Iliac Angioplasty/Stent Insertion
Date issued: November 2024
For review: November 2026
Ref: B-523/LD/Radiology/Iliac Angioplasty/Stent Insertion
PDF: Iliac Angioplasty and Stent Insertion.pdf [pdf] 209KB
This leaflet tells you about having an angioplasty and/or stent insertion. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure. Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests
What is an angioplasty?
An angioplasty is a way of relieving a narrowing or blockage in a blood vessel without having an operation. A thin plastic tube (catheter) is inserted into the artery and passed through the blockage.
A special balloon on the end of the catheter is placed across the narrowing or blockage. This balloon is inflated from outside the body momentarily and then deflated to improve the flow of blood through the vessel. Once the flow in the artery has improved then the balloon is removed.
What is a stent?
A stent is a special device made of metal mesh that is placed across a narrowing or blockage to keep the artery open.
Why do you need an angioplasty/stent insertion?
Your doctor has identified that there is a narrowing or blockage in one of your blood vessels that is causing you a problem. If the arteries in your legs are affected, this may be causing pain in your hip, buttock, thigh or calf. This may occur after you have walked a certain distance.
Other tests such as a Doppler ultrasound scan, a CT or MRI scan may have already been performed.
Are there any risks?
Angioplasty is a very safe procedure and is normally carried out with no significant side effects at all. Sometimes it may not work and clear your symptoms. As with any medical procedure, there are some risks and complications that can arise. A small bruise (haematoma) around the site of the needle can occur, but this is quite normal. The bruise might be sore for a few days but will disappear in a few weeks. Rarely a large bruise may develop and require a small operation to drain it.
Occasionally, a tender pulsating swelling called a false aneurysm may develop over a few days due to ongoing leakage from the arterial puncture site. This can usually be treated by an injection of a blood-clotting agent under ultrasound guidance.
Very rarely, some damage can be caused to the artery by the catheter or by displacement of the material causing a blockage in other arteries (an embolus/clot). This may require a small operation or another procedure.
Very rarely an arterial injury/tear can occur resulting in bleeding. This can result in a stent being placed across the bleed site and a longer hospital stay.
Blockage of the arteries to the legs can occur, resulting in an operation and very rarely leg amputation may occur.
Some complications can be life threatening and although rare death should also be considered as a risk of this procedure.
The dye (contrast agent) used during the procedure is very safe, but occasionally can cause damage to the kidneys. This occurs mainly in patients whose kidney function is abnormal already and this will be identified on the blood tests that are performed before the procedure. Allergic reactions to the dye are also possible but are very rarely serious.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
An angioplasty is usually carried out as a day case procedure under local anaesthetic. You may eat and drink as normal unless sedation has been discussed beforehand with the referring team/radiologist.
Before coming into hospital, you will have been asked about certain risk factors for vascular disease, unless you come into hospital as an emergency. These factors include checking your blood pressure; your kidney function and making sure you are not on treatment for diabetes or blood clots.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you are diabetic, your doctors will advise you about any changes needed to your normal medication. If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) may be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the angioplasty.
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised x-ray equipment has been installed.
What happens during an angioplasty?
Before the angioplasty, the Interventional 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 can decide against going ahead with the procedure if you so wish.
You will be asked to lie on the x-ray table, generally flat on your back. The x-ray machine will be positioned above you. You may have monitoring devices attached to your chest and finger and may be given oxygen.
An angioplasty is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure.
Your skin near the point of insertion, usually the groin area, will be swabbed with antiseptic and you will be covered with sterile drapes. The skin and deeper tissues over the blood vessel will be numbed with local anaesthetic.
A needle followed by a wire and catheter (fine plastic tube) will be inserted into the artery and guided to the correct position to obtain the images required. Once the narrowing or blockage has been identified, a balloon is inflated to open up the artery and allow more blood to flow. Occasionally, the Interventional Radiologist will decide to place a stent (metal mesh) to keep the artery open. This is placed in exactly the same way as the balloon.
Once the Interventional Radiologist is satisfied with the images, the catheter will be removed.
A special device may be used to close the hole in the artery. There are different devices, one is a suture with a collagen plug (which may feel like a pea sized lump under the skin) which dissolves and disappears over a few weeks. Another places a stitch in the artery wall, which is not visible and does not need to be removed. If a closure device is used, then it can allow you to get up and about more quickly.
Sometimes a closure device is not used or cannot be used, in which case the Radiologist will apply firm pressure close to the skin entry point, for about 10 minutes, to prevent bleeding.
Will it hurt?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine. Angioplasty is not painful although you may feel a little discomfort when the balloon is inflated.
How long will it take?
Every patient's situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Some angiograms, for example those looking at the large arteries in the legs, are generally straightforward and do not take very long, perhaps half an hour. Other angiograms, looking at smaller arteries, may be more complex and take longer, perhaps over an hour. As a guide, expect to be in the x-ray department for about an hour and a half altogether.
What happens afterwards?
You will be asked to lie flat, and your nurse will instruct you on how long this will be. Observations and the groin site will be checked frequently in the first few hours. You must not lift your head off the pillow or sit up for the first 2 hours. You must not bend the leg where the puncture was performed or cross your legs whilst on bed rest.
You must tell your nurse immediately if you notice any of the following: increased pain, bleeding/swelling/bruising of the groin, numbness/tingling of the affected leg.
The first time you get out of bed you must mobilise gently and make sure you support the groin with your hand if you move, sneeze or cough.
In certain circumstances you may be required to stay in hospital overnight.
You will need someone to drive you home and ensure that an able-bodied person remains with you until morning.
Other Risks
Angioplasty is a very safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. x-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~ 1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of x-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Recommendations following Angioplasty
Smoking: If you were a smoker before the procedure you should try to give up as smoking can affect the success of the procedure.
If you would like help to give up smoking, please telephone One You Plymouth, Stop Smoking on 01752 437177
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Monday to Saturday (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
