In our Vascular Cath Lab, diagnosis and prevention of vascular disease take place in a private setting, Recovery takes place in private rooms and most vascular catheterization patients stay fewer than a few hours from start to finish.

FAQs

What are Angioplasty and Vascular Stenting?
 
Angioplasty is a way of opening a narrowed or closed blood vessel without having to do major surgery. Instead, a catheter with a tiny balloon at its tip is inserted into the vessel—usually one of the coronary arteries supplying the heart wall or a major artery bringing blood to an arm or leg. After advancing the catheter until its tip is at the site of blockage, the balloon is inflated and then deflated and removed. The narrowing or blockage most often is caused by arteriosclerosis, or hardening of the arteries, when fatty plaques form on the inner wall of the artery and become larger, gradually cutting down on free blood flow. Expanding the balloon stretches the arterial wall and disrupts the fatty plaques, helping to restore blood flow.

Between 70 percent and 90 percent of angioplasty procedures use a stent, a hollow thin-walled wire mesh tube, to keep the vessel open after widening it. Otherwise, because arteriosclerosis is an ongoing disease, more plaques might form and again limit blood flow. The stent is placed onto the balloon and pressed firmly against the artery wall when inflating it. The balloon then is deflated, leaving the stent in place to act as a scaffold. 

What are some common uses of the procedure?
 
Arteries carry blood and oxygen throughout the body. When a major artery is narrowed or blocked, the tissue it supplies does not get enough oxygen. If this happens in a coronary artery, chest pain—or angina—is the usual result. If in the legs, you may have pain when walking or, in time, even when at rest. A blocked artery to one or both kidneys may cause high blood pressure. If angioplasty succeeds in opening up the artery, more oxygen will get to the tissues and relieve the symptoms. If you have any of these conditions, your physician may want to consult an interventional radiologist to advise you on the best form of treatment. Some blockages are best treated by surgery, and some by angioplasty. The most common uses of angioplasty/stenting are:

• To open a narrowed or blocked coronary artery in patients suffering severe angina, which causes chest pain upon physical effort because part of the heart wall is not getting enough blood. Angioplasty often is used as an alternative to coronary artery bypass surgery, a very major undertaking. It may be done in hope of preventing a heart attack, or afterwards with the goal of preventing another attack.  

• To open up a blocked artery in the pelvis, leg or arm of patients with peripheral arterial disease, also caused by arteriosclerosis. The most common site of angioplasty in these patients is the iliac arteries of the pelvis. Insufficient blood can keep the leg muscles from working properly and make it very painful to walk. Those affected may in time become chair-bound, but angioplasty/stenting can restore their ability to walk. This is especially important for older patients.  

• To control the blood pressure in patients with renal hypertension when disease has narrowed one or both arteries supplying blood to the kidneys. 

• To keep blood vessel grafts open in patients with kidney failure who have regular hemodialysis to prevent waste products from building up in the blood. Most of these patients have a graft constructed between an artery and vein in the arm so that blood can easily be withdrawn and replaced during dialysis. On average, these grafts stay open for about one year. Angioplasty with stenting can prolong their life for as long as three to five years.  

• To maintain vital blood flow to the brain by keeping open the carotid artery, the major route of blood and oxygen to the brain. Angioplasty is most helpful to patients who are not good candidates for surgery. 

How should I prepare for the procedure?
 
A chest x-ray, electrocardiogram, and blood tests are routinely ordered; you may have blood drawn at the hospital or a nearby clinic. You may be instructed to temporarily stop taking certain medications such as those that thin the blood. If you have diabetes it may be necessary to alter your insulin dose on the day of angioplasty. The radiologist or a staff person will ask you to sign a consent form that covers bypass surgery as well as angioplasty, in case complications occur that make emergency surgery necessary. It also will cover angiography, an x-ray study of the arteries involving injection of contrast material.

Make sure that the radiologist knows if you have any allergies so that special precautions can be taken. You will be asked not to eat solid foods after midnight, but may take clear liquids. Smoking is to be avoided the day before the procedure. Shortly before starting, the area where the catheter is to be inserted in the groin or arm will be shaved and washed with antibacterial soap to prevent infection. In addition, you will have a tube placed into a vein in the arm or hand to receive fluids and medicines as needed. The intravenous (IV) line is used to give a sedative to help you relax and possibly make you drowsy. It will stay in place until angioplasty is completed.

What does the equipment look like?
 
Angioplasty, and stent placement when done, are monitored as they take place using high-resolution angiography equipment. Once in a while a different imaging procedure, ultrasonography, is performed in addition to angiography.

The equipment includes a balloon catheter, a small, thin angioplasty catheter with a balloon at its tip, and, in some cases, a wire mesh stent that is collapsed when passed into the artery. Stents come in varying sizes so that in each case it matches the size of the diseased artery. 

How does the procedure work?
 
Angioplasty uses an inflatable balloon that is passed to the target vessel and inflated. When plaque is narrowing the artery and limiting the amount of blood that can get through, the inflated balloon will press it against the side of the artery and stretch the artery wall. The result is that the vessel is restored to its initial size and thus allows more blood and oxygen to pass to the body tissues it normally supplies. Occasionally the plaque will not remain against the inner lining of the artery but goes back to its former position after the balloon is deflated. Another possibility is that a small amount of plaque may continue to block the flow of blood.

In these cases the radiologist may place a stent that is expanded at the site of plaque. The muscle tissue in the vessel wall holds the stent in place. In time, a layer of cells forms over the stent, which in effect becomes a part of the vessel. In some cases the size of the diseased artery and the site of blockage make a stent especially useful. A stent also may be placed to keep an artery open if the inflated balloon has torn or damaged it. Some modern stents are covered with a drug that helps keep the artery open; they seem to improve the long-term success rate. 

How is the procedure performed?
 
The first step is to set up an intravenous line and use it to give a sedative. Then a local anesthetic is injected into the skin where the catheter is to be inserted, usually in the groin. A very small incision is made at this site, and a needle is placed in the femoral artery in the groin. Next, a thin guidewire is placed through the needle and the needle is exchanged over the guidewire for a catheter that is then advanced up into the blocked artery. Occasionally access is gained instead through a large artery in the upper arm. The catheter is guided into the diseased segment of artery while being monitored on a TV screen that shows the artery and the catheter. A small amount of contrast material is injected to show the exact location of the narrowing. The balloon-tip catheter, which is thinner, is then inserted through the guide catheter. When its tip reaches the narrowed part of the artery, the balloon is inflated for about 30 seconds and then deflated. This cycle usually is repeated several times to widen the artery. Finally the balloon-tip catheter is removed and angiography is repeated to make sure that blood flow has improved. This entire process usually takes between one to two hours.

Depending on the result of angioplasty, the site of narrowing, and the physician's judgment, one of two types of stents may be placed. One type is collapsed until very small in diameter and placed over a balloon-tip catheter. Inflating the balloon expands the stent, which locks in place to keep the artery open. The other type is secured to a catheter by a sheath and self-expands when the sheath is removed. Stent placement may be combined with angioplasty or it may serve as an alternative procedure. 

What will I experience during the procedure?
 
When you receive a sedative through the IV line at the outset, you will feel relaxed and sleepy but probably will stay awake throughout the procedure. There should be no pain when the catheter first is inserted into the groin artery, but you may notice slight pressure. You may feel pain briefly in the part of your body closest to the site of angioplasty when the balloon is inflated. This could be chest pain for coronary angioplasty, back pain for renal angioplasty, and buttock pain when iliac angioplasty is performed. After removing the catheter, a sandbag may be placed on the groin area to prevent bleeding. You will have to remain flat on your back and avoid moving your leg or groin for about six hours. Most patients will be able to walk about 12 to 24 hours after angioplasty. Some patients return home the same day, but most stay in hospital for a short time.

On returning home you should take it easy, avoid driving for 24 hours, and drink plenty of fluids. You should avoid strenuous exercise for at least two days. It is best not to take a hot bath or shower for the first 12 hours, and to avoid smoking for 24 hours or longer. If bleeding begins where the catheter was inserted, you should lie down, apply pressure to the site, and have someone call your doctor right away. Any change in color or a warm feeling in this area are also signs that something is wrong, as is pain in the area where the balloon was inflated.

If a stent has been placed, you will be asked to take aspirin or another antiplatelet drug indefinitely, as well as a blood-thinning agent for two to four weeks. Blood tests will be done at frequent intervals during this period to make sure that the blood remains able to clot in event of bleeding. MR imaging should be avoided for a month unless a cardiologist approves the study. Metal detectors will not affect the stent. 

Who interprets the results and how do I get them?
 
The radiologist judges the technical results of angioplasty or stent placement by comparing the pre- and post-procedure angiograms. If any narrowing remains, it should not exceed 30 percent of the normal vessel diameter. The patient can be told of the technical result as soon as the procedure is completed, though it is best to wait until the sedative has worn off. The clinical outcome may take longer to gauge. In the case of angioplasty of the arteries to the kidneys, clinical benefit should be evident in one to four weeks as a fall in blood pressure or the ability to reduce medication to control the pressure.

What are the benefits vs. risks?

Benefits

• Angioplasty, with or without stenting, is much less invasive than open surgery, which in the case of a coronary artery block means a bypass operation. When angioplasty succeeds, major surgery and use of a heart-lung machine are avoided. Overall cost is much less, and the hospital stay is days rather than weeks. 

• Angioplasty and stent placement can be done using only local anesthesia; you will not require a general anesthetic. No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed. You can return to your normal activities shortly after the procedure. Unlike bypass surgery, it is not necessary to remove pieces of blood vessels from another part of the body. 

• Although the results may not be as lasting as those of bypass surgery, angioplasty can restore blood flow to vital tissues and relieve symptoms for some time. Even after bypass surgery, some of the new blood vessels occasionally become blocked. 

Risks

• With angioplasty alone, an estimated one in five to one in three blockages recur in a few days or weeks, though most of these arteries can be successfully dilated again. The chance of this happening is less when a stent is placed.  

• The risk of serious effects from coronary angioplasty is similar to that of surgery. Between one percent and three percent of patients die during or shortly after the procedure. Between three percent and five percent have a heart attack. A small number of patients, fewer than three percent, will require emergency bypass surgery because of damage to the artery wall from balloon inflation. The risk of death and the need for emergency surgery are substantially lower for renal and iliac artery angioplasty and for patients having dialysis graft procedures.  

• You may have an allergic reaction to the contrast material injected for angiography. The risk of this happening is greater in patients with kidney disease, diabetes or asthma and those who have had a previous reaction to x-ray contrast material.  

• Heavy bleeding from the catheter insertion site may call for special medication or blood transfusion.  

• Coronary angioplasty carries a risk of damaging the heart that could disrupt its normal rhythm.  

• There is a risk of stroke when angioplasty is performed on the carotid artery and a stent is placed. This is because a blood clot may form and travel to small brain vessels, where it stops blood flow to brain tissue that requires a steady oxygen supply. 

What are the limitations of Angioplasty and Vascular Stenting?
 
In a small percentage of cases, coronary angioplasty—even with stent placement—fails to increase blood flow and coronary bypass surgery is necessary. Whenever angioplasty is attempted, a surgical team must be available to operate immediately if necessary. Regardless of what artery is blocked, angioplasty does not reverse the underlying disease—arteriosclerosis. The procedure may have to be repeated if the same artery or another one becomes blocked.

Only about half of patients with renal hypertension caused by arteriosclerosis have their blood pressure controlled by angioplasty. By the time the procedure is done, many of these patients have disease in small arteries within the kidneys that cannot benefit from angioplasty. Renal artery angioplasty with stenting causes complications in about 10 percent of patients, though few of them are major. As in coronary angioplasty, the dilated artery may again become narrowed, with hypertension the result.

Angioplasty/stenting for arterial disease in the pelvis and legs is less successful when there are narrowings at more than one level; when small vessels have to be dilated; and when not enough blood gets through the treated segment of artery. Either recurrent narrowing at the site of treatment or progressive arteriosclerosis in an untreated artery may produce symptoms. Any patient with this disease, no matter which arteries are affected, stands to benefit from eating a proper diet, getting regular exercise, and controlling blood cholesterol.

Your Angiogram

What is an Angiogram?

An angiogram is a study of the blood vessels in the body. With the use of x-rays and contrast (x-ray dye), the blood flow in your body will be photograpohed and the doctor can determine if there is a problem with the blood flow.

A blockage of an artery is one of the most common reasons for an angiogram. Other reasons for angiogram are to obtain pictures of your vessels for the surgeon prior to an  operation. Looking for internal bleeding also may be reason for angiogram.

How Do I Prepare For An Angiogram?

There are several things you need to prepare for your angiogram.

• Blood work will be drawn prior to the day of your procedure.

• Do not eat any solid food after midnight. You may have clear fluids with your medicines.

• Take all medicines on the day of you test except if you have diabetes. Check with your doctor about your insulin dose. If you taking Coumadin or Glucophage tell your doctor, these medications will need to be stopped for your procedure. Bring your medicines with you if you are an outpatient.

• If you are allergic to contrast (x-ray dye) or iodine, let your doctors know as soon as possible. 

• If you are an outpatient, you will stay in the hospital for the most of the day. Someone else will need to drive you home and you will need to relax for the next 24 hours.

How is the Procedure Done? 

An angiogram has several steps:

• First the Intervential Radiologist will explain the procedure and answer any questions. If you do not have an IV, one will be started by a nurse. 

• Once in the procedure room you will lay flat on your back. The staff will the prepare your groin for the Radiologist by shaving a small area and cleaning the area with soap. You will covered by a sterile drape. Sometimes another site besides the groin is needed. If this happens, the Radiologist will discuss this with you. 

• The Radiologist will then numb you groin with a local anesthetic (numbing medicine). This will sting a bit, but only for a few seconds. After this you will only feel pressure where the Radiologist is working. 

• A small catheter (plastic tube) will be placed into your artery. The Radiologist carefully threads it into the blood vessels and guides it to the area to be studied/ When the catheter reaches the site that needs to studied, contrast is injected through the catheter. This clearly outlines the blood vessel and enables the Radiologist to see irregularities or blockages. 

• As the Radiologist places the catheter, you may notice that the lights go on and off in the room. This allows the Radiologist to see the TV screen more clearly and to follow the catheter's progress. Just as you cannot feel blood flowing in your body, you will not feel the catheter moving inside your blood vessels. When contrast is injected, you may feel a warm or hot flushing feeling. This is a normal response and passes in a few seconds. 

• While taking the x-ray pictures, you will be given breathing instructions from time to time. Once all the necessary pictures are taken, you will be moved to a recovery area where the Radiologist will remove the catheter. Pressure will be applied to the puncture site for 10-20 minutes. This allows the blood vessel to seal over so it does not bleed. A band-Aid or dressing will placed on the site. 

• The length of this test varies according to blood vessels being studied, but it normally ranges from 1-2 hours. The staff will make you as comfortable as possible, however, let them know if you have discomfort. 

• The Radiologist will study your x-rays very carefully and send a final report to your personal doctor.

What Can I expect After The Procedure?

• Drink plenty of fluids and eat your regular diet. The contrast that was used will cause you to urinate more than usual after your procedure, so you will need to drink more fluids.

• Rest in bed for 4-6 hours in apost procedure recovery area (PPRC).

• Keep the area where the catheter was placed dry . Do not take a hot bath or shower for at least 12 hours.

• Your leg must be kept straight to prevent the puncture site from bleeding.

• Complications are rare. If you develop any of the following symptoms, call your doctor immediately. 

  • Fever

  • Weakness

  • Decreased alertness

  • Swelling , redness , or warmth at the needle site

  • Bleeding at the needle site that will not stop

  • Pain, coldness or pallor of the extremity

  • Convulsion

  • Confusion

  • Numbness

  • Paralysis

Your Cardiac Catheterization

How Does The Heart Function?

The heart is a pump which circulates blood throughout the body. It is divided into a left and right side with each side having a different function in the heart's pumping action.

The right side of the heart receives blood that returns from the body through your veins and pumps it to the lungs. In the lungs, the blood picks up a supply of oxygen and releases carbon-dioxide, which is breathed out as a waste product.  The left side of the heart receives the oxygen-rich blood from the lungs. Blood is then pumped into the aorta , or the main artery of the heart, to smaller arteries which carry it to the body.

The heart is a muscle which needs its own supply of oxygen and nutrients. Blood is supplied to the heart muscle so every part is supplied with blood. There are three main coronary arteries. The left coronary artery divides into two branches and carries to the front of the left heart and back of the heart. The right coronary artery supplies blood to the right heart and parts of the back of the heart.

What Is A Cardiac Catheterization?

A cardiac catheterization allows the doctor to examine the chambers, valves and arteries of the heart. The test is done in a special room called the catheterization laboratory (cath lab). Either the right or left side of the heart or both sides are catheterized.

A hollow needle is put into a vein for the right heart cath or an artery in the arm or groin for the left heart cath. A flexible wire is threaded through the hollow needle into the vessel. The catheter is then put over the wire in the blood vessel. 

The doctor watches the catheter move toward the heart on a X-Ray machine known as a fluroscope. When the catheter is in proper  position, dye is put through the opening of the catheter. Dye lets the doctor see the coronary arteries and the chambers of the heart. Blood samples are taken and pressures are measured during the catheterization or cath. Coronary angiogram or coronary arteriography are the terms used to describe the X-Ray pictures taken of dye injected into the coronary arteries during a left heart catheterization.

What Does the Doctor Learn From the Catheterization?

A cardiac catheterization is the most accurate way to see if you have coronary artery disease, and if so, how much. Coronary artery disease is the build up of deposits of fats and cholesterol in the arteries of the heart. The doctor looks for arteries that have become narrowed or blocked.

Blockage prevents blood from flowing freely through the coronary arteries. When this occurs, the heart muscle does not get enough oxygen and nourishment. Chest pain, also known as angina, may result. If there is blockage of the coronary arteries, the doctor may recommend bypass surgery, angioplasty (balloon procedure), or medications.

The cardiac catheterization also shows whether the valves and the heart muscle are working properly. If the valves are not working, medications, surgery, or a balloon procedure may be needed to fix the problem.

How Will I Be Prepared For The Cardiac Catheterization?

• Your doctor will talk to you about the need for catheterization. A doctor or nurse from the cath lab team will explain the procedure and get a written consent from you.

• You will be asked not to eat or drink anything after midnight the night before your catheterization. However, you may drink enough water to take your medications.

• A small are of your groin will be cleaned and shaved to prepare for the catheter.

• On the day of the cath, you will follow your usual morning routine and your family may visit with you. You will need to wear a hospital gown and to remove contact lenses. It is important to empty your bladder before going into the cath lab, and to leave any valuables with your family.

• If you wear a hearing aid, you may wear it to help you hear the staff in the lab. You may also wear dentures and glasses.

• Family may wait in the lobby of the nursing unit, your room, or in the atrium. You may taken to and from the cath lab by stretcher.

• Before the catheterization, an intravenous line (IV) will be put into in to give fluids and medications during the cath.

• Some people may have an allergic reaction to the dye, which can be prevented or treated with medicine. Tell the nurse or doctor if you have a history of allergies or asthma, or reaction to dye (iodine) used in X-Ray exams.

What Will I See, Feel, And Hear During The Catheterization?

The cath lab looks like and is cool like an operating room. The table on which you will lay is firm, narrow, and padded. You will be covered with sterile sheets. The lighting is dim to help the doctors see the pictures of the heart on the fluroscope. The fluroscope resembles a television screen. There are several large machines in the room which help collect information about your heart. The doctors and technicians will wear surgical masks gowns, and gloves.

You will be awake during the cath, but a sedative will be given through the IV line to help you relax. Electrocardiography (EKG) leads are attached to your chest so your heart rate and rhythm can be monitored during the test. 

Before the catheter is put in a technician will scrub the area (arm or groin). The area is then numbed with a local anesthetic. You may feel pressure as the catheter is put into the vessel. As the catheter passes into the heart chambers, you may feel skipped beats pr a fluttering in your chest. You may mention this to the doctor, but do not be alarmed. It is a common occurrence. 

During the catheterization, dye is injected through the catheter, and X-Ray pictures are taken to view the heart and coronary arteries. As the dye is injected, you will feel a warm, flushed, tingling sensation and possibly some nausea. These symptoms may last 20 -30 seconds and are a normal reaction. A slight headache that does not last long may also occur. During the procedure , you may be asked to cough or to take a deep breath and hold it. This helps clear the dye from the arteries and moves your diaphragm away from the heart.

Tell the doctor if you have chest pain, nausea, shortness of breath, or any other discomfort during the catheterization. 

You may hear the staff talking and calling out technical terms and numbers. This is part of the procedure and you should not be concerned. The doctor will talk to you if help is needed. You may be able to see parts of the catheterization on the television monitor. 

After the infomration is taken and the procedure completed, the catheter is removed. Pressure is applied to the area where the catheter was to stop any bleeding.  A clamp is placed on this area for 30 - 40 minutes.

The catheterization procedure usually lasts less than one hour. You will be gone, however, from your room for several hours. For a short time after the catheterization you will be in a recovery area.

What Happens After The Cardiac Catheterization? 

After you return to your room, the nurse will check your blood pressure, heart rate, and rhythm often during the next six hours. The nurse will also check where the catheter was put for any signs of bleeding. The pulses in your arms , legs and feet will also be checked. If the groin was used stay in bed with your leg straight for several hours. The head of your bed may be up slightly. Wiggle your toes and flex your ankles often, but do not bend you leg. After several hours you may get out of bed with help from your nurse. If your arm was used, keep it straight for at least one hour.

You may start your regular diet anytime after the catheterization. Drink large amounts of fluid to help clear the dye from your body.

If you have discomfort where the catheter was put, ask your nurse for pain medicine. Tell your nurse immediately if you notice any swelling or bleeding in this area or if you feel pain, numbness, or tingling in your arm or leg. Your family may visit with you after you are settled back in you room.

After you go home, drink plenty of fluids for the first 24 hours. The dressing on your groin may be removed after 24 hours. You may shower after the dressing has been removed.

What Are The Risks With A Cardiac Catheterization?

When you sign the written consent form for the cardiac catheterization, the doctor will talk possible, though rare, complications that may occur during the procedure. Heart attack, stroke or death occur in less than 1 in 1000 catheterizations done. Minor problems such as feeling faint, bleeding, infection, chills or shakes, or an allergic reaction may also occur. Remember that the lab staff of the catheterization lab is well trained to handle any situation and to prevent problems before they can occur.

When Will I Learn The Results Of My Cardiac Catheterization?

Your doctor will visit you in the evening after the catheterization or on the following day to explain the results of your test.