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Angioplasty

By

Sarah Lewis, PharmD

What is angioplasty?

Angioplasty is a procedure to widen or open a blocked or narrowed artery. It restores normal blood flow through diseased arteries. Angioplasty is used on renal (kidney) arteries, carotid (neck) arteries, cerebral (brain) arteries, and coronary (heart) arteries. It treats coronary artery disease, peripheral artery disease, and carotid artery disease.

Arteries are blood vessels that carry blood from your heart to your organs and tissues. Atherosclerosis is a common cause of narrowed or blocked arteries. Atherosclerosis is a build-up of fatty deposits on artery walls. The deposits harden into a substance called plaque. A buildup of plaque narrows and hardens the artery. A serious narrowing can occur over time and reduce blood flow through artery. 

Atherosclerosis can also cause a blood clot to form. This can totally block the artery and cause a heart attack stroke, stroke, tissue death, and other serious and life threatening problems.

Angioplasty is only one method used to treat atherosclerosis. Discuss all of your treatment options with your doctor to understand which options are right for you.

Types of angioplasty

The types of angioplasty procedures include:

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  • Atherectomy involves inserting a catheter into a blood vessel in your groin or arm. Your doctor passes the catheter into the diseased artery using a guide wire. The plaque is scraped or drilled away with special catheter tools.

  • Balloon angioplasty is a similar procedure. It involves inserting a catheter into a blood vessel in your groin or arm. Your doctor passes the catheter into the diseased artery using a guide wire. Your doctor then expands a balloon on the tip of the catheter wire to open the artery.

  • Laser angioplasty also involves inserting a catheter into a blood vessel in your groin or arm. Your doctor passes the catheter into the diseased artery using a guide wire. A laser on the catheter tip destroys the plaque and opens the artery.

Your doctor considers different factors to decide which type of procedure or combination of procedures to use. Factors include the location, size, shape, and softness or hardness of the plaque. 
Other procedures that may be performed

Your doctor may perform other procedures in addition to angioplasty to diagnose or treat certain conditions. Procedures include:

  • Angiography, which allows your doctor to take a picture or image (called an angiogram) of your blood vessels

  • Minimally invasive bypass grafting, which provides a new route for blood flow around diseased arteries. Grafting uses healthy vessels taken from other places in your body. You may have general anesthesia if your doctor combines this surgery with angioplasty.

  • Stenting, which involves inserting a mesh tube inside the artery and expanding it to keep the artery open after angioplasty.

Why is angioplasty performed? 

Angioplasty treats the following diseases and conditions:

  • Aortic atherosclerosis, a narrowing and hardening of the aorta due to a buildup of plaque. Your aorta is the main artery leaving your heart. Aortic atherosclerosis can lead to an aortic aneurysm, a bulging of the aorta that can rupture and bleed heavily.

  • Carotid artery disease, a narrowing of the carotid arteries in your neck. The carotid arteries carry blood from your heart to your brain. Carotid artery disease increases your risk of stroke.

  • Coronary artery disease (CAD), a narrowing of the arteries that supply your heart with blood. Coronary artery disease can lead to a heart attack.

  • Dialysis fistula or graft narrowing, a narrowing of a fistula or graft used for dialysis. Fistulas and grafts allow access to the body’s blood flow to treat kidney failure. Narrowed fistulas or grafts reduce blood flow so there is not enough blood flow to perform dialysis.

  • Peripheral artery disease (PAD), a narrowing of the arteries in your arms or legs. Peripheral artery disease can lead to poor healing of wounds and serious infections, such as gangrene (tissue death) in the feet and legs.

  • Renal artery stenosis, a narrowing of the arteries that supply the kidneys. It can lead to kidney damage and kidney failure.

  • Vein narrowing. Veins are blood vessels that carry blood from the body to the heart. Larger veins can narrow and require angioplasty. Vein narrowing can lead to a blood clot (deep vein thrombosis) that can travel to your lungs or brain and cause a pulmonary embolism or stroke.

Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on angioplasty.

Who performs angioplasty?

The following specialists perform angioplasty: 

  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

  • Cardiologists and interventional cardiologists specialize in diagnosing and treating the heart and its blood vessels using catheter procedures and imaging techniques.

  • Nephrologists specialize in diagnosing and treating kidney diseases.

  • Vascular and interventional radiologists specialize in the treatment of blood vessel diseases and other conditions using catheter procedures and imaging techniques.

  • Vascular surgeons specialize in the surgical treatment of diseases and conditions of the lymphatic system and blood vessels outside the heart and brain.

How is an angioplasty performed?

Your angioplasty will be performed in a hospital. The procedure takes one to three hours and generally includes these steps:

  1. You dress in a patient gown and lie on a procedure table.

  2. Your team inserts an IV to provide fluids and medications.

  3. Your team attaches devices to monitor your heart rate and blood pressure.

  4. Blood tests are done to check kidney function and blood clotting.

  5. You receive IV medication (a light sedative) to make you drowsy and relaxed. You may receive deeper sedation or anesthesia through an intravenous (IV) line. In this case, you are more relaxed and unaware of the procedure and may not remember it. 

  6. You may receive medication to prevent blood clots from forming in your arteries during the procedure. You may also get medications to prevent spasms in your arteries during the procedure.

  7. Your doctor determines the location to insert the catheter. The area is shaved, cleaned, and numbed. Then your doctor makes a small incision.

  8. Your doctor inserts a catheter and guide wire through the incision and feeds it into the diseased blood vessel. X-rays help guide the wire to the exact location.

  9. Your doctor injects a contrast agent through the catheter to help improve the quality of the X-ray images.

  10. Your doctor  opens or widens the artery using X-ray guidance. Your doctor may place a stent to keep the artery open. 

  11. When the procedure is complete, the team may take more X-rays to confirm that blood is flowing as expected. 

  12. Your doctor removes the catheter and closes the small catheter site.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel a pinch or pin prick pain during the IV placement and brief stinging during numbing of the catheter insertion area with a local anesthetic. You may also feel pressure as your doctor makes the incision and inserts the catheter. It is common to feel some discomfort when the balloon is inflated to open your artery. 

You will receive enough sedative medications to keep you relaxed and comfortable. Tell your doctor or care team if you are uncomfortable.

What are the risks and potential complications of angioplasty?  

As with all procedures, angioplasty involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications of angioplasty are uncommon but can occur during the procedure or recovery. 

Risks and potential complications of angioplasty include: 

  • Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing

  • Bleeding

  • Blood clots within your arteries

  • Damage to an artery from the catheter or balloon

  • Exposure to ionizing radiation, which may be harmful in excessive doses

  • Heart attack

  • Infection

  • Kidney injury from the contrast agent, especially if you already have kidney problems

  • Recurrence of artery narrowing or blockage

  • Stroke

  • Sudden vessel occlusion. This is a total blockage of the artery at the site of the angioplasty. Sudden vessel occlusion is a rare complication that typically occurs within 24 hours of angioplasty. It requires immediate medical attention.

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recomme