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Leg: PVD in the Renal Arteries

Surgery

Preparing for the Procedure

If your physician refers you for angioplasty and stenting, you will be admitted to the hospital for the procedure. You probably will have undergone tests such as renal artery ultrasound, angiography and routine blood tests. Be sure to tell your doctor what medications you are currently taking and any allergies you might have. You will probably be asked not to eat or drink anything after midnight on the night before your procedure. You may be asked to take aspirin for two days prior to the procedure.

The procedure will be performed in a catheterization laboratory or a radiology suite. You will lie on an x-ray table, and an x-ray camera (fluoroscope) will move over your body during the procedure. Your heart and blood pressure will be monitored during the course of the procedure.

Your doctor will have also discussed the procedure in detail with you in addition to the approximate time the procedure is scheduled. The possible risks and benefits will be explained to you and any questions you have should be answered.

The procedure itself will usually involve little to moderate pain in addition to the discomfort usually experienced during the first few hours following angioplasty. During the procedure, you most likely will be injected with the same dye you were given during the diagnostic angiogram you might have received. Although rare, dye injection may produce an allergic type reaction causing low blood pressure and breathing difficulties.

Speak to your doctor about possible risks involved with angioplasty and stent procedures.

Angioplasty Procedure

Your procedure will be performed in a room that is equipped with special instruments and x-ray equipment. Once you enter this room, you will be moved onto an x-ray table. You will be covered with sterile sheets and the area where the catheter will be inserted (groin, arm or wrist) will be shaved and washed with an antiseptic solution to prevent infection. A local anesthetic (numbing medication) will be used at the site where the catheters are inserted.

You may feel a stinging sensation during the administration of the medication. After the medication takes effect, you should only feel dull pressure where the doctor is working with the catheters. If the insertion is made to your inner thigh, a small tube called a sheath will be inserted into the vessel. The balloon catheter will then be placed through the sheath. If the insertion will be in your arm or wrist, then a guiding catheter will be inserted into the artery and advanced to the renal arteries. Dye injected through the catheter will allow the doctor to see the area of blockage in your vessels.

An x-ray machine called a fluoroscope is attached to the table and has a TV screen that allows the doctor to see your vessels and the catheter as it is advanced in your body. Your doctor or a hospital staff member may give you instructions (“don’t move, hold your breath”). When the catheter has reached the diseased area to be treated, a tiny balloon on its tip will be inflated.

The balloon applies pressure to the plaque in the vessel, causing the vessel to open and increase blood flow. It is normal to experience some pain during the balloon inflation. Please tell your doctor if you feel any pain during the procedure.

You will be awake during your procedure. Your doctor or a hospital staff member may give you instructions. It is important to listen for these instructions and do what is asked.

Stent implantation procedure

The procedure for stent implantation is similar to a standard angiogram procedure. The stent is introduced into the renal artery on a balloon catheter and advanced to the blocked area of the artery. As the balloon is inflated you may experience some discomfort or a pressure sensation when the balloon is inflated. The balloon will push the plaque aside and the stent will expand until it fits the inner wall of the renal artery, widening the channel for blood flow.

One or more stents may be expanded in the renal artery depending on the extent of your disease. With the expanded stent remaining in the renal artery, the balloon is then deflated and withdrawn from the body.

Your doctor may choose to further expand the stent with a balloon catheter similar to the one used in the angioplasty procedure. This procedure is called post-dilatation and ensures that the stent is in full contact with the vessel wall. The stent stays in place permanently, holding the vessel open and improving the flow of blood.

The angioplasty and stent procedure usually takes approximately 60 to 90 minutes.