Peripheral angiography and/or peripheral angiogram is a diagnostic study, not an operation, performed to look at the arterial blood flow from your lower abdomen and down each of your legs. During the procedure a catheter (small, thin hollow tube) is inserted into an artery or vein and passed down your legs. Through this catheter, radiographic contrast material, or dye, is injected into the peripheral arteries.
When injected, the contrast material mixes with the blood in the arteries allowing the doctor to visualize the blood flow through the arteries. The dye may cause some discomfort when injected throughout the legs. The contrast material is iodine-based: some people have a known allergy to iodine, shellfish, or x-ray dye. If you are one of these people, let your doctor know before the test. Medication can be given to prevent an allergic reaction.
Preparation
You will be admitted to the hospital the morning of your procedure.
Day of the Procedure
Upon your arrival at the hospital, a nurse will check your vital signs (blood pressure, pulse and temperature) and obtain a current height and weight. At this time you will also be asked to put on a patient gown. Typically you will not be allowed anything to eat or drink except your medications after midnight the night before the procedure. The time of your procedure depends on many factors, including doctor availability, room availability and other patients needing emergency treatment.
Pagers are available for family members/significant others, enabling them to have a flexible routine prior to the start of your procedure. (To request pagers, please ask your room nurse.) Medication will be administered before the procedure to help you feel more relaxed, but you will remain awake at this time. You may wear your glasses, dentures and wedding ring.
The Cath Lab
Members of the Cath Lab staff will come to your room and introduce themselves when it is time for your procedure. You will be transported to the Cardiac Cath Lab. Your family is encouraged to accompany you to the floor where they will be directed to the waiting rooms and be regularly updated by the Cath Lab staff; the procedure will take 1 to 3 hours. The Cath Lab is kept cool because the large X-ray equipment and computers require cool air. You will be given warm blankets upon arrival and more blankets are available anytime during the procedure should you become cold.
Upon arrival in the Cath Lab, the table in the procedure room will move under you. It takes 15-20 minutes to prepare for the procedure before the doctor arrives. During this time an I.V. will be started - if not started on the nursing floor, EKG electrodes (patches) are applied and your groin area will be slightly uncovered while it is trimmed. After your groin is trimmed, the area will be washed with a sterile solution, and it is important to keep your hands at your sides. The procedure is done under sterile technique to prevent any possibility of infection. Therefore, you will notice the staff wearing hats, masks, and shoe covers. The doctor and the person assisting will be wearing sterile gowns, gloves, and protective goggles.
Procedure
Your doctor will use a local anesthetic to numb your groin area at the insertion site. The doctor will then use a small needle to puncture the artery that runs down your leg. A short hollow tube called a sheath will then be placed into the artery. You may feel some pressure with the insertion of the sheath into your groin, but it should not be painful.
A catheter will be inserted through the sheath and up to your lower abdomen. At this time, pictures will be taken of your lower abdomen, legs, and possibly the arteries of your kidneys, using contrast material and X-ray equipment. You may feel warmth or cramping in your legs as the pictures are taken, but the feeling will pass, so do your best to remain still. It is important to follow any breathing instructions given by the doctor during the angiogram.
Percutaneous Transluminal Angioplasty (PTA)
Your doctor may recommend a PTA. A PTA procedure improves blood flow to your legs. This is done when an area of narrowing or plaque has been identified. Special supplies are used for this procedure, including a small wire to cross the area of plaque and a catheter with a balloon on the tip to inflate within the area of plaque. The wire and balloon catheters are positioned across the area of blockage and the balloon is inflated, compressing the plaque against the artery wall. It may be necessary to inflate the balloon several times. You may feel pain or cramping in the affected leg but this will subside. The PTA is a success when the narrowed artery has been opened wide enough to allow adequate blood flow.
Stents
Your doctor may choose also to place a stent at the area of narrowing. A stent is a metal coil, slotted or mesh tube that is mounted on a balloon. When the balloon is inflated, the stent expands. When the balloon is deflated, the stent remains expanded, acting as scaffolding to hold the artery open. A stent is permanently in the artery; the lining of the artery will grow over the stent.
After The Procedure
After the procedure, the sheath in your groin may be sutured in place and removed later in the day, or an arterial closure device may be used to seal the artery. When the sheath is ready for removal, a technician or nurse will be applying pressure to that area for approximately 20-60 minutes.
When you return to your room, your nurse will check your blood pressure and the insertion site frequently to be sure there is no bleeding. The nurse will also check the pulse below the site of insertion. You will have an I.V. infusing and oxygen. You may also eat and drink as your physician orders.
The physician requires you to remain flat in bed for a specified length of time. The nursing staff will assist you in turning and/or raising the head of your bed as the physician orders. Your leg needs to remain straight, and if you need to cough, laugh or sneeze, hold pressure over the Band-Aid applied to your groin. If you have discomfort, inform your nurse; pain medications have been prescribed. You may shiver after the procedure; this is normal and usually due to the coolness of the procedure room and the contrast material used.
A bruise or small lump under the skin at the point of insertion is common and will disappear in about one week. Notify the nurse if you feel numbness or tingling down your legs. Also, it is possible that your groin site may bleed after returning to your room. Signs to watch for are painfulness or a warm, wet feeling near the groin site. If you feel this, hold pressure on the site and call your nurse immediately. Your nurse may need to hold additional pressure to your groin or apply a pressure device.
After the procedure, the physician will provide a progress report to your family. Later your doctor will talk with you and your family about the results when you are back in your room, usually that same day.
When you go home : -
Avoid heavy lifting (over 20 pounds) or strenuous exercise for 3 days
You may shower, but do not take a tub bath or swim for one week
Watch the site for signs of infection: swelling, drainage, or tenderness
If bleeding should occur, apply pressure and go to an emergency room or call 911
Do not have a MRI scan within 8 weeks of stent implantation without first discussing it with your physician
Call your doctor if : -
You notice tingling or pain in your leg
Your leg is white in color and cold to touch
Follow Up Visit
You will need to call immediately upon discharge for a follow up appointment with your physician. This visit will help monitor your progress.
Benefits of Peripheral Angioplasty : -
Quicker and less painful recovery
Short hospital stay, does not require general anesthesia
Small incision
Peripheral Angioplasty can be done under local anesthesia
Chances of major post-operative complications are minimized
Risks of Peripheral Angioplasty : -
Allergic reaction to the dye
Ruptured artery
Bleeding and infection at the site of insertion
Arrhythmia
Stroke
Heart attack
Kidney failure
Rupture or dissection of the artery
Re-stenosis
Alternative of Peripheral Angioplasty
Use of clot dissolving drugs or thrombolytic agents - These medications help to burst the clots
Now or Never
Atherosclerosis is a progressive disease. It can affect your arteries supplying blood to your heart, brain, limbs, and other organs of your body. Over time, the inner walls of your arteries become clogged with deposits composed of fat, cholesterol, fibrin (a clotting material found in the blood), cellular waste products, and calcium.
Accumulation of these materials cut down the blood supply to your vital organs thus causing either a heart attack (if coronary arteries are obstructed), painful muscle cramping during exercise or even at rest (if a leg artery is obstructed) and stroke (if a neck artery is obstructed). Performing a timely Peripheral Angioplasty accompanied with positive life style changes prevents risks of having a heart attack, stroke, gangrene, and the morbidity and mortality associated with these conditions. As they say "a stitch in time saves nine"
Decision to have Peripheral Angioplasty
Peripheral Angioplasty has revolutionized the treatment of Peripheral Vascular Disease. Implantation of stents during angioplasty procedure reduces the chances of re-stenosis of the artery tremendously. The procedure of Peripheral Angioplasty is certainly not a treatment for Peripheral Vascular Disease however, accompanying lifestyle changes can definitely reduce your chances of further problems and complications.
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