Peripheral Revascularization/Stenting

Why are you being sent for peripheral revascularization/stenting?

A peripheral angiogram is a test that directly looks at the peripheral arteries (those that supply blood to your arms and legs).  For patients that have a high suspicion of blocks or obstructions in these vessels with associated symptoms, it may be necessary to directly visualize inside of these arteries.  An “angiogram” is considered the “gold standard” to evaluate the severity of arterial obstruction.  All patients would have had non-invasive testing (arterial Doppler and likely MRI/MRA) that suggests blocks in these arteries. Common symptoms that suggest blockage include pain or cramping of the legs or thighs while walking, early fatigue of the legs or arms with use, or in extremely severe cases pain at rest with discoloration of the limbs or none healing ulcers. The obstructed vessel may be able to be opened with the goal of eliminating or improving symptoms.  Difficult to control hypertension (high blood pressure) can be caused by obstructions of the arteries that supply the kidneys called renal artery stenosis.  If decided that these vessels need to be opened, the vessel can usually be opened by angioplasty and stenting.

How does the peripheral angiogram or peripheral stent work?

You will be given intravenous medication (similar to Valium) to make you comfortable and relaxed during the procedure. The area where the catheter will be inserted is anesthetized. A small puncture is made in the artery and a small tube or introducer sheath is placed in the artery. A catheter passes through the sheath and is guided up into the major leg or arm artery, abdominal aorta, renal artery, or carotid artery. X-ray dye is injected through the catheter and x-rays of the arteries are taken. In an angioplasty, a balloon tipped catheter is inserted into the artery until it reaches the blockage. The balloon is then inflated to compress the fatty deposits. Sometimes special techniques such as rotational atherectomy and laser atherectomy may be required in difficult cases to successfully open the vessel because of severe, hard or calcified cholesterol plaque that prevents the balloon from adequately expanding.  When a stent is placed, it is placed at the area of blockage generally after a balloon tipped catheter has opened the vessel.  After the stent is fully expanded, the balloon tipped catheter is removed and normal blood flow can be restored. The stent remains in the artery permanently.

How does this procedure get set up?

When your cardiologist decides with you that you need to have an angiogram and possible peripheral revascularization procedure, a time is scheduled at the hospital for the procedure.  Our office schedulers will try to arrange a time at the hospital that is convenient for you.

How to prepare for the peripheral angiogram and possible revascularization?

• We ask that you consume nothing by mouth (NPO) after midnight prior to the procedure other than prescribed medication with a small quantity of water. 
• Diabetic patients:  If on insulin: Take ½ dose of prescribed dose night before and morning of the test. If taking oral (by mouth) diabetic medications: No oral diabetic medications on the day of the procedure.  After the completion of the procedure, you will be able to eat and drink, and at that point diabetic patients can return to normal doses of your diabetic medications except Metformin (Glucophage) or combination medication that includes Metformin, as this medication must be restarted 2 days later. 
• We ask that you come with someone that can drive you home or at least have someone prepared to pick you up without planning on driving yourself home because of the effect of sedative medication that you will receive. 
• Report all allergies to your doctor before you come. Since contrast contains iodine it is important to report any allergies to x-ray dye or shellfish. If you are allergic, the catheterization can be safely performed but additional medications may need to be given prior to the test to decrease the chance of any reaction.
• Standard blood tests will be sent prior to the test.
• Please remind us if you have any kidney problems that we should know about.
• The test is performed on the ground floor of the Inova Fairfax Hospital Heart and Vascular Institute.

After the Procedure

After the diagnostic angiogram, you may go on to have a balloon angioplasty or stent and then will have the catheter removed.  A small seal may be inserted to help close the hole made in the artery or direct, firm pressure may also be applied to the puncture site. You will be watched for bleeding and discharged home the same day. You may notice a bruise or small lump in the groin or arm area where the puncture was made. This is normal unless the area increases in size or you experience progressive discomfort.  Make certain to continue your discharge medications indefinitely, especially Plavix and aspirin, unless specifically told otherwise by your cardiologist.

IF YOU EXPERIENCE ANY OF THE FOLLOWING CALL IMMEDIATELY:

• Numbness or pain in the arm or leg where the procedure was done
• Difficulty breathing
• Chest or back pain
• Palpitations or irregular heart beat
• Bleeding at the insertion site
• A fever with temperature > 101.5 F
• Warmth, tenderness or redness around the incision

You may return to usual activities in 1-2 days. Do not push or lift more than 10 pounds for at least 1-2 weeks after the procedure unless told otherwise. Ask the doctor if you have further questions.