Consent: Angiogram, Angioplasty and Stenting

Note: This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines.

Overview of Procedure

An angiogram is performed by percutaneous puncture of the appropriate vessel (typically the common femoral artery) and injection of contrast medium directly in the artery whilst taking X-ray images. This technique is the gold standard for delineating stenosis of a vessel, however it is highly invasive compared to ultrasound, CT or MRI.

Angioplasty and stenting involve undertaking an angiogram and then expanding the stenosed segment of vessel. This is achieved through a combination of wires and catheters to navigate to and then through the stenosis, with the subsequent expansion of a balloon or stent to open the vessel.

Fig 1 – Angioplasty and stenting. This is one of the surgical options available for the treatment of chronic limb ischaemia.

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage This can occur due multiple punctures or insufficient haemostasis. Apply direct pressure to the puncture site post procedure (the duration of which depends of the size of the sheath used) or via the use of a closure device.
Injury to surrounding structures The femoral artery lies between the femoral nerve and femoral vein, either of these can be damaged during the puncture if not careful. Use of ultrasound guidance to identify the relevant neurovascular structures
Anaesthetic Risks This is a local anaesthetic procedure however some people can react to the local anaesthetic.

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain Pain during initial insertion or during balloon inflation Local anaesthesia will be used in the femoral incisions
Bleeding There is a small chance of bleeding and bruising in the groin post-surgery.
Pseudoaneurysm A pulsating lump may occur in the groin due to ongoing bleeding that can occur around the vessel. Direct pressure applied to the puncture site as above.
Vessel Rupture There is the potential to rupture the blood vessel, requiring emergency stenting or an open operation.
Infection Superficial wound infection is possible, however this is uncommon in percutaneous approaches. Peri-operative antibiotics will reduce the risk of superficial infections
Scarring Although there is minimal visible scar, the site of an angioplasty is typically difficult to dissect at a later time point due to internal scarring.
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin to minimise this risk as deemed appropriate.
Reaction to Contrast Medium Skin rashes, vomiting, asthma, hypotension, and cardiac and renal dysfunction can occur as a result of contrast induced reactions.
Technical Failure It may not be possible to treat the lesion, requiring either a different interventional approach or surgery.
Acute Limb Ischaemia Disruption of a plaque causing emboli further down the limb or trauma to the vessel causing extravasation of blood into the surrounding tissues can occur.

In addition, the equipment can incur a technical fault, whereby a piece of material is left in the vessel and may require surgical removal.

Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery, particularly the injection of contrast medium affecting renal function.

Late

Complication Description of Complication Potential Ways to Reduce Risk
Reintervention The stenosis or stent may narrow over time requiring further intervention.

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