Renal angioplasty

Published by Bupa's Health Information Team, October 2011.

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

A renal angioplasty is a procedure used to widen a narrowing of renal arteries, which supply blood to the kidneys.

You will meet the radiologist carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About renal angioplasty

Renal angioplasty is a procedure used to widen narrowed renal arteries to allow blood to flow through normally to your kidneys. It can treat a condition called renal artery stenosis, which is a narrowing of your renal arteries.

Renal artery stenosis usually happens when fatty deposits (plaques) build up in the walls of your arteries, restricting blood flow. This is called atherosclerosis. Sometimes it’s caused by a condition called fibromuscular dysplasia.

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, a CT scan (this uses X-rays to make a three-dimensional image of the part of the body) or an MRI scan (this uses magnets and radiowaves to produce images of the inside of the body). You may need to have an injection of a radioactive substance called a radioisotope, which can be picked up on the scan to measure the blood flow to your kidneys.

You may also have a renal angiography where a radiologist will inject a dye into your blood vessels to make them 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. This is usually only done if angioplasty doesn’t work or isn’t suitable for you.

Preparing for the procedure

Your radiologist will explain how to prepare for your renal angioplasty. If you're having an angioplasty, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about four hours beforehand. However, it’s important to follow your radiologist’s advice.

The procedure is usually done through a big artery in your groin, so you may be asked to shave this area. It’s important that you don’t shave this area unless you’re asked to do so.

It's possible to have an allergic reaction to contrast medium (the dye used during the procedure). Tell your radiologist if you know that you’re allergic to contrast medium.

Your radiologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

About the procedure

Renal angioplasty takes between 30 and 90 minutes. It's usually done in the X-ray department of a hospital.

You will lie flat on your back on an X-ray table. Your radiologist may put a needle into a vein in your arm so that you can have a sedative or painkillers if you need them.

You will have an injection of local anaesthetic into the skin over your artery – usually in your groin. This will completely block feeling from the area and you will stay awake during the procedure.

Your radiologist will insert a needle into your groin artery. He or she will then put a guide wire through the needle. Your radiologist will then remove the needle and place a thin tube called a catheter over the wire into your artery.

Your radiologist will inject a dye called contrast medium through the catheter. You may have a warm feeling when the contrast medium is injected. Once the catheter is in place, he or she will pass the guide wire into the artery supplying the kidney. Your radiologist will then replace the catheter with a one that has a balloon on the tip, which can than be inflated. It may be inflated more than once to make sure the artery is wide enough.

Sometimes your radiologist will put a collapsed wire mesh tube (called a stent) over the balloon at the end of the catheter, and insert it into your artery with the catheter. When the balloon is inflated it opens up the stent. When your radiologist removes the catheter, the stent stays in place to keep your artery open.

After the procedure, your radiologist will remove the balloon and catheter.

Your radiologist will close the hole in your artery. He or she may put a special type of plug over the hole to close it, or press on the puncture site.

What to expect afterwards

You will be asked to lie flat in bed for one hour and stay in bed for a few more hours after the procedure. Your nurses will regularly check the puncture site. 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, so 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 afterwards. You may also have a bruise there.

You may be given some medicine to take to prevent blood clots forming in your arteries.

You can get back to your usual activities as soon as you get home.

What are the risks?

As with every procedure, there are some risks associated with angioplasty. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted, but mostly temporary effects you might get after having the procedure.

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

Complications

Complications are when problems occur during or after the angioplasty.

Specific complications of angioplasty are rare but possible complications are listed below.

• You may get severe bleeding from your artery.
• There may be damage to your arteries, including the renal artery, which can damage your kidney.
• Small parts of the lining of your artery may break away and become stuck in your artery, causing reduced blood supply to your artery.
• You may get blood leaking out under your skin if the hole in your artery isn’t closed properly.
• You may get a wound infection, which can be treated with antibiotics.
• You may have an allergic reaction to contrast medium.
• Your artery may not open up as much as hoped.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.