ANGIOPLASTY AND STENTING
What is Angioplasty and Stenting?
The arteries supplying your head, heart, kidneys and legs may become blocked over time because of smoking, high cholesterol, high blood pressure, diabetes and obesity. These can cause a progressive hardening and occlusion of the vessels (also known as arteriosclerosis). Arteriosclerosis reduces blood flow to your organs as a result of the narrowed or obstructed arteries.
Interventional radiologists are recognised experts in vascular diseases, who can use a technique involving angioplasty and stenting to restore blood flow to the brain, kidneys and legs.
Angioplasty involves the mechanical dilatation of any narrowed or occluded vessel by means of a balloon catheter and a metal stent if necessary. Balloon catheters are tiny empty balloons, which are gently inflated to expand the area. A stent is a metal mesh tube that is inserted over a metallic guide wire and positioned at the point of the stenosis or occlusion. Metal stents are permanent implants and act as mechanical scaffolds to support the vessel wall and keep the vessel open.
What are some common uses of the procedures?
Angioplasty with or without stenting is commonly used to treat conditions that narrow or block blood vessels and interrupt blood flow. These conditions include:
• Narrowing of the large arteries due to hardening of the arteries or atherosclerosis. This is a build-up of cholesterol and other fatty deposits, called plaques, on the artery walls.
• Peripheral artery disease (PAD), a narrowing of the arteries in the legs or arms.
• Carotid artery stenosis, a narrowing of the neck arteries supplying blood to the brain.
• Narrowing or blockage in the veins in the chest, abdomen, pelvis, arms and legs.
• Renal vascular hypertension, high blood pressure caused by a narrowing of the kidney arteries. Angioplasty and stenting may be used to help improve kidney function.
• Narrowing in dialysis fistula or grafts. Fistulas and grafts are artificial blood vessel connections doctors use in kidney dialysis. Angioplasty is generally used when these connections become narrow or blocked. Stenting may also be needed in some cases.
How does the procedure work?
You will have a local anaesthetic for the procedure. The angioplasty and stenting procedure will last around an hour and tends to be performed as an out-patient procedure, though in some cases patients are admitted to hospital overnight afterwards.
The interventional radiologist will puncture an artery in your thigh with a small needle and will then thread a combination of plastic tubes (called sheaths and catheters) into your arteries. Throughout the procedure, the interventional radiologist will use imaging for guidance. A balloon catheter will be inflated across the narrowed or obstructed part of the vessel; you may experience some discomfort at this point. In some cases, the balloon angioplasty is enough to keep the vessel open, but in other cases the vessel needs more support, so a stent is placed. This means the interventional radiologist will put a stent into the vessel to ensure it stays open.
Your vital signs will be monitored during and after the procedure, and you may be able to eat a light meal later the same day.
Why perform it?
This procedure may be beneficial for you if you suffer from leg pain when walking (intermittent claudication) or if you have a restricted blood supply in your legs (leg ischaemia) as a result of diabetes. The angioplasty and stenting procedure can also be a treatment for peripheral arterial disease and for narrowed or blocked arteries in your kidneys.
Angioplasty and stenting is a way to restore blood flow, relieve pain caused by restricted blood flow, improve kidney function and protect the brain from strokes.
Benefits
131. Rapid relief from symptoms.
132. The imaging techniques allow accurate diagnosis and treatment using cutting-edge equipment. Diagnosis is reconfirmed during procedure.
133. Minimally invasive procedures are performed through a small hole in the skin, minimising the patient’s discomfort and recovery time. There won’t be any scar.
134. Most procedures can be performed on an outpatient basis or require only a short hospital stay. As interventional procedures tend to require only local anaesthesia, hospital stays are very short, with patients frequently going home the day the procedure is performed.
135. Patients who undergo IR procedures experience less pain during and after the procedure than patients undergoing surgical procedures. Post-procedural care is provided, along with follow-up imaging to confirm if the treatment has been successful.
136. Minimal damage to surrounding vital anatomical structures with no significant structural weakness.
137. No or negligible blood loss. No requirement of blood transfusion.
138. Return to work and other normal activities usually within the first few days after the procedure.
139. Low risk compared to surgery. The techniques can be used in very sick patients who are unfit for surgery.
140. Overall procedure is less expensive than surgery or other alternatives.
How will you prepare for procedure:
You will be requiring an overnight admission in the hospital.
• You will have had some blood tests performed before the procedure to check that you do not have an increased risk of bleeding.
• You are asked not to eat for 4-6 hours prior to the procedure. You may drink a little water.
• You will need someone to drive you home and to look after you for 24 hours.
• If you have any allergies or you have previously reacted to intravenous contrast medium, you must let the doctor know. Intravenous contrast medium is the injection we give you during some scans.
• If you are diabetic, please contact IR coordinator at 0328 0177770 for further information
• If you normally take any medication to thin your blood (anticoagulation or antiplatelet drugs) such as: warfarin / clopidogrel / aspirin, dabigatran (Pradaxa) / rivaroxiban (Xarelto) / Apixaban (Eliquis) / phendione / acenocoumarol – then these may need to be stopped or altered. Please contact the contact IR coordinator at 0328 0177770 for further information
Angioplasty on its own does not stop peripheral vascular disease. If you have peripheral vascular disease, you should make changes in your lifestyle. These changes include:
• Stop smoking
• Eating foods low in fat, cholesterol, and calories
• Maintaining your ideal body weight
• Exercising aerobically, such as brisk walking, for 20 to 30 minutes at least five times per week
