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Peripheral Angiography and Stenting

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Peripheral Angiography and stenting

Overview

Angiography is a medical term that means the visualization of blood vessels.


Peripheral angiography implies direct visualization of all arteries, excluding coronary arteries and arteries of the central nervous system. However, peripheral artery disease is used, in routine clinical practice, to refer to stenosis or occlusion of arteries that supply blood to arms and legs.


Peripheral artery diseases are manifested by symptoms that are caused by decreased blood flow. The decrease in blood flow may be caused by the formation of plaques (atherosclerosis) – accumulation of fat particles on the lining of the lumen. Calcium and other substances in blood attach to plaques, resulting in enlargement of plaques over time, and therefore, blood flow may gradually decrease or even stop.


Signs and symptoms of peripheral artery disease are related to organs and tissues fed by the stenotic or almost occluded artery and they include, but not limited to muscle pain, cramps, numbed skin, cold hands and feet, changes in skin tone usually on the fingers and toes, no pulse or poor pulse in unilateral limb or leg and organ dysfunction as well as stroke, heart attack, and amputation.


Why is this procedure done?

Fat particles begin to accumulate in peripheral arteries due to particular reasons, such as unhealthy nutrition, accumulation of excess fat in the body, high blood pressure, and diabetes mellitus. These structures, called plaques, grow over time as long as the risk factors are not eliminated. As a result, a condition, called atherosclerosis, develops, resulting in narrowing of peripheral arteries followed by completely blockage.


In early stages, peripheral artery diseases may be asymptomatic or cause very mild symptoms. Even if an artery is completely blocked, the blood supply is usually undertaken by collateral circulation and therefore, the condition progresses insidiously to the advanced stage.  


The principal sign that suggests a peripheral artery disease is the leg pain that develops while walking and stiffness of lower leg muscles – severe enough to make walking impossible. The patient needs to rest and the pain and the muscle stiffness regresses and even disappears after several minutes of resting. This sign of the peripheral artery disease is referred to as claudication.  


A peripheral angiography involves locating the stenotic or clogged segment, removal of the plaque that causes the narrowing or clogging and placement of a stent, if required, to restore and maintain the blood flow.


Risks

The possible risks of a peripheral angiography are listed below:

  • Stroke
  • Heart attack
  • Air embolism
  • Thromboembolism
  • Injury of blood vessel (perforation etc.)
  • Infection
  • Hematoma
  • Renal failure
  • Fistula formation
  • Allergic reaction against contrast agent


In the peripheral angiography suite, any and all necessary instrument, equipment and other means to manage the possible risks and complications are available.


Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.


Our specialists will employ all practices to minimize the risk of complications and our doctors will preoperatively inform you about risks listed above and all other potential complications and will address all your concerns.

Preparation

A number of comprehensive examinations are required to decide whether peripheral angiography is indicated.


Before the procedure is performed, your health history is reviewed and a comprehensive physical examination is done, in which all your vital signs (pulse, heart rate, breath rate, core temperature, etc.) are evaluated.


The blood flow in the lumen of the artery is imaged with a Doppler ultrasound scan and the flow rate and the severity of narrowing or clogging is determined.


If deemed necessary by your doctor, CT or MR Angiography is scanned for more detailed evaluation of arterial structures.


Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications


The time you will stop eating and drinking will be instructed. Medications you take for diabetes, hypertension and other disorders are reviewed. You are informed about medications that you should take in the day of the procedure. Besides, you should also inform your doctor about all over-the-counter medications, herbal products and vitamin and mineral supplements.


Since contrast agent is used for the imaging phase of the procedure, your past history is reviewed regarding allergic reactions against the contrast agent.


Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.


Surgery and early postoperative period

After you are transferred to the suite for the procedure, you will be positioned on the procedure table. There are mobile imaging devices that can move around the table to capture images.


An IV line is inserted to allow intravenous treatments and administer medications, if necessary. At this stage, a sedative agent is administered to make you fall into a nap.


All your vital signs will be closely monitored using ECG, pulse oxymeter and anesthesia monitor.


A small incision is made after local anesthesia is administered to the puncture site. An artery of your groin/leg or your arm is most commonly preferred. After a guide wire is inserted into the artery, a catheter is advanced over this guide wire.  Contrast agent delivered through the catheter helps locating the stenosis or the clogging of the artery(ies). The thin balloon at the tip of the catheter is inflated at the stenotic segment and thus, stenosis is eliminated and the blood flow is restored. Your doctor may decide to place a stent to prevent recurrence of blockage.


If it is decided to insert a stent, the stent that is found in collapsed form in the catheter is advanced to the clogged artery. Once the balloon is inflated, the stent is advanced, expanded and left at the site of stenosis.


After these procedures are completed, images (angiograms) are captured again to see the final status of the arteries. After the catheter is removed and the small incision is stitched, the procedure is completed.


If your doctor decides that your condition cannot be treated with an angiographic method, the procedure is terminated and another medical and surgical treatment options will be discussed with you.



After the peripheral angiography, you will be transferred to the observation room. Before you are transferred to the patient room or discharged, you should be observed here for a while and it should be verified that all your vital signs are stable or within acceptable limits.


Especially if the artery located in your groin is used, bleeding should be carefully monitored and managed after the neuroangiography. For this purpose, it may be necessary to apply compression on the small incision made in the groin.


Discharge after perpheral angiography is entirely related to your health status. If there is no any abnormality, you will usually be discharged in the same day or the next day. But, if an abnormality has been identified and intervened, your doctor will want you to stay at the hospital for one night or longer, if necessary.


After discharge from the hospital, if you experience signs of infection such as pain, redness and swelling at the incision site in the groin, significant swelling or bleeding at the catheter site, and if you experience chest pain or shortness of breath, it is a vital necessity to seek emergency medical treatment immediately.


Results

The narrowing or clogging of the artery is eliminated and the blood flow is restored in peripheral angiography thanks to angioplasty and placement of stent. Thus, the symptoms caused by the blocked blood flow relieve or disappear.


However, since the stenosis or clogging is caused by risk factors, including but not limited to smoking, blood pressure, high blood lipids, cholesterol, diabetes mellitus and unhealthy nutrition, these risk factors should completely eliminated or reduced after the procedure. Otherwise, recurrence of a stenosis or clogging in the unforeseeable future is inevitable.