve any symptoms you are experiencing.

You will have seen a Vascular Surgeon (specialist in the treatment of diseases of blood vessels) who has referred you for this procedure.

What does the procedure involve?

The procedure is performed in the Vascular X-ray department by a Radiologist (X-ray doctor). Local anaesthetic is used to numb the skin and a small tube is placed in the artery in the groin. This is the only uncomfortable part of the procedure.  Occasionally, it may not be possible to use the groin artery, in which case the artery in the elbow is used. A series of pictures are then taken of the arteries by injecting x-ray dye (contrast) into the tube. The contrast will give you a warm feeling each time it is injected and may give you the feeling of passing water.  Do not be alarmed, this is normal. Under x-ray guidance a fine wire and tube are passed through the narrowing or blockage in the artery. A special tube with a balloon on the end of it is passed across the narrowing or blockage and the artery is then stretched by inflating the balloon. The balloon is then deflated and removed from the artery. 

Further pictures are taken to check if the angioplasty has been successful. The angioplasty may need to be repeated.  If the angioplasty fails to improve the blood flow then, in certain instances, an expandable metal mesh (stent) can be placed in the artery. Once the stent is in place it cannot be removed and will eventually become covered by the lining of the artery. 

How long does it take?

The procedure generally takes between 30 minutes to 2 hours to perform. At the end of the procedure the tube will be removed and the doctor or nurse will press over the puncture site in the groin or arm for 10 minutes until the artery stops bleeding or a device called an Angioseal may be placed. If this is the case, further puncture of that particular artery should not be performed for 3 months.

What happens after the procedure?

Once the bleeding has stopped, you will need to remain flat in bed for a period of some hours before being allowed to sit up. A nurse will escort you back to the ward after the procedure.  It is important for you to lie relatively still during this time to prevent the artery from bleeding again.

Are there any risks with the procedure?

There are potential complications associated with every procedure. The overall risk of the procedure is extremely low. The potential risks can be divided into the following categories:

At the puncture site

• Some bruising is common after an artery puncture.

• Very rarely, significant bleeding from the artery or blockage of the artery can occur. Although the risks overall to this type of procedure are extremely low (less than 1%), and our record in this unit is excellent, it must be appreciated that it is a form of operation. There is a tiny risk of the arteries blocking and despite all efforts this could result in the loss of a limb or even, very rarely, death.

Related to the contrast

• Some patients experience an allergic reaction to the X-ray contrast.  In most cases this is minor but very rarely (1 in 3000) a reaction may be severe and require urgent treatment with medicines.

• The x-ray contrast can, in some patients, affect the kidney function. If you are likely to be at risk of this, special precautions will be taken to reduce the chances of this problem occurring. If you are a diabetic on Metformin tablets, you should not take this on the day of the procedure and for 48 hours after the procedure.

Related to the treatment

• Vessel blockage can occur after angioplasty of a narrowed artery. It can sometimes be treated with a stent.

• Vessel rupture following angioplasty occurs infrequently. This can sometimes be treated in the x-ray department by putting a stent with a covering around it (stent-graft) into the artery to seal the tear. If this is not possible, an urgent operation may be required to repair the artery.

• Small fragments from the lining of the artery can occasionally break off and lodge in an artery below the angioplasty site (distal embolisation). This may also require an operation to 'fish out' the fragment if it is causing a problem with the blood flow.

The overall risk of requiring an emergency surgery is low (1-2%)

Other complications

• If the artery in the elbow is used, the tube will pass one or more of the arteries supplying the brain. There is a very small risk that a blood clot could form and cause a stroke (1-2%).

How successful is angioplasty and stenting? 

Angioplasty/stenting is successful in treating the narrowing/blockage of the artery in the vast majority of patients (over 70%). In the small number of patients in whom the procedure is unsuccessful, a surgical bypass operation may be offered as an alternative.

What happens next?

You will be sent an appointment for the pre-clerking clinic where specialist nurses will assess you a few weeks before you have the procedure. This is to check that you are fit enough to have it and to take some blood for routine tests. This will also give you the opportunity to ask any further questions you may have.

Is there anything I can do to help?

You cannot do anything to relieve the actual narrowing or blockage. However, you can improve your general health by taking regular exercise, stopping smoking, reducing the fat in your diet, and taking any prescribed medication regularly. These actions will help slow down the hardening of the arteries which caused the problem in the first place and may avoid the need for further treatment in the future.

Further help is available locally from the Smoking Advice Service Tel: 0300 123 1044

Contact details

Vascular Surgical Unit

Surgical Directorate

Plymouth Hospitals NHS Trust

Derriford Hospital

PL6 8DH

Tel 01752 202082

Consultant Vascular Surgeon and Lead Clinician

Mr Devender Mittapalli

Secretary: 01752 431822

Consultant Vascular and Transplant Surgeon

Mr Jamie Barwell

Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry RN

Secretary: 01752 431822

Consultant Vascular Surgeon

Miss Catherine Western

Secretary: 01752 431805

Consultant Vascular Surgeon

Lt Col Robert Faulconer

Secretary: 01752 431805

Consultant Vascular Surgeon

Mr Hashem Barakat

Secretary: 01752 431822

Vascular Scientists

• Mrs J George
• Mr A Ellison
• Mr R Craven

01752 439228

Vascular Nurse Specialist

Mr Alan Elstone

01752 431805

Matron

Judy Frame

01752 431847