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Renal angioplasty

Published by Bupa's health information team, July 2009.

This factsheet is for people who are having a renal angioplasty, or who would like information about it.

A renal angioplasty is a procedure used to open up a narrowing of your renal artery.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

What is a renal angioplasty?
Diagnosis of renal artery stenosis
What are the alternatives to renal angioplasty?
Preparing for the procedure
About the procedure
What to expect afterwards
Recovering from the procedure
What are the risks?
Questions and answers
Related topics
Further information
Sources

What is a renal angioplasty?

Your renal arteries supply your kidneys with blood. Renal angioplasty is used to treat a condition called renal artery stenosis, which is narrowing of your renal arteries.

Renal artery stenosis usually happens when fatty deposits (plaques) build up in the walls of your arteries. This is called atherosclerosis. The fatty deposits cause your arteries to become narrower, restricting your blood flow.

Sometimes renal artery stenosis is caused by a condition called fibrodysplasia.

Renal angioplasty is used to open up the narrowing of your renal arteries. This can improve the blood flow to your kidneys and reduce the symptoms of renal artery stenosis. During your renal angioplasty, you may have a small metal tube called a stent inserted into your artery and left inside to hold it open.

Renal angioplasty is done by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions).

Diagnosis of renal artery stenosis

Renal artery stenosis is usually diagnosed with an ultrasound scan. An ultrasound scan uses sound waves to produce an image of the inside of your body.

You may need to have an injection of a radioisotope into your bloodstream to measure the overall blood flow to your kidneys.

You may also need to have a renal angiography. An angiography is a test that uses an injection of a special dye into the blood vessels that makes them clearly visible on X-ray images.

What are the alternatives to renal angioplasty?

If you have severe renal artery stenosis, you may need to have bypass surgery. This is an operation to make your blood flow around the blocked artery instead of through it. Your surgeon will attach a graft artery above and below the blocked area of your artery. This is usually only done if angioplasty hasn't been successful.

Preparing for the procedure

You will usually be asked not to eat for four hours before the procedure.

You will be asked to put on a hospital gown. The procedure is usually done through a big artery in your groin, so you may be asked to shave this area first. Don't shave this area unless your doctor or a nurse asks you to do so.

You must let the radiologist know if you're allergic to contrast medium (the dye used during the procedure).

Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead

About the procedure

Renal angioplasty takes about 40 minutes. It's usually done in the X-ray department of a hospital.

You will be asked to lie flat on your back on an X-ray table. You may have a needle put into a vein in your arm so that you can be given a sedative or painkillers if you need them. You may also have a monitoring device attached to your chest and finger.

You will be given an injection of local anaesthetic into the skin over your renal artery. This will completely block feeling from the area and you will stay awake during the procedure.

The radiologist will insert a needle into the large artery in your groin. He or she will then put a guide wire through the needle into the artery. The needle will be removed and a thin plastic tube called a catheter will be placed over the wire and into your artery. The catheter will have a deflated balloon at its tip.

The radiologist will inject a dye called contrast medium through the catheter. You may have a warm feeling when the contrast medium is injected. Contrast medium allows the radiologist to use X-ray images to guide the catheter to your narrowed artery. Once the catheter is in your narrowed artery, the balloon will be inflated to widen your artery. The balloon may be inflated more than once to make sure that the artery is wide enough.

Sometimes, a collapsed wire-mesh tube (called a stent) is put over the balloon at the end of the catheter before it is inserted into your artery. When the balloon is inflated it opens up the stent. When the catheter is removed, the stent is left in place to help to keep your artery open.

Illustration showing a blood vessel treated with balloon angioplasty and stent
A blood vessel treated with balloon angioplasty and stent

When the radiologist is happy that your artery is wide enough, he or she will remove the balloon and catheter.

The radiologist will close the hole in your artery to stop it bleeding. He or she may put a special type of plug over the hole to close it, or press on the puncture site with his or her hand for a few minutes.

What to expect afterwards

You will be asked to lie flat in bed for around an hour after the procedure. This is to make sure that there is no further bleeding from the puncture site of your artery. The puncture site and your blood pressure will both be regularly checked. You may also need to have a blood test.

You will usually need to stay in hospital overnight.

Recovering from the procedure

Sedation temporarily affects your co-ordination and reasoning skills. If you had a sedative, you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

You may have some discomfort in your groin, where the catheter was inserted, for about a week after the procedure. You may also have a bruise in this area.

You will be told how to look after the puncture site before you go home. You may be given some medication to take to prevent blood clots forming in your arteries.

If you have severe pain around the puncture site or in your back, contact the hospital or your GP. If there is bleeding from the puncture site or blood in your urine, contact the hospital or your GP straight away.

What are the risks?

Angioplasty is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment.

You may have some bruising and discomfort around the area where the catheter was inserted.

Complications

This is when problems occur during or after the operation. Most people aren't affected.

Specific complications of angioplasty are rare but can include the following.

Severe bleeding from your artery. If this happens you may need a small operation to stop the bleeding.
Damage to your renal artery. This can sometimes lead to loss of function of your kidney.
Damage to other blood vessels the catheter has passed through.
Small parts of the lining of your artery may break away and become stuck in the artery below where the angioplasty is carried out. If this causes problems with your blood flow, you may need to have a small operation to remove the blockage.
A false aneurysm - if the hole in your artery isn't closed properly, blood can leak out underneath your skin.
A wound infection. This can usually be treated with antibiotics.
An allergic reaction to contrast medium (the dye used during the procedure).
Your radiologist may be unable to move the catheter through your narrowed artery.
Your artery may not open up as much as hoped, even if the balloon has been inflated several times.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your doctor to explain how these risks apply to you.