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Angioplasty and stent placement - peripheral arteries

Definition

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, angioplasty can be done in the following locations:

• 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 that do not get better with other 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 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)

• Failure to open the affected artery

• Loss of limb

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 the 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.

Your provider will explain how to take care of yourself.

Outlook (Prognosis)

Angioplasty improves artery blood flow for most people. Results will vary, depending on where your blockage was, the size of your blood vessel, and how much blockage there is in other arteries.

You may not need open bypass surgery if you have angioplasty. If the procedure does not help, your surgeon may need to do open bypass surgery, or even amputation.

References

Bonaca MP, Creager MA. Peripheral artery diseases. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 43.

Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 44.

Society for Vascular Surgery Lower Extremity Guidelines Writing Group; Conte MS, Pomposelli FB, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61(3 Suppl):2S-41S. PMID: 25638515 pubmed.ncbi.nlm.nih.gov/25638515/.

White CJ. Endovascular treatment of peripheral artery disease. In: Creager MA, Beckman JA, Loscalzo J, eds. Vascular Medicine: A Companion to Braunwald's Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2020:chap 20.

Writing Committee Members, Gerhard-Herman MD, Gornik HL, et al. 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med. 2017;22(3):NP1-NP43. PMID: 28494710 pubmed.ncbi.nlm.nih.gov/28494710/.

Review Date: 1/18/2023

Reviewed By: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.