Preparing for a Percutaneous Transluminal Renal Angioplasty HF#4641



Your doctor has scheduled a Percutaneous Transluminal Renal Angioplasty (PTRA) to be done by our Interventional Radiologists on ______________ at ______________AM/PM.  This handout explains the procedure to you.  It tells you what you need to do before and after the procedure. Before the procedure is done, our doctors will explain it to you and ask for your consent to do it.

 

What Is a PTRA?

 

Kidney (renal) arteries or veins that have been narrowed or blocked are opened using a balloon.  First, a series of x-ray pictures are taken with the use of contrast (x-ray dye).  Next, a special catheter with a balloon on the tip is inflated and deflated in the blocked vessel in your kidney. Sometimes, a small metal stent will be permanently placed into the vessel to keep the vessel open.

 

Why Do You Need a PTRA?

 

• A Magnetic Resonance Angiogram (MRA) or arteriogram has shown that your renal artery is narrowed or blocked.
• You have high blood pressure or problems with your kidney that may be improved by opening up the narrowed artery.
• The PTRA is the best method for a patient who cannot have surgery.
• Most of the time it is the preferred method to open blocked vessels that are easy to reach.

 

How to Prepare

 

1.   We will draw blood for lab tests the morning of the procedure.

2.   If you are taking any blood thinners such as aspirin, Persantin®, warfarin (Coumadin®) or clopidogrel (Plavix®) you will be told whether to stop these medicines before the procedure.

3.   Do not eat for 6 hours before your procedure.  You may have clear liquids up until 4 hours before.

4.   If you have diabetes and take insulin, we will give you instructions on what to do to manage your blood sugars before the procedure.

5.   Take your prescribed oral medicine as scheduled with a sip of water.

6.   If there is any chance you might be pregnant, please tell the Radiologist.

7.   Be sure to tell the Radiologist if you have any allergies to contrast dyes, antibiotics, anesthetic agents, or any other medicines that you may have taken before.

8.   Tell the Radiologist if you are allergic to iodine or latex.

9.   You will stay in the hospital overnight.  Please make plans to have someone drive you home the next day.

10.   If you are on a medicine called Glucophage® (metformin), tell your primary doctor and the radiologist.

 

The Procedure

 

The procedure is done in the Radiology Department.  Again be sure to tell the Radiologist if you have any allergies to iodine, contrast dyes, antibiotics, anesthetic agents, latex, or any medicines that you may have taken in the past.

 

It most often takes an hour, sometimes longer.  An intravenous (IV) catheter will be placed to give you fluids during the procedure.  Medicine to relax you is often given.

 

During the procedure, the nurse will check your vital signs with a clip on your finger (pulse oximeter) and blood pressure cuff.  After the doctor finds your femoral artery and marks it, this area of the groin will be shaved and cleaned.  After this is done, you will be covered with sterile drapes to prevent infection.  The doctors will wear sterile gowns and masks to provide a clean setting.

 

The skin at the entry site will be numbed so you will have little pain.  Lidocaine is used to numb the site.  Most of our patients do not feel a lot of pain during the procedure.  You will feel pressure when the catheter is placed.  Under x-ray guidance a small catheter is placed into the femoral artery.  The doctor will advance the catheter into the kidney which needs to be studied.

 

The small catheter will be hooked up to an injector at which time the contrast is injected into the renal artery.  The contrast creates highlighted pictures of the renal blood vessels. During this injection, you may have a feeling of warmth or heat.  It is most often felt in the abdomen and buttocks.  This is normal.  You will be told to hold your breath for short periods of time so you do not move while the films are being taken.  A number of injections are done through the catheter.

 

 

After finding the place and size of the blockage, the renal angioplasty will begin.  The catheter is threaded up until it reaches the blocked area.  At the end of the catheter is a balloon.  The balloon will inflate for 15-60 seconds and then deflate.  This cycle may be repeated several times.  You may feel pressure at the site when balloon is inflating.  Some patients have a moderate amount of pain while the balloon inflates.  If this happens, you will be given IV pain medicine.  At this time, a metal stent may be placed in the area of narrowing to keep the artery open.  After the angioplasty, another arteriogram is done to see if the renal blood flow has improved.  Most of the time, your blood pressure will improve.  If you have had kidney or flank pain for a long time, this may improve.

 

 

 

 

 

 

After the Procedure

 

After the procedure, you will return to a nursing care unit.

 

• You will need to lie flat with your leg straight for 4-6 hours.
• Vital signs such as blood pressure, pulse, and temperature will be taken often.
• The blood flow to your leg will be checked.
• Your groin site will be checked for bleeding and the presence of a hematoma.
• You may eat and drink what you’d like.
• You may start taking all your prescribed medicines as scheduled.
• To make it easier for you, you may have a Foley catheter in place while you are lying flat.  A catheter is a tube placed into your bladder that empties your urine so you do not need a bedpan or urinal.
• You will have an IV to make sure you get enough fluids.
• You may have a moderate amount of pain after the procedure due to increased blood flow in your kidney.  This happens because the kidney has not had proper blood flow for a long time because of the blockage.  You will be given pain medicine if this occurs.

 

Home Care

 

Before you go home

 

• The nurse or doctor will show you how to apply direct pressure to the site in case it bleeds.
• Write down the date the doctor says you can return to work.
• Write down the date the doctor says you can resume driving (most of the time this is 48 hours after the procedure).
• Write down the date the doctor says you may resume taking your anticoagulants or blood thinners.

 

What to do when you are home

 

• If bleeding occurs at the site, apply direct pressure and go to the nearest emergency room.
• Keep the gauze dressing dry for 24 hours.  After that, you can remove the gauze dressing and shower or bathe as usual.  Put a Band-Aid® over the site for the next 3 days.
• Drink at least 10-20 glasses of fluid (water, coffee, juice, tea, any food that melts at room temperature, etc) for the first 24 hours.  Do not drink alcohol the first day.
• Keep your leg with the puncture site straight when sitting or lying down for the first 24 hours.
• Do not lift more than 10 pounds for 24 hours. 
• Puncture Site - once a day for five (5) days, check the puncture site on your leg for signs of infection.  Call your doctor if you notice any of these signs.
  • red and/or hot puncture site
  • foul-smelling, yellowish or greenish drainage from puncture site
  • increased swelling at puncture site
  • temperature (by mouth) above 100°F or 37.7°C.
• If you feel very dizzy, feel faint or light-headed, this may be due to low blood pressure, and you may be bleeding internally.  If you feel this way, go to the nearest emergency room.
• Make an appointment in the next week to see the doctor who prescribes your blood pressure medicine to see if it should be changed.

 

Pain Medicine

 

You should feel only a little pain after you are home.  For relief, take acetaminophen (such as Tylenol®).  Do not take aspirin unless you have been instructed to do so.  It may increase the chance of bleeding.

 

When to Call Your Doctor

 

Call if you have

• Signs of infection

• Large bruise under and around the puncture site (often firm to touch)

• Severe pain or spasms in the leg

• Numbness or tingling in foot or leg

• Loss of motion in foot or leg

• Itching or hives any place on your body

• Vomiting

 

Phone Numbers

 

If you have any questions or problems once you are at home, call the Radiology Department (608) 263-8355 during the day (8:00 am to 4:30 pm).

 

Nights, weekends and holiday, this number is answered by the paging operator.  Ask for the Angio/Interventional resident on-call.  Leave your name and phone number with the area code.  The doctor will call you back.

 

If you are calling from out of the area, call 1-800-323-8942.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 07/30/2010

Copyright © 07/30/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4641

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