What should I do to prepare for my procedure?
What is my expected recovery time and will I have any
activity restrictions?
Will the procedure be painful?
What is conscious sedation?
What are the risks of my procedure?
What happens after I check in at the hospital?
What is an angiogram?
What is an angioplasty?
Why do I need an angiogram, angioplasty and/or stent?
What signs should I watch for, following the procedure,
which may indicate a problem?
What is peripheral vascular disease (PVD)?
What are the symptoms of PVD?
What are the risk factors of PVD?
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What should I do to prepare for my procedure?
- Your doctor needs to know if you have had an allergic reaction to
contrast (Xray Dye or IVP Dye) or iodine. (If you have, you may need
to take special medication, (prednisone), 24 hours prior to your scheduled
exam.
- If you are diabetic and on insulin: Since you will not be eating your
usual diet, your doctor should inform you to adjust your insulin dose
the morning/day of the exam. You should not have solid food 6 hours
prior to your procedure and clear liquids only, 2 hours prior to the
procedure.
- If you take glucophage/glucovance, you can take this the day of the
exam, but you will be instructed not to take it for 2 days following
the exam at which time you will be asked to get a blood test, (creatinine
level). After your physician has seen these results he/she will inform
you as whether to resume your medication.
- If you are a chronic renal failure patient on dialysis, you will need
to have your potassium, P.T., and INR drawn minimally 1-4 hours before
some procedures.
- Prior to the examination, the physician requesting the procedure will
order blood tests to assess your kidney function and to check your blood's
ability to form a clot, (creatinine, PT/INR and platelets).
- You will need to have someone to drive you home.
- Your doctor needs to know if you are on any blood thinning medicine(e.g.
coumadin, warfarin, plavix, aspirin.).
- Your doctor will advise you as whether to stop taking this medicine
for a certain time period prior to your procedure. Do not stop a medication
on your own! Your doctor needs to advise you when to stop taking them,
if this is unclear please call your doctor.
- You will be asked for a current list of all your over the counter
and prescription medicine. Better yet, bring all the prescription medicines
with you. It is much less expensive to take your own medication if your
regularly scheduled dose comes up while you are still at the hospital.
- Do not eat any solid foods for six hours before your procedure.
- You may have clear water, black coffee or tea, white grape juice,
or ginger ale until two hours before your procedure.
- You may take all of your routine medications with a sip of water.
If you are a diabetic, please consult with your doctor about the amount
of insulin during the time you are not eating.
- You must have a responsible adult available to drive/escort you home
from the hospital.
- If conscious sedation has already been planned for you, you can expect
a phone call from one of our radiology nurses. They will review these
instructions and answer any questions that you may have about the sedation
or the procedure itself. They will also ask you some important health
related questions as they develop an individualized plan of care for
you.
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What is my expected recovery time and will
I have any activity restrictions?
- Recovery will vary with the type of procedure. In general we require
a minimum of 2 hours of observation following IV sedation.
- Following an arteriogram patients will be at bed rest for at least
4-6 hours while keeping the extremity that was punctured straight. Patients
are then be allowed to walk and observed for an additional hour. If
there are no signs of bleeding at that time patients are discharged
home. For the next 48 hours patients should not lift more than 5-10
lbs., minimize use of stairs and bending at the hip such as in picking
things up from the floor. Any straining such as vomiting, coughing,
forced bowel movements, could dislodge the clot that forms to seal the
artery and cause bleeding.
- It is usually safe to resume any blood-thinning medications within
24 hours, however you should ask the physician performing the procedure.
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Will the procedure be painful?
- The doctor will give you local anesthesia in the skin at the site
of entry into the blood vessel. A small nick, (about the size of a pencil
tip,) will be made in the skin, through which the procedure will be
done. The radiology nurse will also give you some medication, (usually
a Valium-like medication: “Versed®” and a morphine-like
medication: “Fentanyl”,) through your IV to help you relax,
(“Conscious Sedation,”) You will not be put to sleep, but
we will make you comfortable and relaxed while you maintain breathing
on your own.
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What is conscious sedation?
- Conscious sedation is a type of anesthesia in which the patient is
given medication to produce a sleepy & relaxed dreamlike state.
It is safer than general anesthesia. The most frequently used drugs
are a Valium-like medication: “Midazolam (Versed®)”
and a morphine-like medication: “Fentanyl.”
- This conscious sedation will be administered through an intravenous,
(IV,) line by a specially trained radiology nurse. Its purpose is to
relax you during your procedure and to reduce perception of any discomfort
that you may experience. If you have an allergy to either of these medications,
please let your doctor know.
- You will be drowsy, but will remain conscious and able to speak and
follow directions throughout your procedure. Your blood pressure, blood
oxygen level, heart rhythm and breathing rate will be continually monitored
throughout the procedure.
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What are the risks of my procedure?
- Any medical procedure has inherent risks. The decision to perform
a given procedure is based upon consideration of the risks and the benefits.
In almost all instances and certainly all elective procedures, the potential
benefits should far outweigh the risks. The relative risks may vary
between patients depending on general health, underlying diseases and
medications being taken.
- Most common general risks include:
- Any procedure which breaks the skin carries the risk of infection.
This may manifest as local wound infection to severe life-threatening
internal infection. Great care is taken to avoid infections as procedures
are performed under sterile conditions.
- In general the pain experienced varies with the type of procedure.
Individual patients may also have different expectations and responses
to pain. Nearly all procedures utilize Lidocaine local anesthetic
which, once injected, blocks perception of sharp pain and temperature.
Patients can expect to continue to feel pressure such as pulling
and pushing.
- Inherent in any procedure which breaks the skin is the potential
to cause bleeding. Bleeding can range from oozing of the incision
or under the skin, (“hematoma”), to massive life-threatening
hemorrhage. Again, relative risks vary with the type of procedure
and underlying medical conditions and medications being taken
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What happens after I check in at the hospital?
- You will be directed to McClure 1 Radiology Department.
- Your family members will be asked to wait in the waiting room while
the nurse prepares you for your exam. You will be able to see your family
member before the start of the procedure.
- The nurse that is working in the Pre-Procedure Holding room will escort
you to where you will change into a hospital gown and an intravenous(IV)
line will be placed in one of your veins. This will be used to give
you fluids and medications during the procedure. The IV will stay in
place until after your procedure is completed.
- They also will take a brief Medical History to include any past medical
problems/surgeries. Write down a complete list of medications. A member
of the Interventional team, (physician or Nurse Practitioner,) will
talk to you about the procedure, explaining the benefits and risks and
give you the opportunity to answer any questions you may have.
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What is an angiogram?
- A small needle is used to access the blood vessel. A wire is placed
through the needle and the needle is removed so there is nothing sharp
in the body. A small catheter, (tube,) is inserted into the artery through
a small incision and used to inject contrast, (dye,) into your blood
vessels to make them visible on X-ray. The contrast may make you feel
warmth and heat in the area in which the contrast dye is injected. The
contrast dye allows the radiologist to see narrowings/blockages in your
blood vessels. If a narrowing is identified you may be benefit from
a balloon angioplasty to re-open thevessel. If not, at the very least
your surgeon will have a road map of your vessels which can be used
to guide bypass surgery.
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What is an angioplasty?
- An angioplasty is a procedure that opens up blocked blood vessels
without surgery. A specially trained physician, known as an interventional
radiologist, can perform this procedure in the radiology department.
During the procedure, the interventional radiologist places a catheter,
(a small tube,) into a narrowed artery. There is a balloon on the end
of the catheter. When the balloon is in the area of narrowing, the balloon
is inflated. Inflating the balloon stretches the artery to a more normal
size, thereby improving blood flow to the area supplied by the blood
vessel. Fluoroscopy, (low energy x-rays,) and contrast, (X-ray dye,)
are used to help guide the catheter into the correct area for the angioplasty.
- The doctor may also be need to place a stent, (wire mesh tube,) to
help keep the blood vessel open.
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Why do I need an angiogram, angioplasty and/or
stent?
- The most common reason for an angioplasty is to open a narrowed artery
caused by atherosclerosis (“hardening of the arteries”).
Atherosclerosis causes fatty/cholesterol deposits, (plaque,) to build
up on the inside of your arteries. These plaques often calcify (collect
calcium deposits,) and become firm.
- Arteries carry blood and oxygen to all the tissues of your body. When
an artery becomes narrowed, the tissues supplied by that artery do not
get enough oxygen. The symptoms you feel depend on which artery is blocked.
For example, a blocked artery in the legs may cause persistent ulcers,
pain when you walk a certain distance or even when you are resting in
bed. A blocked artery to a kidney may cause high blood pressure. Some
blockages are better treated with surgery and others are better treated
with angioplasty and/or stent placement. In many cases, angioplasty
or stents can open up the artery that is blocked. This can relieve your
symptoms as more oxygen will be delivered to your tissues.
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What signs should I watch for, following the
procedure, which may indicate a problem?
- The amount of discomfort will vary with the type of procedure you
have. In most cases, it is normal to have a soreness at the point of
entry into the body. Often this is relieved by non-prescription medication
such as Tylenol or Motrin. Discomfort is usually worse within the first
48 hours following the procedure. Some signs to watch for include progressively
worsening pain, bleeding at the point of entry or fever/chills.
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What is peripheral vascular disease (PVD)?
- Peripheral vascular disease, or PVD, is a condition in which the arteries
that carry blood to the arms or legs become narrowed or clogged. This
interferes with the normal flow of blood, sometimes causing pain, especially
with exercise of the arm or leg, but often causing no symptoms at all.
If you have PVD, you are more likely to have heart disease and stroke.
- The most common cause of PVD is atherosclerosis (“hardening
of the arteries”). This disease of the blood vessels causes formation
of deposits called "plaque" that narrow the blood vessels.
These plaques are the result slowly progressive blood vessel injury
caused by cholesterol deposits and scar formation. Interventional radiologists
may treat blockages with techniques called angioplasty and thrombolysis.
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What are the symptoms of PVD?
- The most common symptom of PVD is painful cramping in the leg or hip,
especially while walking. This phenomenon is called "claudication."
Claudication occurs when there is not enough blood flow to muscles to
meet their metabolic demands. The shorter the distance you can walk
before developing pain, the more severe the vascular disease. Typically
the pain will subside with rest.
- PVD is often not recognized because patients attribute the symptoms
to signs of normal aging or they do not tax their muscles enough to
cause symptoms until the disease if far advanced.
- If you are experiencing any of these symptoms please contact your
physician:
- PVD Symptoms
- Leg or hip pain during walking and relieved at rest
- Numbness, tingling or weakness in the legs (may also be caused
by vertebral disk disease)
- Burning or aching pain in your feet or toes when restingNon-healing
ulcer on your leg or foot
- Cold legs or feet
- Color change in skin of legs or feet
- Loss of hair on legs
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What are the risk factors of PVD?
- Important risk factors for PVD:
- Age over 50 yrs
- Smoking
- Diabetes
- Obesity
- Lack of exercise
- High cholesterol
- High blood pressure
- Family history of PVD / heart disease
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