Peripheral Artery Angioplasty and Stent Placement

Angioplasty and stent placement is a minimally invasive procedure used to open narrow or blocked arteries. This procedure is used in different parts of the body, depending on the location of the clot. This procedure requires only a small incision.

Angioplasty is a medical procedure where a surgeon uses a tiny balloon to widen the artery. A stent is tiny mesh tube that is inserted into the artery and left there to prevent the artery from closing. Your doctor may recommend taking aspirin or antiplatelet drugs (such as Plavix) to prevent clotting around the stent, or may prescribe medications to help lower your cholesterol.

When your cholesterol levels are high, a fatty substance known as plaque can attach to the walls of an artery. This is a condition known as atherosclerosis. As plaque accumulates on the inside of the artery, it can become narrowed and reduce the space available for blood to flow.

Plaque can accumulate anywhere in the body, including the arteries of the arms and legs. These (and other arteries farthest from the heart) are known as peripheral arteries.

Angioplasty and stent placement are treatment options for peripheral artery disease (PAD). This common condition involves the narrowing of arteries in the limbs. Symptoms of PAD include:

• cold feeling in the leg
• color change in the leg
• cramping in the legs after activity
• erectile dysfunction in men
• numbness in the legs
• pain that is relieved with movement
• soreness in the toes

If medication and other treatments do not help your PAD, your doctor may opt for angioplasty and stent placement. It is also used as an emergency procedure if the person is having a heart attack or stroke.

Any surgical procedure carries risks. Angioplasty with stent placement deals with arteries, so there is naturally a concern with bleeding, clotting, and other problems.

The risks associated with angioplasty and stents include:

• allergic reactions to medication or dye
• breathing problems
• bleeding
• blood clots
• infection
• kidney damage
• renarrowing of the artery (restenosis)
• rupture of the artery

The risks associated with angioplasty are small, but can be serious. Your doctor will help evaluate the benefits and risks of any procedure. In some cases, your doctor will prescribe anticlotting medications (such as aspirin) for up to a year after your procedure.

There are several ways you’ll need to prepare for the procedure. You should:

• alert your doctor to any allergies you have
• tell your doctor what drugs, herbs, or supplements you are taking
• quit smoking, as it increases the risk of PAD
• inform your doctor of any illness (even a common cold or flu) or pre-existing conditions such as diabetes or kidney disease
• do not eat or drink anything, including water, the night before your surgery
• take any medications your doctor prescribes for you

Angioplasty with stent placement typically takes one hour, however the procedure may take longer if stents need to be placed in more than one artery. You’ll be given a local anesthetic to help relax your body and mind. Most people are awake during this procedure, but do not feel any pain.

Angioplasty with stent placement is a minimally invasive procedure that is done through a small incision, typically in the groin or hip. The goal is to create an incision that will give your doctor access to the blocked or narrowed artery that is causing your health issues.

Through that incision, your surgeon will insert a thin, flexible tube known as a catheter. He or she will then guide the catheter though your arteries to the blockage. During this step, the surgeon will be viewing your arteries using a special X-ray called fluoroscopy. Your doctor may use dye to identify and locate the blockage.

The surgeon will pass a small wire through the catheter. A second catheter, attached to a small balloon, will then follow the guide wire. Once the balloon reaches the blocked artery, it will be inflated. This forces the artery open and allows blood flow to return.

The stent is inserted the same time as the balloon and expands with it. Once the stent is secure, the surgeon removes the catheter and ensures that the stent is in place.

Some stents, called drug-eluting stents, are coated in medicine that slowly releases into the artery. This keeps the artery smooth and open, and helps prevent future blockages.

Following stent placement, the incision will be closed and dressed, and you’ll be taken back to a recovery room for observation where a nurse will monitor your blood pressure and heart rate. Your movement will be limited at this time.

Most angioplasties with stent placements require an overnight visit to ensure there are no problems, but some people are allowed to go home the same day.

The incision site will be sore and possibly bruised for a few days following the procedure, and your movement will be limited. However, short walks on flat surfaces are acceptable and encouraged. Avoid going up and down stairs or walking long distances in the first two to three days after your procedure.

You may also need to avoid activities such as driving, yard work, or sports. Your doctor will let you know when you can return to your normal activities. Always follow whatever instructions your doctor or surgeon gives you following your surgery.

Full recovery from the procedure may take up to eight weeks.

While your incision wound heals, you’ll be advised to keep the area clean to prevent possible infection and change the dressing regularly. Contact your doctor immediately if you notice:

• swelling, redness, or unusual pain at the incision site
• bleeding that cannot be stopped with a small bandage
• discharge at the incision site
• swelling in your legs
• chest pain or shortness of breath that does not go away
• chills or a fever over 101°F
• dizziness, fainting, or extreme weakness

While angioplasty with stent placement addresses an individual blockage, it doesn’t fix the underlying cause of the blockage. To prevent further blockages and reduce your risk for other medical conditions, you may have to make certain lifestyle changes, such as:

• eating a heart-healthy diet that limits saturated fats, sodium, and processed foods
• regular exercise
• avoiding tobacco
• managing stress
• taking cholesterol-reducing medications (if prescribed by your doctor)

Your doctor may also recommend long-term use of anticlotting drugs, such as aspirin, after your procedure. Do not stop taking these medications without talking to your doctor first.