Learning About Your Health

Patients' Frequently Asked Questions (PFAQ): Tests, Exams & Procedures

Barium Enema

What is a barium enema (Lower Gastrointestinal Tract Radiography)?

A barium enema is a radiology test to evaluate the large intestine (or "colon") for the presence of disease. A specially trained doctor known as a Radiologist performs this test in the Radiology department. The Radiologist carefully instills a contrast material (barium liquid) into the rectum, and uses a precisely measured low dose of radiation (fluoroscopy) to view the colon in real-time. This study allows the Radiologist to study the colon in active motion, which is often the most effective way to view an abnormal or blocked large intestine.


Back to top

What are some common reasons for a barium enema?

Your doctor may order a barium enema to evaluate for diseases of the colon such as ulcers, benign polyps, cancer, or inflammation. It may also be performed as a screening examination for cancer in asymptomatic individuals over the age of 50. The procedure is frequently requested on patients suffering from chronic diarrhea, bloody stools, constipation, or irritable bowel syndrome. Other indications include unexplained weight loss, a change in bowel habits, or to detect a source of suspected blood loss. These images of the bowel and colon are also used to diagnose inflammatory bowel disease, a group of disorders that include Crohn's disease and ulcerative colitis.


Back to top

How should I prepare for the barium enema procedure?

When you call to schedule your appointment, you will be given detailed instructions on how to prepare for your barium enema. You will be asked to purchase a Fleet® Prep Kit from your local drug store. The Fleet® Prep Kit is a complete 3-step bowel preparation procedure. Detailed instructions for diet and clear liquid guidelines, along with instructions for taking each of the 3 products, are provided with each Prep Kit. It is important to read these instructions at least 48 hours in advance of your examination. It is important that you follow each step in the instructions provided in the kit so that your colon is adequately cleaned out and a useful, accurate barium enema exam is performed. Otherwise it is possible that you may be asked to repeat the entire preparation or the x-ray exam. If you have any questions, call your doctor. During the day before the procedure, you cannot eat, and may only drink clear liquids such as juice, tea, black coffee, cola, or broth. You cannot drink milk or any other dairy products. After midnight, you should take nothing by mouth. You also will be instructed to take a laxative (pill, suppository or liquid form) and to use an over-the-counter enema preparation the evening, or even a few hours, before the procedure. Just follow the Fleet® Prep Kit instructions.

You are allowed to take your usual prescribed oral medication with small amounts of water even the morning of the exam. Once you arrive at the Radiology Department or imaging center, you will be asked to change into a gown before your examination. You may also be asked to remove jewelry, eyeglasses, or any metal objects that could make it difficult to view the images. Women should always inform their doctor or x-ray technologist if there is any possibility that they are pregnant.


Back to top

How is barium contrast used to view images of the colon?

The organs of the abdomen and pelvis are similar in density, so a contrast material is needed to provide exquisite detail of the colon. Liquid barium, a dense, non-absorbable white solution, is introduced into the colon through a rectal tube. The barium coats or fills the inside of the colon and, with the use of low dose x-ray pictures, a sharp, well-defined image of the colon is produced.


Back to top

What will I experience during the barium enema procedure?

You will be positioned on a large flat table, referred to as a fluoroscopy table in the x-ray department. This table can move and be tilted at different angles during your exam. A moveable x-ray camera extends over a portion of the table and sends real-time images to a nearby television monitor for viewing by the radiology doctor performing your exam.

First, the Radiologist will obtain a preliminary film to check for the adequacy of your bowel preparation. The Technologist will then introduce the barium contrast material through a small tube gently inserted into your rectum. A liquid mixture of barium and water is passed into the colon through the tube. As the barium fills your colon, you will feel the need to move your bowels. You may feel abdominal pressure, or minor cramping, but these are sensations most people are able to tolerate. The tip of the enema tube is specially designed to help you hold the barium. If you are having trouble, let the Radiologist or Technologist know. We want you to be as comfortable as possible during this important examination.

During the imaging process, you will be asked to turn from side to side, and to hold several different positions so that the Radiologist or Technologist can obtain views of the colon from several angles. Occasionally, if there is evidence of severe colonic spasm, you may be given a medication to relax the colon. This medication is called Glucagon, which is a synthetically derived natural hormone that is administered intravenously. This medication may allow the detection of disease that may otherwise be difficult to detect because of the colonic spasm.

At times, the Radiologist may press on your abdomen to obtain better pictures of your colon. With some barium enema examinations (so called air contrast studies), the table may be turned into an upright position. Only enough barium to line the inner surface of the colon is left in place and air is introduced through the rectal tube to obtain well-defined x-ray images of the large intestine. Once the examination is complete, most of the barium is drawn back into a bag, and you will be directed to the washroom to expel the remaining barium and air. In some cases, the Technologist may then take additional images to help the doctor see how well the colon has cleared. After this, you are finished with your procedure.


Back to top

What can I expect after the barium enema procedure?

You are able to return to a normal diet and activities immediately after the exam. Your stools may appear white for a day or so, as your body clears the barium liquid from your system. You will be encouraged to drink additional water for 24 hours after the examination. After a barium enema, some people experience constipation. If you do not have a bowel movement or are unable to pass gas for more than two days after your exam, call your doctor promptly. You may need an enema or laxative to assist in eliminating the barium, and your doctor will prescribe the right solution for you. A lower GI barium study typically takes between 30 and 60 minutes.


Back to top

Who interprets the barium enema results and how do I get them?

A Radiologist, a specially trained doctor experienced in GI studies and other radiology examinations, will study the images and send a signed report with his or her interpretation to your primary care doctor or referring doctor. It will be your primary care doctor or the referring doctor who will inform you of your test results.


Back to top

Ultrasound

What is an ultrasound?

Ultrasound (US), also referred to as sonography, is an imaging technique which generates high resolution pictures of the body and internal organs with the use of high-frequency sound waves. The principle of ultrasound is similar to sonar used in the ocean; the sound wave's reflections are recorded and displayed as a real-time, visual image. No ionizing radiation (x-ray) is involved in ultrasound imaging. An abdominal or pelvic ultrasound image is a useful way of examining internal organs, including the liver, gallbladder, spleen, pancreas, kidneys, and pelvic organs. Because ultrasound images are captured in real time, they can show movement of internal tissues and organs and enable physicians to see blood flow.


Back to top

How do I prepare for an ultrasound?

The preparation for an ultrasound examination depends on the type of examination your doctor has requested. For an abdominal scan, you will be instructed not to eat or drink for 6 hours before your appointment. This is important to allow optimal visualization of the abdominal organs, and to prevent the gallbladder from collapsing and becoming undetectable. For a pelvic examination, you will be asked to drink four glasses of water an hour prior to your exam and to avoid emptying your bladder during that period, so that your bladder is full when the scan begins. A full bladder helps with visualization of the pelvic organs. The water should be taken leisurely to prevent abdominal discomfort.


Back to top

What will I experience during the ultrasound procedure?

The part of your body scanned will depend upon your physician's order. Therefore, it is important that you bring the written order from your referring physician.

Ultrasound imaging of the abdomen is painless, fast, and easy. The sonographer will spread warm gel on your skin and then press the transducer firmly against your body, moving it until the desired images are captured. You will be asked to hold your breath for brief periods of time so that high quality motion-free images can be obtained. There may be varying degrees of discomfort from pressure as the sonographer guides the transducer over your abdomen, especially if you are required to have a full bladder. The examination usually takes less than 30 minutes.


Back to top

Who interprets the ultrasound test and how do I get them?

A radiologist, who is a physician trained in the interpretation of sonograms and other radiologic images, will analyze the study and send a signed report with his or her interpretation to your personal physician. Be sure to notify the technologist of any additional physicians who should receive a copy of the report. Your physician's office will inform you of how to obtain your results.


Back to top

What are the limitations of ultrasound?

Ultrasound is an ideal screening study for the evaluation of many disorders of the abdomen and pelvis. However, ultrasound waves are reflected by air or gas, and thus bowel gas may obscure visualization of some areas of the abdomen and pelvis. In many cases, a CT scan will provide a more thorough evaluation of the abdomen. For the evaluation of pelvic disorders, MRI may provide additional information and superior characterization of internal organs and diseases. Barium examinations and CT scanning may be the methods of choice for bowel-related problems.


Back to top

How is an abdominal ultrasound performed?

The ultrasound procedure is performed by a sonographer, who is a trained technician skilled in the art of obtaining ultrasound images. The equipment consists of a transducer and a monitoring system. The transducer is a small, hand-held device that resembles a microphone. The patient lies on their back on an examination table, and a clear gel is applied to the abdomen to help the transducer make secure contact with the skin. The sound waves produced by the transducer cannot penetrate air, so the gel helps to eliminate air pockets between the transducer and the skin. The sonographer then presses the transducer firmly against the skin and sweeps it back and forth to obtain images of the area of interest.

When the examination is complete, the patient will be asked to wait while the technologist reviews the ultrasound images with the radiologist.


Back to top

How is a pelvic ultrasound performed?

There are two methods of performing pelvic ultrasound:

  1. Trans-abdominal ultrasound consists of placing the transducer on your abdomen, and using a full urinary bladder as the means by which the sound waves can enter the pelvis to allow visualization of the pelvic organs. For the trans-abdominal approach, you must have a very full urinary bladder. After applying the clear gel to your skin, the sonographer will place the transducer against your abdomen and sweep it back and forth to image the pelvic organs.


  2. Trans-vaginal ultrasound involves the insertion of the transducer into the vagina after you empty your bladder, and is performed very much like a gynecologic exam. Since the transducer is much closer to the pelvic organs with this technique, the image quality is exquisite, allowing for improved diagnostic sensitivity and specificity. Many patients prefer the vaginal sonogram as it is more comfortable than having to hold a full urinary bladder. A vaginal sonogram is usually more comfortable than a manual gynecologic examination since the ultrasound transducer is smaller than the standard speculum used when performing a Pap test. A protective cover is placed over the transducer, lubricated with a small amount of gel, and then inserted into the vagina. Only two to three inches of the transducer end are inserted into the vagina. The images are obtained from different orientations to get the best views of the uterus and ovaries.

Back to top

CT Scan

What is a CT scan?

CT is an abbreviation for computed tomography, an advanced type of x-ray study which uses x-rays to show cross-sections of body tissues and organs. This type of study is also referred to as a CAT scan (computed axial tomography). CT of the body is a patient-friendly exam that involves little radiation exposure.

CT imaging is particularly useful because it allows visualization inside the body with amazing clarity. Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as infectious disease, trauma, tumors, and musculo-skeletal disorders).


Back to top

What will I experience during the CT scan?

CT scanning causes no pain. At CPMC, the state-of-the-art helical CT scanners reduce the need to lie still for extended lengths of time. During the scan, you are typically asked to hold your breath for a few seconds at a time. Following the breathing instructions is imperative to ensure we obtain high quality, motion-free images. If you have breathing problems, please notify the technologist so that he or she may adjust the scanning procedure accordingly.

Preparation for the examination is dependant on the part of the body which is being imaged. As described above, the CT exam usually requires the use of different contrast materials. Commonly, a special contrast material is injected into a vein. Before giving the IV contrast material, the radiologist or technologist will ask whether you have any allergies, especially to medications or iodine, and whether you have a history of diabetes, asthma, a heart condition, or kidney problems. These conditions may indicate a higher risk of reaction to the contrast material, or potential problems eliminating the material from your system after the exam. Some people report feeling a flush of heat and sometimes a metallic taste in the back of the mouth. These sensations usually disappear within a minute or two. Some people experience a mild itching sensation. If this sensation persists or is accompanied by hives (small bumps on the skin), the itch can be treated easily by the radiologist with medication. In very rare cases, a patient may become short of breath or experience swelling in the throat or other parts of the body. These symptoms can be indications of a more serious reaction to the contrast material that should be treated promptly. Tell the technologist immediately if you experience these symptoms. Fortunately, with the safety of the newest contrast materials (non-ionic), these adverse effects are very rare.

During the examination, the technologist will be in constant contact with you and will be able to see, hear, and speak with you at all times. In pediatric patients, a parent may be allowed in the room with the child to alleviate fear. A CT examination usually takes from five minutes to half an hour. When the exam is over, the patient may be asked to wait until the images are examined by the radiologist to determine if more images are needed.


Back to top

What does the CT machine look like?

The CT scanner is a large machine with a wide hole in the center, something like a "doughnut". Since the machine is only about a foot thick, only a small portion of your body will be inside the machine at any one time. The patient lies on a table, which can move up or down as well as slide into and out of the center of the hole. Within the machine, an x-ray tube on a rotating slip ring moves around the body to produce images, making clicking and whirring noises as the table moves.


Back to top

Who interprets the CT test results and how do I get them?

A radiologist, who is a physician trained in CT and other radiologic examinations, will analyze the images and send a signed report with his or her interpretation to your personal physician. Be sure to notify the technologist of any additional physicians who should receive a copy of the report. Your physician's office will inform you of how to obtain your results.


Back to top

How is the CT study performed?

The part of your body that is scanned will depend upon your physician's order. Therefore, it is important that you bring the written order from your referring physician when you have your study. Metal objects can affect the image. Thus, you may be asked to remove hairpins, jewelry, eyeglasses, hearing aids, and any removable dental work, depending on the part of your body that is being scanned. Also, staff may ask you not to eat or drink anything for one or more hours before the exam. Women should always inform their doctor or x-ray technologist if there is any possibility that they may be pregnant.

Staff will ask you to change into a gown. The technologist begins by positioning you on the CT table. If needed, you may be supported by pillows, especially under the knees, to place you in the proper position and to help you hold still during the scan. As the study proceeds, the table will move slowly into the CT scanner which is shaped like a large "doughnut". Depending on the area of the body being examined, the increments of movement may be so small that they are almost undetectable. Or, they may be large enough that you feel the sensation of motion.

It is important to realize that most of the human body is composed of water and is similar in overall density. As a result, many tissues within the body look very similar on a CT scan. In order to differentiate normal structures from potential abnormalities, such as tumors, cancer, or infection, the CT procedure involves the use of contrast materials. These contrast materials are essential to optimize the quality of your study and to ensure the highest possible sensitivity and specificity of the CT test. In other words, these contrast materials improve the radiologist's ability to detect abnormalities within the body.

Contrast can be administered by several different routes, including orally (by mouth) and intravenously (by vein). The oral contrast is a barium compound that is not absorbed by the body. If it is used, you will be asked to drink the contrast agent solution prior to the examination. Some patients find the taste mildly unpleasant, but most tolerate it easily. If the pelvis or colon is being evaluated, the radiologist may request you have a contrast enema. Contrast given by enema can be very valuable in helping the radiologist detect any abnormalities. If you are given a contrast enema, you will experience a sense of abdominal fullness, and may feel an increased need to expel the liquid during or right after the enema. Be patient; the mild discomfort will not last long. The intravenous contrast is a non-ionic, iodine-based substance. Allergic reactions to this form of contrast are unusual. However, if you have a history of any allergic reaction to "X-ray dye" or iodine, or a history of diabetes, asthma, a heart condition, or kidney problems, make certain you notify the technologist of this.


Back to top

Mammogram

What is a mammogram?

A mammogram is an imaging study that uses a low-dose x-ray system to produce a high resolution film for examination of the breasts. Such breast radiography is also called mammography. Mammography plays a central part in the early detection of breast cancers. This is true even for people who have no complaints or symptoms, because mammography can show cancerous changes in the breast several years before a patient or physician can feel them. However, it is important to realize that mammography has certain limitations. Not all cancers of the breast can be seen using mammography; some can only be physically felt in the breast but do not show up on the mammogram study. Because of this, it is imperative that your routine breast exam include a thorough physical examination by your doctor. It is also very important that you perform regular self examination.


Back to top

How often should I have a mammogram?

Current guidelines from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) all recommend that screening mammography be performed every year beginning at the age of 40.

The National Cancer Institute (NCI) recommends that women who have had breast cancer and those who are at increased risk due to a genetic or family history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.


Back to top

How should I prepare for a mammogram?

You should describe any breast symptoms or problems with your private doctor as well as the technologist performing the examination. The technologist will make special notation of your symptoms and history in your chart.

This information will be of value to the physician who will interpret your mammogram. Interpretations of a mammogram can be difficult because a normal breast can appear differently for each woman. As a result, having a prior examination can be valuable in the interpretation of your study. Therefore, if possible, try and obtain your prior mammogram and make it available to the radiologist at the time of the current exam.

Before the examination, you will be asked to remove all jewelry and clothing above the waist, so wearing a two piece outfit will be helpful and you will also be given a gown or loose-fitting material that opens in the front. Please do not wear deodorant, talcum powder, or lotion under your arms on the day of the examination. As it turns out these materials may appear as calcium spots on the x-ray studies.

A radiologist, who is a physician experienced in mammography and other x-ray examinations will analyze the images and describe any abnormalities, and suggest a likely diagnosis.


Back to top

What should I expect during a mammogram?

During mammography, a specially-qualified radiology technologist will position you to image your breast. The breast is positioned on a special device and compressed with a paddle. The compression may cause some discomfort, so it best to schedule the test when your breasts are least tender, usually one to two weeks following your period. Be sure to inform the technologist if pain occurs as compression is increased.

Please note that compression is very important as this optimizes the quality of your study, as it ensures that the breast thickness is uniform, and small abnormalities will not be obscured by the overlying breast tissue. Views of each breast are obtained in two different positions. In certain cases, additional views may be needed to better define portions of the breast.

Always inform your doctor or the x-ray technologist prior to your mammogram if there is any possibility that you may be pregnant.


Back to top

How much radiation do I get from a mammogram study?

The effective radiation dose from a mammogram is about 0.7mSv which is a unit of measurement of radiation and this is about the same as the average person receives from natural environmental sources in about six months. The potential benefits of early detection of breast cancer far outweigh any potential risk from the minute radiation exposure.

Authored By: Jerome Barakos, MD
Reviewed By: Edward Baker, MD



Back to top

Blood Test

Why was so much blood taken in so many tubes when I got my blood tested?

Most tubes of blood used by clinical laboratories hold 5 cc of blood (1 tablespoon). By comparison the average human body has 5 liters or 5,000 cc of blood which is 1.2 gallons. Thus, drawing a few tubes of blood is of no consequence for the vast majority of patients.

Tubes come with stoppers in various colors. The color of the tube stopper designates the specific preservatives in the tube. There are more than 30 types of tubes available. Different tests require different preservatives. For example, we perform some tests on clotted blood. We may perform other tests on unclotted blood.


Back to top

What is a CBC?

CBC stands for a complete blood count. A CBC looks at the cells in blood; it counts the types of cells and characterizes the types of cells. Approximately one half the volume of blood is cells and the other half is primarily water, electrolytes, and proteins. The CBC focuses on the cells of which there are 3 major types in blood:

  • White cells: primary function is responding to infections. The number and types of white blood cells (WBC) often reflect infections, less commonly leukemia.

  • Red cells: carry oxygen. A decreased number identifies anemia.

  • Platelets: active in stopping bleeding or clotting blood. Decreased numbers are seen in some bleeding disorders.

Back to top

Why did my doctor order a TSH?

Thyroid stimulating hormone (TSH) is, by far, the best global test for evaluating a person's thyroid function. TSH is the hormone produced by the brain/pituitary in response to the amount of effective thyroid hormones circulating in the blood. This is like a thermostat function. When the thyroid gland is overactive (hyperthyroid), the TSH goes down. The converse is also true. When the thyroid is secreting too little thyroid hormones, the brain/pituitary produces more TSH.

The thyroid secretes hormones that regulate overall metabolic activity and energy levels. Thyroid disease is relatively common, but symptoms and signs of thyroid disease are very nonspecific. Also, thyroid disease can coexist with and complicate other medical conditions.

Authored by: Richard Garcia-Kennedy, MD
Reviewed by: Toni Brayer, MD



Back to top

What is an Interventional Radiologist?

In some ways, this is one of my favorite questions. While the field of vascular and interventional radiology has been evolving over 20 years, many people still don't understand what we, physicians, do. An Interventional Radiologist is a specialist physician who has undergone rather rigorous training in medical imaging and further training in applying that skill of imaging to minimally invasive substitutes for surgery. The Interventional Radiologist can manipulate small tubes through vessels and other body channels to do things, such as drain an abscess, open a blocked vessel, or direct chemotherapy to a specific internal target.

Because the tools of the Interventional Radiologist are small, consisting of catheters and small tubes, many procedures can be done with simple sedation and local anesthesia. This allows the patient to go home the same day of the procedure, avoiding a significant hospitalization. Innovation continues in the field of interventional radiology with new minimally invasive procedures being developed each year. At California Pacific Medical Center, we developed a section of Interventional Radiology over 24 years ago. We pride ourselves on being in the forefront of this technology.


Back to top

I have been told I have uterine fibroids. They cause bleeding with very heavy periods, and I feel uncomfortable and bloated. I have been offered the option of a hysterectomy. But I am not that old and frankly, I still may want another child. I have heard of this embolization procedure. Is that something that might be right for me?

Well, first a little background. Fibroids are simply benign growths of muscle tissue within the uterus. They are common and vary in size from very tiny or insignificant to quite large. Also, they vary quite a bit in their ability to cause problems.

The uterine fibroid embolization is a relatively new treatment option and is available for many patients with symptomatic fibroids. The blood vessels that supply the fibroids are generally slightly larger than those that supply the normal tissue of the uterus. It is possible for the Interventional Radiologist to pass a tiny catheter directly into the artery that supplies the uterus and to feed microscopic particles through that catheter to plug up the abnormal vessels. This deprives the fibroids of some of their own blood supply which allows them to shrink over time. This shrinkage is accompanied by a decrease in symptoms.

Uterine Fibroid Embolization generally preserves ovarian and even uterine function, although loss of menstrual cycle and early menopause are possible but unusual potential side effects. Some discomfort, consisting of severe cramps, is frequent immediately after the procedure. The discomfort, which responds to medication, generally lasts for a few days to a week. The preservation of uterus and ovarian function is a significant attribute of the embolization procedure. Another significant advantage of this procedure is the absence of recovery from significant surgery. Appropriate patient selection is extremely important for this to be a successful procedure. Ultrasound and magnetic resonance imaging (MRI) are used to help screen the patients to select those who respond best to this procedure.


Back to top

My father is having a biopsy, what can we really expect?

While the thought of a biopsy can be an anxiety provoking event for both the patient and family, this procedure is really a fairly common procedure nowadays and most are very simple indeed. While the method of biopsy varies a bit from person to person, depending primarily on the site of the abnormality and the nature of what is anticipated to be found, there are a few commonalities in performing a biopsy. Most biopsies rely upon the sampling of a tiny drop of tissue. We obtain this using a very thin needle. The procedure is nearly painless in most cases and uses local anesthesia, such as lidocaine, and, in some cases, intravenous sedation. The accuracy of a biopsy is determined by the imaging modalities used which may be modern CT, fluoroscopy, or ultrasound.

Generally, having a biopsy requires staying a few hours in the hospital in order to ensure a patient's safety and comfort. At California Pacific Medical Center, this is usually arranged through the Ambulatory Care Unit. In special circumstances, for example, some liver biopsies for generalized liver disease like hepatitis or possibly a renal biopsy for nephritis, a slightly larger piece of tissue is required from the biopsy and we will monitor the patient for several hours or even overnight. Generally, the patient can return completely to normal activities the day following the day of the biopsy. Results of the biopsy are usually available for the physician who ordered the procedure within 24 to 48 hours after the biopsy.


Back to top

A good friend of mine has nearly died from severe bleeding from his stomach, and his doctor has suggested a TIPS procedure be done. What is this about?

A TIPS (Transjugular Intrahepatic Portosystemic Shunt) involves creating a conduit or a channel between the portal vein which drains the intestinal blood flow into the liver back to the heart, and the hepatic vein, which drains blood from the liver to the heart. Note that many diseases that affect the liver cause tiny vessels in the organ to scar down, sort of like plugging the pores in a filter. In turn, this scaring causes the pressure in the portal vein to rise. The high pressure blood in the system has to get back to the heart in some fashion. This blood frequently gets back to the heart by forming dilated channels within the intestinal walls that are susceptible to rupture and massive hemorrhage. This situation can be a life threatening condition.

A TIPS procedure creates a direct channel from the portal system back to the right artium of the heart. This channel reduces the pressure in the system and, thus the risk for bleeding. A TIPS is much, much safer than the surgical options of a porto-systemic shunt. But, the TIPS procedure requires close follow-up to maintain its function. Although the TIPS procedure replaces the much more serious surgical option, we still view this as a significant procedure and generally require a one to two-night hospitalizations to ensure the patient's safety.


Back to top

My mother had an angioplasty a year ago and now has pain again when she walks. Will she need the procedure again?

An angioplasty, also known as percutaneous transluminal angioplasty, uses a small balloon, which sometimes has an associated spring device or stent, to open up a blockage in an artery. Opening up the blockage in the artery restores blood flow in the vessel and creates a controlled injury to the inside of the vessel at the site where the balloon was inflated. Usually the body heals this localized injury to the vessel without a problem. Recurrence of symptoms after an angioplasty can be due to one of several factors. One of the more common factors is progression of the underlying disease process at a nearby site in the same vessel unrelated to the angioplasty. Note that the artery that was diseased is still in the patient and frequently the disease process affects several spots in that vessel. An area of mild disease can progress to a blockage at another site.

Additionally, the site of the angioplasty, itself, could narrow back down in a period of months to years with what is called intimal hyperplasia. This hyperplasia really represents a sort of exaggerated healing response of the vessel to the injury of the angioplasty, itself. Either process, a continuation of underlying arteriosclerotic disease or the intimal hyperplasia resulting from the healing which is a little excessive at that site, can produce a similar sort of narrowing to the inside channel and reduce blood flow to the extremity. Angioplasty, in contrast to surgery, in some circumstances can usually be repeated, when necessary. And, the results of the second procedure can often be more successful and longer lasting than that of the initial angioplasty.

We are now beginning to see the application of some stents, or little metal spring devices, that are coated with drug-eluding polymers that help prevent the development of re-stenosis or intimal hyperplasia. Presently, these devices have limited application. But, the technology is very promising and likely to expand significantly in the near future

Authored By: Jon Wack, MD
Reviewed By: Edward Baker, MD


Produced by the Center for Patient and Community Education in association with the staff and physicians at California Pacific Medical Center.

© 2003-2010 California Pacific Medical Center

Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

Back to top