Angioplasty and Stenting (Vascular Surgery)

Angioplasty and stenting is a minimally invasive procedure to treat narrowed or blocked arteries or veins).

Angioplasty is a procedure in which a catheter with a balloon is used to open up narrowed or blocked blood vessels in order to restore proper blood flow.

Stenting is a procedure that is performed after angioplasty where a small metal device called a stent is used to maintain the patency of the blood vessel and prevent it from future narrowing.

Disease Overview

There are two main types of blood vessels in the body: arteries and veins. Arteries are the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. In contrast, veins carry oxygen-poor blood from various parts of your body (organs and tissues) back to your heart for reoxygenation. Healthy blood vessels are normally flexible and smooth on the inside. However, plaque (deposits of cholesterol, calcium, and fibrous tissue) can build up on the inner walls of the vessels, a condition called atherosclerosis. This can cause the blood vessels to harden, stiffen and narrow, reducing or completely blocking the flow of blood through them. The result can be a stroke, heart attack, necrosis (tissue death), or another grave and life-threatening condition.

Indications

Angioplasty and stenting is one of the most common treatments for conditions that occur when hardened blood vessels prevent sufficient blood flow to areas such as the heart, legs and feet, abdomen, or brain.

Some common vascular conditions treated with angioplasty and stenting include:

• Peripheral arterial disease
• Peripheral venous disease
• Carotid artery disease
• Coronary artery disease
• Deep vein thrombosis (DVT)
• Diabetic neuropathy
• Diabetic foot conditions
• Venous thromboembolism (VTE)
• Vascular disease
• Varicose veins and chronic venous insufficiency

Your physician may recommend angioplasty and stenting when:

• Blockage of the blood vessel is severe, and your condition is considered serious
• Medications or lifestyle changes have not improved your condition
• You have experienced or are at risk of a heart attack or stroke

Preparation

Preparation for angioplasty and stenting may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any medications or supplements you are taking
• Refraining from blood thinners, aspirin, or NSAIDs, if indicated
• Informing your doctor of any allergies to medications, anesthesia, or contrast dye
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after the procedure

Procedure

Angioplasty and stenting is a minimally invasive procedure that is performed through a small incision, usually in the groin area, under local anesthesia.

A dye is injected into the body to view blood flow through the vessels and to identify and locate the area of blockage. Once the treatment area is located, fluoroscopic guidance (live X-ray imaging) is used to insert a thin guide wire through a blood vessel (usually in the groin) and advance it to the blocked or narrowed area with a small needle. A balloon catheter (thin tube) is then threaded through the guide wire to the narrowed vessel. The balloon catheter has a deflated balloon at its tip, which is inflated at the site of blockage. The balloon widens the vessel by compressing the plaque against the inner walls. Following this, a wire mesh tube called a stent is inserted along with the balloon catheter to help keep the artery open and prevent it from narrowing again. The balloon and catheter are removed, while the stent is left in place to keep the artery wide open and allow free flow of blood.

Post Procedure Care

Following the procedure, you will be able to go home the same day or may have to remain in the hospital for a day or two. You may develop swelling, pain or bruising at the catheter insertion site. Medications are provided as needed to address these. Blood-thinning medications, such as Plavix and aspirin are also provided to prevent the formation of blood clots inside the stent. You can return to your normal activities in a week but should refrain from lifting heavy weights or engaging in strenuous activities for a defined period. Instructions on incision site care and bathing will be provided to keep the wound clean and dry. A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Risks and complications associated with angioplasty and stenting may include:

• Infection
• Bleeding
• Blood clots
• Re-narrowing of the blood vessel
• Allergic reactions to dye or medication
• Damage to nerves or blood vessels
• Heart attack
• Kidney failure

Summary

Angioplasty with stenting is often employed as a choice of treatment for conditions that block or narrow blood vessels and interrupt blood flow. The procedure helps to avoid complications associated with hardened vessels by reinforcing the inner walls of the affected vessels and minimizing the risk of the vessel becoming blocked or narrowed again.