Angioplasty & Stenting

 Problem: Blockage

The arteries are blood vessels that carry oxygen-rich blood throughout the body. In normal, healthy arteries, the inside of the artery is open and the lining is smooth. This allows blood to flow freely throughout the body. Damage to the artery walls can occur with certain health factors such as smoking, high blood pressure, and diabetes. This damage causes the lining of the artery to become rough, which is known as arthrosclerosis. This allows cholesterol and other elements in the blood to stick to the artery wall, forming plaque. As plaque continues to build up, a narrowing of the artery called arterial stenosis occurs. Blood clots can also form on the plaque.

Having plaque in the arteries is dangerous because the plaque can rupture, allowing small pieces of plaque and blood clots to travel freely in the bloodstream. These small pieces of plaque and blood clots can become lodged in smaller blood vessels, cutting off blood flow to that area. Stopping blood flow to vital organs can be very dangerous or even deadly: strokes are caused by cutting off blood flow to the brain and heart attacks are caused by cutting off blood flow to the heart. Blood flow to other tissues such as the kidneys or muscle tissue in the legs can be cut off by blood clots as well.

Treatment: Angioplasty

One treatment option for narrowed arteries is angioplasty. Angioplasty involves using a balloon catheter to widen the narrowed artery. A balloon catheter is a long, narrow tube with a balloon that can be inflated and deflated on the end. The catheter travels through the artery with the balloon closed. The balloon is inflated when it reaches the blockage, compressing the plaque.

Treatment: Stenting

Should the artery walls need support, stenting is done. Stenting reduces the risk of restenosis, or a re-narrowing of the artery in the same place. Stents can be placed after an angioplasty, but it can also be placed directly without angioplasty. A stent is a tiny wire mesh tube that stays in place permanently. Some stents are drug-eluting, meaning they slowly release medication over time. This release of medication prevents restenosis by reducing the amount of scar tissue that forms inside the artery. A collapsed stent is threaded onto a balloon catheter. By inflating the balloon, the stent is expanded and secured to the artery wall.


 

Risks and Complications

Some risks and possible complications of angioplasty and stenting include the following:

  • Bleeding or clotting
  • Allergic reaction to dye used in arteriogram
  • Tearing of the artery lining
  • Kidney damage or failure
  • Need for emergency bypass surgery
  • Heart attack, stroke, or death

 

What to Expect

Whether you are having angioplasty, stenting, or both, Dr. Robbins and hospital staff will closely monitor your status during the procedure. Usually the anesthesiologist uses a type of anesthesia called MAC, or monitored anesthesia care. MAC provides light sedation, so you will be relaxed and feel no pain during your surgery. Dr. Robbins first puts a needle into an artery in the groin, inserting a catheter into the artery. The catheter is guided to the blockage using x-ray. A special kind of x-ray called an arteriogram is done by injecting contrast fluid into the affected artery to take x-ray images of the artery. This allows Dr. Robbins to see the severity of the blockage, its size, and exact location. Heparin, a strong blood thinner, is given to prevent any clot formation. In angioplasty, the balloon catheter is positioned directly over the blockage with the balloon closed. The balloon is next inflated to compress the plaque into the artery wall. In stenting, the balloon catheter with the collapsed stent is positioned at the narrowed part of the artery. The balloon is inflated, expanding the stent. Tiny metal hooks or springs secure the stent to the artery wall, keeping the stent in place. At the end of the procedure, a second arteriogram is done to compare the end results to the previous ones.

You will next be taken to a recovery room. Blood tests will be done to assess how quickly your blood clots. This is to make sure the heparin that was given during the procedure is no longer acting. Once a satisfactory clotting time is assessed, the catheter is removed and pressure is applied to the insertion site for 30 minutes. You will be lying flat during the recovery process to ensure proper circulation.

Preparing for Your Procedure

You will be told by our office how to prepare for your procedure. This includes special instructions about medications. Be sure to follow the instructions we give you, or your surgery may have to be canceled.

 

A Week Before

  • Tell us about any allergies you have.
  • Tell us about any medications you take, including prescriptions, over-the-counter medications, supplements, and herbs.
  • Make medication changes as we direct you. This can involve stopping certain medications you normally take or starting certain medications before surgery.

The Day Before

  • Don’t drink or eat after midnight the night before you surgery. Do not smoke, chew tobacco, or chew gum after midnight. If you were instructed to continue any medications, take them with a sip of water only.
  • Arrange a ride home for when your recovery is finished.
  • Follow any special instructions we give you.

The Day of the Procedure

  • Arrive on time to the hospital.
  • Bring all medications you take with you to the hospital.
  • Hospital staff will prepare you for the procedure.

 

Recovery

Following the 30 minutes of pressure being applied to the incision site, you will be placed on bed rest for 3 hours. This means you will continue to be as still as possible, lying flat on the bed. If you are stable and your vital signs are good, you should be discharged from the hospital at the end of the 3 hours. Plan on being at the hospital for most of the day, and be sure to have someone scheduled to drive you home once you are discharged. You should be able to resume normal activity within a week following your procedure. The following are some basic guidelines to follow while recovering at home:

  • Take all medications as directed. This is very important and can impact the success of your procedure.
  • Do not drive until cleared to do so.
  • Avoid strenuous exercise and lifting objects more than 10 pounds for a week or otherwise instructed.
  • Do not take tub baths for a few days to allow your insertion site time to heal.

 

When to Call VascularTyler

Call our office if you experience any of the following:

  • Problems at the incision site such as swelling, increasing pain, redness, or warmth
  • Fever
  • Changes in color or temperature of your legs or feet
  • Blood in the urine or inability to urinate