When arteries become narrowed or blocked, the circulation of blood round your body is reduced. This can cause symptoms such as muscle pain, dizziness and tissue damage as the affected regions are deprived of blood and oxygen.
Angioplasty or stenting is a procedure used to treat the narrowing or blockage of an artery. This uses either a balloon to stretch the artery (angioplasty) or metal scaffold to hold the artery open (stent). These procedures improve blood flow which helps to relieve any symptoms you are experiencing.
If you have been referred for this procedure, you will have seen a vascular surgeon and will have symptoms caused by narrowing or blockages in an artery. The following information will help explain the process of angioplasty and stenting.
What does the procedure entail?
The procedure is performed in the vascular x-ray department by a radiologist
Local anesthetic is used to numb the skin and a small tube is inserted into the artery in the groin. This is the only uncomfortable part of the procedure. In some cases it may not be possible to use the inguinal artery and an alternate artery in the elbow will be used. A series of images is then taken of the arteries by injecting an x-ray dye (contrast agent) into the tube. The contrast gives you a warm feeling with each injection and can make you feel like you are conducting water. Don’t be alarmed, this is normal. A fine wire and tube are passed through the narrowing or blockage in the artery, using an X-ray. A special tube with a balloon on the end is passed over the narrowing or obstruction, and the artery is then expanded by inflating the balloon. The balloon is then deflated and removed from the artery. Additional images will be taken to verify that the angioplasty was successful.
The angioplasty may need to be repeated. If angioplasty does not improve blood flow, a metal scaffold (stent) can be inserted into the artery. Once in place, the stent cannot be removed and will eventually be covered by the lining of the artery.
Do I have to go to the hospital for the procedure?
You will be given a pre-admission clinic appointment, where you will be examined by specialist nurses a few weeks before the procedure to check that you are fit and to draw blood for routine tests. This also gives you the opportunity to ask further questions.
The procedure is usually carried out on an inpatient basis.
You will be asked to come directly to the ward the day before or the morning of the procedure and you will have to stay overnight. The process usually takes about 30-45 minutes. At the end of the procedure, the tube is removed and the doctor or nurse presses on the entry point in the groin or elbow for 10 minutes until the artery stops bleeding. Once the bleeding has stopped, you will need to stay flat in bed for an hour and then sit up. A nurse will accompany you back to the ward after the procedure. It is important that you lie relatively still during this time to prevent the artery from bleeding again.
In some cases, at the end of the procedure, the radiologist will place a special “plug” over the hole in the artery to stop the bleeding. In this case, another puncture of that particular artery should not be done for 3 months.
Are there any risks with the procedure?
There are potential complications associated with every procedure. The overall risk of the procedure is extremely low. The potential risks can be divided into the following categories:
At the puncture site:
Bruising is common after an artery puncture.
Very rarely, significant bleeding from the artery or obstruction of the arteries that may require minor surgery.
The surgical risk is less than 1%.
In terms of contrast:
Some patients are allergic to X-ray contrast. In most cases this is minor, but very rarely (1 in 3000) a reaction can be severe and require urgent medical treatment.
X-ray contrast can affect kidney function in some patients. If you are likely to be at risk, special precautions are taken to reduce the chance of this problem occurring.
If you are diabetic on metformin tablets, you should not take them on the day of the procedure and for 48 hours after the procedure.
Related to treatment:
Vascular blockage can occur after angioplasty of a narrowed artery. It can sometimes be treated with a stent.
Vascular ruptures after angioplasty are rare. This can sometimes be treated in the x-ray department by inserting a stent with a cover (stent graft) into the artery to seal the tear. If this is not possible, surgery may be needed to repair the artery.
Small fragments from the lining of the artery can occasionally break off and become lodged in an artery below the angioplasty site (distal embolization). This may also require surgery to fish out the fragment if it is causing a problem with blood flow. The overall risk of an operation is low (1-2%).
When the artery in the elbow is used, the tube runs through one or more of the arteries that supply the brain. There is a very small risk of a blood clot forming and causing a stroke (1-2%).
How successful is angioplasty and stenting?
Angioplasty / stenting is successful in treating the narrowing / blockage of the artery in the vast majority of patients (90-95%). Alternatively, surgical bypass surgery may be offered for the small number of patients in whom the procedure is unsuccessful.
Is there anything i can do to help?
There is nothing you can do to remove the actual constriction or blockage. You can improve your overall health by exercising regularly, quitting smoking, and reducing the fat in your diet. These measures will help slow down the hardening of the arteries that caused the problem and possibly avoid the need for further treatment in the future.