What to Expect from an Interventional Vascular Procedure

So, you're scheduled to have an interventional procedure? Like many patients, you probably wonder what to expect. To begin with, it's helpful to know what interventional procedures are. They are specialized procedures performed within body systems, organs, arteries, and veins. These procedures are performed using catheters, miniature cameras, imaging, and other technology to minimize surgically cutting open the skin or other organs. One of the most common procedures is angioplasty, which is a technique of threading a catheter through an artery to a blocked or narrowed area and then opening a small balloon to press the plaque against the artery wall and increase the opening. Often a metal stent is then inserted. A stent is a small wire mesh frame that stays in the blood vessel to keep it open. Another procedure, called embolization, closes blood vessels. A catheter is again threaded to a specific blood vessel which needs to be closed so blood can circulate via other arteries or veins. Various compounds are delivered at the specific blood vessel to close it off. Other common interventional procedures include angiograms, which involve the injection of x-ray dye to find blockages in blood vessels, and central catheter placement for dialysis or chemotherapy.

Now that you have a basic understanding of interventional procedures, how do you prepare for a procedure? Generally, you must not eat after midnight on the day of the procedure. When you arrive for your procedure, medical staffers will go through a checklist with you and answer any questions you may have. If your procedure requires intravenous (IV) sedation or other medications, an IV will be started. Then you are ready for your procedure.

You will be taken to the angiographic suite, which can make you feel anxious. However, by understanding how a typical room is arranged, your anxiety may be decreased. This room has all the specialized imaging equipment to see inside your blood vessels and the tools needed to treat them. First, there will be a large C-shaped machine near the center of the room. This is the x-ray camera the physician will use to see inside your body. A table for you to lie upon will be there as well as other instruments.

Someone will assist you onto the procedure table. A nurse will place various devices onto your body to monitor your vital signs, such as electrodes for the EKG machine, a blood pressure cuff, and a small clip onto your fingers to measure your blood oxygen level. The nurse may also give you intravenous sedation. The area that is needed for the procedure is cleaned. You will be covered with a sterile sheet.

When the physician is ready to start the procedure, he or she will put a local anesthetic in the location of the procedure. For most procedures, this may be the most uncomfortable part and may feel like a mild pinch. In many cases intravenous sedation is administered as well. A small incision is made for catheters and wires. If you do feel pain, tell the physician or nurse. You may feel pressure during the procedure and this is normal.

The length of time for interventional procedures varies, but most of them last under two hours. When the procedure is over, the physician may apply pressure at the site for several minutes to stop bleeding. If the catheter was placed through a blood vessel in the groin area, you may be required to keep your leg straight for several hours to minimize the chance that the hole in the vessel will bleed. This is important, and your cooperation after the procedure is strongly advised.

Once the procedure is completed, your skin will be cleaned, and sterile dressings may be applied. You will be moved onto the stretcher or wheelchair and taken to a recovery area. Nurses will observe you for sleepiness if you were sedated and to make sure you have no complications.

You may experience mild to moderate tenderness or bruising in the procedure area for several days. Over-the-counter pain medications usually work well for mild discomfort. You should ask your physician when you can resume normal activities and what restrictions you may have. Typically, heavy lifting (over ten pounds) is usually discouraged for at least several days. Following most procedures, resumption of normal activities is rapid.

About the Author: Meghal R. Antani, MD, is an interventional radiologist at Washington Hospital Center. His special area of interest is in the main vein leading back to the heart. Dr. Antani also serves on the Vascular Disease Foundation's Editorial Review Board for Keeping in Circulation.