Peripheral Angioplasty

Angioplasty and stent placement -- peripheral arteries :

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. Fatty deposits can build up inside the arteries and block blood flow.
A stent is a small, metal mesh tube that keeps the artery open.
Angioplasty and stent placement are two ways to open blocked peripheral arteries.

Description :

Angioplasty uses a medical "balloon" to widen blocked arteries. The balloon presses against the inside wall of the artery to open the space and improve blood flow. A metal stent is often placed across the artery wall to keep the artery from narrowing again.
To treat a blockage in your leg, angioplasty can be done in the following:

  •  Aorta -- the main artery that comes from your heart
  •  Artery in your hip or pelvis
  •  Artery in your thigh
  •  Artery behind your knee
  •  Artery in your lower leg

Before the procedure :

  •  You will be given medicine to help you relax. You will be awake, but sleepy.
  •  You may also be given blood-thinning medicine to keep a blood clot from forming.
  •  You will lie down on your back on a padded operating table. Your surgeon will inject some numbing medicine into the area that will be treated, so that you do not feel pain. This is called local anesthesia.

Your surgeon will then place a tiny needle into the blood vessel in your groin. A tiny flexible wire will be inserted through this needle.

  •  Your surgeon will be able to see your artery with live x-ray pictures. Dye will be injected into your body to show blood flow through your arteries. The dye will make it easier to see the blocked area.
  •  Your surgeon will guide a thin tube called a catheter through your artery to the blocked area.
  •  Next, your surgeon will pass a guide wire through the catheter to the blockage.
  •  The surgeon will push another catheter with a very small balloon on the end over the guide wire and into the blocked area.
  •  The balloon is then filled with contrast fluid to inflate the balloon. This opens the blocked vessel and restores blood flow to your heart.

A stent may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands when the balloon is blown up. The stent is left in place to help keep the artery open. The balloon and all the wires are then removed.

Why the Procedure is Performed :

Symptoms of a blocked peripheral artery are pain, achiness, or heaviness in your leg that starts or gets worse when you walk.
You may not need this procedure if you can still do most of your everyday activities. Your health care provider may have you try medicines and other treatments first.

Reasons for having this surgery are:

  •  You have symptoms that keep you from doing daily tasks. Your symptoms do not get better with other medical treatment.
  •  You have skin ulcers or wounds on the leg that do not get better.
  •  You have an infection or gangrene on the leg.
  •  You have pain in your leg caused by narrowed arteries, even when you are resting.

Before having angioplasty, you will have special tests to see the extent of the blockage in your blood vessels.

Risks :

Risks of angioplasty and stent placement are:

  •  Allergic reaction to the drug used in a stent that releases medicine into your body
  •  Allergic reaction to the x-ray dye
  •  Bleeding or clotting in the area where the catheter was inserted
  •  Blood clot in the legs or the lungs
  •  Damage to a blood vessel
  •  Damage to a nerve, which could cause pain or numbness in the legs
  •  Damage to the artery in the groin, which may need urgent surgery
  •  Heart attack
  •  Infection in the surgical cut
  •  Kidney failure (higher risk in people who already have kidney problems)
  •  Misplacement of the stent
  •  Stroke (this is rare)

Before the Procedure :

During the 2 weeks before surgery:

  •  Tell your provider what medicines you are taking, even drugs, supplements, or herbs you bought without a prescription.
  •  Tell your provider if you are allergic to seafood, if you have had a bad reaction to contrast material (dye) or iodine in the past, or if you are or could be pregnant.
  •  Tell your provider if you are taking sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis).
  •  Tell your provider if you have been drinking a lot of alcohol (more than 1 or 2 drinks a day).
  •  You may need to stop taking drugs that make it harder for your blood to clot 2 weeks before surgery. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), Naprosyn (Aleve, Naproxen), and other medicines like these.
  •  Ask which medicines you should still take on the day of your surgery.
  •  If you smoke, you must stop. Ask your provider for help.
  •  Always let your provider know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

Do NOT drink anything after midnight the night before your surgery, including water.
On the day of your surgery:

  •  Take your medicines your provider told you to take with a small sip of water.
  •  You will be told when to arrive at the hospital.

After the Procedure :

Many people are able to go home from the hospital in 2 days or less. Some people may not even have to stay overnight. You should be able to walk around within 6 to 8 hours after the procedure.

Peripheral vascular disease (PVD) is an umbrella term for a group of diseases that affect blood vessels outside of the heart and brain. PVD often involves narrowing of the vessels carrying blood to arms, legs, stomach or kidneys.

Yes, there are two main types – organic PVDs and functional PVDs. Organic PVDs are the results of structural changes, such as inflammation, blockage or tissue damage, within blood vessels. Functional PVD does not involve physical problems in blood vessels; this type of PVD causes spasms or other short-term symptoms.

Many people with PVD experience no symptoms. For others, symptoms of PVD, such as painful cramps, fatigue, achiness and burning, develop slowly. Symptoms often appear with walking, especially when walking at a fast pace, with more exertion or for a long distance and subside with rest. Other symptoms may appear as PVD progresses. These symptoms often affect the legs and feet, such as skin changes, weak pulses, wounds that will not heal, gangrene, reduced hair, blue toes and toenails that appear thick and opaque. Other symptoms may include muscles that feel heavy and arms or legs that are reddish-blue.

Yes, complications of PVD can include blood clots, impotence, heart attack, stroke and death.

Treatment usually includes lifestyle changes, such as smoking cessation, weight loss, regular exercise and a balanced diet. Doctors may prescribe medications, including cilostazol or pentoxifylline to increase blood flow, clopidrogel or daily aspirin to reduce the risk for blood clots, and medications to control other conditions, including drugs to control high blood pressure, high cholesterol and diabetes.
Surgical treatment may be necessary. Vascular surgeons can perform angioplasty by inserting a long, flexible catheter into the blockage and inflating a small balloon that holds the blood vessel open. Sometimes the surgeon inserts a stent, which is a small wire tube that holds the vessel open. Vascular surgery involves bypassing the blocked vein by grafting a healthy vein onto the affected blood vessel.

Using image guidance, an inflatable balloon mounted at the tip of a catheter is inserted through the skin into an artery and advanced to the site of an arterial blockage where the balloon is inflated and deflated. In this process, the balloon expands the artery wall, increasing blood flow through the artery. A stent may be placed at the treatment site to hold the artery open.

Compared to surgical interventions such as bypass surgery, balloon angioplasty and stent placement are much less invasive and relatively low-risk, low-cost procedures.
These procedures are performed using local anesthesia; no general anesthetic is required in the majority of patients.
No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
You will be able to return to your normal activities shortly after the procedure.