RENAL ARTERY ANGIOPLASTY & STENTING

Other Names: renal artery intervention, kidney intervention, kidney angioplasty, kidney stenting

Description/Test Basics/Reasons for the test: Angioplasty and stent deployment are procedures to reopen or widen clogged or blocked arteries that supply blood throughout the body (including limbs and organs), thus improving blood flow. During angioplasty, a tiny balloon is temporarily inserted into the clogged or blocked artery and inflated where the artery is clogged. This flattens the plaque buildup within the artery against the arterial wall, widening the artery and restoring blood flow to the kidney(s). This process is called revascularization. Stent placement often follows angioplasty. A renal artery stent is a small metal coil/mesh tube that is placed at the point where the artery was widened to prop the artery open and decrease the chance the artery narrows again (restenosis). 

As people age, the normal flow of blood through the arteries feeding the kidney(s) can be reduced by the buildup of plaque along the inside of the arterial walls. Plaque is composed of cholesterol and fat. When enough buildup has occurred to reduce the flow of blood to the kidney(s), a person is diagnosed with renal artery stenosis. Angioplasty is used to treat this type of arterial disease. 

Test preparation/pre-test guidelines: Before your scheduled angioplasty, your physician will review your medical history and perform a physician exam. You will be instructed to not eat or drink anything 8-12 hours prior to the test, bring all your medications with you, inform your physician and the hospital staff if you take any medications for angina, hypertension, high cholesterol, diabetes or blood-thinning medications, notify your physician and the hospital staff of any allergies, particularly to iodine, and if you might be pregnant. You will also be instructed by the hospital staff to have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure. Depending on what medications you take, your physician may discontinue some of them prior to the procedure. Bring all your medications with you. You'll be asked to use the restroom to empty your bladder. You'll also be asked to remove dentures if applicable and may need to remove jewelry that could interfere with obtaining pictures of your heart. Arrange for transportation- angioplasty typically requires an overnight stay. Even the next day, you will not be able to drive yourself home. 

Test process/How the test is done: Before your angioplasty, the patient will have an angiogram to determine if the blockages can be treated with angioplasty. Angiograms or catheterizations are done in a special operating room called a catheterization lab. Catheterizations are usually performed with the patient lying flat on a table with an x-ray machine above or on the side of the table. An IV line will likely be placed in your arm and a mild sedative given to relax you. You will be awake during the procedure. Just before the procedure, a nurse or technician may shave the hair from the site-arm, neck or groin- where the catheter will be inserted and a local anesthetic will be applied to numb the area. A cut will be made where the local anesthetic was applied and a plastic sheath inserted into the cut to provide access for your physician to insert the catheter, a long thin tube that is inserted in an artery or vein in your groin, neck or arm and threaded to the blood vessels to your heart. The catheter is carefully threaded into the renal arteries leading to the kidneys using a specially-designed x-ray machine that produces real-time pictures (fluoroscopy). Once the catheter is in place, the renal angiogram comes next. During angiography, a contrast dye will be injected through the catheter into the renal arteries leading to one or both of your kidneys. The dye blocks x rays. While flowing through the renal arteries to the kidneys, the physician traces the flow of this dye with an x ray machine to get a 'road map' of the arterial blood vessels. X-ray images of your kidneys will be taken. These x-rays, called angiograms, help your physician find the location and severity of the blockages affecting your heart's blood supply and decide on a treatment course. In a renal angiogram, the catheter is usually placed in the artery in your groin. More than one injection of dye may be used during an angiography.
 
Following the angiogram is the renal angioplasty. A smaller balloon catheter will be led through the flexible catheter and inflated at the narrowed area to open it. The balloon compresses the blockage (plaque) against the arterial wall, widening the blocked artery allowing increased blood flow through the renal artery. The balloon will stay inflated up to several minutes at the site of the blockage, stretching out the artery before it's deflated and removed. In many cases, your doctor will also place a mesh coil called a stent at the narrowed portion to help keep the artery open. Your physician will do this by removing the angioplasty balloon catheter and inserting a catheter that has a closed stent around deflated balloon. This catheter is taken to the site of the blockage and the balloon expanded, opening the stent. The stent locks into place within the artery. The balloon is then deflated and removed, leaving the stent in place. Your physician may use a drug eluting stents have an anti-platelet coating that further help to reduce the chance of restenosis, or the blockage reappearing. Your physician will then perform more angiograms to see how the blood is flowing through your newly opened artery. This procedure may take anywhere from 45 minutes to three hours to complete.
 
Post-test guidelines: You'll probably remain hospitalized one day, maybe more, while your kidneys are monitored. You must remain in bed and allow the access site to heal. You will be closely monitored for any complications. Your doctor may prescribe medications such as aspirin or anticoagulants/anti-platelets to prevent blood clots. Avoid lifting more than a few pounds the first few days you‚Äôre home. Do not do any strenuous exercise for the first few days as well. Drink plenty of water and other clear fluids for at least two days- this will help rid your body of the contrast dye.  Do not shower for at least 24 hours after returning home. Avoid taking a bath for a few days. You should be able to return to work or your normal routine the week after angioplasty. Call our office immediately if: 
  • You develop chest pain or shortness of breath
  • You feel weak
  • You develop bleeding or swelling at your catheter site.
  • You have signs of infection, such as redness, swelling, drainage or fever
  • Any other symptoms or signs that concern you.
 
It's important that you closely follow your physician's instructions regarding your blood-thinning medications- for example, aspirin, Coumadin, plavix, clopidrogel or similar medications. Most patients who have undergone coronary angioplasty regardless of stent placement will need to take aspirin for the rest of their lives. Those who have had stent placement will need a blood-thinning medication such plavix for at least one year if they are not a high risk for bleeding. Although drug-eluting stents have been shown to reduce renarrowing in certain cases, recent research has shown that drug-eluting stents slightly raise the long-term risk for the development of blood clots, which can lead to adverse cardiac events, including heart attack and death. If you have any questions talk to your cardiologist before stopping any of these medications. If you plan on having surgery, or seeing the dentist, and they advise stopping your blood-thinning medication prior to the procedure, talk to your cardiologist first.
 
Test location: Angioplasty and stent placement will be performed at Denton Regional Medical Center and Texas Health Resources Presbyterian Hospital Denton.
 



HOSPITAL PRIVILEGES:   •  Denton Regional Medical Center   •  Texas Health Presbyterian Hospital Denton
   •  Muenster Memorial Hospital   •  North Texas Medical Center


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