Patient Information - Renal Angiogram and Angioplasty

'The information contained in this patient information sheet is not a substitute for medical advice or treatment, and the Society recommends consultation with your doctor or health care professional'

1. Why do I need the procedure?

Kidney disease can give rise to high blood pressure and reduced kidney function.
The high blood pressure can in turn be associated with other problems such are heart attacks and stroke.
If the kidney function worsens, you might, in the end, require dialysis to replace your lost kidney function.
The Doctors looking after your kidneys, have asked that you have a special test to look more closely at your kidneys. This might either be because of high blood pressure which is difficult to control, or because of deteriorating kidney function.
It is reduction in the blood supply to the kidneys which can give rise to these two problems. The kidney arteries can become narrowed by atheroma (hardening of the arteries). If this is detected in you, the artery(ies) can be stretched with a balloon (angioplasty) to improve blood flow, reduce blood pressure and maintain better kidney function.

2. What is the procedure?

An angiogram is an Xray of the arteries. It is performed by puncturing the artery under local anaesthetic, and injecting contrast (dye) to outline the blood vessels.
Angioplasty means to stretch the artery with a balloon. The balloon is passed, uninflated, through the artery to the narrow area. It is then inflated to open it up and improve the flow.

3. Before your procedure

Before your angiogram, you will be asked to attend the hospital for pre-clerking. This involves completing the paperwork and doing some blood tests (if required) and an ECG (electrical test of your heart).
The process takes about 90 minutes. You will be given a specific appointment time.

4. Coming into hospital

Please bring with you all the medications that you are currently taking.
When you arrive at the ward, you will be shown to your bed by one of the nurses, who will also complete your nursing record.
You will be visited by one of the Junior Doctors, who will ensure that all the formalities have been completed prior to the Xray.
You will need to starve for four hours prior to the Xray. The staff will tell you when this begins.

5. The Anaesthetic

The procedure is performed under local anaesthetic, sometime augmented by some sedation.
Local anaesthetic is infiltrated into the skin of one groin (usually right) over the femoral artery. The femoral artery can be felt pulsating in the groin. The local anaesthetic stings a little for about 45 seconds, and then you should feel nothing.
If sedation is required, it may be given either by mouth or intravenously. It helps you to relax. If you are nervous, please ask for some.

6. The Procedure

A small nick is made in the anaesthetised skin at groin level, usually about 8mm long (1/3 inch). The femoral artery is punctured with a needle, and a fine wire is passed through the needle up the artery into the artery in the abdomen. A flexible cannula (fine narrow flexible tube) is passed along the wire, and up the artery from groin level to diaphragm level. You don’t feel this at all.
Once the tip of the cannula is in position, the wire is temporarily removed, and contrast (dye) is injected. We can get an outline of the arteries from your diaphragm down to your feet.

As the contrast is injected you might get a warm feeling in your legs. This is transient, and not normally unpleasant.
The contrast will outline the arteries to the kidneys. Usually there is just the one artery to each kidney, but sometimes there may be as many as four. If there is a narrowing in the artery, it will be clearly visible.
Next, the Radiologist will proceed to pass a balloon catheter along the wire from groin level up and just into the narrowed kidney artery. Again you cannot feel this at all. Once in position, the balloon is inflated and the narrowing dilated (angioplasty). Sometimes the dilation is fully successful, but sometimes the narrowing recoils somewhat when the balloon is deflated.
If the dilation is not entirely satisfactory, the Radiologist may place a stent at the point of persistent narrowing. Again you do not feel this at all.
A stent is a tube made of a special metal alloy looking like chicken wire. It is delivered squashed down small, and can be dilated to its maximum diameter with an angioplasty balloon.

The stent is also passed in from groin level over the wire. Once positioned at the point of narrowing, the stent is opened up to a predetermined diameter and holds the kidney artery open.
When the procedure is completed, the cannula and wire are withdrawn. The puncture in the artery must be sealed to prevent bleeding.
Sometimes the puncture will be sealed with a device called an Angioseal. It is inserted as the cannula is removed. It seals the opening in the artery immediately. If an Angioseal is not used, the Radiologist will press on the puncture site with his hand for up to 20 minutes to make sure the puncture seals.
The whole process normally takes between 30 and 90 minutes. You will usually be able to watch what is happening on a TV monitor (if you want to).

7. After the procedure

You will return to the Ward from Xray as soon as the Xray staff are happy that there is no bleeding from the groin puncture.
On the Ward you will stay on bed rest for 12 hours. After this you will be able to get up and walk around. You will be given something to eat later in the day.
Normally you will return home the day after the Xray. Usually a blood test will be done before you leave the hospital.

8. At home

When you get home, there will be some discomfort in the groin for up to a week. Sometimes this is associated with visible bruising.
You can take as much exercise as you like after this procedure as soon as you get home.
The Kidney Doctors will review you as an outpatient within a few weeks of your discharge from hospital.

9. Complications

Wound infection: Wounds sometimes become infected and this may need treatment with antibiotics. Bad infections are rare.
False aneurysm: Sometimes, if the arterial puncture doesn’t seal completely blood leaks out to form a cavity beneath the skin called a false aneurysm. A false aneurysm is associated with discomfort in the groin and a pulsatile lump. False aneurysms are rare (about one in 100).
Major Complications: As with any procedure, there is a small risk of you having a medical complication such as a heart attack, stroke, kidney failure, chest problems, or loss of circulation in the legs or bowel. Each of these is rare, but overall it does mean that some patients may have a fatal complication from their operation. For most patients this risk is about 1% - in other words 99 in every 100 patients will make a full recovery from the operation. The doctors and nurses will try to prevent these complications and to deal with them rapidly if they occur.
If your risk of a major complication is higher than this, usually because you already have a serious medical problem, then your surgeon will discuss this with you.

Simon Parvin
26 September 2004
Version 2004/02/16

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