This information explains what an upper limb angiogram and angioplasty involve, why the procedure is recommended, and the possible risks and benefits. It is intended to support discussions between you and your healthcare team.
What is an Upper Limb Angiogram, Angioplasty and Stent?
An upper limb angiogram is a test used to look at the arteries in your chest, arms and hands. A special dye (contrast agent) is injected into the bloodstream and X-rays are used to identify narrowed or blocked arteries.
This procedure may be performed to investigate or treat:
- Reduced blood flow (ischaemia)
- Trauma or injury to blood vessels
- Haemodialysis access problems
- Vasculitis (inflammation of blood vessels)
- Vascular abnormalities
Angioplasty is when a small balloon is passed into the artery and inflated briefly to improve blood flow.
A stent is a small metal mesh tube that may be inserted into the artery to help keep it open.
Your doctor has identified a narrowing or blockage in one or more blood vessels supplying your arm or hand. This can reduce blood flow and may cause:
- Pain in the arm or hand
- Coldness, numbness, or weakness
- Poor healing or ulcers
- Problems with dialysis access
You may already have had other tests such as:
- Doppler ultrasound scan
- CT angiogram (CTA)
- MR angiogram (MRA)
Unlike these tests, angiography can be combined with treatment during the same procedure.
How do I prepare?
You can eat and drink before the procedure unless told otherwise.
Please tell the team if you:
- Have any allergies or previously reacted to contrast dye
- Are diabetic
- Take blood thinning medication such as warfarin, apixaban, rivaroxaban, or edoxaban
- Take metformin or insulin
You can continue to take aspirin and clopidogrel unless advised otherwise.
You may need blood tests before the procedure to check kidney function and blood clotting.
How is it performed?
Consent
The operating interventional radiologist will explain this to you in more detail during the day of your procedure, where you will be asked to provide your permission to proceed by signing a consent form.
Anaesthetic
The procedure is usually performed in the radiology department under local anaesthetic
You may feel:
- A brief stinging sensation when the local anaesthetic is injected
- Warmth when the contrast dye is injected
- A stretching or pressure sensation during balloon inflation
Most patients tolerate the procedure well.
Procedure
- A specially trained doctor called an Interventional Radiologist will perform the procedure.
- You will lie flat on an X-ray table.
- Monitoring equipment may be attached to measure your pulse, oxygen levels, and blood pressure.
- The skin in the groin area is cleaned with antiseptic and covered with sterile drapes.
- Local anaesthetic is injected into the skin.
- A small tube (catheter) is inserted into the artery.
- Contrast dye is injected so the arteries can be seen on X-ray images.
- If a narrowing or blockage is found, a balloon may be inflated to widen the artery.
- A stent may also be inserted if needed.
At the end of the procedure the catheter is removed and pressure or a closure device is used to stop bleeding.
The procedure usually takes between 30 minutes and 2 hours.
Staff involved
Interventional Radiology (IR) procedures are performed by a multidisciplinary team. The team includes the following key Staff:
What are the risks?
Angiography and angioplasty are generally very safe procedures, but complications can occur.
Common:
- Small bruise at the puncture site
Uncommon or rare:
- Need for further procedures or surgery
- Large bruise or bleeding requiring further treatment
- Damage to the artery or blockage caused by displaced material (embolus)
- False aneurysm (a tender pulsating swelling at the puncture site)
- Kidney injury caused by contrast dye
- Allergic reaction to the contrast dye
- Failure to improve symptoms
Extremely rare:
- Worsening blood flow which may threaten the arm or hand
What else to expect from this procedure?
Admission
This procedure is usually done as a day case. You will be admitted in Radiology Theatres as day case, we will clerk you in, gather some data and you will be asked to undress and put on suitable hospital gown. If you needed a bed due to social or any other reasons, the hospital bed manager will arrange one for you, but you may need to wait until a bed is available. If you are already an inpatient, you will just go back to your ward after the procedure.
Recovery
After the procedure you will return to the recovery area or ward.
Nursing staff will monitor:
- Blood pressure, pulse and oxygen levels
- The puncture site for bleeding
You may need to remain resting for a few hours
Most patients go home the same day
Aftercare
For the first 48 hours:
- Avoid strenuous activity and heavy lifting
- Keep the puncture site clean and dry
- Drink plenty of fluids unless advised otherwise
Care at home
Driving:
- You may drive again after 48 hours if you can perform an emergency stop comfortably.
Work:
- Most people return to work within about one week, depending on the type of work they do.
Exercise:
- Avoid heavy lifting and strenuous activities initially, then you can return to normal activities and exercise is encouraged.
Medicines:
- Continue your medications as advised by your doctor. You will be told when to restart blood thinning medication.
Follow up:
- The vascular or renal Team will contact you to arrange a follow-up appointment if required.
Seek urgent medical advice if you develop:
- Bleeding from the puncture site
- Increasing pain, swelling, or redness
- Fever or signs of infection
- Changes in the colour or temperature of the arm or leg
- Severe pain, numbness, or weakness in the arm or hand
Contact information
We hope this information has answered some of your questions. If there are any further questions you would like to ask before you come for your operation, please get in touch.
Interventional Radiology, St James’s University Hospital
Interventional Radiology, Leeds General Infirmary
Your GP or NHS direct on 111
CALL 999 FOR A LIFE THREATENING EMERGENCY
How to get to our department
We are located in the Lincoln Wing of St James’s University Hospital, Ground Floor. Check this link to see how to get to us.
www.accessable.co.uk/leeds-teaching-hospitals-nhs-trust/st-james-s-university-hospital/access-guides/lincoln-wingWe are also located in the Jubilee Wing of Leeds General Infirmary, Ground Floor. Check this link to see how to get to us.
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