Angioplasty
What is an angioplasty?
While watching a “live” X-ray, your physician guides a catheter (a hollow tube) to the area of blockage through the femoral artery in your leg. A tiny balloon located at the end of the catheter is inflated to widen the passageway for blood flow. Sometimes a stent (a small mesh tube) is placed inside the artery to hold it open and create a smooth surface within the artery.
Atherosclerosis
Atherosclerosis, or “hardening of the arteries,” affects millions of people. Atherosclerosis is the term used to describe a buildup of plaque — hard, fatty deposits — on the inside of your arteries. This buildup reduces the amount of blood that can flow through the vessels to your legs and, therefore, also reduces the amount of oxygen to the lower extremities. Your physician may have talked to you about the possibility of balloon angioplasty and stenting to open the narrowed areas in your arteries.
Balloon Angioplasty
Balloon angioplasty is a minimally invasive technique that can be used to open clogged arteries. To perform angioplasty, your vascular specialist will make a small puncture in the artery in your groin and slip a small plastic tube called a sheath into your artery. Your physician will then place a balloon catheter through the sheath and, while watching with live X-ray images, will maneuver the balloon to the area of your blockage. The balloon is inflated to fracture the plaque buildup that is blocking the artery, which creates a wider channel for blood flow through the artery.
Sometimes a stent will also be placed in the artery. A stent is an expandable wire mesh tube that is 
maneuvered into place on a balloon catheter. The stent expands as the balloon is inflated. After the stent is deployed, the balloon catheter is withdrawn leaving the stent in place. The purpose of the stent is to provide a smooth surface on the inside of the vessel, creating a better channel for blood flow.
Stent placement is rapidly becoming the standard procedure during most angioplasty procedures. Drug-eluting stents are coated with medicines that prevent restenosis due to tissue regrowth. These coated stents are even more effective than standard stents in preventing the artery from closing again.
After angioplasty and stenting, you will take antiplatelet medicines to help prevent another heart attack or a stroke. You will probably take aspirin plus another antiplatelet such as clopidogrel (Plavix). If you get a drug-eluting stent, you will probably take both of these medicines for at least one year. If you get a bare metal stent, you will take both medicines for at least one month but maybe up to one year. Then, you will likely take daily aspirin long-term. If you have a high risk of bleeding, your doctor may shorten the time you take these medicines.
In rare circumstances, other tools and procedures may be used to help open arteries blocked by atherosclerosis plaques.
Rotational Atherectomy:
A Rotational Atherectomy is a diamond burr rapidly spins and pulverizes plaque into tiny particles. The particles dissipate without causing major damage.
Directional Atherectomy:
A Directional Atherectomy a rotating blade cuts slices of plaque, which are captured by the catheter and removed from the body.
How do I prepare for angioplasty?
You will receive specific instructions from your physician, but generally you will be asked not to have anything to eat or drink for eight hours before your procedure. You may have some routine tests done before your angioplasty:
Your physician will be able to tell you how long you can expect to be in the hospital; some patients may stay for a day or two, while others may leave within a few hours.
Some suggestions to help you prepare:
- If you will be staying in the hospital overnight, pack a small bag with a robe, slippers, and toiletries
- Do not bring valuables or currency to the hospital
- Bring your list of medications with the exact names and dosages
- Arrange for someone to drive you home
- Be sure to mention if you are allergic to X-ray dyes or shellfish
- You may wear your dentures, hearing aids, or glasses
What happens the day of my angioplasty?
Most patients will be asked to arrive at the hospital a couple of hours before the scheduled time of their procedure. Before your procedure, you will have an IV started. You will be transported to a procedure room on a rolling bed and your nurse will tell your loved ones where they may wait. You may be given some sedatives through your IV. Some patients will have local anesthetic administered to numb the area in the groin where the sheath will be inserted. Other patients may have epidural anesthesia. Your vascular specialist will be able to tell you what kind of anesthesia will be right for you.
What happens after my angioplasty?
You will be asked to remain lying down for several hours. Your nurse will monitor you carefully, taking your blood pressure and checking the puncture site frequently to make sure there is no bleeding. You will be asked to drink lots of fluids to flush the dye out of your system.
How will I feel after my angioplasty?
After the procedure, most people enjoy complete relief from the discomfort felt in their legs. Some people may still experience some discomfort when they walk, but the distance they are able to walk usually increases after a balloon angioplasty.
What can I do when I get home?
Avoid heavy lifting and do only light activities for a few days.
When should I call my doctor?
Call your doctor if:
- The insertion site bleeds
- Your leg feels cold or numb
- You notice worsening of the bruising around the insertion site
- You have a fever, or signs of infection such as redness, swelling, or drainage at the inserion site
What are the risks?
As in any invasive procedure, there can be some risk involved. Your physician will discuss with you the risks particular to your individual case.
Remember:
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your vascular specialist. Early detection of circulatory problems is the key to effective treatment.