The Leeds Teaching Hospitals NHS Trust Renal artery angioplasty and stenting

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1 n The Leeds Teaching Hospitals NHS Trust Renal artery angioplasty and stenting Information for patients

Your doctor has recommended that you have a procedure to treat a narrowing in the artery to your kidney. This is called renal artery angioplasty and stenting.

2 Your doctor has recommended that you have a procedure to treat a narrowing in the artery to your kidney. This is called renal artery angioplasty and stenting. This leaflet will explain what this involves, the outcomes and the possible risks. Why do you need this treatment? We have identified a narrowing in a blood vessel supplying one (sometimes both) of your kidneys. This is called renal artery stenosis. It is usually due to hardening of your blood vessels (a process called atherosclerosis) though sometimes can be caused by other diseases. The narrowing results in reduced bloodflow to the kidney. When the narrowing becomes severe renal function deteriorates (meaning the kidneys become less efficient at filtering the blood) and blood pressure increases as the body tries to compensate for the poor flow to the kidneys. Occasionally the narrowing can result in sudden bouts of breathlessness (called flash pulmonary oedema ) What is renal artery angioplasty? Stretching (angioplasty) treats the narrowing in the artery to the kidney (the renal artery). A small balloon is inserted via a skin puncture into an artery, either in the groin or at the elbow. The balloon is passed through the blood vessels into the narrowing 2

3 in the artery to the kidney and is then inflated to stretch the narrowing, then is deflated and removed. The picture shows a balloon inflated in a renal artery. In most cases a small metal scaffold needs to be placed within the stretched up narrowing to keep it open. This is called a stent. It is inserted in exactly the same way as the balloon. What are the results? Renal artery stenosis is rarely an isolated problem and patients with narrowed arteries to the kindeys often also have other related kidney or cardiovascular disease. This makes it difficult to assess of the results of renal artery angioplasty. There have been several large studies comparing patients treated with renal artery angioplasty or stenting with those treated without it (usually with medication to control blood pressure and treatments to preserve kidney function). No difference was found between those who received the treatment and those who did not. In Leeds we therefore reserve the treatment for a small group of patients in whom other treatments have failed, are not tolerated due to sideeffects or in whom there are few other options. We also treat patients with non-atherosclerotic renal artery stenosis or those with a kidney transplant. We believe these patients do well after angioplasty. Are there any risks? The risk of a major complication with renal artery angioplasty and stenting is about 5%. 3

4 The main risk is of causing damage to the renal artery or the kidney in which case kidney function and blood pressure control can get worse. This can occasionally result in you needing to go onto dialysis regularly. Bleeding from puncture site at the groin or arm may occur. This usually settles with firm pressure but rarely may require blood transfusion or surgery to manage. Most patients get bruising at the skin puncture site which settles after a few days. Rarely the artery may rupture during the procedure. This can sometimes be managed during the angioplasty procedure but if this is not possible emergency major surgery is needed. There is an approximately 1% risk of a stroke if an elbow skin puncture is needed. Finally there is a small risk of allergic reaction to x ray dye though severe reaction is uncommon. What are the alternatives? Your doctors (usually a kidney doctor or heart doctor a nephrologist or cardiologist) will have considered alternative treatments and tried to manage your blood pressure and kidney function with medication. Further drug therapy can sometimes be tried instead of angioplasty though most patients will already have been taking several medications for some time already. Open surgery carries greater risk than angioplasty, is a major procedure and can only be recommended in extremely rare circumstances. 4

5 Do I need to make any special preparations? Renal artery angioplasty and stenting is usually performed as an inpatient. You will need to stay in hospital for a few days after the procedure so we can monitor your blood pressure and kidney function. Most patients will need a drip before and after the procedure. If you are taking blood thinning medications (such as warfarin), these will need to be stopped before the procedure. You will be given specific instructions about this. Please contact the vascular radiology department in good time before your appointment if you have not received these instructions. If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before the procedure. Who will I see? A specially trained team led by an interventional radiologist. Interventional radiologists are doctors with special expertise in using medical imaging techniques to undertake procedures through tiny pinholes in the skin. In most circumstances you will be invited to a clinic to discuss the procedure with an interventional radiologist well before the procedure. If you wish they will show you your imaging. This will help you understand the process, gives you an opportunity to ask any questions and allows you time to consider whether you wish to have the procedure. 5

6 What happens during renal artery angioplasty and stenting? You will need to put on a hospital gown. A small needle will be placed in your arm in case you need an injection of a painkiller or light sedative. The skin over the groin or arm will be cleaned. Local anaesthetic will be injected to numb the skin. A fine plastic tube will then be placed into the artery and will be passed to the kidney. You may be asked to hold your breath for a few seconds while images are taken and as the balloon is inflated or the stent inserted. The balloons and stents all go through the fine plastic tube at the skin puncture site. Sometimes a gas is used to get the pictures. This is very safe, but can occasionally cause abdominal pain or nausea. At the end of the procedure someone will press on the skin over the puncture site for minutes. Renal angioplasty and stent procedures usually take about an hour though every patient is different and some procedures can take substantially longer. Will it hurt? At the start of the procedure, the local anaesthetic stings for a minute or two. You may feel a little discomfort in your back when the balloon is blown up but this should not be severe and will abate once the balloon is deflated. If you feel persistent pain, then you need to let the radiologist or the staff know. 6

7 Will I be on any medication afterwards It is likely that you will need to be on aspirin and another medication called Plavix for six months after the procedure if a stent was inserted. We hope that we might be able to reduce blood pressure medication after the procedure though it is very unlikely that you will be able to come off blood pressure medication entirely. Care at home If you have bleeding at the skin puncture site press firmly over it and call 999 for an ambulance to take you to hospital. Call your doctor or go to the nearest A&E if you have persistent pain or an enlarging lump or pus at the puncture site. If you have other concerns you can contact the vascular radiology department on: if your procedure was done at St James s University Hospital, or if it was done at LGI. What are the late complications? Narrowing in renal arteries tends to recur, even when stents are used. Your doctors will arrange for you to have further tests if it seems this is happening. The angioplasty or stenting procedure can be repeated if necessary. 7

8 Finally We hope some of your questions should have been answered by this leaflet. An interventional radiologist will discuss it with you in clinic and again immediately beforehand and you will have the opportunity to ask questions. Please make sure you are satisfied that you have received enough information about the procedure before you agree to The Leeds Teaching Hospitals NHS Trust 1st edition Ver 1 Developed by: Dr Christopher Hammond, Consultant Vascular Radiologist Produced by: Medical Illustration Services MID code: _013/JG LN Publication date 11/2017 Review date 11/2019

The Leeds Teaching Hospitals NHS Trust Fistulogram, Fistuloplasty and Venoplasty

n The Leeds Teaching Hospitals NHS Trust Fistulogram, Fistuloplasty and Venoplasty Information for patients Your doctor has recommended that you have a procedure on your fistula. This leaflet will explain