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Angioplasty for Peripheral Arterial Disease of the Legs - Forrest Health
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    Angioplasty for Peripheral Arterial Disease of the Legs

    Procedure Overview

    Angioplasty (also called percutaneous transluminal angioplasty, or PTA) is a procedure in which a thin, flexible tube called a catheter is inserted through an artery and guided to the place where the artery is narrowed.

    When the tube reaches the narrowed artery, a small balloon at the end of the tube inflates for a short time. The pressure from the inflated balloon presses the fat and calcium (plaque) against the wall of the artery to improve blood flow.

    In angioplasty of the aorta (the major abdominal artery) or the iliac arteries (which branch off from the aorta), a small, expandable tube called a stent is usually put in place at the same time. Reclosure (restenosis) of the artery is less likely to occur if a stent is used. Stents are less commonly used in angioplasty of smaller leg arteries like the femoral, popliteal, or tibial arteries, because they are subject to trauma and damage in these locations.

    How It Is Done

    Iliac artery is narrowed by plaque

    Peripheral arteries of the leg, with detail of the iliac artery narrowed by plaque
    slide 1 of 5
        
    slide 1 of 5, Iliac artery is narrowed by plaque,

    Angioplasty is used to open narrowed arteries and increase oxygen-rich blood flow to muscle and tissue. These images show angioplasty for the iliac artery. Angioplasty can also be done for the femoral, popliteal, and tibial arteries.

    Catheter is inserted

    Location of the iliac artery, with detail of the catheter and guide wire inserted in the artery
    slide 2 of 5
        
    slide 2 of 5, Catheter is inserted,

    After you are sedated, the surgeon inserts a thin, flexible tube called a catheter through a femoral artery in the thigh and carefully guides it to the narrowed part of the iliac artery. A wire inside the catheter is used to guide tools, including a small balloon, into the artery.

    Balloon is inflated, stent is expanded

    Balloon and stent positioned and expanded
    slide 3 of 5
        
    slide 3 of 5, Balloon is inflated, stent is expanded,

    The surgeon guides the catheter to the narrowed part of the artery and inflates a small balloon at the end of a tube. The balloon may remain inflated for a short time. If the doctor is going to place a stent in the artery, the balloon is inflated inside of the stent. The pressure from the inflated balloon causes the stent to expand and press the plaque against the wall of the artery, creating more room for blood to flow.

    Balloon is removed, stent is in place

    Deflated balloon removed and expanded stent in place
    slide 4 of 5
        
    slide 4 of 5, Balloon is removed, stent is in place,

    Next, the surgeon deflates the balloon and removes it, leaving the expanded stent in place to keep the walls of the artery open.

    Before and after angioplasty

    Decreased blood flow before angioplasty and normal blood flow after angioplasty
    slide 5 of 5
        
    slide 5 of 5, Before and after angioplasty,

    Angioplasty can widen a narrowed part of an artery. This increases the flow of oxygen-rich and nutrient-rich blood to the leg.

    What to Expect

    After the procedure, pressure will be applied to the area where the catheter was put into your blood vessel. Then the area may be covered with a bandage or a compression device. This will prevent bleeding. Nurses will check your heart rate and blood pressure. The nurse will also check the catheter site for bleeding.

    You will need to lie still and keep your leg straight for several hours. The nurse may put a weighted bag on your leg to keep it still.

    You may have to stay overnight in the hospital. After you leave the hospital, you can most likely return to normal activities. You may have a bruise or a small lump where the catheter was put in your blood vessel. This is normal and will go away.

    Why It Is Done

    This procedure is commonly used to open narrowed arteries that supply blood flow to the heart. It may be used on short sections of narrowed arteries in people who have peripheral arterial disease (PAD).footnote 1, footnote 2

    How Well It Works

    Angioplasty can restore blood flow and relieve intermittent claudication.footnote 3, footnote 4 Angioplasty may help you walk farther without leg pain than you did before the procedure.footnote 5

    How well angioplasty works depends on the size of the blood vessel, the length of blood vessel affected, and whether the blood vessel is completely blocked.

    In general, angioplasty works best in the following types of arteries:

    • Larger arteries.
    • Arteries with short narrowed areas.
    • Narrowed, not blocked, arteries.

    Risks

    Complications related to the catheter include:

    • Pain, swelling, and tenderness at the catheter insertion site.
    • Irritation of the vein by the catheter (superficial thrombophlebitis).
    • Bleeding at the catheter site.
    • A bruise where the catheter was inserted. This usually goes away in a few days.

    Serious complications are rare. These complications may include:

    • Sudden closure of the artery.
    • Blood clots.
    • A small tear in the inner lining of the artery.
    • An allergic reaction to the contrast material used to view the arteries.
    • Kidney damage. In rare cases, the contrast material can damage the kidneys, possibly causing kidney failure.

    Radiation risk

    There is always a slight risk of damage to cells or tissues from being exposed to any radiation, including the low levels of X-ray used for this test. But the risk of damage from the X-rays is usually very low compared with the potential benefits of the test.

    References

    Citations

    1. Conte M, et al. (2015). Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. Journal of Vascular Surgery, 61(3S): 2S–41S. DOI: 10.1016/j.jvs.2014.12.009. Accessed November 25, 2016.
    2. Gerhard-Herman MD, et al. (2016). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, published online November 13, 2016. DOI: 10.1161/CIR.0000000000000471. Accessed November 25, 2016.
    3. Gerhard-Herman MD, et al. (2016). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, published online November 13, 2016. DOI: 10.1161/CIR.0000000000000471. Accessed November 25, 2016.
    4. Conte M, et al. (2015). Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. Journal of Vascular Surgery, 61(3S): 2S–41S. DOI: 10.1016/j.jvs.2014.12.009. Accessed November 25, 2016.
    5. Fakhry F, et al. (2018). Endovascular revascularization versus conservative management for intermittent claudication. Cochrane Database of Scientific Reviews (3). DOI: 10.1002/14651858.CD010512.pub2. Accessed April 13, 2018.

    Credits

    Current as of: December 15, 2019

    Author: Healthwise Staff
    Medical Review:
    Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
    E. Gregory Thompson MD - Internal Medicine
    Martin J. Gabica MD - Family Medicine
    Adam Husney MD - Family Medicine
    David A. Szalay MD - Vascular Surgery


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