Angioplasty and Stenting
Catheter angiography involves lying on a special x-ray table. Sterile paint and drapes are used. Local anaesthetic is administers and then an artery is (often the femoral artery in the groin) is accessed with a needle and through this needle a wire is passed over which sheathes / catheters / balloons and stents can be passed. Using dye to provide a roadmap (angiogram) and special x-ray imaging to guide the interventionist. A vast array of endovascular interventions can possible be carried out. The most straightforward of these is the ballooning of a narrowing in an artery (balloon angioplasty). You may have heard of this being done by cardiologists in the coronary (heart) arteries and this is the same process in your leg arteries.
Occasionally the interventionists will determine that it is necessity to use a stent to try to ensure that the artery remains open often just after balloon angioplasty. The narrowing of the artery recurs over time.
There are two main types of stent – bare metal stents and covered stents. After stenting an artery there can be narrowing form inside the stent because of the reaction of your body to the stent. Often after an endovascular intervention we continue to survey what is happening at the intervention site with duplex ultrasound.
Catheter angiography and endovascular interventions are often an excellent way to improve the blood supply (revascularization) the leg. Compared with surgery it is a more straightforward process often done as a day case under local anaesthesia without a wound to worry about afterwards.
Occasionally there can be problems. As with all dye studies the kidneys can be affected and allergic reactions can occur. At the site where the needle enters the artery there can be an injury to the artery and sometimes after the procedure there is on-going leakage from the artery causing extensive bruising or bleeding behind the abdominal contents (retroperitoneal haematoma) or a false aneurysm.
The actual ballooning can rarely rupture the artery and also cause bleeding. Sometimes despite the best predictions for success it is not possible to reopen the artery.
About 2 - 3% of patients who have a catheter angiogram need to have an operation to fix a complication and for less then 1% of patients there is a major complication leading to amputation or death.
The other way of re-vascularizing a leg is with open surgery.