Transient Ischemic Attack (TIA) clinic

What may have caused my symptoms?

Possibly a Transient Ischaemic Attack (TIA): this can take place because of a temporary blockage in a blood vessel in a part of the brain.

This can be similar to a stroke with symptoms such as weakness, numbness, talking problems or trouble with your vision. 

TIA is different as it only lasts between a few minutes to a few hours.

There are other possible causes for these type of symptoms and over half of the people attending the clinic turn out not to have a TIA.

Why is an urgent appointment with a stroke specialist so important?

About one in ten people who have a TIA develop a stroke within the next week but we can greatly reduce this with the right treatment.

The right medication can reduce your chance of a stroke, as can changes to your diet and exercise. Rarely an operation may be useful. We will discuss all this when you see us in clinic.

What may we need to do? (each case is different – you may not need all these investigations)

• A blood pressure check
• A heart recording (ECG)
• A scan of the arteries in your neck
• A brain scan
• A blood test
• A consultation with a stroke specialist - this may be a consultant, registrar or an advanced nurse practitioner for stroke

You can expect to be at the clinic for 3-4 hours.

What happens now?

The clinician who initially diagnosed you may give you medication to take. You need to take this each day until you are seen in our clinic.

There are clinics at Bristol Royal Infirmary and Weston General Hospital and weekend clinics at Southmead Hospital. If you are told to attend a TIA clinic, the TIA co-ordinator will tell you which clinic to attend.

Every day, the stroke specialist on duty will review all new referrals. If we decide that we need to see you urgently over the weekend or at a bank holiday, the co-ordinator of the TIA Service will phone you on the day tell you what time to come to the unit.

Otherwise, the TIA co-ordinator will be in touch on the next working day to arrange an appointment for you to come in. In some cases, the appointment will be a telephone consultation only. The appointment will usually be on the same day. If you have not heard from us within two working days, please ring the TIA co-ordinator on 0117 342 4800.

What do I need to bring?

Please bring a list of all the prescribed tablets you take – this is very important. If there are other tablets you buy over the counter, please tell us about these. If possible, it will be helpful for the person who witnessed you having your symptoms to come to the appointment as well.

There is a Costa Coffee, a small shop and a League of Friend’s coffee shop on Level 1 of the Brunel building where you can purchase refreshments. Alternatively, you may want to bring your own provisions.

What about driving?

It is not safe or legal for you to drive until you have been seen in clinic. We will discuss any possible further driving restrictions related to your diagnosis with you in the clinic.

What if I have further symptoms before the specialist appointment?

If you think you are having a stroke, don’t wait – call 999!

Angiogram, angioplasty, and stents

There are two types of treatment to open up blocked or narrowed arteries, without the need to make an opening in the skin. These are called “angioplasty” or “stenting,” and can be done using X-ray guidance. They are usually performed while you are awake, using local anaesthetic to numb the skin. 

What is an angiogram? 

The first stage of your procedure is called an angiogram. This is used to make a detailed map of your arteries, because blood vessels do not show up on ordinary X-rays. A needle, followed by a thin plastic tube (catheter) is inserted into your artery to do this.

What is an angioplasty? 

After the angiogram, a soft guidewire is inserted into the artery through the catheter. The wire must then be passed through the blockage or narrowed section of artery, if this is not possible we will discuss your options with you. A special balloon is then passed over the top of the wire. This balloon is inflated to stretch open the blockage or narrowing and allow more blood to flow through. 

Once the artery has been stretched the balloon is removed and another angiogram is done to look at the result. If it is not possible to pass through the blocked artery we will discuss your options with you.

What is a stent? 

A stent is a hollow mesh tube about the size of your little finger. It is made of fine, sterile metal and is used to open an artery. When it is used, unlike an angioplasty balloon, it is left inside the artery after the procedure and remains there forever. Once it is in position the stent will not give you any discomfort or sensation. It is important to remember it is there and to tell any doctors treating you in the future that you have it. It can be placed in the artery using similar equipment to the angioplasty and usually requires no additional anaesthetic.

Stents are often used if there is a long blockage in a large artery. It may also be used if you have an angioplasty and the result is not as good as hoped for, or if the artery is not smooth enough for an angioplasty.

If with time, a narrowing that was treated with an angioplasty reoccurs, a stent can be used to decrease the likelihood of it narrowing again. Narrowing can also develop within or around a stent, or the stent could get blocked. If the stent blocks, your symptoms may return or get worse.

Where will the procedure be done?

Most angioplasties/stents are performed by the Major Arterial Centre in Southmead Hospital. They are done by specialist radiology doctors called interventional radiologists, who are part of the multidisciplinary team involved in treating patients with vascular disease. Unless you live alone, are frail, or have certain other medical needs, you will usually go home the same day as your procedure. 

The procedure is done in a specially adapted room called an “Interventional Radiology (IR) room”. Some patients will have surgery at the same time as angioplasty or stenting. This is done in a specialist operating theatre (hybrid theatre) which has X-ray equipment. 

Who will be doing the angiogram or angioplasty?

 The procedure will be performed by a team of specialists. In most cases the team is led by a consultant interventional radiologist. The lead doctor may be assisted by another specialist, or a doctor training in radiology or vascular surgery. Other members of the team in the IR room will include radiology nurses and radiographers.

How do I prepare for an angiogram? 

Before the procedure

• There is no preparation for this procedure; you can eat and drink as normal unless we tell you otherwise.
• If you take blood thinning tablets (including anti-platelets) please contact the Imaging Department before your appointment using the phone number on your appointment letter as they may ask you to speak to your GP.
• Please inform us if there is any possibility you are pregnant.
• Please make arrangements for someone to collect you from the hospital after your procedure and take you home by car. We advise you do not use public transport. For the first 24 hours following your procedure you are not permitted to drive, and we advise someone stays with you at home. Please tell the Imaging Department if this is not possible so we can make alternative arrangements.

On the day of the procedure

• You will arrive at the Imaging Department (Gate 19) and will be accompanied into our day case area.
• Please bring a list of your regular medications with you.
• Please inform us if you are allergic to anything.
• You may take your normal medication unless instructed otherwise.
• An interventional radiologist will discuss the procedure with you including the benefits and potential risks to you. You will have an opportunity to ask questions about the procedure. 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.
• We will place a small plastic tube (cannula) into a vein in your arm or hand – this allows us to administer medications or intravenous fluids during the procedure if necessary.
• Once all the checks have been performed and consent form signed, you will be taken to the IR room. You will be asked to lie down on the X-ray table for the procedure. There will be a small team of nurses, doctors, and radiographers with you throughout.
• Monitoring equipment will be attached to you so we can monitor your blood pressure, heart rate, and oxygen levels throughout the procedure.
• The nurse will then clean the area at the top of your leg with an antiseptic solution and cover you with sterile drapes. The X-ray machine at this point may move around you but will not touch you.
• An ultrasound machine will be used to find a suitable blood vessel.
• The interventional radiologist will then inject local anaesthetic into the area at the top of your leg, which may briefly sting and then go numb. After this, you may just feel a pushing sensation when a small plastic tube (catheter) is inserted into your artery and the catheter fed through.
• Once the catheter is moved into the correct position, contrast medium (X-ray dye) will be injected into different blood vessels and X-ray images are taken. The injection of the contrast medium, may give you a momentary warm feeling. n The injection will be repeated until all the necessary images have been obtained.
• The interventional radiologist will then usually discuss the map of your arteries with you and go through the pro and cons of proceeding with treatment to open up the blocked or narrow segments.
• Sometimes the interventional radiologist may find that the pattern of artery disease is different to what we were expecting. It may be that that the risks of doing a procedure under X-ray guidance to improve the circulation are not advisable. This will be discussed with you.
• At the end of the procedure the catheter will be removed from your leg.
• Usually one of the team will press on the area where the catheter was inserted for 10-15 minutes to prevent any bleeding. If more appropriate, the specialist will use a plug or “closure device” to seal up the artery where the catheter was inserted.

Will the procedure hurt? 

When the local anaesthetic is injected it will sting to start with, but this soon wears off. The skin and deeper tissues should then start to feel numb. After this the procedure should not be painful but you may feel pressure or pushing. If the procedure becomes uncomfortable we can give you some painkillers through the cannula in your arm. 

As the contrast medium passes around your body you may get a warm feeling, which some people find a little unpleasant. This will soon pass and should not concern you.

Some people feel a bit of discomfort when the angioplasty balloon is inflated or when the stent is expanded. This usually passes quickly when the balloon is removed.

How long will it take? 

Every patient’s situation is different, and it is not always easy to predict how straightforward the procedure will be. For example, those with a large artery in the leg are usually straightforward and do not take long – around half an hour. Other times the vessels may be much smaller and complex, and the procedure can take 2-3 hours.

It is important to be aware of rare, but serious complications:

• Bleeding can occur from the place where the catheter entered the artery in the groin. This may result in a large, painful bruise (haematoma) which requires you to stay in hospital and have surgery. The occurs in: angiogram: 3 in 100 patients; angioplasty/stent: 4 in 100 patients.
• The artery may not seal up at all in the area where the catheter was inserted (a false aneurysm). This may happen in 1 in 500 patients. It may require a blood transfusion or further procedures including surgery.
• Sometimes it is not possible to cross the blockage in the artery. Occasionally the narrowing or blockage cannot be opened up, or the angioplasty/stent fails immediately. n
• Occasionally small fragments of blood clots break off and lodge in the artery below the angioplasty. This may require you to stay in hospital for close observation to take blood thinning medication, and/or have emergency surgery. n
• Occasionally the artery can rupture (leak) following the angioplasty. This can sometimes be treated in the Imaging Department by using a stent in the artery to seal the tear. If this is not possible an operation may be required.

Overall there is a 1 in 100 chance an angioplasty will fail and immediately make your leg worse. In this situation you may need urgent surgery. In severely diseased arteries the risk of requiring urgent surgery is 3 in 100. If urgent surgery fails to restore blood flow to the leg you may even need an amputation.

What problems can occur after this procedure? 

Complications following an angioplasty are less frequent than following surgical alternatives but can include: 

• Allergic reaction to the X-ray contrast medium. In most cases this is a minor reaction. Very rarely (1 in 1500) a reaction may be severe and need to be treated with medicines.
• X-ray contrast medium can affect kidney function. If you are at risk of this, special precautions will be taken to reduce the chances of problems occurring.
• A small risk from the X-rays used. The team will work hard to keep the dose as low as possible.
• Over time the treated section of the artery may narrow again. This can happen following both angioplasty or stenting. If you have a stent inserted into an artery, you may be referred for an ultrasound surveillance programme for a year after your procedure to detect this.

What will happen afterwards? 

You will be taken back to our day case area on a trolley. Nurses in the day case area will carry out routine observations such as taking your pulse and blood pressure to make sure there are no problems. They will also look at your skin where the catheter was inserted to make sure there is no swelling or bleeding around it. In most cases you will be required to lay flat in bed for a few hours until you have recovered. If the specialist has used a closure device you will be able to sit up quite soon after your procedure. 

Your specialist may make recommendations about your usual medication following the procedure. It is common to prescribe a short course (6 weeks) of tablets to help keep your angioplasty or stent open and working well whilst the artery repairs itself. 

How soon will I recover?

If your procedure goes as planned, most patients come into hospital, and go home from hospital, on the same day. 

If you go home the same day a responsible adult should accompany you home in a car or taxi. They should stay with you at home for 24 hours. You should not drive, operate machinery, or do any potentially dangerous activities for at least 24 hours. You should wait longer if you don’t feel fully recovered. 

You should not do strenuous exercise for 1-2 days.

You should check your travel insurance if you wish to travel within 4 weeks of this procedure.

How effective is angioplasty or stenting? 

The benefits you get from a successful procedure depends on many factors, especially whether you smoke, and the pattern of your arterial disease. 

The results of angioplasty and stenting are most effective when they treat:

• Short sections of arterial disease.
• Narrowing rather than blockages.
• Large arteries like those higher in the leg such as thigh arteries rather than knee arteries.
• Patients who have single areas in the legs with narrowing/ blockages.

Is there anything I can do to help?

You cannot do anything to relieve the actual narrowing or blockage being treated. 

You can improve your general health by doing regular exercise, stopping smoking, and reducing fat in your diet. These actions will help slow down the hardening of arteries which caused the problems in the first place, and may help you avoid the need for further treatment in the future.

When will I be followed up by the team?

Most patients will have a telephone follow-up with a clinical nurse specialist. This is a member of the specialist team. 

If you have ongoing symptoms, we will arrange for you to be seen in an outpatients appointment. 

If you have had a stent inserted in the thigh artery or behind the knee, the vascular team will arrange for you to have an ultrasound (arterial duplex) done at your closest hospital, around 6 weeks after your procedure. You will then be asked to attend further scans (surveillance) at regular intervals over the next 12 months. Sometimes the stent can develop narrowing without causing any symptoms. Your specialist would then discuss the pros and cons of intervention (further angioplasty). 

We hope this information is helpful. If you have any questions before or after the procedure, the staff in the Imaging Department will be happy to answer them. The phone number is on your appointment letter.

Where can I find more information? 

About vascular conditions and surgeries: 

The Circulation Foundation | The UK Vascular Disease Charity

Patients and Referring Physicians | Society for Vascular Surgery 

Home - Vascular Society 

NICE | The National Institute for Health and Care Excellence

Peripheral arterial disease (PAD) - NHS (www.nhs.uk)

About our consultants: 

A-Z of Consultants | North Bristol NHS Trust (nbt.nhs.uk)

Find a Vascular Society Member - Vascular Society 

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003077. 

You have been advised by your hospital doctor to have an investigation known as ERCP (Endoscopic Retrograde Cholangio-pancreatography). 

What is an ERCP?

This is a medical examination performed to diagnose and treat disorders of the bile duct, gallbladder, pancreas and liver.

Why is an ERCP performed?

The most common reasons to do an ERCP are jaundice (yellowing of the skin or eyes) or abnormal liver tests or if a scan (ultrasound or CT scan) shows a blockage of the bile of pancreatic ducts. Blockages can be caused by stones, narrowing of the bile ducts and growths or cancers of the pancreas and bile ducts.

During an ERCP, stents (small plastic or metal tubes) can be inserted into the bile ducts to allow bile to drain into the intestine. If indicated a therapeutic procedure can then be undertaken. This may involve the removal of gallstones by cutting a larger opening in the bile duct (sphincterotomy) allowing the stones to fall out. An ERCP can give more information about the pancreas and bile ducts and brushings and biopsies (specimens of cells) can be taken from the bile ducts or the pancreas for analysis.

What happens before the procedure?

• You will have attended pre-assessment clinic or completed a telephone assessment to perform standard checks e.g. blood tests, MRSA test and medication checks.
• You can continue taking your normal medication. However, if you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the interventional radiology department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.

On the day of the procedure

• You should not eat or drink anything from 6 hours before your procedure so that the upper intestine is clear of food and liquid.
• You will arrive at the Imaging Department (Gate 19) and be accompanied into our day case area.
• Please inform us if you have any allergies.
• Please inform us if you think there is a chance you may be pregnant.
• A doctor specialising in the digestive system 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 (cannnula) 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 doctor, nurses and radiographer with you throughout the procedure.

During the procedure

• A nurse will attach monitors to record your pulse and oxygen level, as well as monitor your blood pressure and heart rhythm.
• You will be given a local anaesthetic throat spray to help numb the throat.
• You will need to lie on your left side and a plastic mouth guard will be placed in your mouth.  This allows the telescope to pass through your mouth.
• We will give you oxygen through a small soft tube placed into your nostril.
• You will be given an injection of intravenous sedation and painkiller through the cannula in your hand.  These medicines will relax you and may make you drowsy but will not necessarily put you to sleep.  
• A nurse will stand by your head and monitor you for the whole procedure.
• Once you are drowsy the endoscope will be passed through your mouth, down your gullet into the stomach and then into the top part of the small intestine (duodenum).
• The doctor will insert a fine wire through the scope into the bile duct and inject a dye which shows up on x-ray.  
• If stones need to be removed from the bile or pancreatic ducts, a small cut (sphincterotomy) may be made in the lower end of the bile duct to allow a fine tube to pass through. This also allows a small basket or balloon to be inserted to grasp a stone or stones.
• Specimens may be taken from the bile ducts using a small brush or forceps, and a plastic or metal tube (stent) may be inserted to help with the drainage of bile or pancreatic juice.

An ERCP usually lasts between 30 and 60 minutes depending on its complexity.

Taking your medications:

It would be helpful to bring a list of your current medications.

It is advisable to take your regular medications with a small amount of water no less than two hours before your test i.e. blood pressure tablets. Except: 

• Diabetic Tablets or Insulin: Please contact your diabetic nurse or GP in advance of your procedure to discuss the appropriate measures. If necessary your GP surgery can seek further specialist advice from the hospital diabetes Centre.
• Anticoagulant and Anti-platelet drugs: eg. Warfarin, Coumadin, Clopidogrel, Rivaroxaban, Dipyridamole, Apixaban, Dabigatran.

Please make sure that you are told when to stop this medication by the doctor who referred you for this procedure. The level of the blood test (INR) must be <1.3 on the day of your procedure. If necessary your GP surgery can seek further specialist advice from the hospital haematology department.

What to expect after the procedure

• 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 6 hours.
• Please make arrangements for someone to collect you from the hospital and take you home by car, as we advise not to use public transport. You are not permitted to drive for 24 hours post procedure and we would like someone to stay with you at home in the first 24 hours. Please inform the department if this is not possible, as we will need to identify alternative arrangements.

Furthermore, you should avoid the following activities after the procedure:

• Driving.
• Operating machinery.
• Drinking alcohol.
• Signing any legally binding documents.
• Carrying out any activities involving cooking, heights, bending, exercises.
• Caring for young children (sole responsibility).

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

If you start to feel unwell or feverish, or develop severe abdominal pain, you must contact your GP or the local GP Emergency Service as soon as possible, it may be necessary to re-admit you to hospital.

You may resume a normal diet when able to do so.

Side effects and possible complications of ERCP

After the procedure your throat may feel sore for up to twenty-four hours.  The indication for this test will have been determined by previous tests, such as an ultrasound scan, and considered to be the safest way to help you. However, an ERCP is not risk free.

You should be aware of the following possible complications:

• Failure to gain access to the bile duct due to differences in anatomy which occurs in 1/10 cases and may require a repeat or alternative procedure at a later date.
• Inflammation of the pancreas (pancreatitis) is due to irritation caused by contrast and occurs in 4/100 cases.  This causes abdominal pain and is usually self-limiting.  However, in 1/100 cases it can require a prolonged stay in hospital.
• Sometimes a cut is made in the intestine (sphincterotomy) which allows the release of displaced gall-stones.  In 1/140 cases bleeding occurs which is usually controlled during the ERCP. Perforation of the intestine can occur in 1/1000 cases. Both situations can require open surgical correction.
• Death is a very rare outcome after ERCP. It occurs following severe complications of the type outlined above. The national mortality figure following ERCP is one in 3000 cases lead to complications that can result in death.

References

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002079

Your doctor has requested that you have a rhizolysis procedure. We hope the following information will answer some of the questions you may have about this procedure.

What is Rhizolysis or radiofrequency lesioning?

This is a technique that deliberately damages the nerve that supplies the facet joint. These nerves are responsible for transmitting the pain that is caused by the facet joints. 

Why do I need to have a Rhizolysis treatment?

If you have had success from facet joint injections in the past but the effects have not lasted, this procedure may offer improved long-term pain relief. The effect of this procedure may take longer to act (a few weeks), however could last up to a year and beyond. 

The doctor in charge of your case feels this is an appropriate procedure for you. However you will have the opportunity for your opinion to be taken into account; if you do not want the procedure carried out then you can decide against it.

How do I prepare for this procedure?

• There is no preparation for this procedure; you can continue to eat and drink as normal.
• If you are taking any blood thinning tablets which include anti platelets for example: Aspirin, Clopidogrel, or anti-coagulants for example: Warfarin, Dabigatran, Rivaroxaban and Apixaban please contact the department using the number on your appointment letter before the appointment, as you may need to consult your GP before undergoing this test.

Are there any side effects?

• Occasionally patients may have flare up pain afterwards, which may be short lived but could last a few days. (If this does occur you may take your usual pain relief medication).
• Bleeding or haematoma (a bruise under the skin), this should settle down by itself.
• Infection – contact your GP if you experience any redness or tenderness at the injection site.
• Failure of the procedure to help. 

The procedure uses X-rays to confirm that the needle is in the correct place. The amount of radiation used is small, however, please inform us if you think there is a chance you may be pregnant before attending the appointment.

What will happen during the procedure?

• The procedure is performed by a radiologist, under x-ray guidance.
• It is performed as an outpatient, which means you will be asked to arrive shortly before the procedure and allowed home 15-30 minutes after it has finished. Please allow up to 3 hours for this procedure.
• You will arrive at the Imaging Department (Gate 19) and be accompanied into the procedure room.
• A nurse will take a brief medical history. It would be helpful to bring a list of any current medications along with you.
• The radiologist will talk to you before the procedure to ensure you have read this leaflet and understood it. They will explain the procedure and answer any questions you have.  
• Should you wish to proceed, you will be asked to sign a consent form. 
• You will be then asked to position yourself face down on the X-ray couch. It is important that you are comfortable as you will need to stay in that position for anything between 30-60 minutes. 
• The radiologist will image your spine first before starting the procedure.
• The skin will be marked and cleaned with antiseptic solution, which may feel cold.
• The radiologist will use local anaesthetic in the skin first before directing a fine needle using X-ray guidance, into the nerves that supply the facet joints. 
• Once in the correct position, a probe will be passed through the needle and more local anaesthetic will be injected, before the probe is heated. The radiologist will ask you a series of questions to determine the correct position before treatment is performed.
• Local anaesthetic may also be added after the treatment, in order to decrease discomfort caused by the procedure.
• This may occur several times, depending on how many facet joints are being treated.
• At the end, a dry dressing will be placed over the puncture site/s. 

After the procedure

• You will be asked to stay in the department for up to 30 minutes after the procedure has finished, if necessary to ensure you are feeling ok before going home.
• If you need assistance to your car, there are wheelchairs and porters available at reception.
• You should not drive for 24 hours after as your insurance may not be valid if you are involved in an accident. 

What happens next?

• You will be asked to fill in a pain chart, for the next month. This is so that the doctors can track whether the procedure has had an effect.
• The radiologist will send a report to your referring doctor.
• Follow up appointments will be with the doctor who referred you for the procedure.

Finally we hope this information is helpful. If you have any questions either before, during or after the procedure the staff in the Imaging department will be happy to answer them.

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

References

Journal of spinal disorders and techniques. 2011 Apr;24 (2) 69-75

Spine. 2008 May 20; 33 (12): 1291-7

How to contact us

Southmead Hospital, Bristol, BS10 5NB

See your appointment letter for the number to phone with any queries you may have.

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002796

Welcome to the Radiology Department

The Radiology Department may also be called the X-ray or Imaging Department. It is the facility in the hospital where radiological examinations are carried out using a variety of equipment.

Radiologists are the doctors who are specially trained to interpret the images and carry out more complex examinations. Radiologists are supported by Radiographers who are highly trained to carry out the examinations. You have been referred for an MRI scan. The results will go back to the clinic that referred you.

What is a MRI scan?

The MRI scanner is a circular tube which is open at both ends. MRI uses a very strong magnet to produce cross-sectional images of the body.

The magnet in the scanner collects information and sends it to the computer in the control room which displays your images.

The scanner is very noisy while it collects the images, and it is important you stay still so clear pictures can be taken.

Risks, alternatives, and benefits

MRI does not use any form of X-ray. MRI is now the alternative for some X-ray and operative procedures. The images produced by MRI are very detailed and show bones and soft tissue.

It may not be possible to have an MRI if you have a metal implanted device, this may include:

• Cardiac devices including pacemakers and defibrillators.
• Aneurysm clips.
• Metal fragments in your eyes.
• Implanted electronic stimulators.
• Implanted pumps.

Please let the MRI unit know as soon as possible if you have any implanted devices. The phone number is on your appointment letter.

Before your MRI scan, you will be asked some questions to check that you are safe to enter the scan room. People with dental fillings, bridges, joint replacements or stents can all be scanned if you have had them for at least 6 weeks. The Radiographers will need to be aware of these so they can optimise your scan.

Pregnancy

Claustrophobia

Contrast injections (dye)

Children

What happens during the MRI scan?

How long will it take?

How will I get the results?

References

Questions

Please do not hesitate to ask questions either before or after your scan. Contact details can be found on your appointment card.

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002009

Your doctor has requested that you have a vertebroplasty. We hope the following information will answer some of the questions you may have about this procedure.

What is a vertebroplasty?

Vertebroplasty is used to relieve the pain caused by compression fractures of the spine, which can be caused by osteoporosis, multiple myeloma or less commonly cancer and trauma. The procedure involves injecting a substance called “bone cement” into the vertebral body which can reinforce the weakened vertebral body and prevent further vertebral collapse. The cement is injected under x-ray guidance by the radiologist. 

Why do I need to have a vertebroplasty?

The purpose of vertebroplasty is to stabilise the vertebral body, which will in turn alleviate pain and improve posture.
Who has made this decision?

Your suitability for the treatment will have been made by the consultant radiologist at the hospital. The purpose of the procedure and potential complications will have been explained and will be explained again when you attend for treatment.

What are the risks associated with vertebroplasties?

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

• Bleeding or haematoma (a bruise under the skin) around the injection site, which should settle down by itself
• Infection. Contact your GP if you experience any redness or tenderness at the injection site
• Allergic reaction to the drugs or cement used at the time of the procedure
• Leakage of the cement which might compress the spinal cord or block a blood vessel to the lungs
• Rib fractures
• X-rays are used in this procedure but with modern equipment the risk from the x-rays is low (Public Health England 2014).

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

What happens before the procedure?

Prior to the procedure you may have already:

• Had an assessment for your suitability for the treatment by the consultant radiologist
• Attended for an MRI
• If necessary, you may have been asked to attend the pre assessment clinic, to perform standard checks, including blood tests, ECG and discussed existing medication.

On the day of the procedure:

• Depending on the time of the procedure, you may either have a light breakfast or you will be sent instructions by letter, of what times you can eat and drink beforehand. Please take a sip of water with your regular medication only.
• You will arrive at Radiology Day Case (Gate 19), where a suitable day case bed will be allocated for you. However if you use warfarin routinely, you may need to stay in hospital overnight.
• You will be asked to change into a hospital gown.
• A nurse or doctor will put a cannula into a vein in your arm. This is so that we can give sedation, antibiotics, fluids and painkillers you might need during the procedure.
• The consultant radiologist will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to proceed with the procedure you will be asked to sign a consent form.  
• The procedure will be carried out under local anaesthetic, which numbs the area to be treated, together with some sedation. 
• Once brought to the x-ray room, you will have to lie face down on the x-ray table. There will be a small team of nurses, doctors and radiographers throughout.
• A hollow needle is introduced into the vertebral body through the skin of the back. The radiologist will position the needle into the correct place by use of x-ray guidance. Once the tip is precisely positioned within the affected vertebral body the liquid cement is injected. The cement hardens inside the fractured vertebral body over the next few minutes.
• A CT scan is then performed in the same room, to confirm the position of the cement.
• The procedure will take approximately 30 minutes for each fracture that needs to be treated.

What happens after the procedure?

• You will be taken back to a recovery area initially, so that nursing staff may monitor you closely as the sedation wears off.  After the effects of the sedation have worn off, you will rest for a few hours before being allowed home.
• You are likely to have some discomfort in the area of the wounds, please inform the staff if you require painkillers.
• If you are allowed home on the same day, you will need someone to stay with you at least overnight and until the effects of the sedation have worn off.

What happens next? 

• Please continue your regular painkiller medication for three days after the procedure. If the pain is eased at this point, you may then wean off your painkillers under doctor supervision.
• You will be invited for a follow up appointment with the consultant radiologist 4 weeks after the procedure.
• If you experience any symptoms you are concerned about, please contact the imaging department directly or alternatively contact your GP or the emergency department.

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 telephone number for the Imaging department can be found on the appointment letter.

Reference:

• National Institute for Health and Clinical Excellence - Percutaneous Vertebroplasty
• Radiologyinfo.org - Vertebroplasty & Kyphoplasty
• Public Health England - Exposure to ionising radiation from medical imaging: safety advice - GOV.UK

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

This information is for patients whose doctor has requested they have a liver biopsy. We hope the following information will answer some of the questions you may have about this procedure.

What is a liver biopsy? 

A liver biopsy is a medical test, where a small sample of tissue is removed from your liver with a needle. The sample is then sent to the pathology department where it is examined under a microscope.  

Why do I need to have a liver biopsy?

A liver biopsy helps to assess and diagnose the problem, if any, in your liver.  This helps your doctor to make a correct diagnosis and plan any necessary treatment.

Are there any alternatives to a liver biopsy?

There is no other procedure that will give your doctor the same information as a liver biopsy.  

What are the risks associated with liver biopsies?

Liver biopsy is usually a safe procedure. Potential complications are uncommon and include:

• Some people experience pain, which is usually not severe and can be controlled with simple painkillers.
• Bleeding or bruising around the puncture site which should settle down by itself.
• There is a small risk of internal bleeding after the biopsy.  This risk is around 1 in 100.  The nurse will monitor your blood pressure and pulse during and after the procedure and you will stay in hospital for up to five hours after the procedure, so that we can monitor you.
• Occasionally people will have a significant bleed, in which case it may be necessary to do a further procedure to try to stop the bleeding. 
• There is a very small risk of death.  This risk is around 1 in 1,000. 

What happens before the procedure?

• You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy. 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. These may need to be stopped to keep the risk of bleeding to a minimum. 
• Please make arrangements for someone to collect you from the hospital and take you home by car, as we advise not to use public transport.
• You are not permitted to drive for 24 hours post procedure and we would like someone to stay with you at home in the first 24 hours. Please inform the department if this is not possible, as we will need to identify alternative arrangements. 

On the day of the procedure:

• You should eat nothing for six hours before your appointment. You may drink water until the time of your appointment. 
• You will arrive at Gate 19 and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you are allergic to anything.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm.
• A doctor will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
• 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 and a doctor with you throughout the procedure.
• The doctor will use an ultrasound machine to look at your liver to find the correct area to take the biopsy from.
• Your skin will be cleaned with an antiseptic solution and covered with sterile drapes. 
• The doctor will then inject local anaesthetic into the area selected for biopsy, which will briefly sting and then go numb. Most people will feel a pushing sensation, but the biopsy is not usually painful. A special needle is used to remove a small piece of liver tissue. Occasionally it is necessary to take more than one sample. 
• Once the doctor has taken the sample, the needle will be removed and the doctor will apply a dressing. 

What happens after the procedure?

• You will be taken back to the day case area 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 flat for one hour and then sit up for a further two hours. Then walk around for half an hour.
• You will be able to eat and drink as normal.
• If everything is satisfactory, you will be free to go home.  Please arrange for someone to collect you on discharge rather than drive yourself. 
• Have someone stay with you overnight.
• You should rest for the remainder of that day and the following day, avoiding any strenuous activities for 36 hours.
• Keep a regular check on the biopsy site. The dressing can be removed after 24 hours.
• If you have any discomfort take your usual pain relief, as prescribed, but if the pain is severe please contact the Imaging department using the number on your appointment letter.

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

What happens next? 

The results of the biopsy will be sent to the consultant who referred you, who in turn will either contact you or write to your GP with the results.  

If you experience any symptoms you are concerned about, please contact the Imaging department directly on the number on your appointment letter or alternatively contact your GP or the emergency department.

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.

References

© North Bristol NHS Trust.  This edition published January 2024. Review due January 2027. NBT003106.

This page is for patients whose doctor has requested that you have your PEG (percutaneous endoscopic gastrostomy) tube removed. We hope the following information will answer some of the questions you may have about this procedure.

Why does my PEG need to be removed? 

It could be that your dietician/doctor has decided that you are now able to take sufficient food orally. Alternatively it might be because your tube is not functioning correctly, therefore it needs to be changed. 

How is the PEG removed? 

The PEG is held in place inside your stomach by a circular piece of plastic (the internal flange) about the size of a 10 pence coin. This is what stops it being accidentally pulled out. Because of this piece of plastic it is not possible to remove your tube by pulling it from the outside. PEG tubes can be removed endoscopically, however, for some patients this method is not always possible. In your case it is necessary to use another way to remove the PEG. This is the “cut and push” method. The PEG tube is cut away close to the skin on the outside and the circular piece of plastic (the internal flange) is pushed into your stomach. 

What are the risks associated with a PEG removal? 

There is a small risk that the internal flange could get stuck somewhere in the stomach or bowel. This could cause an obstruction and require another procedure. 

If you experience any vomiting, abdominal pain or constipation in the days following the procedure contact your GP and let him/her know that you have recently had a PEG removed by the “cut and push” method. If you are feeling very unwell you should go directly to your nearest Emergency Department. 

The procedure uses X-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging Department before attending the appointment.

On the day of the procedure

• You should not eat or drink anything for 6 hours before your appointment.
• You may take your normal medication unless instructed otherwise.
• You will arrive at the Imaging Department (Gate 19) and be accompanied into our day case area. Please inform us if you are allergic to anything. 
• You will be asked to change into a hospital gown and a cannula (a small tube) will be placed in a vein in your arm for pain relief if needed.
• The interventional 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.
• Once all the checks have been performed and a consent form signed, you will be taken to the angiography suite (X-ray room) on the trolley. There will be a radiologist, nurses and a radiographer with you throughout the procedure.
• You will be asked to lie on your back on the X-ray table.
• The skin around the PEG tube will be cleaned with an antiseptic solution and covered with a drape.
• The PEG tube is then cut close to the skin on your stomach and the circular piece of plastic is then pushed into your stomach.
• If you still need a tube for feeding then a new replacement tube will be inserted into the hole immediately following the “cut and push”. This procedure will be similar to when the PEG was initially fitted and will be discussed with you.

What happens after the procedure?

At first, when the PEG is removed some patients experience a small amount of leaking of fluid - but the hole in the stomach wall usually heals within 24 hours and the hole in the skin within a few days. 

You will be given a small dressing to use for the first few days. You may take a shower straight away however, we advise that you wait 24 hours before taking a bath. 

Once the procedure has been completed, the internal flange will pass through your system and leave through your bowels when you go to the toilet. It’s painless and most people do not realise that the flange has been passed.

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 can be found on your appointment letter.

Reference

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003258

Your doctor has requested that you have an oesophageal stent inserted. We hope the following information will answer some of the questions you may have about this procedure.

What is oesophageal stent insertion?

The oesophagus, or gullet, is a hollow, muscular tube which takes food from the mouth down to the stomach. If it becomes blocked or narrowed, then there will be a problem with swallowing. 

One way of overcoming this problem is by inserting a metal, mesh tube, called a stent, down the oesophagus and across the blockage or narrowing. Food can then pass down the gullet through this stent, and this should make swallowing easier. This procedure is called oesophageal stent insertion, and is usually very helpful to people.

Why do I need an oesophageal stent insertion?

Other tests that you probably have had done, either an endoscopy (telescope test) or a barium swallow, have shown that your oesophagus has become blocked or narrowed. Your doctor will have discussed with you the likeliest cause for this and the possible treatments. It is likely that an operation has been ruled out, and that a stent insertion is considered the best treatment option for you.

Who has made the decision?

The doctors in charge of your case, and the consultant clinician performing the oesophageal stent insertion will have discussed the situation, and feel this is the best treatment. However, your opinion to be taken into account, and if, after discussion with your doctors, you do not want the procedure carried out, then you can decide against it.

Who will be doing the oesophageal stent insertion?

A specially trained Radiologist or Gastroenterologist who are both doctors with special expertise in using X-ray equipment, and in reading the images produced. They need to look at these images while carrying out the procedure, to make sure that the stent is positioned correctly.

How do I prepare for oesophageal stent insertion?

• The procedure uses X-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.
• You should eat nothing for 6 hours before your appointment. You may drink water until the time of your appointment.
• 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 are allergic to anything.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm in case you need painkillers or sedatives during the procedure.
• A doctor will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
• Once all the checks have been performed and consent signed, you will be taken to the procedure room on the trolley. There will be a doctor, nurse and radiographer with you throughout the procedure.

What actually happens during an oesophageal stent insertion?

• You will be asked to lie on the X-ray table.
• Monitoring equipment will be attached to you so we can record your pulse and oxygen level, as well as monitor your blood pressure and heart rhythm.
• You will be given a local anaesthetic throat spray to help numb the throat.
• We will give you oxygen through a small soft tube placed into your nostrils.
• A plastic mouth guard will be placed in your mouth. This allows the endoscope (small camera) and/or a soft guidewire to pass through your mouth.
• A nurse will stand by your head and monitor you for the whole procedure.
• Once you are comfortable the endoscope and/or guidewire will be passed through your mouth, down your gullet into the stomach.
• The stent is then passed over the guidewire into the correct position across the blockage. Finally, the endoscope and/or guidewire is removed.

Will it hurt?

Some discomfort may be felt in your throat, but this should not be too sore. There will be a nurse standing next to you and looking after you. If the procedure does become painful for you, then they will be able to arrange for you to have painkillers through the cannula in your arm.

How long will it take?

Every patient’s situation is different, and it is not always easy to predict how complex or straightforward the procedure will be. It will probably be over in 45 minutes, but occasionally it may take an hour.

What happens afterwards?

You will be taken back to the day case area on a trolley. Nurses there will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. You will generally stay in bed for a few hours, until you have recovered.

How soon can I eat and drink, and what happens next?

Most patients will be able to start on fluids within a few hours. It is then necessary to have a fairly liquid diet for a few days, until starting on soft solids. More solid food should be chewed properly before swallowing. Depending on how well the stent has overcome the blockage/narrowing, you may be back on a fairly normal diet within a week or so.

Things to remember:

• Do not continue to eat or drink if you feel something is stuck at the back of your throat. Contact your GP if this happens.
• If you feel your swallowing difficulty recurs, seek your GP’s advice, as there is a likelihood that the stent may be blocked and requires a further examination or treatment.

Are there any risks or complications?

Oesophageal stent insertion is a safe procedure, but there are some risks and complications that can arise, as with any medical treatment.

• It is possible that a little bleeding occurs during the procedure, but this generally stops without the need for any action.
• It is normal to experience moderate chest pain while the stent “beds in”, but this normally settles in a day or two. Some patients get heartburn afterwards and need to take medicine for this.
• Very rarely the stent may slip out of position, and it is necessary to repeat the procedure.
• Very, very rarely, putting the stent in may cause a tear in the oesophagus. This is a serious condition, and may need an operation, or insertion of another stent.

Despite these possible complications, the procedure is normally very safe.

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.

Dietary advice and consideration: 

Remember to chew your food well before swallowing and have fluid available when having your meal. Supplementary high nutritious drink may be necessary to maintain your weight.

Example

Meat: Cut into small pieces, or minced.

Cheese: Grated or in sauce.

Puddings: Creamy yoghurt, custard etc

Fruit & veg: Well cooked, pureed or liquidised. Smoothies.

Cereals: Porridge, Ready Brek.

References

© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT003149.

Your doctor has requested that you have  a nerve root block to help diagnose the cause of your pain. We hope that the following information will answer some of the questions you may have about this procedure.

What is a nerve root block?

Nerve roots exit the spinal cord and divide into nerves that travel to your arms and legs. These nerve roots can become inflamed due to pressure from nearby bone spurs or  intervertebral discs. Inflammation of nerve roots may cause pain in the back, neck/arms and/or the legs. A nerve root block provides important information for your doctor and may also provide you with some relief from pain.

Why do I need to have a nerve root block?

The procedure is designed to prove which nerve is causing your pain by placing temporary numbing medicine over the nerve root of concern. If your pain improves after the injection then that nerve is the most likely cause of your pain. If your pain remains unchanged, then that nerve is probably not the cause of your pain.

What is injected around the nerve root?

The injection is a combination of local anaesthetic (a numbing agent) and steroid (an anti-inflammatory agent). The local anaesthetic works immediately and the steroid usually begins to work within two to three days but may take up to a week.

How do I prepare for a nerve root block?

You can continue to eat and drink as normal. 

If you are diabetic please inform the doctor before the examination as there is a possibility that your sugar levels will vary after the injection. It is important that you continue to monitor your levels carefully for several days and consult your GP if necessary.

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 on 0117 414 9110 as we may need to adjust your medication before undergoing this procedure. These may need to be adjusted to keep the risk of bleeding to a minimum.

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

Afterwards your leg may feel numb or weak and you should not drive for 24 hours. You will need to arrange for someone to take you home. We advise against using public transport.

What will happen during the procedure?

• You will arrive at Gate 18 whereby a member of the Imaging team will take you through to the fluoroscopy waiting room.
• Following confirmation of your details and history you will be shown into the x-ray room and introduced to the staff performing the procedure. You will be cared for by a small team including a radiologist (x-ray doctor) and/or radiographer and an imaging support worker.
• Before the examination begins the radiologist or specialist radiographer will explain what they are going to do. You will be given the opportunity to ask any questions you  may have. If you are happy to proceed you will be asked to sign a consent form.
• You will then be asked to lie on your front on the X-ray couch. The skin will be cleaned and a small amount of local anaesthetic will be injected under the skin. This stings for a few seconds and the area then goes numb.
• A very fine needle will be directed just next to the nerve root using the X-ray machine. Sometimes the needle can touch the nerve itself in which case you may feel a sharp pain going down your leg. This will only last for a second or two. A special dye called contrast medium is then injected around the nerve root. This shows up on the X-ray machine to confirm the needle is in the correct position. When the radiologist or specialist radiographer is satisfied with the needle position, the local anaesthetic and steroid will be injected along the nerve root.
• Afterwards you will be asked to sit in our waiting room for 20-30 minutes so that we can ensure you are feeling well before you go home.

How long will it take?

You will be awake throughout the procedure, which lasts about 15–30 minutes.

Will it hurt?

You may feel a little pressure or discomfort, which may travel down the leg, during the injection of the local anaesthetic and steroid. This will last for only a few seconds.

Afterwards your leg may feel numb or weak for up to 24 hours. You will be asked to wait for 20 to 30 minutes before going home.  As your leg may feel numb or weak, you should not drive for 24 hours and you will need to arrange for someone to take you home. We advise against using public transport. 

Some people find that their pain feels worse for two to three days after the procedure. This is because the steroid can sometimes irritate the nerve. Do not worry if this happens, as it will settle down by itself. 

If your leg becomes numb you may need someone to stay with you overnight.

Are there any risks associated with a nerve root block?

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

• An increase in your pain in the first 24 hours following injection. Should this occur, take your usual or prescribed pain medication and seek advice from your pharmacist or GP if necessary.  
• Bleeding or haematoma (a bruise under the skin) – this should settle down by itself.
• Infection developing at the injection site. This will happen to less than 1 in 5000 people. Contact your GP if you experience any redness or tenderness at the injection site.  
• Flushing of the face for up to 48 hours after the injection – this should settle down by itself.
• Skin dimpling or discolouration at the site of the injection – this should settle down by itself.
• A disruption in your mood – this should settle down by itself.
• Occasionally a change in menstrual cycle may be experienced. This is most likely due to the steroid but contact your GP if this happens to inform them.  
• If you are diabetic you may notice a rise in your blood sugar levels. It is therefore important you monitor your levels carefully for several days after the procedure and consult your GP if necessary.
• The procedure uses X-rays to confirm that the needle is 
  in the correct place. The amount of X-rays used is very small however patients who are or who may be pregnant should inform the department before attending for their appointment.

Finally

We hope this information is helpful. If you have any questions either before, during or after the procedure the staff in the Imaging department will be happy to answer them.
The telephone number of the X-ray department can be found on your appointment letter.

References

Overview | Low back pain and sciatica in over 16s: assessment and management | Guidance | NICE [Accessed January 2024]

British Association of Spine Surgeons - Booklets [Accessed January 2024]

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003237