A coronary angiogram (sometimes called ‘cardiac catheterisation’) is an X-ray study which takes pictures of the blood flowing through the coronary arteries which supply the heart with blood. It can highlight narrowings or blockages in these arteries caused by fatty calcified deposits – coronary artery disease. 

The angiogram gives a detailed assessment of the arteries to give doctors extra information to help them decide on the appropriate treatment. If you have a narrowing coronary (heart) artery, that can be treated with ‘balloon coronary angioplasty and stent’ (PCI). This can be done in the same procedure or sometimes separately at a later date.  

Coronary angioplasty, often called PCI (Percutaneous Coronary Intervention), is a procedure where a balloon is used to open a blockage in a coronary artery. It is very similar to an angiogram procedure and is performed in the same room, under the same conditions, and the recovery is similar. The main difference is that an angiogram only collects information (pictures), whereas an angioplasty performs a treatment (inserting a stent). 

An angioplasty/PCI takes approximately 1-2 hours to perform. The length of time will vary from person to person depending on the complexity of the coronary artery disease. A balloon is used to stretch the artery and a stent (wire mesh tube) is then put in the narrowed artery and acts as internal scaffolding, keeping the artery open.

Generally it is a very safe procedure. Potential complications are uncommon but include: 

Damage to the blood vessels in the leg or arm. Bleeding or haematoma (a lump/bruise under the skin) around the puncture site.

• A small risk of stroke.
• A small risk of heart attack.
• A small risk of emergency cardiac surgery. 
• A small risk of death.
• Very rarely an allergic reaction to the injected substance.
• X-ray is used in this procedure but with modern equipment the risk from the X-ray is very low.

You will be invited to attend pre-assessment clinic/ telephone consultation, where we will explain the procedure to you and collect information. If you need an interpreter, please let us know as soon as possible. An ECG will be performed and you might be asked for a blood sample. 

You will need someone to take you to and from the procedure and who will stay with you at home overnight. If this is not possible, let us know in advance and we will arrange an overnight bed. They will not be able to stay with you on the day of the procedure.  

Please let us know if you might be pregnant. Also, let us know of any allergies, and bring a list of your current medication. 

• If you take diuretics (water tablets), do not take them on the morning of your procedure as you may find it inconvenient.
• If you are taking metformin (glucophage), ideally it should be stopped 48 hours prior and not re-started until 48 hours after your procedure. 
• If you take warfarin, stop taking it 4 days prior to the procedure. 
• If you take any other anticoagulant (blood thinner, e.g. rivabaxan, dabigatran, apixaban, edoxaban) stop taking it 2 days prior to the procedure.

It is now very common to have combined ‘angiogram and angioplasty (PCI)’ and it is very important that you take dual anti-platelet medication leading up to, and on, the morning of the procedure. This is usually a combination of aspirin and clopidogrel, or aspirin and ticagrelor. This will be discussed in pre-assessment, and prescribed if necessary. These medications are vital for the procedure to go ahead as they prevent blood clotting in the stent.

• Have nothing to eat after 6:30am if your procedure is in the morning.
• Have nothing to eat after 10:30 am if your procedure is in the afternoon.  
• You can drink water up until the procedure. 
• Bring all your usual medication in with you on the day of the procedure.
• Your wedding ring can be taped to your finger but please leave other valuables at home. Please remove all nail varnish.
• Bring a newspaper or a book with you so that you will have something to do when the procedure is over.
• Bring slippers and a dressing gown, but as few other possessions as possible. 
• Take/stop taking medication as instructed. You should take your usual regular medication unless instructed otherwise.

You will arrive at the Imaging Department (Gate 19) and be accompanied into our day case area. A cardiologist will explain the procedure to you, and the benefits and potential risks. You will have an opportunity to ask questions. If you choose to go ahead with the procedure you will need to sign a consent form, which may be done during your pre-assessment visit. Please let us know of any allergies too. From there, you will be asked to change into a hospital gown and paper pants and a nurse will go through the procedure checklist and place a small plastic tube called a cannula, in a vein in your forearm to allow medications to be given if necessary during the procedure.

You will be taken to the Cardiac Catheterisation Laboratory (Cath Lab). You will be asked to lie down flat on the X-ray table with a pillow for the procedure. There will be a small team of nurses, doctors, cardiac physiologists and radiographers with you throughout. 

If you are feeling anxious, you will be offered sedation but will stay awake. The nurse will then cover you with a drape and clean the area at the top of your leg or wrist with antiseptic solution. Then the doctor will inject local anaesthetic into your wrist (if radial) or the area at the top of your leg (if femoral) which will briefly sting and then go numb. 

After this, you may just feel a pushing sensation when a small plastic tube (sheath) is inserted into your femoral or radial artery. A catheter is passed though the sheath and up inside the artery to the heart. Once the catheter reaches your coronary (heart) arteries, contrast liquid is injected into the bloodstream and X-ray images are taken.

The X-ray machine will move around you, but will not touch you. It is important that you stay still throughout to take the clearest pictures possible. Once the doctor has acquired enough images, the X-ray machine will be removed. 

If the doctor used the wrist artery (radial), a pressure device called a TR band will be placed on your wrist and inflated. This will be deflated gradually until it can be removed. Alternatively, if the doctor used the leg artery (femoral), a seal may be used to plug the artery or pressure will be applied either with a pressure device or manual pressure. 

You will be taken back to recovery/day case area initially, so that nursing staff can monitor your observations and the wound site very closely. Relax as much as you can and tell the nurse straight away if you experience any discomfort, notice any swelling or bleeding at the wound site, numbness in the leg/arm, or you feel unwell. You will be able to eat and drink as normal. Please make sure you drink plenty of fluids after this procedure which will help pass the contrast liquid out in the urine. 

Recovery time after an angiogram is usually around 3 hours, but can sometimes be longer. 

Recovery time after an angiogram is usually around 3 hours, but can sometimes be longer. If you have an angioplasty (PCI), your recovery time will be longer (about 6 hours) or you may require an overnight stay in hospital. This will be discussed in your pre-assessment appointment. 

If the doctor used the wrist radial artery:

• The band around your wrist will be slowly deflated over 2-3 hours and then removed. This will be longer, usually 3-5 hours, for an angioplasty/PCI. 
• The band will then be removed and replaced with a small dressing. 
• Try not to move your wrist much while your artery is healing.

• If the doctor used the leg femoral artery:

• If a pressure device or manual pressure was used to stop the bleeding you will need to stay flat for 1 hour and bed rest for a total of 3 hours. 
• If you have had a seal you can sit up straight away if there is no bleeding, and move around after 2 hours. This may be longer if bleeding occurs. require an overnight stay in hospital. This will be discussed in your pre-assessment appointment. 

Before you are discharged, the doctor will discuss the results with you. If you have coronary artery disease that requires further treatment, the doctor will explain the options and there may be a meeting. This may be cardiac surgery (coronary artery bypass grafts – CABG), coronary angioplasty/PCI or drug therapy. You will then be given a discharge letter. 

Do not do any heavy lifting or strenuous exercise, like weight lifting or cycling, for 4-5 days. Do not drive 48 hours after an angiogram and 1 week after an angioplasty/PCI (DVLA advice). Drink lots of water (2L) in the following 24 hours. If you were sedated, don’t sign any legal documentation for 48 hours.

Radial (wrist) puncture: 

• Rest the arm for 2-3 days.
• Avoid flexing/ bending the wrist, lifting and putting weight through the arm. 
• Avoid bathing and washing up for 48 hours after. You may shower the following day, but avoid scrubbing the wound. If wet, replace the dressing with a plaster.

Femoral (groin) puncture: 

• Avoid bending from the hip for 2-3 days or anything that strains stomach muscles. 
• Avoid straining when going to the toilet. 
• Apply light pressure over the puncture site, when coughing, sneezing, or laughing. 
• Avoid bathing for 48 hours post procedure. You may shower the following day, but avoid scrubbing the wound, and pat dry thoroughly. 

Complications are rare but can happen, particularly in the first 24 hours, so make sure you have a responsible adult with you. If the wound starts to bleed or swell suddenly, apply firm pressure to the puncture site for 10-20 minutes. If the wound is in the groin, lie flat while pressure is applied for you. If the bleeding stops, seek medical advice. If you are unable to stop the bleeding, call 999 immediately. 

A bruise around the site is common but should fade after 2-3 weeks. If it becomes swollen, or you develop persistent pain/ tenderness, contact your GP. If you get any chest discomfort after discharge that does not resolve 5-10 minutes after using your GTN spray, call 999.

To reduce the amount of phosphate additives you eat:

• Eat freshly cooked, unprocessed food more often.
• Check ingredient labels and limit foods with phosphate additives.
• Swap to brands without phosphate additives.

When the kidneys are not working properly, the level of phosphate in the blood often rises too high. The normal range for blood phosphate is between 0.8mmol/l and 1.5mmol/l. 

High levels of phosphate can cause:

• Hardening of blood vessels.
• Damage to your heart.
• Weak bones.
• Aching joints.
• Itchy skin.

If a food contains phosphate additives, you will see the name or E number on the ingredient label. Additives with “phos” in their name contain phosphate. You may be able to swap to a different brand without phosphate additives. 

Check ingredient labels and try to avoid these additives:

To help you avoid phosphate additives, here are some examples of food labels. They show how phosphate additives are listed on the packaging.

Sausages

Cake

If food contains phosphate additives try checking similar options to find one without. 

By choosing fresh, unprocessed foods where possible, you can reduce the phosphate additives you are eating. This will help to you lower your blood phosphate levels. 

Here are some suggestions for swaps:

It can be difficult to find processed meat without phosphate additives. Your dietitian can guide you on processed meats without additives available where you normally shop. 

Eating less red and processed meat is recommended for us all as they are linked with causing bowel cancer. They are also high in fat and salt. For healthier, lower phosphate options, see the NHS websites on the next page.

Many people want to eat food that is more environmentally friendly. These are good ideas for the planet and for you too:

• Limit red and processed meats. Try some plant food sources of protein such as beans, lentils, soya mince, Quorn, and tofu instead.
• Moderate the amount of dairy foods you eat and consider a plant-based milk.
• Eat less processed food that is high in fat, sugar, and salt.

For guidance on healthy amounts of meat to help reduce your risk of bowel cancer:

Meat in your diet - NHS (www.nhs.uk)

Information on kidney disease and food written by the kidney dietitians at North Bristol NHS Trust:

Nutrition & Dietetics Patient Information (Kidney Disease) | North Bristol NHS Trust (nbt.nhs.uk)

Recipes to enable you to cook delicious kidney friendly meals from scratch:

Recipe Index | Kidney Care UK

Practical advice to help you reduce your weekly food shopping bill while maintaining a nutritious and kidney friendly diet:

Shop for a kidney friendly diet on a budget | Kidney Care UK

Research can be defined as the attempt to derive generalisable or transferable new knowledge to answer or refine relevant questions with scientifically sound methods. This excludes: audit; needs assessments; quality improvement and other local service evaluations. It also excludes routine banking of biological samples or data, except where this activity is integral to a self-contained research project designed to test a clear hypothesis.

If you are in any doubt, please contact the Research Development & Grants team – we can support your project or signpost you to a more appropriate team, if required. 

Yes. There are lots of opportunities to get involved in research, including developing a project or grant application of your own, as part of your role. The R&D Department have funding available to cover your time to work in research. This would be discussed on a case-by-case basis with your department, so please get in touch with the Research Development & Grants team who can support you with conversations with your line manager and clinical division.

Research ideas and grant applications are welcome from everyone, no matter how much (or little) prior experience you have. The Research Development & Grants team can provide additional support to those that need it, especially if you are new to research.

Please email the Research Development & Grants team: ResearchGrants@nbt.nhs.uk

The Research Development and Grants team can support you from early stages of developing a research idea. We can help to find suitable funding opportunities, calculate costs for an established proposal, and navigate systems for submitting your grant application, and much more.

Any time! From just having a brief idea for a research project, to needing final costings on a grant application. You can speak to the Research Development & Grants team at any stage of your research development. The sooner you contact us the better though, and the team will provide tailored support.

This is dependent on your project. But the Research Development and Grants team can support you with every aspect of your costing. The sooner you get in touch with us (i.e. as soon as you begin writing your grant application) the more support we can offer.

Fibroids are benign, non cancerous, fibrous growths of the muscular part of the uterus (womb). They are very common.

The diagnosis is made with an ultrasound scan or an MRI scan. Other tests such as blood tests, a gynaecological examination  or internal biopsy may also be necessary.

Many fibroids do not cause any symptoms at all, and don’t require treatment as they are benign. Often fibroids are found by chance as part of an examination for other reasons, e.g. pregnancy scanning.

The most common symptom is heavy and prolonged periods, which may be more painful than usual. This can cause anaemia (a lack of red blood cells or the chemical haemoglobin, which is found in the blood). It can make you feel tired and faint or cause headaches.

Large fibroids can cause symptoms because of their size putting pressure on the bladder leading to a constant urge to urinate. They may also push on your spine or back passage causing constipation and bloating. Occasionally, fibroids may be so large that they are visible as a swelling in the abdomen.

Fibroids are also associated with infertility and miscarriage.

If the gynaecologist does advise treatment, options include:

• Drug treatment: A variety of hormonal drugs can be used to manage the symptoms of fibroids and sometimes even allow them to shrink. Often these medications can be started and monitored by your GP. The decision about whether this is right for you will depend on your specific symptoms and personal preferences for treatment
• Intrauterine contraceptive device: A Mirena coil releases progestogens and may help to reduce heavy bleeding. The coil can be left in place if you are to proceed to UFE.
• Myomectomy: In some cases it may be possible to surgically remove fibroids (myomectomy) without taking the uterus itself. This means that future pregnancyremains possible. However, it is important to understand that hysterectomy (removal of the uterus) may very occasionally be necessary at the time of myomectomy.
• Fibroids may regrow after myomectomy, and in the long term about 1 in 10 people require further surgery. Myomectomy may be performed as an open operation, or by a keyhole technique. This procedure is particularly successful if there are one or two symptomatic fibroids, but is less successful if there are multiple fibroids.
• Hysterectomy: This is the surgical removal of the uterus, usually including the cervix. Future pregnancy is impossible. The operation usually requires about 2-3 days in hospital and 4-6 weeks off work afterwards Uterine Fibroid Embolisation (UFE): as discussed next.

Fibroid embolisation is a procedure designed to shrink uterine fibroids and reduce bleeding. A small plastic tube is placed into a blood vessel (artery) in the groin or the wrist and used to access the blood supply to the uterus and the fibroids. This blood supply is then blocked with extremely tiny beads made of polyvinyl alcohol (PVA) and will permanently stay in the small arteries within the fibroids.

• There are now good long-term studies of the results of fibroid embolisation. Over 80% of people will be relieved of their symptoms after UFE.
• On average, UFE shrinks the fibroids by about half and this usually gives an improvement in symptoms relating to the size of the fibroids or pressure.
• Unlike other surgical treatments for fibroids, UFE treats all the fibroids in a person’s uterus.
• Successful pregnancy can be possible after fibroid embolisation.

You will need to have a blood test a few days before the procedure to check your kidney function and your haemoglobin levels. This may be arranged to take place at your GP surgery.

You can continue taking your normal medication. If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging Department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.

• You should not eat anything from 6 hours before your procedure but you may continue to drink water up to 2 hours beforehand.
• You will arrive at the Imaging Department (Gate 19) and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you have any allergies.
• A radiologist (X-ray doctor) will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form (this may already have been filled out in an earlier clinic consultation).
• You will be asked to change into a hospital gown and a small plastic tube (cannula) will be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
• A drip containing strong pain killers (patient controlled analgesia - PCA) will be connected to your cannula, which will allow you to manage your own pain after the procedure by pushing a button that injects a small dose of morphine into your vein. We will give you an extra pain killer via a pessary (diclofenac) as well.
• Once all the checks have been performed and consent signed, you will be taken to the procedure room on the trolley. There will be nurses, a radiographer and the radiologist with you throughout the procedure.

During the procedure

• You will be asked to lie on your back on an X-ray table for the duration of the procedure.]
• The skin near the groin/wrist will be cleaned with an antiseptic solution and covered with sterile drapes.
• Using an ultrasound machine, the radiologist will then inject local anaesthetic into the skin and deeper tissues over the groin/wrist artery. This will briefly sting and then go numb. Most people will feel a pushing sensation.
• A small tube (catheter) is inserted into the artery and navigated inside your blood vessels with the help of the X-ray machine to select the arteries responsible for the blood supply of the fibroid(s).
• An X-ray dye will be injected into your arteries several times during the procedure to help outline your anatomy.
• During these injections you may be asked to hold your breath and keep very still. The injection of the X-ray dye can cause a hot sensation in your pelvic area which is normal and temporary.
• Once the catheter is in the correct position, tiny PVA beads are slowly injected to block the arteries supplying the fibroid(s).
• It might be necessary to access the arteries in both groins in order to block the arteries on both sides of the uterus which are supplying the fibroid(s).
• When the procedure is complete, the catheter is removed from the artery and pressure by hand or a special stitch is applied at the puncture site to prevent bleeding.
• The procedure itself usually takes around 1-2 hours.

What to expect after the procedure

• You will be taken back to the day case area, so that nursing staff may monitor you closely.
• You will be required to lie flat for 2 hours to allow the small hole in your artery to heal but you can mobilise 4 hours after the procedure.
• You may experience pain similar to period cramping in your lower abdomen, but this can be controlled with your PCA morphine pump. Additional pain killers can be given if required.
• Later on you will be transferred to the gynaecology ward (Cotswold ward) where you will stay at least 1 night so we can ensure adequate pain relief is available to you.
• Most patients are normally discharged just after lunch the following day.
• There may be a small bruise in the groin/wrist around the puncture site but this is quite normal.

Will I feel any pain?

You will be given strong painkillers before, during and after the procedure designed to minimise any pain. If you are in pain at any point this medication can be adjusted to ensure your pain is controlled. The local anaesthetic used to numb groin/wrist may sting for about 20 seconds.

Mild pain or discomfort is usual for some days after the procedure, which can be managed with standard pain killers like paracetamol and ibuprofen.

Some patients experience a thick yellow/green vaginal discharge. Use sanitary towels rather than tampons as these could increase the risk of infection.

You may have a slightly raised temperature for up to a week afterwards, sometimes with feverish symptoms.

You may feel tired and we advise you to rest for one to two weeks depending on your recovery. You can then resume your usual activities. We usually recommend taking up to 2 weeks off work but some people recover more quickly and are able to return to work within a week.

You will be followed up via in person or telephone clinic by the radiologist in 4-6 months after the procedure.

It takes time for fibroids to shrink after UFE. It is common for the first period after UFE to be a little different from usual.

Gradual improvement can be expected for up to 6 months afterwards.

UFE is generally very safe however as with any procedure there are some risks.

• There is a minor risk of bleeding or bruising at the groin/ wrist or injury to the arteries.
• Most patients feel some pain afterwards. This ranges from very mild pain to severe cramp, period-like pain. This pain is usually most severe during the first 12 hours, and will be controlled with strong painkillers. By time of discharge home the following day, ‘over the counter’ painkillers are usually adequate to control the pain.
• Infection is a risk with any operation. Currently there is a quoted risk of about 2%. Antibiotics are given at the time of the UFE to minimise this risk but late infection some weeks afterwards has been reported. Most infections can be treated with antibiotics at the time but rarely patients will need to have a hysterectomy for infection. If you feel you would not like to have a hysterectomy under any circumstances then it is probably best not to have a fibroid embolisation.
• You may experience post-embolisation syndrome. This is caused by the breakdown of the fibroid within the body and is very common. People experience a mild fever and flu-like symptoms. It usually passes on its own and anti-inflammatory medicines (ibuprofen) can help. If your symptoms continue, please contact us so we can make sure you don’t have an infection.
• There is a small risk of blocking blood vessels to other organs inside your pelvis (including urinary bladder, bowel or genitals). This could result in reduced blood supply to the affected organ and could potentially be a serious complication, however in most cases it settles down by itself. A special CT scan of your blood vessels will be used during the procedure to reduce this risk to a minimum.
• Rarely a patient may have an allergic reaction to the X-ray contrast (dye) used during UFE. This reaction could be mild with itching to severe affecting breathing or blood pressure. Patients undergoing UFE are carefully monitored throughout the procedure so any allergic reaction can be detected immediately and treated.
• About 1% of patients have an early menopause as a result of UFE. This risk is smaller in younger people and higher in patients who are approaching the menopause. 
• Rarely patients may pass bits of fibroid after the UFE. If a larger fibroid is passed you may need to see your gynaecologist who can help to remove it.
• Some patients experience vaginal discharge, which usually lasts up to 2 weeks and on occasion up to 4 weeks.

It is possible to have a successful pregnancy after fibroid embolisation. Current advice is to wait at least 1 year after the procedure before trying to conceive. Approximately 50% of people trying to conceive after fibroid embolisation will be successful.

There is evidence that the rate of spontaneous abortion or miscarriage is higher among patients having fibroid embolisation than in patients who have a surgical myomectomy. If you want to conceive then depending on the anatomy of your uterus and fibroids, myomectomy may be a better procedure.

You may find the following information useful after going home from hospital after a UFE.

Eating and drinking

You should not eat or drink until the conscious sedation medication has entirely worn off. The antibiotics may make you feel nauseated, so it is best to avoid alcohol for 24 hours.

Driving

You should not drive or operate machinery for at least 2 days after this procedure; this means you should ask for a relative or friend to drive you home from hospital. It is important you ensure you can perform an emergency stop prior to any driving.

Your groin

If we do the procedure through the artery in your groin,  You may have bruising or swelling in the first few days at the puncture site. If you are worried about this call the ward.

Vaginal discharge

It is common for patients to experience a moderate vaginal discharge after this procedure, which may be blood stained or contain small pieces of fibroid. If the discharge becomes more offensive and smelly it is important that you contact the ward as this may indicate you are developing an infection.

Pain

The purpose of staying overnight in hospital after UFE is to ensure you are pain free. Make sure you have paracetamol and ibuprofen at home. The ward will give you further painkillers to take home with you should you need them. Should the pain worsen following discharge home call the ward for further advice.

Fever

It is common to experience a low grade temperature for up to 1 week after this procedure. You may have flu like symptoms. If you have a high temperature (above 37.5°C) more than 7 days after the procedure it may indicate that you are developing an infection so you should contact the hospital.

Sexual intercourse and contraception

You can resume sexual activity when you feel ready and once the discharge has settled.

It is important to use appropriate contraception for one year after UFE.

If you do not want to get pregnant you will still need to use contraception.

Please check with your travel insurance if you wish to travel within 4 weeks of your procedure

Finally we hope this information is helpful.

If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.

The phone number for the Imaging department can be found on your appointment letter.
 

The decision was made by your urologist and an interventional radiologist who is going to perform the procedure.

Interventional radiologists are doctors specially trained to perform minimally invasive treatments of various diseases with guidance of an x-ray machine, avoiding the need for open surgery. This includes inserting and navigating special catheters inside blood vessels.

In addition to the standard tests for prostate enlargement, you will need to have a special CT scan (CT angiogram) to help us visualise the arteries in your pelvis. This will help the radiologist to decide if the anatomy of your arteries is suitable for the treatment. If tests have shown that you are suffering from an enlarged prostate gland you probably have already been told about the more traditional treatment options, including a

TURP (trans urethral resection of prostate) operation and medication by your urologist or GP.

In your case, a decision was made that you are likely to benefit from an alternative non-surgical treatment option: prostate artery embolisation.

• You will need to have a blood test a few days before the procedure to check your kidney function, that you are not at increased risk of bleeding and that it will be safe to proceed. This may be arranged to take place at your GP surgery.
• You can continue taking your normal medication. If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the imaging department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.

• You should not eat anything from 4 hours before the procedure but you may continue to drink water.
• You will arrive at the Imaging Department and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you have any allergies.
• A radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
• Once all the checks have been performed and consent signed, you will be taken to the angiography suite on the trolley. There will be a nurse, radiographer and a radiologist with you throughout the procedure.

• You will need to lie on your back on an X-ray table for the duration of the procedure.]
• The skin near the groin will be cleaned with an antiseptic solution and covered with sterile drapes.
• Using an ultrasound machine, the radiologist will then inject local anaesthetic into the skin and deeper tissues over the groin artery. This will briefly sting and then go numb. Most people will feel a pushing sensation.
• A small tube (catheter) is inserted into the artery and navigated inside your blood vessels with the help of the x-ray machine to select the arteries responsible for the blood supply of the prostate gland. An x-ray dye will be injected into your arteries several times during the procedure to aid the navigation of the catheter. During these injections you may be asked to hold your breath and keep very still. The injection of the x-ray dye can cause a hot sensation in your pelvic area which is normal and temporary.
• Both the left and right prostate arteries can usually be reached with accessing only one groin artery but sometimes we may need to use the artery in your other groin.
• Once the catheter is in the correct position, tiny particles are slowly injected into the prostate gland. When the injection into both left and right prostate arteries is complete, the catheter is removed from the artery and pressure by hand or a special stitch is applied at the puncture site to prevent bleeding. You will be asked to remain still for another few hours after the procedure.
• Insertion of a urinary catheter may be necessary for this procedure. This is usually removed after the procedure before discharge.

• You will be taken back to the radiology day case unit, so that nursing staff may monitor you closely.
• If you are in pain tell the nursing staff so you can be given appropriate painkillers.
• You will be required to stay in our day case unit for about 4 hours. Occasionally one night stay in the hospital might become necessary.
• There may be a small bruise in the groin around the puncture site but this is quite normal.
• You will have antibiotics prescribed to be taken for 5-7 days following the procedure.
• You should be able to resume most normal daily activities within 24-48 hours. However, we recommend avoiding driving and all strenuous activities for 48 hours.
• The prostate gland should begin to shrink over the next few weeks and over 70% of men will notice an improvement in their symptoms after PAE.
• You will be reviewed at a follow up appointment in 3 months’ time.
• If you had a long-term bladder catheter before the procedure, recent studies have shown the majority of patients can have their catheters removed after 7-10 days.
• Please check your travel insurance if you wish to travel within 4 weeks of your procedure.

Prostate artery embolisation is a relatively new procedure for treatment of prostate enlargement. The current evidence from research data has been reviewed by the National Institute for Health and Care Excellence (NICE) and clearly shows that the procedure is safe and an effective treatment option. 

However, as with any other medical procedures complications may arise:

• There is a minor risk of bleeding or bruising at the groin or injury to the arteries.
• In up to 10% of cases (1 in 10 people) the prostate arteries are too small or diseased and it will not be possible to safely access them with the catheter, meaning we are unable to treat the arteries.
• You may experience some discomfort in the lower abdomen and have some discomfort on urinating but this normally resolves after 10 days.
• The prostate can become more swollen immediately after the procedure which can make passing urine temporarily more difficult. On rare occasions, a urinary catheter may be necessary until the swelling settles down.
• There is a small possibility of experiencing pain when passing urine or having blood in the urine after the procedure but this should settle down by itself.
• Blocking arterial flow to the prostate makes the gland slightly more prone to infection. To avoid this, antibiotics will be prescribed for you to take when you arrive at the department and following the procedure.
• There is a small risk of blocking blood vessels to other organs inside your pelvis (including urinary bladder, bowel or genitals). This could result in reduced blood supply to the affected organ and could potentially be a serious complication, however in most cases it settles down by itself. A special CT scan of your blood vessels will be used before and during the procedure to reduce this risk to a minimum.
• Some patients may feel tired for up to a week following the procedure. We advise patients to take at least one week off work following PAE.

1. NICE (2018) “Interventional procedure overview of prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia” https://www.nice.org.uk/guidance/ ipg611/evidence
2. Ray et al (2018) “Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE Study)” BJU Int 2018; 122: 270-282