MetroHealth Heart & Vascular Center
Peripheral Arterial Angioplasty and Stenting
What is Peripheral Arterial Disease?
Your arteries are normally smooth and unobstructed on the inside, but as you
age, plaque can build up in the walls of your arteries. Cholesterol, calcium,
and fibrous tissue make up this plaque. As more plaque builds up, your arteries
can narrow and stiffen. This process is called atherosclerosis, or hardening of
the arteries. Eventually, enough plaque builds up to reduce blood flow through
Am I a candidate for angioplasty and stenting?
You are a candidate for angioplasty and stenting if you have moderate to
severe narrowing or blockage in one or more of your blood vessels. Usually, you
will also have symptoms of artery disease, such as pain or ulceration, in one of
If you have extremely hard plaque deposits, blockages that contain blood
clots or a large amount of calcium, extensive or particularly long blockages, or
blood vessel spasms that don't go away, you probably are not a good candidate
Depending upon the particular circumstances, your physician may recommend
angioplasty as an alternative to bypass surgery, which also treats narrowed
For certain types of blockages, angioplasty has
some advantages when compared to bypass surgery.
- Angioplasty does not require a large incision.
Because of this, angioplasty patients usually spend less time in the hospital
and recover at home faster than bypass surgery patients.
- Your physician can usually perform angioplasty while you are awake,
whereas bypass surgery requires general or regional anesthesia.
Nevertheless, in some circumstances, bypass surgery
may be a better option. Your vascular surgeon will help you decide what
alternative is best for your particular situation.
What is angioplasty and
In an angioplasty, your vascular surgeon inflates a small balloon inside a
narrowed blood vessel. The balloon helps to widen your blood vessel and restore
normal blood flow. After widening the vessel with angioplasty, your vascular
surgeon sometimes inserts a stent depending upon the circumstances. Stents are
tiny mesh tubes that support your artery walls to keep your vessels wide open.
Angioplasty and stenting are usually done through a small incision or
puncture in your skin, called the access site. Your physician inserts a long,
thin tube called a catheter through this access site. Your physician guides the
catheter through your blood vessels to the blocked area. The tip of the catheter
carries the angioplasty balloon or stent.
Angioplasty most often is
used to treat peripheral arterial disease (PAD), which is another name for
hardening of the arteries not involving your heart. It can also be used,
in some circumstances, to treat narrowed areas in your veins.
Your physician will order tests to show how much plaque has built up in your
arteries. These tests can help your physician determine whether you need an
angioplasty. The choice of test depends on the blood vessel in question and not
all of the tests need to be used for every situation.
These tests include:
• Duplex ultrasound
• Magnetic resonance angiography (MRA)
• Computed tomography (CT) scan
• Arterial Doppler Studies
If these tests show that your arteries are moderately to severely narrowed,
your vascular surgeon may also plan a test called angiography that shows your
blood vessels on an x-ray.
What can I Expect?
• Prior to your procedure, tests may be scheduled such as blood work,
electrocardiogram (ECG), and chest x-ray. These may be done at a separate
appointment, or the day of the procedure
• Angioplasty or stenting is commonly done as an outpatient procedure,
although some patients are hospitalized (inpatients)
• You can wear whatever you like to the hospital. You will wear a
hospital gown during the procedure.
• If you normally wear dentures, glasses or a hearing assist device,
plan to wear them during the procedure to assist with communication.
• Your doctor or nurse will give you specific instructions about what
you can and cannot eat or drink before the procedure.
• Ask your doctor what medications should be taken on the day of your
test. You may be told to stop certain medications, such as Coumadin (warfarin, a
• If you have diabetes, ask your physician how to adjust your
medications the day of your test.
• Tell your doctor and/or nurses if you are allergic to anything,
especially iodine, shellfish, x-ray dye, penicillin-type medications, latex or
rubber products (such as rubber gloves or balloons).
• You may or may not return home the day of your procedure. When you are
able to return home, arrange for a companion to bring you home.
• Please bring a list of your medications (including over-the-counter)
and dosages. When you arrive for your appointment, please tell your nurse if you
are taking Coumadin (warfarin), Plavix (clopidogrel), diuretics (water pill) or
• You will be given a hospital gown to wear. A nurse will start an
intravenous (IV) line in your arm so that medications and fluids can be
administered during the procedure.
• You will lie on a special table and you will be
able to watch your procedure on the
• The nurse will clean your skin at the site where the catheter (narrow
plastic tube) will be inserted (arm or groin). The catheter insertion site may
• Sterile drapes are used to cover the site and help prevent infection.
It is important that you keep your arms and hands down at your sides, under the
• Electrodes (small, flat, sticky patches) will be placed on your chest.
The electrodes are attached to an electrocardiograph monitor (ECG), which
monitors your heart rate and rhythm.
• You will be given a mild sedative to relax you, but you will be awake
and conscious during the entire procedure.
• In some cases, a catheter may be placed into your bladder during the
• The doctor will use a local anesthetic to numb the site. A plastic
introducer sheath (a short, hollow tube through which the catheter is placed) is
inserted in a blood vessel in your arm or groin. A catheter will be inserted
through the sheath and threaded to the arteries of your heart. You may feel
pressure as the introducer sheath or catheter are inserted, but you should not
feel pain. Tell the nurse or doctor if you feel any pain.
Angiography is usually performed again at the beginning of the angioplasty
procedure or sometimes the angioplasty procedure is performed at the time of the
Please tell the doctor or nurses if you feel:
• itching, tightness in the throat (allergic
• chest discomfort
• any other
After the procedure:
• The catheters and sheath are removed.
- If the catheter was inserted in the arm: The incision will be bandaged. You will need to
keep your arm straight for at least an hour. You will be observed for a few
hours to monitor any symptoms or side effects of the procedure.
- If the catheter was inserted at the groin: The incision
will be closed with applied pressure, suture device or a "plug." A "plug" is a
material which works with your body's natural healing processes to form a clot
in the artery. You will need to lie flat and keep the leg straight for two to
six hours to prevent bleeding (less time if a plug was used). Your head cannot
be raised more than 30 degrees (2 pillows high). Do not try to sit or stand.
• A sterile dressing will be placed on the angio site to protect it from
infection. The nurse will check your bandage regularly, but call your nurse if
you think you are bleeding (have a wet, warm sensation) or if your toes begin to
tingle or feel numb.
• You will need to drink plenty of liquids to clear the contrast
material from your body. You may feel the need to urinate more frequently. This
is normal. If you are on bed rest, you will need to use a bedpan or urinal.
• Your doctor will tell you if you are able to return home or will need
to stay overnight. In either case, you will be monitored for several hours after
• Treatment, including medications, diet and future procedures, will be
discussed with you prior to going home. Care of the wound site, activity and
follow-up care will also be discussed.