What is angioplasty?
Angioplasty is a procedure to expand narrowed or blocked blood vessels (arteries or veins) and improve blood flow. Angioplasties are performed by interventional radiologists and are usually done through the groin or arm. Angioplasties can be performed to address various issues including the narrowing of the arteries to the kidneys, narrowing of the veins in the pelvis (iliac veins) or in the chest (subclavian or brachiocephalic veins).
Risks of angioplasty
Angioplasties are usually low-risk procedures. Major complications are extremely rare. The risk may increase depending on your child’s condition, age and health.
The risks of angioplasty include:
- pain, bruising or bleeding at the site where the catheter was inserted
- infection
- a bulge or weakness in the artery wall (pseudoaneurysm) where the catheter was inserted
- poor circulation to the leg or arm where the catheter was inserted
- clotting (blockage) of the arteries examined
- damage to the arteries examined (dissection, rupture, blockage)
- bleeding inside the body in the area examined
- allergy to X-ray dye or contrast
- reduced function of organ and tissue (rarely a stroke, paralysis, organ loss)
Visiting the clinic before the procedure
Your child may have a clinic visit with the interventional radiology team before the procedure. During the visit, you should expect:
- A health assessment to make sure your child is healthy and that it is safe to have general anesthesia and to go ahead with the procedure.
- An overview of the procedure and a review of the consent form.
Giving consent before the procedure
Before the procedure, the interventional radiology team will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh benefits against the risks. It is important that you understand all these potential risks and benefits of the angioplasty and that all your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of their procedure. If your child starts to feel unwell or has a fever within two days before the angioplasty, let their health-care provider know. Your child’s procedure may need to be rescheduled.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty before general anesthetic.
- If your child has special needs during fasting, talk to their health-care provider to make a plan.
- Your child can take their regular morning medicine with a sip of water up to two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their health-care provider and the interventional radiology team.
On the day of the angioplasty
Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will be dressed in a hospital gown, weighed and assessed. You will also be able to speak to the interventional radiologist who will be doing the angioplasty, and the anesthesiologist who will be giving your child medication to make them comfortable during the procedure.
During the angioplasty, you will be asked to wait in the surgical waiting area.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. For angioplasties, most children are given general anesthesia.
How an angioplasty is done
The interventional radiologist will insert a flexible tube, called a catheter, into the groin or the arm. The catheter is then directed into the area that requires imaging. Next, contrast dye is injected into the catheter. The dye is a clear, colourless liquid that helps to outline the arteries, so they show up on X-rays, which are used to take pictures of the blood vessels. A deflated balloon is then threaded on the tip of the catheter and guided into the narrow blood vessel. The balloon is then inflated to dilate or open the narrowed blood vessel.
When the procedure is finished, the catheter is taken out. The radiologist presses on the groin or arm to stop any bleeding. The insertion site will have a small clear dressing.
An angioplasty can take from two to four hours, depending on how complex the blood vessels being examined are. It can also take longer if any additional treatments are done to the arteries.
After the angioplasty
Once the angioplasty is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, you will be notified and taken to be with your child.
Your child should remain on their back with their leg or arm kept straight for six hours after the procedure. Some pressure may be applied at the insertion site in the groin or arm to prevent further bleeding.
Going home
In most cases, children stay in the hospital for observation for 24 hours or longer. Your child will require blood thinner medicine to prevent a blood clot from forming at the angioplasty site. Your child’s health-care provider will let you know when they are well enough to go home.
Results
The health-care provider who ordered the procedure will receive the results of your child’s angioplasty. You will need to make an appointment with them to discuss the results.
At SickKids
If you have any questions or concerns regarding your child after discharge, please contact the Image Guided Therapy (IGT) clinic at (416) 813-7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message. Alternatively, you can email the IGT clinic nurse at igt.clinicnurse@sickkids.ca.
If you have concerns and it is after working hours, see your child’s primary care provider or go to the nearest Emergency Department. You can also contact the Hospital for Sick Children switchboard at (416) 813-7500 and ask them to page a member of your child’s health-care team or the interventional radiology fellow on call.
For more information on preparing your child for their procedure see Coming for surgery.
