Peripheral vascular angioplasty is a procedure to treat peripheral artery disease in the legs.
Overview of Peripheral Vascular Angioplasty
The procedure widens narrowed and stiffened arteries in the pelvis or legs. Peripheral vascular angioplasty can improve blood flow, which may reduce leg pain or help wounds heal better in people with diabetes.
Peripheral arteries can narrow due to plaque, an accumulation of fat in the arteries. Plaque occurs in the peripheral arteries and the arteries supplying the heart.
You will be awake for this procedure. You will be given medication to prevent pain and help you relax. First, your doctor will perform a test to find narrowed peripheral arteries. He will put a small tube, called a catheter, into an artery in your thigh or leg. The doctor moves the catheter through the artery and injects it with a dye. The dye makes the arteries appear on X-ray images, allowing the doctor to see any narrow parts or blockages in the peripheral arteries.
If your doctor finds a narrowing or blockage in the peripheral arteries, he may perform an angioplasty. This procedure involves using a catheter with a balloon at its tip to access an artery in the thigh or leg. The doctor then moves the balloon to the narrow area and inflates it. The balloon presses the plaque against the walls of the artery, providing more space for blood flow.
The doctor may also place a stent using a catheter in the artery, which is called a stent. A stent is a small tube that helps keep the artery open. It can also be a treatment that prevents small pieces of plaque from breaking off and causing vascular disease and blockage of the peripheral leg arteries.
After treating blocked arteries with an angioplasty, you may need to spend the night in the hospital. You will need to relax at home for a day or two after the procedure.
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Indications for Peripheral Therapeutic Catheters
This procedure is commonly used to open narrowed arteries that supply blood flow to the heart (cardiac catheterization). It can also be used to open short sections of narrowed peripheral arteries in people with peripheral arterial disease (PAD) due to atherosclerosis.
Why is peripheral vascular angioplasty performed?
Symptoms of clogged leg arteries due to atherosclerosis are pain, aching, or heaviness in your leg that starts or worsens when you walk.
You may not need a peripheral catheter for peripheral arterial disease if you can still do most of your daily activities. Your healthcare provider may ask you to try medications and other treatments that may help treat peripheral vascular and peripheral arterial disease before needing an arterial catheter.
Reasons for performing peripheral vascular angioplasty in peripheral arterial disease
- You have symptoms that prevent you from doing daily tasks. Your symptoms do not improve with other medical treatments
- You have skin ulcers or wounds on your leg or foot that are not getting better
- You have an infection or gangrene in your leg due to the hardening of the arteries and decreased blood flow to the extremities
- You have pain in your leg caused by narrowing and blockage of your peripheral arteries, even at rest
Before peripheral vascular angioplasty for peripheral arterial disease, you will undergo special tests to see the extent of blockage in your peripheral blood vessels.
Description of the process of peripheral vascular angioplasty
peripheral vascular angioplasty uses a medical “balloon” to dilate blocked peripheral arteries with atherosclerosis. The balloon applies pressure to the artery’s inner wall to open up atherosclerosis and improve blood flow. A metal stent is often placed via a catheter through the artery wall to prevent the peripheral arteries from narrowing again.
To treat blocked peripheral arteries in your leg, peripheral vascular angioplasty may be performed in the following:
- The aorta (the main artery that comes from the heart)
- An artery in the hip or pelvis
- Arterial insufficiency in your thigh
- An artery behind your knee
- The peripheral arteries in your lower leg
Peripheral vascular angioplasty helps blood flow better. This may reduce leg pain or help wounds heal better.
What to expect during an arterial and peripheral vascular angioplasty procedure
- You will be given medication to help you relax. You will be awake but sleepy.
- You may also be given anticoagulant medication to prevent blood clots.
- You will lie on your back on a padded operating table. The surgeon will inject some anesthetic medicine into the area that will be treated so that you do not feel pain. This is called local anesthesia.
He will then insert a fine needle into the peripheral blood vessels in the groin. A small flexible wire will be inserted through this needle toward the peripheral arteries affected by atherosclerosis.
- The catheterization surgeon can view the artery using live X-ray images. A dye will be injected into your body to show blood flow through your peripheral arteries. The dye will make it easier to see the area of the peripheral arterial blockage (arteriography).
- The surgeon will insert a catheter through the artery into the area of the peripheral arterial blockage.
- Next, the surgeon will pass a guidewire through the interventional catheter to the area of the peripheral arterial blockage.
- The surgeon will advance another catheter with a very small balloon on the end over the guidewire and into the blocked area of the peripheral arteries.
- The catheter balloon is then filled with contrast fluid to inflate the balloon. This opens blocked blood vessels and arteries and restores blood flow to the 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 pops. The stent is left in place to help keep the artery open. The balloon and all of the catheter’s wires are then removed.
Before performing peripheral vascular angioplasty
Within two weeks before surgery:
- Tell your provider about the medications you take, including those 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 used in angioplasty, or if you are pregnant or could be pregnant.
- Tell your provider if you are taking sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis).
- Tell your provider if you drink a lot of alcohol (more than one or two drinks a day).
- You may need to stop taking medications that make blood clotting more difficult two weeks before surgery. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), Naprosyn (Aleve, Naproxen), and other medications like these.
- Ask what medications you should take on the day of surgery.
- If you smoke, you should stop. Ask your provider for help.
- Always tell your provider about any cold, flu, fever, herpes, or other illness you may have before surgery.
Do not drink anything after midnight the night before surgery, including water.
On the day of peripheral vascular angioplasty surgery
- Take the medications your provider has told you to take with a small sip of water
- You will be informed of your arrival time at the hospital
After peripheral vascular angioplasty
After the procedure, pressure will be applied to the area where the catheter was placed in the blood vessel. The area may then be covered with a bandage or compression device to prevent bleeding. Nurses will check your heart rate and blood pressure and check the catheter site for bleeding.
You must lie down and keep your leg straight for several hours. The nurse may place a heavy bag on your leg to keep it still.
Many people are able to go home from the hospital in two days or less, and some may not even have to stay overnight. You should be able to walk around within 6 to 8 hours after the procedure. You may have a bruise or small lump where the catheter was placed in the blood vessel. This is normal and will disappear.
Your provider will explain how to take care of yourself.
The effectiveness of peripheral vascular angioplasty
Peripheral vascular angioplasty can help restore blood flow and relieve intermittent claudication.
How well the catheter works depends on the size and length of the affected blood vessel and whether it is completely blocked.
In general, catheters work best in:
- Large arteries.
- Arteries with short, narrow spaces.
- Narrow and unblocked arteries.
Risks of peripheral vascular angioplasty
Catheter-related complications include:
- Pain, swelling, and tenderness at the site of the catheter insertion
- Irritation of the vein by the catheter (superficial thrombophlebitis)
- Bleeding at the catheter site
- Bruising where the catheter was inserted. This usually goes away within a few days
Serious complications rarely occur. These complications may include:
- Sudden closure of an artery
- Blood clots
- A small tear in the inner lining of the artery
- Allergic reaction to the contrast material used to examine the arteries
- Kidney damage. In rare cases, the contrast material can cause kidney damage, which may lead to kidney failure
Radiation risks
There is always a slight risk of cell or tissue damage from exposure to any radiation, including the low levels of X-rays used in this test. However, the risk of damage from X-rays is usually very low compared to the potential benefits of the test.
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