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, in routine clinical practice, peripheral artery disease refers 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) – the accumulation of fat particles on the lining of the lumen

Calcium and other substances in blood attach to plaques, resulting in the 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. They include but are 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 accumulate in peripheral arteries for 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 if the risk factors are not eliminated. As a result, a condition called atherosclerosis develops, resulting in the narrowing of peripheral arteries followed by complete blockage. In the early stages, peripheral artery diseases may be asymptomatic or cause 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 suggesting 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; the pain and muscle stiffness regress and even disappear after several minutes of rest. This sign of peripheral artery disease is referred to as claudication. Peripheral angiography involves locating the stenotic or clogged segment, removing the plaque that causes the narrowing or clogging, and placing 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

All necessary instruments, equipment, and other means to manage the possible risks and complications are available in the peripheral angiography suite.
Although all possible measures that modern medicine allows are taken to prevent the occurrence of risks, it is by no means likely to warrant that the risks will be eliminated.
Our specialists will employ all practices to minimize the risk of complications, and our doctors will preoperatively inform you about the risks listed above and all other potential complications and will address all your concerns.

Preparation

Several comprehensive examinations are required to decide whether peripheral angiography is indicated.
Before the procedure, your health history is reviewed, and a comprehensive physical examination is done to evaluate all your vital signs (pulse, heart rate, breath rate, core temperature, etc.).

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 are determined. If deemed necessary by your doctor, CT or MR Angiography is scanned for a more detailed evaluation of arterial structures.
Assessment by anesthesiologists 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 you should take on the day of the procedure. Besides, it would help to tell your doctor about all over-the-counter medications, herbal products, and vitamin and mineral supplements.

Since the contrast agent is used for the imaging phase of the procedure, your 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 to better manage the postoperative period.
During surgery and the early postoperative period, you are transferred to the suite for the procedure, and you will be positioned on the procedure table. Mobile imaging devices 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 an ECG, pulse oximeter, and anesthesia monitor.

A small incision is made after local anesthesia is administered to the puncture site. An artery of your groin/leg or arm is most commonly preferred. After a guide wire is inserted into the artery, a catheter is advanced over this guide wire. A contrast agent delivered through the catheter helps locate 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 the recurrence of the blockage.

If it is decided to insert a stent, the stent found in the 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. The procedure is completed after the catheter is removed and the small incision is stitched. Suppose your doctor decides your condition cannot be treated with an angiographic method. The procedure is terminated in that case, and other 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.

Mainly, 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 peripheral angiography is entirely related to your health status. If there is no abnormality, you will usually be discharged on 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 a stent. Thus, the symptoms caused by the blocked blood flow are relieved or disappear. However, since the stenosis or clogging is caused by risk factors, including but not limited to smoking, high blood pressure, high blood lipids, cholesterol, diabetes mellitus, and unhealthy nutrition, these risk factors should be eliminated or reduced after the procedure. Otherwise, the recurrence of a stenosis or clogging in the unforeseeable future is inevitable.