Angioplasty & Stenting
The principal of Angioplasty and Stenting is to identify and reopen the narrow or blocked segment of artery. The blockage can be anywhere from the pelvis down to the ankle.
Initial access to the arterial circulation in an area that is away from the diseased segment, classically through the femoral artery in the groin. Access is obtained by placing a plastic tube or sheath in the artery over a wire that is placed via a needle puncture. Through the sheath another wire is passed across the diseased segment of artery. Once the wire has traversed the blocked segment, the track can be widened using a series of high pressure balloons. The new track can be held open using a metal stent. The stent is a self-expanding cage which sits permanently in the artery.
The procedure is performed in a Catheter Lab. The patient is awake, although in a significant percentage of patients some sedation will be given.
The procedure commences by placing local anaesthetic around the access artery, generally the femoral artery in the groin, although sometimes via the arm. After the sheath is placed and access to the circulation is confirmed, the procedure is relatively painless. There can be some discomfort during passage or a wire through a chronically blocked artery and there may be transient pain as the vessel is forcibly opened. Pain generally only lasts about 30 seconds to 1 minute and when the balloon is deflated and the stent deployed there is no further pain.
After the artery is reopened, it is my practice to close the puncture with a closure device. The most common device Mr Holdaway uses is an ‘Angioseal’. This puts a small dissolving plug at the point of puncture. It allows the patient to sit up within 30 minutes of the procedure, walk within 1 hour and reduces the risk of bleeding complications. There is a small risk the dissolving plug can get infected. If this is the case then the plug needs to be removed surgically.
Patients are kept in hospital overnight and the leg is observed to make sure there are no complications.
- Puncture site bleeding. The artery can bleed or be damaged by the needle or wire. At the target vessel site the balloon may burst the artery causing bleeding.
- There is a chance that the cholesterol plaque that is blocking the artery can break off and go down to the foot blocking the smaller blood vessels around the ankle.
- There is a small chance in the efforts to re-open the narrowed artery can result in its completed obstruction and worsening of the circulation.
With all of these complications there is a small chance of surgery being required to control it – approximately 1/250.
On discharge the following day, the patient should have a reasonably quiet time for the next 2 days and then can walk normally.