Definition

Atherectomy and angioplasty are methods that can be used to open the arteries without surgery.

There are several different devices that can be threaded through blood vessels to the site of a narrowing or occlusion. Once there, these devices remove the obstruction so that blood flow is restored.

  • Shavers chew away and remove tiny pieces of the obstruction until blood flow is restored.
  • Burrs grind the obstruction into tiny particles that are so small they are washed away in the blood.
  • Lasers vaporize the obstructing material.
  • Balloons inflate within the obstruction, pushing the material aside.
  • Stents are metal tubes that expand once in place, forming a rigid framework to hold the artery open.

Balloon Angioplasty

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Parts of the Body Involved

  • Any artery that is diseased to the point where blood flow through it is inadequate, nearly always due to atherosclerosis [3] (hardening of the arteries)

Reasons for Procedure

Most often these procedures are done when an artery is so narrowed by atherosclerosis that enough blood is no longer able to pass through. The body part then suffers from ischemia (lack of oxygen). Legs cramp, the brain [4] suffers from or threatens to have a stroke [5] , and the bowel produces bloody diarrhea [6] . If a kidney [7] has inadequate blood supply, it will raise blood pressure throughout the body. Occasionally, the vascular access needed to perform hemodialysis, which is used for kidney [8] failure , narrows and requires this procedure to reopen it.


Risk Factors for Complications During the Procedure

Aside from your general health [9] and the extent of disease in your arteries, the only significant risk factor is the status of your blood clotting system, which will be thoroughly evaluated before proceeding. Make sure you inform your physician if you are allergic to x-ray [10] contrast dye.


What to Expect

Prior to Procedure

You will have been thoroughly evaluated before deciding upon the best procedure. This may involve contrast x-rays, ultrasound, or computerized scans ( CTA [11] or MRA [12] ) to identify the area or areas of concern. You will be asked not to have anything by mouth for several hours before the procedure. You may have to suspend taking certain medications. Be sure to tell your physician if you are taking medications to thin your blood, such as aspirin, coumadin, or Plavix.

Anesthesia

You will most likely be sedated but not put to sleep [13]. A local anesthetic will numb the site of insertion of the device.

Description of the Procedure

You will be lying down in a special procedure room similar to a surgical suite. It will be filled with x-ray machines as well as an array of surgical equipment. Depending upon what artery is to be opened, a blood vessel in your groin or arm will be prepared and covered with sterile drapes. Your physician will then puncture your numbed skin, and a catheter will be placed into your blood vessel to the site of the obstruction. Dye may be injected through the catheter to visualize the obstruction. There may be more than one location that requires opening. The type of device used will depend on the type of obstruction and location in the vessel. Possible approaches include angioplasty [14] , angioplasty and stent placement [15] , and atherectomy.

After Procedure

Recovery time is minimal. You will probably spend the night in the hospital to make sure there are no complications, and you will likely be prescribed a medication, such as aspirin, to prevent blood clots.

How Long Will It Take?

The entire process takes between 30 minutes to two hours.

Will It Hurt?

Some minor discomfort may accompany the actual procedure.

Possible Complications

  • The principal risk is that the artery will close again after the procedure. If this happens, either a repeat procedure or a similar one will be required, or open surgery will have to be performed—usually urgently.
  • Rarely, the artery may be damaged, requiring surgical repair.
  • There may be bleeding from the puncture wound in the skin through which the device was introduced.
  • If the carotid artery is the site of the procedure, a stroke [5] may occur.

Average Hospital Stay

Overnight

Postoperative Care

There will be a bandage over the puncture site. You may be prescribed a “blood thinner” such as aspirin. Certain strenuous activities will be limited. Other activities, including exercises [16] and fluid intake, may be encouraged. Your physician will want to see you several days or weeks later.


Outcome

The success rate for these procedures is high and the complication rate is low. Research into better devices and techniques continues to improve the outcome.


Call Your Doctor If Any of the Following Occurs

Depending upon the site of your procedure, call your doctor if you experience the following:

  • Leg pain [17] that persists or worsens
  • Fever
  • Shortness of breath
  • An arm or a leg that turns blue or feels cold
  • Problems with your access site—bleeding, swelling, pain [17], or numbness