Angioplasty and stent placement - peripheral arteries

Definition

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. These peripheral arteries can become blocked with fatty material that builds up inside them. This is called atherosclerosis.

A stent is a small, metal mesh tube that expands inside an artery.

Angioplasty and stent placement are two ways to open blocked peripheral arteries.

See also:

• Peripheral artery bypass - leg
• Peripheral artery disease

Alternative Names

Percutaneous transluminal angioplasty - peripheral artery; PTA - peripheral artery; Angioplasty - peripheral arteries

Description

In angioplasty, your blocked artery is widened with a medical ?balloon.? The balloon presses against the inside wall of your artery to open your artery and improve blood flow.

Angioplasty can be done in these arteries to treat a blockage in your leg:

• Aorta -- the main artery that comes from your heart
• Iliac artery -- in your hip
• Femoral artery -- in your thigh
• Popliteal artery -- behind your knee
• Tibial and peroneal 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 make a small incision (cut) in your skin, usually near your groin. Your surgeon will insert a catheter (a flexible tube) through the incision into the blocked artery.

Your surgeon will be able to see your artery with live x-ray pictures. This kind of x-ray is called fluoroscopy. 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 carefully guide the catheter through your artery to the area where it is blocked.

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 blockage. The balloon is then blown up. This opens the blocked vessel and restores proper 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 is 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.

Reasons for having this surgery are:

• When your symptoms keep you from doing daily tasks, and they do not get better with other medical treatment.
• Skin ulcers or wounds on the leg that do not get better
• Infection or gangrene on the leg
• Pain in your leg (caused by narrowed arteries) that happens even when you are resting (called rest pain of critical limb ischemia)

Risks

Risks of angioplasty and stent placement are:

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

Before the Procedure

During the 2 weeks before surgery:

• Tell your doctor what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
• Tell your doctor 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 doctor if you are taking sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis).
• Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), Naprosyn (Aleve, Naproxen), and other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, you must stop. Ask your doctor or nurse for help.
• Always let your doctor 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 drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

The average hospital stay for this procedure is 2 days or less. Some people may not even have to stay overnight in the hospital. You should be able to walk around within 6 hours after the procedure.

Outlook (Prognosis)

Angioplasty improves artery blood flow for most people. But, results will depend on where your blockage was and how much blockage you may have in your other arteries.

Having angioplasty may make open bypass surgery unnecessary. But if it does not help, your surgeon may need to do open bypass surgery, or even amputation.

Angioplasty does not cure the cause of the blockage in your arteries. Your arteries may become narrow again. Follow your heart-healthy diet, exercise, stop smoking (if you smoke), and reduce your stress to help lower your chances of having a blocked artery again. Your health care provider may prescribe medicine to help lower your cholesterol.

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References

Creager MA and Libby P. Peripheral arterial disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 57.

Eisenhauer AC, White CJ. Endovascular treatment of noncoronary obstructive vascular disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 59.