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What is angioplasty and stenting?
During an angioplasty, your vascular surgeon inflates a small balloon inside a narrowed blood vessel. The balloon helps to widen your blood vessel and improve blood flow. After widening the vessel with angioplasty, your vascular surgeon sometimes inserts a stent depending upon the circumstances. Stents are tiny metal mesh tubes that support your artery walls to keep your vessels wide open.
Angioplasty and stenting is usually done through a small puncture, or sometimes a small incision, in your skin, called the access site. Your vascular surgeon inserts a long, thin tube called a catheter through this access site. Using X-ray guidance, your physician then guides the catheter through your blood vessels to the blocked area. The tip of the catheter carries the angioplasty balloon or stent.
Angioplasty most often is used to treat peripheral arterial disease (PAD), which is another name for hardening of the arteries supplying blood to your limbs or to organs in your body other than your heart. Angioplasty can also be used, in some circumstances, to treat narrowed areas in your veins, which are blood vessels that drain blood out of your limbs or organs and return the blood to your lungs and heart.
Your arteries are normally smooth and unobstructed on the inside, but as you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries can narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your arteries causing pain or damage to the part of the body that the artery supplies.
Depending upon the particular circumstances, your physician may recommend angioplasty as an alternative to bypass surgery, which also treats narrowed arteries. For certain types of blockages, angioplasty has some advantages when compared to bypass surgery. For example, angioplasty does not require a large incision. Because of this, angioplasty patients usually spend less time in the hospital and recover at home faster than bypass surgery patients. Also, your physician can usually perform angioplasty while you are awake, whereas bypass surgery requires general or regional anesthesia. Nevertheless, in some circumstances, especially for extensive PAD, bypass surgery may be a better option. Your vascular surgeon will help you decide what alternative is best for your particular situation.
How do I prepare?
First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. As part of your history and exam, your physician will ask you if you smoke or have high blood pressure. Your physician will also want to know when and how often your symptoms occur, and their location.
Next, your physician will order tests to show how much plaque has built up in your arteries. These tests can help your physician determine whether you need an angioplasty or some other form of treatment. The choice of test depends on the blood vessel in question and not all of the tests need to be used for every situation.
These tests include:
If these tests show that your arteries are moderately to severely narrowed, your vascular surgeon may also plan a test called angiography. An angiogram directly shows your blood vessels on an X-ray and may also provide an opportunity to treat the narrowing with angioplasty at the time of the angiogram. During angiography, your vascular surgeon inserts a long, thin tube called a catheter into an artery in your groin or arm after first making the area numb with a local anesthetic. Using X-ray guidance, your physician then guides the catheter through your blood vessels to the blocked area and injects a dye that allows the arteries to be seen on the X-ray. The dye is later eliminated in your urine after it is filtered out by your kidneys.
Your vascular surgeon will give you the necessary instructions you need to follow before the procedure, such as fasting. Usually, your vascular surgeon will ask you not to eat or drink anything several hours before your procedure. Your vascular surgeon will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications. If you have any allergies to contrast dye, which is used in angiography, you should tell your vascular surgeon at this time. Since the contrast dye may contain iodine, you should also let your vascular surgeon know if you have allergies to iodine or shellfish.
Before your procedure, your physician may order tests to check your kidney function as well as your blood's ability to clot. In addition, he or she may insert an IV to deliver fluids. Depending upon the circumstances, the angioplasty procedure may sometimes be performed at the time of the initial angiogram or later on as a separate procedure.
Am I a candidate for angioplasty and stenting?
You may be a candidate for angioplasty and stenting if you have moderate to severe narrowing or blockage in one or more of your blood vessels. Usually, you will also have symptoms of artery disease, such as pain or ulceration, in one of your limbs.
If you have extremely hard plaque deposits, blockages that contain blood clots or a large amount of calcium, extensive or particularly long blockages, blood vessel spasms that don't go away, or complete blockages that cannot be crossed with the catheter, you probably are not a good candidate for angioplasty.
Am I at risk for complications during angioplasty and stenting?
Complications to angioplasty and stenting may include reactions to the contrast dye, weakening of the artery wall, bleeding at the access puncture site in the vessel or the angioplasty site, re-blocking of the treated artery, and kidney problems. Additionally, blockages can develop in the arteries downstream from the plaque if plaque particles break free during the angioplasty procedure. If severe, these can lead to worsening of the blood flow.
If you have diabetes or kidney disease, you may have a higher risk of complications from the contrast dye, such as kidney failure. In the case of kidney disease, sometimes pre-treatment with medications or fluids may decrease the impact on your kidneys.
People with blood clotting disorders also may have a higher risk of complications from the procedure. If the plaque deposits in your arteries are especially long, you may have a greater chance of your artery closing up again after angioplasty and stenting.
What happens during angioplasty and stenting?
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