This section describes the procedure known as cardiac catheterization. If you or a family member has any additional questions, please feel free to discuss them with your doctor or nurse at any time.

The purpose of cardiac catheterization

A cardiac catheterization is a diagnostic test that will give your doctor detailed information about your heart and coronary arteries. Your doctor will be able to evaluate any blockages in your coronary arteries, the overall health of your heart and valves, the presence of aneurysms, and abnormal blood flow in your heart. Based on this information, your doctor will make a diagnosis and recommend a plan of care. The doctor will usually discuss the results of your test with you the same day.

Words you should know

• Anesthetic: a medicine applied to an area to numb it.
• Aneurysm: abnormal bulge in the wall of the heart or an artery.
• Antiseptic: a disinfectant used to kill germs.
• Catheter: a small, thin, flexible line.
• Electrocardiogram or ECG: computerized recording of the electrical activity of the heart.
• IV: intravenous needle used for administering medication.

Testing instructions:

Do not eat or drink after midnight the day of the test until the test is over. Take all medications as prescribed with a small sip of water unless directed otherwise by your doctor. Be sure to tell your doctor if:

• You have an allergy to seafood, x-ray dye or iodine.
• You know or suspect that you are pregnant.
• You are taking blood thinners.
• You have a history of bleeding problems.
• You are diabetic.

The procedure is performed by a physician who is specially trained in performing cardiac catheterization. You will be awake during the entire procedure and your doctor and nurses will explain each step as it occurs. You will wear a hospital gown and you may wear your eyeglasses, hearing aid and dentures. At the start of the procedure, a nurse will give you a sedative to help you relax. If you don’t already have an intravenous needle (IV), one will be started. Your blood pressure and electrocardiogram will be monitored constantly throughout the test.

The procedure will begin by administration of an anesthetic to the site where the catheter will be inserted – usually in the groin or arm. You may feel a slight “stinging” sensation during the injection. A small incision is made in the skin and a special catheter is then inserted. The catheter will then be advanced through a blood vessel into your heart. Since blood vessels do not have nerves, you should experience no pain while the catheter is threaded into your heart.

Once the catheter is in place, several injections of dye will be made into the arteries and chambers of your heart. You may experience some discomfort for 20 – 30 seconds as dye is injected into your heart. This sensation may give you a “hot flash” or the feeling that you’ve urinated, but you will not lose control of your bladder. An x-ray camera will be moved around the table to take pictures of your heart from a number of different angles. You may be asked to cough, hold your breath or take a deep breath to help the doctor get more detailed pictures. The procedure usually takes 30 – 60 minutes.

It is unusual to experience any pain during the procedure. If you do, report it to your doctor immediately. After the procedure, the catheter will be withdrawn and a nurse may apply pressure to the site for about 20 minutes. If the catheter was inserted in your arm, you may be given stitches to that area.

Complications

Complications during cardiac catheterization are rare. The most common complication is bleeding at the site of the blood vessel where the catheter is inserted. If this occurs, it usually results in minor bruising. Sometimes a small lump occurs at the site, but this will go away in a week or so. The possibility of a heart attack, stroke, sudden closure of a blood vessel, or death is very rare. Your doctor will discuss your risks and answer any questions you may have. Experienced personnel are prepared to act immediately in the event of any complication.

What to expect following surgery

Your doctor will decide when you will be able eat and drink after the test. You will remain in bed for about 4 – 6 hours, with the head of the bed either flat or slightly raised. The nurse will check your catheter insertion site and take your blood pressure and pulse rate. Once the doctor allows you to have liquids, you will be asked to drink frequently in order to flush the x-ray dye out of the body.

The IV will remain in place for 2 – 3 hours and the nurse may place a small weight on the catheter insertion site to prevent bleeding. It is not uncommon to have swelling, bruising and a small lump at the catheter insertion site. The dye you received may temporarily cause you to urinate more than usual. The nurse will help you use the bedpan or urinal. The leg below the catheter insertion site will be monitored for bleeding. Movement of your leg will be restricted for several hours. Please tell your nurse if you experience any pain or discomfort including warmth, wetness, numbness or tingling, or if you develop a fever over 100°F.

Your doctor will decide, based on your concerns, whether you will be discharged to your home or transferred to another unit in the hospital. Discharge usually takes place within 4 – 6 hours of the procedure. Exercise and driving may usually resume after 1 – 2 days with the permission of your doctor.

Returning Home

• Avoid heavy activity for seven days, including pushing or pulling heavy objects or lifting more than 10 pounds.
• Stop exercising before you become tired or short of breath. If you experience chest pain during exercise, stop immediately, call your doctor and follow all instructions given. If you cannot reach your doctor and are still in pain, call 911.
• Avoid rubbing the lump at the catheter insertion site.
• Avoid driving for two days after the procedure.
• Keep all follow-up appointments with your doctor.

Call your doctor if:

• Your arm or leg becomes numb or painful, or if there is redness or a yellow discharge at the catheter insertion site. It is normal to have soreness at the catheter insertion site.
• You have pain or numbness below the catheter insertion site (leg, toes, arm, fingers).
• The catheter insertion site swells or bleeds. If this happens, lie down immediately on a firm surface and have someone apply pressure to the catheter insertion site for 10 minutes by pressing the heels of both hands over the lump and pushing down. If the swelling and/or bleeding don’t stop, call your doctor or go to the emergency room while continuing to hold pressure to the site. Seek emergency medical care immediately if you have chest pain like the pain before or during your catheterization.

Medications

You may be placed on medications following your catheterization to prevent blood clots from forming. Report all side effects from medications to your doctor. Do not stop taking any medicine unless directed by your doctor.

Follow-up

Be sure to contact your cardiologist for a follow-up evaluation and final discussion of the results of your catheterization within 7 – 10 days of the procedure.

What is carotid stenting?

A small metal tubular structure called a stent is inserted into the carotid artery that supplies essential blood flow to the brain. The stent acts as scaffolding, keeping the artery stretched open and maintaining adequate blood flow through the vessel after it is opened with a balloon. Debris that might otherwise enter the circulation to the brain at the time the carotid artery obstruction is dilated is removed by a removal device prior to stenting to help prevent the debris from causing a stroke.

When does a patient’s condition require carotid artery stenting?

When plaque build-up (atherosclerosis) causes enough narrowing or blockage of a carotid artery so that blood supply to part of the brain is reduced or such that blood clots may begin to form, the risk of stroke becomes very high. Symptoms accompanying this condition often include transient ischemic attacks (TIA or mini-stroke), or full-blown stroke with damage to the brain. Even with no symptoms or history of stroke, very severe blockages in a carotid artery should be opened or treated with surgery in order to prevent strokes that may otherwise occur.

What tests can determine a need for carotidstenting?

During regular physical exams your physician often examines your carotid arteries by listening to them with a stethoscope. Narrowing in a carotid artery often causes an audible noise, or bruit, due to increased velocity of blood flow through the area of obstruction. Diagnostic tests may be ordered to confirm the presence of atherosclerosis with narrowing or obstruction in patients with a bruit or in patients with symptoms suggestive of TIA or stroke.

A carotidultrasound (sonogram of the carotid arteries) uses sound waves to evaluate the structure and function of the carotid arteries. It provides a moving image of the arterial blood flow, allowing your cardiologist to study the carotid arteries’ diameters and the blood flow through them.

Computed tomography angiography (CTA) is a type of CAT scan that uses x-ray beams taken from different angles around the patient to create pictures of cross-sections of the body. Contrast medium is injected into the veins at the time of the CT scan so that the arteries will also be visualized. Using computerized techniques, the scanner can be programmed to show pictures of only the arteries, which is a CTangiogram.

A carotidangiogram, or arteriogram is an invasive procedure involving insertion of a catheter, usually through a leg artery, up to the carotid vessel(s) of the neck, where contrast medium is injected and X-rays pictures are taken to show the inside of the carotid vessels. A carotid angiogram is one of the most accurate tests in the diagnosis of carotid artery disease, and is used to pinpoint the location and severity of plaque build up and blockage.

How is carotid artery stenting performed?

Carotid stenting is a catheter-based procedure. The catheter acts as a guide to place the stent in the carotid artery to open a narrowing or blockage. The stent is deployed at the time the blockage in the artery is dilated with a balloon. Stents come in a variety of strengths, sizes, and other properties. Stent selection for each procedure depends upon many factors, including the size of the artery, the location of the plaque build-up or blockage, and the severity of arterial narrowing.

What should be expected after carotid artery stenting?

Carotid stents are exposed to blood flow and may cause clots to form until they become covered with tissue by the body. Medications are taken during this time, and possibly longer, to prevent thrombosis (formation of blood clots).

Sometimes new blockages develop months or years later at a different site in a carotid vessel. Rarely, carotid stents re-narrow (restenosis). Because of the possibility of restenosis and / or new blockages, your cardiologist will want you to follow-up with a diagnostic testing schedule. Adhere to your testing and follow-up schedules below. Call your cardiologist’s office (915) 523-4542 to schedule any tests that are not prescheduled. Follow-up is vital to early detection of re-narrowing or new disease of the carotid arteries.

The usual recommendation for carotid stent follow up is an ultrasound study at:

• Six weeks
• Six months
• One year
• Then Annually

All testing schedules are subject to change according to each individual patient’s condition, risk factors, or recurrence of carotid artery disease signs and symptoms.

An echocardiogram, or “echo,” is a test in which your cardiologist can observe and evaluate the movement of your heart valves and the pumping of blood in the chambers of the heart.

During the echocardiogram, a sonographer, or ultrasound technician, uses a small wand to direct high frequency sound waves (also called ultrasound) at your heart. The sound waves bounce off the heart and create an “echo” that is translated into a graphic video that your cardiologist can use for diagnostic purposes.

The difference between a standard chest echocardiogram and a transesophageal echocardiogram (TEE), is that the ultrasound wand is part of an endoscope, which is a long, thin, flexible tube about 1/2 inch in diameter. The endoscope is placed into your mouth and passed into your esophagus. This test gives the doctor a better look at your heart because your ribs and lungs cannot obstruct the sound waves.

Why do I need a TEE?

Your doctor may ask you to have a TEE to:

• Evaluate your heart’s valves and chambers.
• Determine the presence of different types of heart disease.
• Evaluate the effectiveness of valve surgery.
• Evaluate abnormalities of the left atrium; a chamber of the heart.

Can I eat or drink on the day of the test?

No. DO NOT eat or drink anything for at least 4 hours before the test. If you must take prescribed medication before the test, take it only with a small sip of water.

Can I take medications before the test?

Yes. Take all medications according to your normal schedule as prescribed. Medication taken 4 hours before the procedure should be taken with only with a small sip of water.

Special Instructions for Diabetics

If you are diabetic, please contact your doctor for specific instructions about taking your medication before the test.

Should someone come with me the day of the test?

Yes. You will need someone to drive you home. You should not drive until the day after the test. The sedation given to relax you during the procedure causes drowsiness and may make it unsafe to drive or operate machinery.

Who will answer my questions before the test?

Before your test, a cardiac sonographer (ultrasound technician), nurse, or your cardiologist will explain the procedure in detail, including possible complications and side effects.

The Transesophageal Echocardiogram Procedure

• You will be given a hospital gown and asked to remove clothing from the waist up.
• An (ultrasound technician) sonographer will place electrodes on your chest to monitor your electrocardiogram (ECG). The electrodes are small, circular pads with a sticky substance to help them adhere to the skin.
• An intravenous line (IV) will be inserted into your arm or hand so medications can be delivered when necessary.
• A blood pressure cuff will be placed on your arm to monitor your blood pressure.
• A small clip will be placed on your finger to monitor oxygen levels in your blood.
  You will be asked to gargle liquid solution that will numb your throat.
• The sonographer will spray an anesthetic (pain-relieving medication) at the back of your throat and medication will be administered through the IV line to help you relax.
• You will be asked to lie on your left side on an exam table and a dental suction tip will be placed in your mouth to remove secretions. The doctor will then insert the endoscope into your mouth and into your esophagus. The endoscope does not interfere with breathing. You may be asked to swallow at certain times to help pass the endoscope. Throughout the exam, your heart rate, blood pressure and blood oxygen levels will be monitored during and immediately after the exam.

How will I feel during and after the test?

The doctor, sonographer and nurse will keep you as comfortable as possible during the test. Tell them if you feel uncomfortable at any time during the test. You may feel a temporary soreness or numbness in your throat after the test.

How long does the test take?

The test will take approximately 50 – 60 minutes. After you have recovered from the sedation and are no longer drowsy, you may go home or go to other scheduled appointments. DO NOT drive yourself home after the test.

Can I eat after the test?

You should wait at least one hour after the test, or until the numbness in your throat is gone, before eating or drinking. Start by drinking a cool liquid. If you have no problems drinking cool liquids, you should be able to resume eating and drinking normally.

How will I be notified about the results of my test?

After a cardiologist reviews the test results, a report will be mailed to your doctor. Your physician will provide the test results to you.

This section describes cardioversion, a procedure used in the treatment of atrial fibrillation. If you or a family member have any additional questions, please feel free to discuss them with your doctor or nurse at any time.

The purpose of the cardioversion procedure

Your doctor has recommended that you have a cardioversion procedure because you have cardiac arrhythmia, or atrial fibrillation (AF). AF causes an irregular – usually fast – heart rhythm. The purpose of the procedure is to convert your heart rhythm from atrial fibrillation to sinus rhythm (your heart’s normal rhythm).

What is atrial fibrillation?

Atrial fibrillation is a heart rhythm disturbance that occurs when there is an abnormality in the atrial chambers, or the SA node. AF is rare in younger individuals and the chances of it occurring greatly increase after age 60. Between the ages of 60 to 65, 4 in 100 people have atrial fibrillation. For those over 65 years of age, the chances increase to 10 in 100. There are many causes, including: valvular heart disease, coronary artery disease, lung disease, thyroid disease and major surgical procedures. About 15% of patients with atrial fibrillation have no known cause.

Symptoms of arrhythmia include: dizziness, fainting, palpitations and a “fluttering” feeling in the chest.

Having a stroke is the number one danger in patients with atrial fibrillation. Because of the irregular rhythm, the heart does not pump effectively. This can cause blood to pool in the heart and form clots. These clots can then travel through the bloodstream and cut off or decrease circulation in the blood vessels. When this occurs in the brain, the result is a stroke.

In addition, long-term atrial fibrillation may result in stretching or elongating the heart muscle, causing the heart to pump less effectively, which decreases the amount of blood going to all parts of the body.

Treatment

Your cardiologist studies heart rhythms, identifies arrhythmias and pinpoints their origin in the heart. In treating atrial fibrillation, your cardiologist attempts to eliminate the cause, thus restoring a regular heart rate and controlling rapid heart rates. Common treatment options include:

• Antiarrhythmic medications
• Blood thinners
• Cardioversion

In some cases, it is impossible to restore a normal heart rhythm to a patient with atrial fibrillation despite vigorous treatment. Every patient is unique and a variety of circumstances will determine the success of the treatment. Medication Antiarrhythmic medications are usually prescribed to control your heart rate. To reduce the possibility of stroke, your medication may include blood-thinning drugs.

Pre-procedure instructions

On the day of your procedure:

• Do not eat or drink 6 hours before your cardioversion.
• Take your regular medication in the morning as you normally would with small sips of water unless directed otherwise by your doctor.

What happens during the procedure?

Cardioversion is usually performed on an outpatient basis at the hospital. Admission to the hospital is generally not required.

• You will be lying in bed during and after the procedure.
• Small electrodes will be placed on your chest to monitor your heart rhythm.
• An intravenous line will be placed in your arm to allow the anesthesiologist to give you medication to make you sleepy.
• You will be given oxygen, either through a mask or through a soft plastic tube in your nose.
• Your doctor will administer a brief, low-dose electric shock through pads on your chest and back. You will be asleep during this time and will not feel any pain.
• Your heart rhythm will be monitored to ensure that normal rhythm has been restored.

What happens after the procedure?

• You will remain in the hospital for 2 to 4 hours to monitor your heart rhythm and ensure that it remains normal.
• During this time you may sit, walk, and have something to eat or drink as soon as you are fully alert.
• For a day or two after the procedure, the skin on your chest may feel a little sore, like a mild sunburn. Your doctor may prescribe a cream or lotion for this.
• Once you are home, you may resume your normal activities.
• Continue to take all of your medications as prescribed until you see your doctor.
• Call your doctor for a follow-up appointment within 1 – 2 weeks.
• If your irregular heartbeat returns and you feel skipped beats, a rapid heartbeat, or tightness in your chest, call your doctor.

Complications

There is a 2% chance that a stroke-causing blood clot can occur if a person has had atrial fibrillation for more than four days, or if he or she has not received blood thinners before the procedure. Complications are greatly reduced by the use of blood-thinning medications. The doctors and nursing staff are highly skilled and are prepared to act immediately in the event of any complication.

The tilt table test is designed to find out the cause of syncope or fainting spells. During the test, the patient lies on a bed that is tilted at different angles (30 – 60 degrees) for a period of time to help the cardiologist determine the cause of the fainting spells.

Patient Preparation

1. Take all medications as prescribed.
2. You should have an empty stomach during the test. Do not eat or drink anything after midnight the evening before your test. If you must take medications, drink only small sips of water to help you swallow your pills.
3. Drinking small amounts of water is allowed before the test.
4. Wear comfortable clothing. It is best not to wear jewelry or valuables.
5. Do not drink caffeine (coffee or tea) the morning of the test.

Tilt table test procedure

Your test will take place in a special room called the EP (electrophysiology) lab at the hospital.

Before your test begins, a small needle will be inserted into a vein in your arm. This is to allow doctors and nurses to give you medications and fluids during the procedure if necessary.

A physician’s assistant or registered nurse will prepare you for the test. A cardiologist will monitor your test. In order to monitor your vital signs and your reaction to the test, you will be connected to three monitors:

• Electrocardiogram: Your chest will be cleaned with an alcohol pad to remove skin oil at the areas where the electrodes will be placed. Men may need to have some chest hair shaved in order to help the electrodes adhere to the skin. Wires will then be attached to each of the electrodes in order to record and monitor your electrocardiogram (ECG) before and during the test.
• Oximeter monitor: A small clip will be placed on the tip of your finger to check the oxygen level of your blood.
• Blood pressure monitor: A blood pressure cuff will be placed on your arm to check your blood pressure intermittently throughout the study.

You will be awake throughout the entire test. You will be asked to lie quietly and keep your legs still. The table you are lying on will be tilted at different angles. You may feel nothing at all, or you may feel the same symptoms you feel when you experience a fainting spell. The test may even induce you to faint. Remember, you are being monitored and the doctors and nurses are in the room with you.

It is important to tell your doctor or nurse all symptoms you feel during the test. As part of the test, your doctor may give you a medication, which may make you feel nervous, jittery, or may cause your heart to beat faster or stronger. This feeling will go away as the medication wears off.

How long does the test take?

About 1 – 2 hours.

Can I go home after the test?

Most patients are able to go home after the test. However, you should make arrangements to have someone drive you home.

How do I get the results of my tilt table test?

After your cardiologist reviews the test results, a report will be mailed to your primary care physician. Your doctor will then discuss the test results with you.

What is a peripheral artery stenting procedure?

A small metal tubular structure called a stent is inserted into a peripheral artery through a catheter under local anesthesia. The peripheral arteries supply blood flow to the legs and feet. At the time a peripheral stent is deployed, blockage in the artery is dilated with the balloon on which the stent is mounted. The stent acts as scaffolding, keeping the artery wall stretched open and maintaining adequate blood flow through the vessel while holding the plaque back.

When does a patient’s condition require peripheral artery stenting?

When peripheral artery disease (PAD) has caused enough narrowing, or blockage, in a peripheral artery that blood supply to the legs or feet is significantly limited, serious problems may occur. Symptoms accompanying this condition often include impotence, discoloration of the legs or feet, skin ulcerations that take longer than normal to heal, or intermittent claudication (pain) caused by inadequate oxygen supply to the leg muscles. Thus, PAD is a major cause of diminished ability to walk and can lead to leg amputation.

What tests can determine a need for peripheral artery stenting?

During a physical exam, your doctor periodically checks your peripheral pulses. Diminished or absent pulses are the first signs of blockage in the peripheral arteries.

An ABI (arterial brachial index) exam is a noninvasive test that evaluates the arterial circulation of legs and feet. The test uses blood pressure measurements and Doppler ultrasound wave forms to obtain information about the circulation of each segment of your legs. The test is performed at rest for all patients and is repeated after exercise for some patients.

Computed tomography angiography (CTA) is a type of CAT scan that uses x-ray beams taken from different angles around the patient to create pictures of cross-sections of the body. Contrast medium is injected into the veins at the time of the CT scan so that the arteries will also be visualized. Using computerized techniques, the scanner can be programmed to show pictures of only the arteries, which is a CTangiogram.

A peripheral arteryangiogram, or arteriogram, is an actual picture of the inside of the arteries of the lower extremities and is used to pinpoint the location and severity of PAD. It is an invasive procedure that involves insertion of a catheter, usually through a leg artery, into the aorta and/or vessels of the legs where contrast medium is then injected and x-rays are taken to reveal pictures of the vessels. Because of the invasive nature of this procedure, it is not used routinely to follow the condition of patients with PAD and is reserved for special circumstances, especially when the diagnosis is in question or a need to open a blockage in an artery appears to be present.

How is peripheral artery stenting performed?

Peripheral stenting is a catheter-based procedure. The catheter acts as a guide to place the stent in the peripheral artery to open a narrowing or blockage. Stents come in a variety of strengths, sizes, and other properties. Stent selection for each procedure depends upon many factors, including the size of the artery, the location of the blockage and the extent of that blockage and blockages in other arteries.

What should be expected after peripheral artery stenting?

Peripheral stents are exposed to the blood and may cause clots to form until they become covered with tissue by the body. Powerful anticoagulants are taken during this time, and possibly longer, to prevent thrombosis (formation of blood clots). Check your anticoagulant therapy section below to determine what your cardiologist has prescribed for you to follow.

Aspirin and Plavix are almost always prescribed after peripheral stenting. Sometimes peripheral stents may re-narrow (restenosis) within six to eight months of placement. Because of the possibility of restenosis, your cardiologist will want you to follow-up with a preplanned diagnostic testing schedule. Your testing and follow-up schedule is shown below. Call your cardiologist’s office to schedule any that are not yet arranged. Follow-up is vital to early detection of new disease or re-narrowing of the stents.

The usual recommendation for peripheral artery stent follow up is a diagnostic study at:

• at 3 months
• at 6 months & 12 months
• then annually

Your cardiologist may request other tests depending on your condition.

What is renal stenting?

A small metal tubular structure called a stent is inserted into the renal artery that supplies essential blood flow to the kidneys. The stent acts as scaffolding, keeping the artery stretched open and maintaining adequate blood flow through the vessel after it is opened with a balloon.

When does a patient’s condition require renal artery stenting?

Plaque build-up (atherosclerosis) and sometimes other abnormalities of the renal artery may cause enough narrowing or blockage so that blood supply to the kidney is reduced and the risk of kidney damage becomes very high. Because the kidneys serve as a filter to remove waste products and excess fluids from blood, the kidneys receive almost one third of the blood flow from the heart. The kidneys also play a major role in regulating blood pressure. If left untreated, renal artery stenosis can lead to a form of high blood pressure called renovascular hypertension, poor functioning of the kidneys, and/or kidney failure.

What tests can determine a need for renal artery stenting?

A renal arterial duplex ultrasound is a noninvasive test that uses sound waves to create an image of the renal arteries and to measure the speed at which blood flows through them in order to detect any narrowing or obstruction in the renal arteries. It is useful as a screening test and for follow up studies.

Computed tomography angiography (CTA) is a type of CAT scan that uses x-ray beams taken from different angles around the patient to create pictures of cross-sections of the body. Contrast medium is injected into the veins at the time of the CT scan so that the arteries will also be visualized. Using computerized techniques, the scanner can be programmed to show pictures of only the arteries, which is a CT angiogram.

A Magnetic Resonance Angiogram (MRA) is a variant of an MRI study that uses radio waves and a magnetic field to take pictures of blood vessels. Unlike CTA and invasive angiography, MRA does not use x-rays or any form of radiation. MRA also uses a different type of contrast medium that does not have the same potential for side effects and complications. Not all patients can have MRA.

A nuclear kidney scan, a form of radionuclide imaging, tracks a small amount of nuclear tracer as it moves through the renal arteries. Images are recorded and blockages or narrowing in the renal artery may be detected, but the test is only an indirect assessment of arterial blockage.

A renal angiogram, or arteriogram is an invasive procedure involving insertion of a catheter, usually through a leg artery, up to the renal arteries where contrast medium is injected and X-ray pictures are taken to show the inside of the renal vessels. A renal angiogram is the most accurate tests in the diagnosis of renal artery disease, and is used to pinpoint the location and severity of plaque build up and blockage.

How is renal artery stenting performed?

Renal stenting is a catheter- based procedure. The catheter acts as a guide to place the stent in the renal artery to open a narrowing or blockage. The stent is deployed at the time the blockage in the artery is dilated with a balloon. Stents come in a variety of strengths, sizes, and other properties. Stent selection for each procedure depends upon many factors, including the size of the artery, the location of the plaque build-up or blockage and the severity of arterial narrowing.

What should be expected after renal artery stenting?

Renal artery stents are exposed to blood flow and may cause clots to form until they become covered with tissue by the body. Medications are taken during this time, and possibly longer, to prevent thrombosis (formation of blood clots). Check your anticoagulant therapy section in this brochure to determine what medication your cardiologist has prescribed.

Sometimes new blockages develop in the renal arteries months or years later at a different site in a renal vessel. Occasionally, renal stents re-narrow (restenosis). Because of the possibility of restenosis and / or new blockages, your cardiologist will want you to follow-up with a diagnostic testing schedule. Adhere to your testing and follow-up schedules below. Call your cardiologist’s office to schedule any tests that are not prescheduled. Follow-up is vital to early detection of re-narrowing or new disease of the renal arteries. The usual recommendation for renal stent follow up is a diagnostic study at:

• Six weeks
• Six months
• One year
• Then Annually

All testing schedules are subject to change according to each individual patient’s condition, risk factors, or recurrence of renal artery disease signs and symptoms.

What is an Abdominal Aortic Aneurysm (AAA)?

An aortic aneurysm is the dilation, bulging, or ballooning out of part of the wall of the aorta, the artery through which blood flows out of the heart to the body. Abdominal aortic aneurysm refers to the section of the aorta within the abdominal region that eventually splits off into two smaller iliac arteries that supply blood to the pelvis and legs. An aneurysm develops where the wall of the aorta has weakened, often due to atherosclerosis, high blood pressure, genetic defects, or other causes. It is considered to be an aneurysm when the widening of the area is more than 1.5 times its normal size.

When does a patient’s condition require AAA repair?

The pressure of blood flow within the aorta may eventually lead to the aneurysm expanding and rupturing. Ruptures are very painful events that cause massive internal bleeding, and usually death. There is low risk of rupture if the abdominal aneurysm is less than 4 centimeters. However, an increase in the size of an aneurysm means an increased risk of rupture because the wall stress is proportional to the diameter of the vessel.

What tests can determine a need for AAA repair?

An ultrasound examination of the abdomen is a noninvasive test that uses sound waves to visualize the aorta and any aneurysm that may be present.

A CAT scan (computed axial tomography scan) is a highly accurate test for assessing aortic aneurysms. It is performed with a contrast medium (or dye) to create two- dimensional sectional pictures in 0.5 cm cuts (sections) of the abdomen.

A magnetic resonance imaging (MRI) test may assess aortic aneurysms through high resolution contrast imaging of the arteries and blood flow, and can provide a three-dimensional picture of the aorta.

An aortogram is an invasive catheter based procedure for assessing the extent of disease in the arteries of the lower extremities as well as pre-surgical evaluation of aortic aneurysms.

How is AAA repair performed using a stent?

During abdominal aortic aneurysm stent graft repair, a device called a stent-graft is inserted into the aorta from one of the arteries in the groin under local anesthesia. In a stent-graft procedure (also known as endoluminal aortic stent grafting or endovascular repair), the physician places the device into the aorta at the level of the aneurysm, creating a new channel for blood to flow, without coming into contact with the walls of the aneurysm, so there is no stress on the walls of the aneurysm any longer. Because the grafts are delivered via a catheter, the use of grafts is much less invasive than traditional surgery. The recovery time is greatly reduced and the amount of pain and risk of other complications are much less also. Aortic aneurysm stent graft repair procedure and the devices used in this procedure under go frequent improvements and the results achieved are correspondingly better with each advance in technique and technology.

What should be expected after AAA repair?

Proper wound care in the groin area post-procedure is essential to avoid such complications as infection and bleeding. Vigorous physical activities and heavy lifting should be avoided for two weeks after the procedure. Mild discomfort, bluish discoloration and swelling in the groin area are common. A low grade fever (101 degrees F, maximum) is a common occurrence for up to a week following the procedure. Contact your physician if high fever or chills, bleeding, an increase in swelling or hematoma, or an increase in groin or leg pain should occur.

To assure good long-term results after the procedure you should be seen by your physician at the following intervals:

• One week
• One month
• Six months
• Annually thereafter

The usual recommendation for AAA repair follow up is a CT scan without and with contrast and 3 mm cuts or MRA of the abdomen and pelvis at the following intervals:

• One month
• Six months
• Annually thereafter

All testing schedules are subject to change according to each individual patient’s condition and risk factors.