Angioplasty and Stenting

If you have been diagnosed with peripheral vascular disease (PAD), angioplasty or angioplasty with stenting may be a procedure your physician recommends as part of your treatment. Your arteries are normally smooth and unobstructed on the inside, but as you age, the plaque can build up in the walls of your arteries. This plaque eventually causes blockages in the vessels.

With angioplasty, a small incision is made in the skin to access your vessel, where a long catheter with a balloon is inserted and advanced to the area that is blocked. The tip of this catheter carries the angioplasty balloon and at times a stent. Angioplasty is a minimally invasive procedure and patients usually spend less time in the hospital and recover at home faster than patients having bypass surgery or endarterectomies.

Are you a candidate?

You may be a candidate for angioplasty if you have moderate to severe disease in one or more vessels. If your plaque is extremely hard, long or completely blocks the vessel, you’re probably not a good candidate. Your vascular surgeon will help you decide what treatment is best for your particular situation.

Preparing for Angioplasty

In preparing for your angioplasty, your physician may have completed other testing such as:

  • Pulse volume recordings (PVRs)
  • Duplex ultrasound
  • Magnetic resonance angiography (MRA)
  • Computed tomography (CT) scan

When your testing is completed and the decision that angioplasty will be performed is made, planning for your procedure will begin. It is very important to inform your physician of your medications and allergies, especially to contrast dye or shellfish. Contrast dye is used during this procedure which contains iodine. You will be given instructions from your surgeon on fasting prior to your procedure and whether to reduce or stop any medications that might increase your risk of bleeding or other complications.

During the Angioplasty

You may be given some mild sedation. Usually your vascular surgeon will want you to stay reasonably alert to follow instructions and describe your sensations during the procedure. Your surgeon will localize your skin and area of catheter insertion. Your vessels have no nerve endings; therefore, you will not feel the catheter as it moves through your body. Next, your vascular surgeon guides the catheter to the narrowing under x-ray guidance. Once this area is located, the balloon is inflated and deflated several times to force the plaque against the artery walls. You may experience pain during the procedure when the surgeon inflates the balloon to open the vessel. However, the pain should go away when your surgeon deflates the balloon and normal blood flow resumes. Be sure to describe these symptoms to your surgeon during your procedure.

After your angioplasty, your surgeon may need to use a stent to keep the artery open. A stent is a tiny mesh tube that looks like a small spring, used to brace the artery and prevent re-occlusion. To place the stent, the surgeon would remove the balloon catheter and insert a stent catheter, advance it in the vessel to the same area of the angioplasty and inflate the balloon, causing the stent to expand and remain in the artery to support the walls. This procedure can take 45 minutes to three hours and longer depending on circumstances. After your angioplasty is completed, the catheter is removed and pressure is applied for 15 to 30 minutes to allow sufficient time for the puncture site to seal.

After the Angioplasty

You will be monitored closely for any complications. Usually you will stay in bed for six hours with the affected extremity straight to minimize the risk of bleeding. After you return home it is important to follow all your discharge instructions for the best recovery. You should call your surgeon if any of the following occur:

  • Sudden bleeding at the site/incision
  • Increasing pain or swelling
  • Incision red/warm
  • Numbness or weakness in any part of the body
  • Fever over 100° F
  • Chest pain or shortness of breath
  • Dizziness or lightheadedness
  • Symptoms of your artery problem that suddenly reappear

Complications

Serious but unusual complications include:

  • Reaction to contrast dye
  • A clot in the artery being treated
  • Rupture of artery being treated
  • Kidney problems
  • Blockage developing further down artery from free floating plaque (embolization)
  • Hematoma (large collection of blood)
  • Heart or lung complications