Upper Limb Angiography Angioplasty +/- Stent Insertion
Date issued: November 2024
For review: November 2026
Ref: B-532/LD/Radiology/Upper Limb Angiography Angioplasty Stent
PDF: UpperLimb Angiography Angioplasty Stent.pdf [pdf] 219KB
This leaflet tells you about having an upper limb angiogram, angioplasty +/- 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 form says that you need to know what risks are involved. 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 angiogram?
An angiogram is a special X-ray examination designed to show the arteries in your body relevant to your problems. A dye (contrast agent), which usually contains iodine, is injected directly into the artery through a fine tube (catheter). The dye fills the arteries and makes them more visible on an X-ray screen.
What is an angioplasty +/- stent?
Arteries can develop a narrowing which is diagnosed with an angiogram. A special balloon called an angioplasty balloon is introduced into the area of narrowing inside the artery. This balloon is inflated from outside the body momentarily and then deflated to improve the narrowing.
A completion angiogram is then carried out to check the result. Once the radiologist is happy that the flow of blood in your artery has been improved then the balloon is removed.
Sometimes a special metal tube called a stent is inserted into the artery. This is permanent and keeps the narrowing open. Stents are generally only used if the balloon does not improve the narrowing satisfactorily or if there is a complication.
Why do you need an angiogram, angioplasty +/- stent?
Your doctor feels that there may be a problem with the circulation in your arm/upper chest.
You may already have had a Doppler ultrasound scan to assess the flow of blood in your arm to help decide how to approach this problem.
What are the risks of an angiogram, plasty, stent?
Angiograms are very safe procedures but there are some risks and complications that can occur. Very occasionally, a small bruise can appear at the site of needle puncture. Less commonly, ongoing bleeding in this area leads to further treatment by the interventional radiologist or a small operation. The risk of infection is very low.
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 have to 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 these procedures?
You will be asked to lie flat on your back. A monitoring device will be placed on your finger and a blood pressure cuff will be place on the unaffected arm. If a sedative is given, you will be given oxygen via a face mask.
The skin on your arm will be swabbed with an antiseptic and you will be covered with sterile drapes. Local anaesthetic will be injected into the skin. A needle, often followed by a fine plastic tube, will then be placed in the artery and dye injected. You will be asked to hold your breath for a few seconds while the images are taken.
Pressure is applied for 10 minutes to the region where the needle/plastic tube was placed 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 +/- stent insertion is not painful although you may occasionally feel a dull ache when the balloon is inflated but this will pass when the balloon is let down.
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.
Expect to be in the radiology department for around an hour and a half.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered and are ready to go home.
However, in certain circumstances you may be required to stay in hospital overnight.
Other Risks
These procedures are safe 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
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 Mon-Sat (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
