Percutaneous transluminal angioplasty is a procedure in which arteries that are blocked or narrowed (stenosed) by vascular calcification are widened. In the process, a balloon is inserted into the vein with a catheter and the narrowed portion is widened with the balloon (balloon dilation). The procedure conducted on coronary arteries is known as percutaneous transluminal coronary angioplasty and will be explained in detail in the chapter entitled Operations on coronary arteries.
Outside the coronary arteries, percutaneous transluminal angioplasty is used primarily in the case of peripheral artery occlusion disease. Peripheral artery occlusion disease is the result of arteriosclerotic narrowing of the leg arteries, and is also known as intermittent claudication. It received this name because the affected parties can only walk short stretches and take constant breaks, similar to pedestrians who are standing before a display window.
What preparations are carried out before the procedure?
An angiograph with x-ray contrast agent is carried out before the angioplasty to locate the narrowed coronary arteries. The patient must stop taking blood-thinning medication beforehand, and they should be sober for the procedure.
How is the operation performed?
The operation is usually performed under local anaesthetic. After local anaesthetic, the artery, generally in the groin, is punctured and a small tube is inserted. This enables the catheter to be inserted into the artery. The catheter is then inserted using the balloon all the way through to the constricted point under fluoroscopic imaging. Once it has reached the narrowed section, the balloon is inflated and the narrowed section thereby widened. If necessary, a stent is then inserted to stabilise the widened section. Apart from the prick for the anaesthesia, the operation is painless. The injection of the contrast agent used to identify the vessels may cause a warm sensation. The procedure takes one to two hours. Afterwards, a pressure bandage is applied for a few hours. The patient can leave the hospital on the same day as the operation.
What is the success rate of this procedure?
The success rate of transluminal angioplasty is very good – between 85 and 95%. Sometimes there is renewed stenosis in the same section as a result of scar formation in the artery after a few months. If this occurs, the procedure can be repeated without difficulty.
What are the possible complications and risks of this procedure?
This procedure is low-risk and usually complication-free. In rare cases, it can result in injuries to the arterial wall or detachment of deposits, which can cause vascular construction. A bypass operation is sometimes necessary in such cases to restore the blood flow.
What happens after the operation?
People who have undergone this operation should avoid major physical exertion in the first few days afterwards. Regular check-ups are foreseen in the first few months. Treatment of the arteriosclerosis or the underlying illness which has caused the arteriosclerosis must be continued. General lifestyle changes, such as stopping smoking, weight loss, healthy nutrition and sufficient physical movement are important, concomitant treatment measures.
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