Diseases & Conditions

Angioplasty


Overview & Description

Angioplasty is a procedure to reconstruct or repair a blood vessel. In most cases, this term refers to a procedure to open and restore blood flow through a clogged artery. This procedure is often used as a less invasive treatment instead of traditional surgery.

Who is a candidate for the procedure?

Over time, cholesterol and other fatty substances in the bloodstream can form deposits on the inside of the artery walls. This process is known as atherosclerosis. When arteries become severely blocked, blood flow is diminished. This can cause damage to the organs served by those arteries. Heart attack and stroke are examples of the consequences of clogged arteries.

To prevent organ damage, people with severe artery blockage often undergo procedures to restore blood flow. One option is surgery that provides an alternate route around the blockage for blood flow. This is known as heart bypass surgery.

The other option is angioplasty. When possible, this technique is preferred. It is often less risky and requires less healing time. The surgeon will decide if a person is a candidate for angioplasty based on factors such as his or her general health and the location and severity of the blockage. Angioplasty is sometimes performed as an emergency, immediately following a heart attack. In other cases, the procedure is done as a scheduled procedure when a person has symptoms of artery blockage, such as occasional chest pain, without current tissue damage. The technique is generally the same whether the procedure is done routinely or as an emergency.

How is the procedure performed?

Angioplasty may be performed on the arteries of the heart, neck or legs. The same general procedure is used; however it may vary slightly from location to location.

A thin tube called a catheter is used to perform the angioplasty. At the end of the catheter is a tiny, inflatable balloon. The catheter is inserted through the skin into an artery, usually in the groin area. Before the catheter is inserted, the skin over the artery is cleaned the hair in the area is shaved. Next, a local "numbing" medication is injected under the skin to provide local anesthesia. The person may also be given a mild sedative to relax.

A small skin incision is then made at the site. The tube is passed over a wire, which is used to guide it, and into the artery. The part of the tube that contains the inflatable balloon is positioned at the point of the blockage. In order to know exactly where to position the balloon, an x-ray test is performed to position the catheter and balloon, as well as to "map" the affected arteries. These x-rays are taken in "real time," meaning, that instead of taking one picture, multiple images are obtained one after the other. This helps the surgeon position the wire, the tube, and the balloon, and look at the areas of blockage in the arteries. This procedure involves squirting a contrast agent into the artery. The contrast agent outlines the artery so that the contours show up when x-ray images are taken. In this way, the surgeon can see the blockage.

After being positioned, the balloon is inflated. When the balloon is inflated, it expands inside the clogged artery. The expanding balloon forces the blockage to open by pushing the walls of the artery outward. The artery then remain open because the walls are stretched and some of the deposits on the walls are broken up. This restores blood flow through the artery. Another set of x-rays is taken after the procedure to ensure that the artery has been successfully opened. If these images confirm that the angioplasty restored blood flow, the procedure is over. If not, the process can be repeated. In some cases, the angioplasty may not be successful and the procedure is stopped. If this occurs, other treatment options must be considered, such as heart bypass surgery. In either case, the tube is removed and the skin incision is bandaged.


Preparation & Expectations

What happens right after the procedure?

The person is taken to a surgery recovery room to be monitored for a few hours. There is usually little pain after this procedure, but pain medication can be given if needed. The person needs to lie flat for a few hours after the procedure. In some cases, the individual can return home later the same day. In other situations such as when an angioplasty is performed during a heart attack, a hospital stay is often needed.


Home Care and Complications

What happens later at home?

The wound where the catheter was inserted must be monitored for bleeding and infection. Pain medications can be taken as needed. People who have had angioplasty must also watch out for renewed symptoms of artery blockage such as chest pain or heart attack. The individual will be given specific instructions for follow up care from his or her healthcare provider.

What are the potential complications after the procedure?

Complications of the procedure include:

  • bleeding and infection at the site where where the catheter was inserted
  • allergic reaction to pain medication or dye used during the x-ray
  • return of the blockage in the artery. This may occur quickly or within the next several months. Some people need repeated procedures to keep their arteries open.
  • rarely, a rupture or tear in the wall of the artery. This can be caused by the balloon as it is inflated or by the wire that is used to guide the tube that contains the balloon. This is a life-threatening complication that may cause the person to need emergency open-heart surgery.

  • Attribution

    Author:Adam Brochert, MD
    Date Written:
    Editor:Slon, Stephanie, BA
    Edit Date:06/26/00
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:09/04/01

    Sources

    Harrison's Principles of Internal Medicine, 1998, Fauci et al.