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Leg arteriogram

A leg arteriogram is an imaging test that uses x-rays and a special dye to see inside the arteries in the leg. The purpose is to diagnose and see any blockages or stenoses (narrowing). This may be performed on one, or both legs.

Once an arteriogram has been completed, and a blockage or stenosis has been confirmed, if it is appropriate, treatment can commence. Treatment options include angioplasty, stenting, lithoplasty or atherectomy. Your interventional radiologist will determine which treatment is best suited for you.

Angioplasty

Percutaneous Transluminal Angioplasty (PTA) is the opening of a stenosed (narrowed) or blocked blood vessel using a balloon catheter. The balloon inflates to a specific size, forcing the blood vessel to expand.

In most cases the artery will remain open following the balloon inflation, and, in most instances, a drug coated balloon will then be utilised to help stop the narrowing returning. Sometimes however, the artery does not respond well to a balloon catheter, and in that case, the next step would be to place a stent in the artery.

Stenting

If an angioplasty has been unsuccessful, or a recurrent stenosis persists, a stent will then be inserted so the artery can remain patent.

A stent used in the artery is a metal, mesh like tube made from either nitinol (nickel-titanium alloy) or cobalt chromium. Alternatively, it can be covered with a material, such as polytetrafluoroethylene (ePTFE). Your interventional radiologist or vascular surgeon will decide on the type of stent depending on your specific circumstance, and the location of the blockage.

Before the Procedure

Fasting: Do not eat or drink anything for 4 hours prior to your procedure time.

Allergies: Please tell Intra staff at the time of booking if you have any food or medication allergies, or previous reactions to X-ray contrast (dye).

Diabetes: If you are a diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication with your interventional radiologist or vascular surgeon.

Anticoagulation (blood thinner) If you are taking any blood thinners (e.g. Warfarin, Clexane, Pradaxa, Rivaroxaban), please make this known to Intra staff at the time of booking. You will need to stop this medication temporarily 2-5 days before the procedure, but this will be advised via your interventional radiologist, vascular surgeon, Intra nurse, or the admin team.

Other usual medications: Continue taking these, especially your blood pressure tablets.

During the Procedure

An arteriogram with or without treatment is performed by an interventional radiologist or vascular surgeon. This can take up to 1.5 hours to perform, depending on the type of treatment required. During the procedure you will be sedated but awake. Local anaesthetic will also be injected around the access site

The area around your groin will be painted with an antiseptic solution, and a sterile drape will then be placed over your body, to ensure sterility is maintained. Local anaesthetic will be injected around the artery in your groin. This will sting for approximately 30 seconds, but after this, you should not feel any pain. If at any time you feel pain, or discomfort, please inform the doctor immediately, and more pain relief can be given via your IV line, as well as more local anaesthetic.

Using ultrasound guidance, the artery in the groin will be accessed, and a small hollow tube (sheath) will be inserted into the artery. Using contrast dye and fluoroscopy, arteriograms will take place.

If the blockage or narrowing can be treated endovascularly (inside the blood vessel), wires and catheters will be used to cross the lesion, and treatment will commence. Depending on the location of the lesion you may feel some discomfort during the inflation of balloons or stents. These are momentary and subside once the balloon is deflated. Please inform the doctor if you have pain, and it is not going away. More pain relief can be given.

Once treatment of the lesion has been completed, a device will be used to close the hole made in your artery. This will mean that you can start to sit up, an hour after your procedure has been completed.

After the Procedure

If your procedure is performed at our Epsom facility, you will be transferred to the CIU, Mercy Hospital to recover. Alternatively, if you have your procedure at North Harbour you will be transferred to the recovery area.

The nurses will monitor your recovery and if appropriate, you will usually be discharged after 4-6 hours, or you may need to stay overnight.

Due to a hole being made in the artery, there is a risk of bleeding after the procedure, therefore:

  • If a closure device was utilised to close the hole, you will need to remain flat for 1 hour
  • If a closure device was not utilised, and manual pressure was applied to the groin after the sheath was removed, you will need to remain flat for 2 hours.
  • You will be on full bed rest for 4 hours. This may need to be increased to 6 hours, if there is a haematoma or ooze at the puncture site.

Going home and recovery

Someone must drive you home or accompany you in a taxi. Please arrange for accompanied transport in advance.

  • Due to the sedation, you may feel lethargic afterwards with reduced concentration. For this reason, for 24 hours after your procedure, please:
    • Do not drive.
    • Do not drink alcohol.
    • Do not make any legal decisions or sign legal documents.
  • Do not do any activity requiring strength, concentration, or full alertness for the rest of the day.
  • Due to the risk of bleeding from your groin, someone must stay with you overnight, if you are discharged home. Please arrange this in advance, or you will need to stay in hospital overnight.
  • You can undertake light activities such as walking.
  • No heavy (>5kg) lifting for at least one week.

What are the risks?

As with any procedure, there are potential risks involved. Your interventional radiologist or vascular surgeon will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur on the day of your procedure.