The method of angioplasty is that the surgeon inserts a narrowing of blood vessels with a catheter balloon inflated. This balloon, inflating, expanding the artery and restores blood flow in this way. Sometimes angioplasty complemented by stenting. Stent - a wire cylindrical structure that serves to frame portion of the artery.
Usually, angioplasty and stenting are done through a small incision or puncture. Puncture through the surgeon inserts a special catheter in the form of a thin tube. By controlling the course of the procedure on the monitor with the help of x-rays he brings the catheter to the site of narrowing of the vessel. At the tip of the catheter balloon is or stent.
Most often the method used in angioplasty treatment of peripheral arterial disease. Sometimes angioplasty is used for the treatment of venous patency.
Normally, the inner wall of the arteries smooth and level. With age, the arterial wall plaques are deposited. These plaques are composed of cholesterol, calcium and fibrous tissue. The more plaque there in the artery wall, the more it narrows the lumen. This pathological process is called atherosclerosis. Eventually, the artery is completely closed and blood flow through it stops. This leads to pain, ischemia and necrosis - necrosis.
In some cases, angioplasty is carried out as an alternative to bypass surgery. In certain types of vasoconstriction angioplasty has advantages over shunting. For example, the fact that angioplasty does not require for the implementation of the cut. Therefore, patients who had undergone angioplasty, spend less time in hospital and rehabilitation period they have shorter, compared with bypass surgery. In addition, unlike bypass surgery, angioplasty can be performed under local anesthesia. However, in the treatment of certain types of severe narrowing of blood vessels is better to use bypass.
Preparation for surgery of angioplasty and stenting
Before surgery, a doctor conducts a full examination of the patient, finds out his complaints, their nature. Further, some samples are held to assess the nature of blood supply to the affected area. The doctor discovers the presence of concomitant diseases such as hypertension, diabetes and others. Thereafter shall research methods that allow to see the degree of narrowing of the arteries with plaque, clogging them, to identify blood flow velocity and some parameters of blood circulation. These methods include:
Magnetic resonance angiography
If, during these studies revealed a moderate or severe narrowing of blood vessels, your doctor may schedule execution angiography. Angiography can directly see the condition of vessels on the radiograph, in addition, this procedure allows for angioplasty. The technique is angiography is that the femoral artery catheter introduced special, which is supplied to the narrowed portion of the vessel. After that, through a catheter into the vessel entered a special radiopaque substance. During the injection of contrast, a series of x-rays. After exploring the contrast agent excreted by the kidneys.
Before performing the procedure, the doctor recommends a patient to stop taking any medication, it is prohibited to drink and eat. Obligatory in allergic test for a contrast agent. If the patient has an allergy to iodine, it must tell the doctor about it, as contrast agents for angiography contain iodine.
Before angiography (and angioplasty), a doctor conducting a study of kidney function. This is done for the reason that the contrast agent is excreted by the kidneys.
Who shows angioplasty and stenting?
Usually, angioplasty and stenting indicated in patients with moderate or severe narrowing of blood vessels. Angioplasty is not suitable for large vessel occlusion, when the tip of the catheter can not pass through the narrow space. What is the risk of complications during angioplasty and stenting?
Complications of angioplasty and stenting are allergic to contrast dye, bleeding from the puncture site, re-blockage of the arteries, as well as disorders of kidney function.
In addition, there may be obstruction of the lumen of the vessel below the constriction due to the separation of particles of atherosclerotic plaque.
If you have diabetes or kidney disease have an increased risk of renal failure. In order to prevent this complication of the procedure the patient make special preparations.
In patients with bleeding disorders also have an increased risk of complications. With its long atherosclerotic plaque at risk of re-narrowing of vessels after angioplasty.
Angioplasty and stenting procedure
In the area of the femoral artery through a puncture or small incision in the groin or elbow crease catheter - a thin tube with a balloon inflated at the end. Before the introduction of the catheter at the site of skin shaved, treated with antiseptic and analgesic anesthetic. Initially, the vessel entered a special catheter guide-wire. This process is controlled by an X-ray monitor. After the conductor was at the place of constriction in the vessel with a balloon catheter. When the tip of the catheter is in place the blood vessel constriction, the doctor inflates the balloon and the vessel lumen expands. This procedure is painless, since the inner wall of the vessel does not have nerve endings.
After angioplasty, there is risk of re-narrowing of the vessel - restenosis. Usually restenosis occurs within a few months or years after angioplasty. If the observed sudden occlusion of the vessel, it is called reocclusion.
In order to prevent restenosis, the surgeon establishes in the extended position of the vessel stent - a wire cylindrical structure to provide a framework for the portion of the artery. For the stent surgeon removes the catheter and enters another catheter with a stent at the end. The catheter is introduced into the vessel. The tip of it is supplied to the affected area of the artery. Further inflated balloon with a stent installed. Thus the stent presses against the artery wall.
However, even stenting does not give an absolute guarantee exclusion of restenosis. The fact is that over time the stent overgrown scar tissue and re-narrowing of arteries occur.
Currently available stents are coated with special material that prevents the development of scar tissue. So far, this type of stent used in coronary artery stenting. The use of stents for arteries other sites have not been studied until the end.
After the procedure, angioplasty catheter is removed. The puncture of the vessel is pressed for 30 minutes to stop bleeding. Duration of angioplasty and stenting takes between 45 minutes to 3 hours.
Postoperative period after angioplasty and stenting
Typically after angioplasty patient is bed-6 -24 hours. At this time, the surgeon carries out careful monitoring of the patient and monitors the occurrence of complications.
If after surgery you feel any unusual sensations, deterioration of health, you should immediately tell your doctor. This can be a pain in the leg, fever, shortness of breath, skin color change hands or feet, any complications of the puncture site, such as swelling or numbness.
After being discharged from the hospital is not recommended in the first few days of heavy lifting. It is also recommended to drink plenty of liquids for 2 days in order to excrete the dye. One day after surgery you can take a shower, but recommended for a time limit taking baths.
Postoperatively, the doctor may recommend taking aspirin to prevent blood clots, as well as light exercise.
After a certain time, it should be re-consultation with a doctor to control blood clotting, as well as the result of the operation.
Complications during angioplasty and stenting
Serious complications during angioplasty and stenting is rare, but can still happen.
Less serious complications - is bleeding from the puncture site. Sometimes the hole after the catheter is not closed completely. Even rarer is a complication arises as a channel between the artery and vein.
During the first months after stent placement have an increased risk of blood clots around the stent. Prevent this complication the doctor may prescribe a patient, such as aspirin, which prevents the formation of blood clots.
The more time has passed since the angioplasty and stenting, the higher the risk of restenosis. The risk of this complication is reduced by using the above-mentioned stent with a special coating. However, in some cases, you may need to reinstall the stent.
More serious but rare complications:
Allergic reaction to contrast
Thrombus formation in the artery
Rupture or weakening of the vessel wall
Stratification of the artery walls
Blockage of the lumen of the artery below the narrowing