Patient education: Angioplasty and stents for peripheral artery disease (The Basics)

What is peripheral artery disease? — 

Peripheral artery disease, or "PAD," is a condition that affects the blood vessels (called arteries) that bring blood to the limbs. The legs are more often affected than the arms.

Normally, blood flows easily through arteries to all parts of the body. But sometimes, fatty clumps called "plaque" build up inside the walls of arteries (figure 1). Plaque can cause arteries to become narrow or blocked. This prevents blood from flowing normally.

When muscles or other tissues do not get enough blood, it can cause symptoms. A common one is muscle pain that gets worse with activity and better with rest. In the legs, this is called "claudication."

Severe PAD can cause pain even while resting. PAD can also cause wounds to heal more slowly than usual.

What is angioplasty? — 

This is a procedure to widen blood vessels that are too narrow or blocked. This can improve blood flow to the limbs.

During angioplasty, the doctor puts a thin tube into a blood vessel (often in the groin). They move the tube to the part of the blood vessel that is narrow or blocked. Then, they inflate a tiny balloon inside the artery to reopen it.

What is a stent? — 

This is a small mesh tube the doctor might use to hold the blood vessel open. A stent can be placed during angioplasty. The doctor decides whether to use a stent based on:

●Where the blockage is

●How much of the blood vessel is blocked

How do I prepare for angioplasty? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam. They might send you to get tests, such as:

●Ankle-brachial index – This measures and compares blood pressures in your arms and legs.

●Imaging tests, such as CT or MR angiogram – These create pictures of the inside of the body.

Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past procedures or surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have, and if you ever had a reaction to "contrast materials"

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before the procedure – You might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●Lowering the risk of infection – You might need to wash the area with a special soap.

●Stopping smoking, if you smoke – Smoking makes the procedure less effective in the long term.

●What help you will need when you go home – For example, you need someone else to bring you home and stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during angioplasty? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Local – This uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. You might be awake. Or you might get "sedative" medicines to make you relax and feel sleepy.

•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure. They will give you medicines to prevent blood clots.

●The doctor might use ultrasound or make a small cut ("incision") in your skin to help find the blood vessel. Then, they will put a thin plastic tube, called a "catheter," in the blood vessel. They will gently push the tube through the blood vessel to reach the narrow or blocked area. They might need to make more than 1 incision to do this.

●While this is happening, an X-ray takes pictures of the tube in your body. This helps the doctor know when the tube reaches the correct place.

●When the tube is in place, the doctor will inject a dye that shows up on an X-ray. This dye can show narrow or blocked areas. Your body might feel warm during this part.

●The doctor will pass a tiny balloon into the narrow area. Then, they will inflate the balloon to reopen your artery. If needed, the doctor can place a stent to keep the blood vessel open.

●The doctor will remove the tube from your body and put pressure on the incision to prevent bleeding. They might use a special dressing or stitches to close the incision. They will cover it with a bandage.

What happens after angioplasty? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. They will also watch for bleeding. You will rest in bed for some time, depending on your risk for bleeding.

As you recover:

●The staff will tell you when it is safe for you to move around more. Many people can go home the same day. You might need to stay in the hospital overnight if your procedure was very long or if you need IV fluids or medicines.

●If you had a stent put in, you will probably get "antiplatelet" medicine. This helps prevent blood clots from forming and blocking the stent.

●Drink plenty of fluids for the next few days. This helps clear the dye from your system.

What are the risks of angioplasty? — 

Your doctor will talk to you about all the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●Blood clots in the artery

●Tear in the blood vessel

●The treated artery getting blocked again

●The stent moving out of position or breaking

●Minor or serious allergic reaction to the dye

●Kidney damage from the dye

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Peripheral angioplasty – Discharge instructions (The Basics)
Patient education: Peripheral artery disease and claudication (The Basics)
Patient education: Atherosclerosis (The Basics)

Patient education: Peripheral artery disease and claudication (Beyond the Basics)