Consent: Angiogram, Angioplasty, and Stenting - Podcast Version TeachMeSurgery 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x 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, and the applicable and appropriate law in your jurisdiction governing patient consent. 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 imaging. 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. 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. Frequent questions What is an angiogram and how is it performed? An angiogram is a diagnostic procedure that involves the percutaneous puncture of a blood vessel, usually the common femoral artery, to inject a contrast medium while taking X-ray images. This technique is considered the gold standard for identifying vessel stenosis. What are the main risks associated with angioplasty and stenting? The primary risks of angioplasty and stenting include haemorrhage, injury to surrounding structures, and infection. These complications can be mitigated through careful technique, use of ultrasound guidance, and administering peri-operative antibiotics. How can complications such as bleeding and pseudoaneurysm be managed after an angioplasty? To manage complications like bleeding and pseudoaneurysm, direct pressure should be applied to the puncture site after the procedure. This helps to minimise ongoing bleeding and reduce the risk of a pulsating lump in the groin. What measures can be taken to reduce the risk of blood clots during angioplasty? To decrease the risk of blood clots, patients may be fitted with anti-embolism stockings and administered low molecular weight heparin as deemed appropriate. These measures are particularly important for patients with additional risk factors like obesity or a history of DVT. What are the potential late complications following an angioplasty? Late complications after angioplasty can include reintervention due to the narrowing of the stent or stenosis over time. Monitoring and follow-up care are essential to address any issues that may arise after the initial procedure. Rate This Article