Angioplasty, stenting, and atherectomy for peripheral arterial disease (PAD)
What is angioplasty and stenting?
In an angioplasty, your vascular surgeon inflates a small balloon inside a narrowed blood vessel. The balloon helps to widen your blood vessel and improve blood flow. After widening the vessel with angioplasty, your vascular surgeon sometimes inserts a stent depending upon the circumstances. Stents are tiny mesh tubes that support your artery walls to keep your vessels wide open.
Angioplasty and stenting are usually done through a small incision or puncture or sometimes a small incision in your skin, called the access site. Your vascular surgeon inserts a long, thin tube called a catheter through this access site. Using X-ray guidance, your surgeon then guides the catheter through your blood vessels to the blocked area. The tip of the catheter carries the angioplasty balloon or stent.
Angioplasty most often is used to treat peripheral arterial disease (PAD), which is another name for hardening of the arteries that supply blood to your limbs or organs in your body other than your heart.
Your physician will usually insert the angioplasty catheter through a small puncture point over an artery in your groin, or your elbow. Before the insertion, he or she will clean your skin and shave any hair in the immediate area. This reduces your risk of infection. Your physician numbs your skin and then makes a small cut to reach the artery below. Although you may be given some mild sedation, your vascular surgeon will usually want you to stay reasonably alert to follow instructions and describe your sensations during the procedure.
Your vascular surgeon then inserts a guide wire into your artery. Using a type of x ray that projects moving pictures on a screen, your physician guides the catheter through your blood vessels. Because you have no nerve endings in your arteries, you will not feel the catheters as they move through your body.
Next, your vascular surgeon will insert a balloon catheter over the guide wire or through the guide catheter. The balloon catheter carries a deflated and folded balloon on its tip. Your vascular surgeon guides the balloon catheter to the narrowed section of your artery and then partially inflates and deflates the balloon until the balloon can be fully inflated
When the balloon is full, your vascular surgeon may deflate and re-inflate it repeatedly to press the plaque against your artery walls. Usually, this process takes a few minutes. Sometimes, if you have a severe blockage, this may take longer.After angioplasty, your vascular surgeon will sometimes need to brace the artery open to prevent re-narrowing and re-occlusion. A stent is a tiny mesh tube that looks like a small spring, and comes in a variety of sizes. To place a stent, your physician removes the angioplasty balloon catheter and inserts a new catheter. On this catheter, a closed stent surrounds a deflated balloon. Your vascular surgeon guides the stent through your blood vessels to the place where the angioplasty balloon widened your artery. Your physician inflates the balloon inside of the stent. This expands the stent. Your physician then deflates and removes the balloon. The stent remains in place to support the walls of your artery. Your artery walls grow over the stent, preventing it from moving.
Once your vascular surgeon finishes angioplasty and stenting, he or she removes all of the catheters from your body. If blood-thinning medications have been used, your physician may leave a short tube, called a sheath, in your artery for a short time until the medications have worn off sufficiently to allow the puncture site to seal over when the sheath is removed.
Eventually, your physician removes the sheath and presses on the puncture area for 15 to 30 minutes to prevent bleeding. Sometimes, instead of pressing, your physician may close the area with a device that looks like a tiny cork or he or she may give you stitches that will dissolve.
Angioplasty and stenting usually takes between 45 minutes and 3 hours, but sometimes longer depending upon the particular circumstances.
Minor complications include bleeding or bruising where your vascular surgeon inserted the catheters. Sometimes, the hole created by the catheter does not completely close. This can create a false channel of blood flow. Rarely, an abnormal connection can form between an artery and a vein at the place where the catheter was inserted. These problems usually go away. However, if you have any serious symptoms, your vascular surgeon can treat you.
You may have an increased risk for blood clots forming along your stent, especially in the first month after your procedure. To reduce this risk, your physician may prescribe medications that thin your blood.
Serious, but unusual complications include reaction to the contrast dye, a clot in the artery that the surgeon treated, a torn or weakened artery, kidney problems, damage to the lining of the artery (dissection) and a blockage in an artery “downstream” from the treated artery from particles of plaque breaking free (embolization).
What to expect after surgery
Usually, you will stay in bed for 6 to 24 hours after your angioplasty. During this time, your vascular surgeon and the hospital staff closely monitor you for any complications. If your physician inserted the catheters through an artery in your groin, you may have to hold your leg straight for several hours. Similarly, if your arm was used, then you will need to hold it still to minimize the risk of bleeding
If you notice any unusual symptoms after your procedure, you should tell your vascular surgeon immediately. These symptoms include leg pain that lingers or gets worse, a fever, shortness of breath, an arm or a leg that turns blue or feels cold, and problems around your access site, such as bleeding, swelling, pain, or numbness.
When you go home
After you return home, your vascular surgeon will give you instructions about everyday tasks. For example, you should not lift more than about 10 pounds for the first few days after your procedure. You should drink plenty of water for 2 days to help flush the contrast dye out of your body. You can usually shower 24 hours after your procedure, but you should avoid baths for a few days.
Your physician may prescribe aspirin or other medications that thin your blood. These medications will help prevent clots from forming on your stent. Your physician may also ask you to follow an easy exercise program, like walking.
You will be asked to schedule a time to see your physician after the procedure to check your insertion site. Also at this appointment, your surgeon may repeat your vascular lab studies to see how blood is flowing through your treated artery.
Risk factors for PAD that YOU can control
- High Cholesterol
- High blood pressure
- Heart Disease
- Lung disease (Emphysema, COPD)
- Poor kidney function
If you are unsure whether you have any of these risk factors, your primary care provider can perform tests to determine if you do.
Copyright by the Society for Vascular Surgery and NorthPoint Domain