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PATIENT INFO - PERIPHERAL ANGIOPLASTY AND STENTING
Angioplasty and stenting are treatments for narrowed or blocked arteries and veins.
- Angioplasty opens a blood vessel by inflating a small balloon inside it.
- Stenting places a tube-shaped device called a stent in the blood vessel to keep it open.
While angioplasty can be done alone, it’s often combined with stenting.In peripheral angioplasty and stenting, a doctor uses these treatments for blood vessel problems in other areas of the body. Examples include narrowing of the arteries that supply the arms and legs (known as PVD, or peripheral vascular disease) and narrowing of the arteries in the head and neck (which can lead to a stroke).
This treatment is called “minimally invasive” because it involves only a very small incision in the groin area. Compared with surgery, it has fewer risks of complications and a shorter recovery. The procedure itself takes 1 to 2 hours, with about 4 to 8 hours spent in a special recovery area afterward.
Types of angioplasty
- Balloon angioplasty – a small balloon is inflated inside the blocked artery to open the blocked area.
- Atherectomy – the blocked area inside the artery is “shaved” away by a tiny device on the end of a catheter.
- Laser angioplasty – a laser is used to “vaporize” the blockage in the artery.
- Stenting – a tiny coil, called a stent, is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
Tests before angioplasty
The tests may include:
- Pulse Volume Recordings (PVRs)
- Duplex ultrasound
- Magnetic Resonance Angiography (MRA)
- Computed Tomography (CT) scan
How do I prepare?
- Avoid food and drink the night before. Do NOT eat solid foods or drink liquids after midnight on the night before. (If you do, your procedure might be cancelled and rescheduled.)
- Arrange for a ride. Ask someone to drive you to and from the hospital.
- Tell your doctor about your allergies. Your doctor needs to know if you have asthma, ifyou’re allergic to any medications or dyes, or if you’ve ever had a bad reaction to contrast dye.
- Talk to your doctor about your medications. Tell your doctor about the medications you take, and follow your doctor’s directions. You may be prescribed medication to take a few days before your procedure. If you take metformin (Glucophage), you’ll need to stop taking it the day of the procedure and wait to restart it until at least 2 days after. You’ll need blood tests beforestarting it again. Monitor your blood glucose during this time, and call your doctor if it’s higher than 300 mg/dL.
- Arrive one and a half hours before your scheduled procedure time.
Risks of peripheral angioplasty and stenting
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 leg.
- 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).
Procedure of peripheral angioplasty and stenting
- Before it starts – A nurse will place an IV line to give you sedation (medication that makes you feel comfortable). You’ll be connected to heart and blood pressure monitors. A healthcare provider will clean the skin and clip the hair in the area where the catheter will be placed — often the groin, but sometimes the arm or neck.
- Local anesthetic – The doctor will inject numbing medication in the area. This usually feels like a pinprick with some burning, and only lasts a few seconds.
- Placing the catheter – The doctor will insert a sheath(short plastic sleeve) into a blood vessel. You’ll feel some pressure at first. A catheter (a narrow tube) will be put into the sheath.
- Contrast dye and x-rays – A clear liquid called contrast dyewill be injected through the catheter. For a few seconds, you’ll feel a warm sensation. The contrast dye shows up on x-rays to create real-time images (fluoroscopy) to guide the doctor.
- Balloon – The doctor will guide the catheter to the narrowed or blocked artery. The doctor inflates a small balloon at the tip of the catheter. The balloon opens the vessel, restoring blood flow.
- Stent – In many cases a stent, a small tube-shaped device, is placed and remains there to hold the vessel open.
- Removing the catheter – The catheter and sheath will be removed. A healthcare provider may put pressure on the insertion site to prevent bleeding.
Alternatives to angioplasty and/or stenting may include:
- Surgery to open a blood vessel or bypass it.
- Medication.
After catheterization for angioplasty or stenting
The catheters and sheath are removed.
- If the catheter was inserted in the arm - The incision will be bandaged. You will need to keep your arm straight for at least an hour. You will be observed for a few hours to monitor any symptoms or side effects of the procedure.
- If the catheter was inserted at the groin - The incision will be closed with applied pressure, suture device or a "plug." A "plug" is a material which works with your body's natural healing processes to form a clot in the artery. You will need to lie flat and keep the leg straight for two to six hours to prevent bleeding (less time if a plug was used). Your head cannot be raised more than 30 degrees (2 pillows high). Do not try to sit or stand.
- A sterile dressing will be placed on the angio site to protect it from infection. The nurse will check your bandage regularly, but call your nurse if you think you are bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb.
- You will need to drink plenty of liquids to clear the contrast material from your body. You may feel the need to urinate more frequently. This is normal. If you are on bed rest, you will need to use a bedpan or urinal.
- Your doctor will tell you if you are able to return home or will need to stay overnight. In either case, you will be monitored for several hours after the procedure.
- Treatment, including medications, diet and future procedures, will be discussed with you prior to going home. Care of the wound site, activity and follow-up care will also be discussed.
Advantages of peripheral angioplasty and stenting
- Small puncture instead of long open incisions.
- Less trauma to muscles and other tissue.
- Avoidance of surgery-related complications.
- Shorter hospital stay; most patients are discharged within 24 hrs.
- Shorter recovery time for return to normal activities.
Complications of peripheral angioplasty and stenting
Serious complications are unusual following angioplasty and stenting but, nevertheless, can occur.
- Reaction to contrast dye.
- A clot in the artery that your physician treated.
- A torn or weakened blood vessel.
- A large blood collection called a hematoma.
- Kidney problems.
- Damage to the lining of the artery (called dissection).
- Blockages developing in arteries downstream from the treated artery from particles of the plaque breaking free (called embolization).