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giatroi Treatment

Balloon angioplasty & stenting

Please note the information provided is intended to support patients and is not a substitute for medical advice and treatment. We strongly recommend consultation with your doctor or health care professional, before using any information obtained from articles of this website.

What is balloon angioplasty and stent insertion?

Percutaneous Transluminal Balloon Angioplasty (PTBA or PTA) is the widening of a narrow vessel done through a small skin puncture, usually under local anaesthesia. Initially, a small puncture, or sometimes a small incision, in the skin, usually in your groin but it can also be in your arm, is done. Through this access site, your physicians insert a long, thin tube called a catheter, and guide it through your blood vessels to the blocked area using X-ray guidance. They inject a liquid, the “contrast”, to obtain an angiogram.

The tip of the catheter carries the angioplasty balloon. This small balloon is inflated inside the narrowed blood vessel. The balloon helps to widen your blood vessel and improve blood flow.

The stages of widening of a tight arterial lesion with a balloon-angioplasty catheter are demonstrated

In certain cases, a metal stent may be inserted inside the vessel to support its wall and keep it wide open. Stents are tiny mesh tubes, usually composed of nitinol. The decision whether to use a stent or not depends upon the anatomical circumstances, such as the location and the type of the vascular lesion.

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What do I need this treatment for?

From your medical history, physical examination and imaging investigations, it was found that you have a medical problem related to a very narrow or blocked artery. The most common cause is atherosclerosis, or hardening of the arteries. It usually affects the arteries of your legs, then called peripheral occlusive arterial disease, however, another artery (of an arm, kidney, bowel) may be affected too. This obstructing lesion may reduce the blood flow to the respective organ (limb, kidney, bowel etc) to such a low level that its function is affected or its viability is at risk.

On rarer occasions, balloon angioplasty is performed to veins which have very tight narrowings. The present article will focus on angioplasty to arteries only.

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Is this treatment preferable to surgery?

Based on certain scientific criteria, your vascular surgeon will decide whether the condition of your artery is amenable to balloon angioplasty, whether the only feasible treatment is an open operation (arterial bypass surgery), whether both options are feasible or whether neither method is appropriate in your case.

Generally speaking, lesions amenable to angioplasty are the ones of short lenght and located in relatively large arteries (subclavian artery in the upper limb, iliac, femoral and popliteal arteries in the lower limb, renal artery).

Long lesions in small arteries, lesions with very hard atheromatous plaques, lesions with fresh clot in the arterial lumen and lesions in arteries in persistent spasm are usually unsuitable for angioplasty.

Also, if you have health problems which put you at a very high surgical risk, then angioplasty will probably be preferred as a lower risk procedure, although it isn’t the first choice in cases with extensive peripheral occlusive arterial disease, where bypass surgery may have superior long-term results.

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How do I prepare before the angioplasty?

Prior to angioplasy, certain laboratory tests, such as checking blood clotting and kidney function, need to be performed. You are usually admitted into the hospital on the day of the procedure or the day before.

The physician will have probably asked you to discontinue for a few days (if you take) any anticoagulant like Warfarin or Sintrom, but you will not generally discontinue antiplatelet drugs like Clopidogrel (Iscover, Plavix etc) or Aspirin. Before proceeding with any interventional procedure (such as angioplasty or surgery), your physicians will generally require that a couple of blood units are available for you. In Greece, you need to personally liaise with the Blood Bank of your hospital in order that blood is secured for you. You will be asked to sign a form confirming that you understand why the procedure needs to be performed, its risks and that you agree to the procedure.

You will be asked to be starved for 6 hours before the procedure. If your kidney function is reduced, intravenous fluids may be administered to you before and afterthe procedure to prevent its deterioration. If you are allergic to the contrast material or iodine, you may have been preventively given some medication to reduce the risk of an allergic reaction.

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What does the procedure involve?

Your physician will insert an IV to provide you with fluids and medications, and will choose where to insert the angiographic catheter, usually into an artery in your groin or near your elbow. Before the insertion, your skin will be cleaned with an antiseptic solution and any hair in the area shaved to reduce your risk of infection. Your physician then numbs your skin with a local anaesthetic and makes a tiny puncture to reach the artery below. Your artery is punctured with a hollow needle, a thin wire is advanced through the needle, and then a catheter is passed over the wire guided to the desired location. Your physician uses x-rays that are projected on a video screen, a process called fluoroscopy, to see the catheter as it moves through your arteries. You don’t feel the catheters in your arteries, because there are no nerve endings in them. Your physician usually moves the x-ray table to follow the catheter as it is advanced through your blood vessel. Once your physician has positioned the catheter properly, the contrast is injected; the contrast causes a brief, mild warm feeling as it enters your bloodstream. Your physician takes more x-ray images to see how the contrast is flowing through your arteries. During the test, your physician may ask you to hold your breath for about 5 to 15 seconds. In addition, your physician may ask you to lie perfectly still to prevent sudden movements from blurring the x-ray pictures.

Your physician will thread a special wire to the blocked area, and then will guide a special catheter with a deflated balloon on its tip to this area. After positioning the balloon catheter properly, your physician will inflate the balloon by sending fluid through the catheter until the pinch caused by your artery flattens out and he/she may deflate and re-inflate it repeatedly for a few minutes to press the plaque against your artery walls. This may cause some discomfort or pain, however, it should go away when they deflate the balloon and normal blood flow resumes. Make sure to tell your physician if you experience any symptoms during the procedure.

There is a risk that your artery will re-narrow (re-stenosis) or become blocked again (re-occlusion) at the site where the balloon was inflated. This can happen soon after the procedure, or months to years later, and may be the result of scar tissue building up inside your arteries where the balloon compressed the plaque deposits.

In certain cases, your physician decides to insert a stent (a tiny metal mesh tube which comes in various sizes) to keep the vessel wide open. It is placed with a special catheter whose tip has a deflated balloon surrounded by the closed stent. The balloon is inflated and the stent deployed. Then, the balloon is deflated and pulled out, but the stent is permanently left there. Eventually, a completion arteriogram will be performed to confirm that the artery has opened up well and the stent has been properly placed.

When the investigation is over, your physician will remove the catheter and will aplly pressure on the insertion site for 10-20 minutes with the fingers and may also apply a compression tape to prevent any bleeding. The whole procedure will take around 60 minutes.

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What can I expect after the procedure?

After angioplasty you will be trensferred back to your room for observation. Your physician will explain to you when you can safely get off your bed so that no bleeding or wound haematoma (collection of blood clots) occurs at the access site. You should be able to drink fluids and have a light meal later. Your physician will also tell you when you can start your medications again.

Tell the staff or your physician if you experience any symptoms after angioplasty, such as fever, shortness of breath, sensation of coolness or numbness of a limb, and any unusual problem at the access site, like bleeding, swelling or pain.

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Going home and aftercare

Most people stay in the hospital overnight.

After discharge keep drinking plenty of fluids for 1-2 days and avoid strenuous activities, such as climbing stairs, driving or brisk walking for 12 hours. Your physician will advise you to go for short walks and then take some rest. You may return to your normal activities as soon as you feel ready. Bruising at the puncture site is common and usually resolves on its own within 1-2 weeks.

You will also be asked to take Aspirin or similar medication as you had probably done before the procedure.

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Am I at risk for complications?

Risks are possible with any medical intervention. The overall risk from angioplasty is small.

Complications can be weakening of the arterial wall, pseudoaneurysm formation, dissection of the artery, bleeding, haematoma formation (this is a collection of blood clots) or wound infection. Another problem may be blockage of the artery of the limb reducing the blood flow to it. In 1-2% of cases, an operation may be required to fix this problem.

Rarely, allergic reactions can occur, especially among people who have had previous allergic reactions to the contrast. If you have a heart condition associated with poor pumping action, such as congestive heart failure, or asthma, you may experience shortness of breath, but this rarely is a serious problem. Also rarely, impaired kidney function, or kidney failure, can occur following an angioplasty, especially if you are a diabetic or have kidney disease, in which cases, however, IV fluids will have probably been given to you several hours before the procedure.

There is a risk that re-stenosis or re-occlusion of the treated artery occurs months to years later. In some cases a repeat angioplasty or bypass surgery may be required.

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What can I do to help myself?

Your procedure does not stop plaque build up. If you have had an angioplasty, you should make changes in your lifestyle to preserve its success and help avert the chances to further damage your arteries. If you don’t, you are at increased risk for a heart attack, a stroke or further problems with the circulation to your feet.

These changes include:

  • Quitting smoking completely
  • Exercising aerobically, such as brisk walking, for 25 to 30 minutes daily
  • Maintaining your ideal body weight
  • Eating foods low in animal fat, cholesterol, and calories
  • Taking your medication to control blood pressure, blood cholesterol and diabetes

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Last modified 10/10/2017