With or without Balloon Angioplasty and/or Vascular Stenting
HOW SHOULD I PREPARE FOR THE PROCEDURE?
You will receive instructions from staff at the interventional radiologist's office at least a day before the procedure. You may have blood drawn for pre-procedure testing at either the hospital or a local clinic. Staff will advise you if changes in your regular medication schedule are necessary. Make sure you let the staff know if you have any allergies to medication or to contrast material that may be used to enhance x-ray images. You will be asked to not eat or drink anything after midnight on the night before your procedure. In most cases you should take any medications that you usually take, especially blood pressure medications. If you are on any blood thinning medication such as Aspirin, Coumadin, Plavix, Lovenox, or Heparin you should check with the staff about it and when you should stop the medication. If you have any allergies to medications or to contrast material make sure to let the staff know that as well. Make sure someone will be available to drive you home afterwards.
HOW DOES THE PROCEDURE WORK?
Angiogram is the injection of contrast into an artery in order to visually see the artery using enhanced x-ray imaging. Angioplasty uses an inflatable balloon mounted on a catheter that is passed to the site of the blockage where it is inflated and deflated. In this process, the balloon expands the artery wall, increasing the flow through the artery. A stent may then be placed at the site of the blockage to hold the artery open
HOW IS THE PROCEDURE PREFORMED?
The radiologist will inject a local anesthetic into the groin and insert a needle and catheter into the artery. To perform an angioplasty, the radiologist makes a small nick in the skin and inserts a balloon-tipped catheter. The catheter is threaded through the artery until it reaches the site of the blockage, where the balloon is inflated, then deflated and removed. Expanding the balloon helps restore blood flow by stretching the arterial wall, which increases the inner diameter of the artery.
Many angioplasty procedures also include the placement of a stent, a small flexible tube made of plastic or wire mesh, to support the damaged artery walls. Stents are typically placed over a balloon-tipped catheter, which is expanded, pushing the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place.
WHAT WILL I EXPERIENCE DURING THE PROCEDURE?
An IV line will be inserted into your arm so that you can be given a mild sedative and other medications as necessary during the procedure. Although this sedative will make you feel relaxed and drowsy, you will probably remain awake during the procedure. Devices to monitor your heart rate and blood pressure will be attached to your body.
Next, depending on which artery your physician is using for the procedure, your groin area, wrist, or arm will be cleaned, shaved, and numbed with a local anesthetic. A short tube called a sheath is commonly inserted into the artery. Next, the physician will insert a catheter (a long flexible tube) through the sheath and advance it to the site of the blockage. An x-ray camera connected to a video monitor will help the physician guide the catheter. You may experience a dull pressure where the physician is working with the catheter, but no pain.
Once the catheter is in place, a contrast material, may be injected into the artery and an angiogram will be taken of the blocked artery to help identify the site of the blockage. With x-ray guidance, a guide wire will then be advanced to the site, followed by the balloon-tipped catheter. Once it reaches the blockage, the balloon will be inflated for several seconds to several minutes. The same site may be repeatedly treated or the balloon may be moved to other sites. It is common for patients to feel some mild discomfort when the balloon is inflated because the artery is being stretched. Your discomfort should disappear as the balloon is deflated.
Additional x-ray pictures will be taken to determine how much the blood flow has improved. When your physician is satisfied that the artery has been opened enough, the balloon catheter, guide wire and guiding catheter will be removed. The entire procedure usually lasts between 30 minutes to two hours. The length of the procedure varies depending on the time spent evaluating the vascular system, as well as the complexity of the treatment.
When the procedure is completed, you will return to the Heart and Vascular Unit. You may feel groggy from the sedative. The catheter insertion site may be bruised and sore. If the sheath was inserted into your arm or wrist, it will be removed and the site bandaged. If the catheter was inserted in your groin, you may need to lie in bed with your legs straight for several hours.
For several hours, your catheter site will be checked for bleeding or swelling and your blood pressure and heart rate will be monitored. Your physician may prescribe medication to relax your arteries, to protect against spasm of the arteries and to prevent blood clots. If a contrast material was used during the procedure, you will urinate often to rid your body of this material. You may be asked to drink extra fluids. If you feel any pain, warmth or swelling in the groin notify the nursing staff as this could indicate bleeding and needs to be checked.
Depending on the complexity of the procedure some patients may need to stay overnight and return home the day after the procedure. You will typically be able to walk within two to six hours following the procedure.
After you return home, you should rest and drink plenty of fluids. You should avoid lifting heavy objects, strenuous exercise, and smoking for at least 24 hours ( and smoking you should avoid permanently since this is the cause of atherosclerosis). If bleeding begins where the catheter was inserted, you should lie down, apply pressure to the site and call your physician. Any change in color to your leg, pain, or a warm feeling in the area where the catheter was inserted should be reported to your physician.
You should be able to return to your normal routine by the following week.
If a stent is placed in your artery, you will be asked to take aspirin or another antiplatelet drug daily; in some cases you may be given another blood thinning medication in addition to the antiplatelet medication. These medications will help keep your stent/artery from becoming clotted.
WHAT ARE THE LIMITATIONS OF THIS PROCEDURE?
Angioplasty with vascular stenting is just one way to treat narrowed or blocked arteries. Medications and exercise are often the first step in treating atherosclerosis.
Regardless of which artery is blocked, angioplasty does not reverse or cure the underlying disease of arteriosclerosis. It is important for patients to make lifestyle changes, including eating a healthy diet that is low in saturated fat, getting adequate exercise and not smoking. Individuals with diabetes, high blood pressure and high cholesterol need to follow the treatment plan prescribed by their healthcare providers.
Angioplasty and stenting may have to be repeated if the same artery becomes blocked again. If a stent is placed at the time of the angioplasty, the chance of restenosis may be reduced but can still occur.
Angioplasty and vascular stenting for peripheral vascular disease (PVD) affecting arteries in the pelvis and legs are less successful when there are multiple leg vessels that are narrowed or when small vessels have to be opened. Any patient with PVD can benefit from eating a proper diet, getting regular exercise and controlling blood cholesterol.