Balloon dilation (PTA)

Overview of balloon dilation

Percutaneous transluminal angioplasty (PTA) is a procedure used to expand blocked or constricted (stenosed) arteries caused by vascular calcification (arteriosclerosis). These constrictions are usually caused by fats or calcium (plaques) depositing in the arteries, which can impede blood circulation and cause serious health problems. Balloon dilation involves the use of a catheter to insert a balloon into the vessel and expand the constricted area (balloon dilation). The procedure is often performed in combination with the insertion of a stent implant, which keeps the blood vessel open permanently and reduces the risk of renewed constriction.

When percutaneous transluminal angioplasty (PTA) is used to treat a coronary heart disease (CHD), this is referred to as percutaneous transluminal coronary angioplasty (PTCA). If PTCA does not achieve its goal in coronary heart disease, for example due to complicated or heavily constricted vessels, a bypass operation is usually considered to restore blood circulation. You can find out more about this on the treatment page ‘Bypass operations’.

Outside of the coronary arteries, percutaneous transluminal angioplasty (PTA) is mainly used in  peripheral arterial occlusive disease (PAOD). Peripheral arterial occlusive disease results from arteriosclerotic constrictions of the leg arteries and is also known as ‘window shopper’s disease’. This name stems from the fact that patients can only walk for short distances due to the pain in their legs and constantly have to take a break. Similar to passers-by that stop outside every shop window.

Treatment goal of balloon dilation

The treatment goal of balloon dilation is to expand constricted or blocked blood vessels in order to restore blood flow and improve oxygen supply to the affected tissue. The stent is used to stabilise the vessel walls after expanding the artery, and to ensure that the artery remains open to minimise the risk of renewed closure (restenosis).

Treatment goal in CHD

In the case of coronary heart disease, balloon dilation can expand constricted coronary arteries and reduce the risk of severe complications such as a heart attack, cardiac insufficiencyor arrhythmias, relieve symptoms such as angina pectoris, and improve heart function.

Treatment goal in PAOD

In peripheral arterial occlusive disease (PAOD), balloon dilation can expand constricted or blocked peripheral arteries and improve blood flow to the affected limbs. This is intended to relieve symptoms such as pain when walking, extend walking distances and reduce the risk of severe complications like ulcers, tissue loss or amputation. Restoring the blood flow also increases the patient’s quality of life.

Treatment procedure

Before the angioplasty takes place, an angiography is performed with X-ray contrast medium in order to identify the precise location of the constricted areas. The injection of contrast medium can generate a feeling of warmth. If a PTCA is performed, blood tests and an electrocardiogram (ECG) are usually also carried out before the intervention.

Percutaneous angioplasty is usually performed while the patient is conscious, with gentle sedation. During this procedure, which was actually invented in Switzerland, a balloon catheter is inserted into an artery via an incision in the groin, or more rarely on the arm. The site of the incision is numbed using local anaesthesia. X-ray monitoring is used to push the balloon catheter into the constricted vessel. The movement of the catheter itself is a painless procedure. Once it has reached the site of the constriction, the balloon is stretched with liquid to expand the blocked vessel. Sometimes, the stretching of the balloon catheter results in some temporary localised pain.

In some cases, a medication-releasing balloon catheter is also used, where the balloon is coated with a medication that is applied to the site of the vascular constriction during the balloon dilation procedure and prevents growth of the cells on the internal vascular wall.

At the same time or afterwards, a fine, flexible metal or plastic mesh tube known as a stent or vascular support is usually placed inside the vessel to support it and keep it open longer term. The stent is often coated with medication that prevents the unwanted new formation of cells that could block the stent implant again.

The procedure takes around one to two hours, with the patient generally able to leave hospital at the latest one day after the intervention.

Preparation and precautions

No extensive preparations tend to be needed before the treatment. However, it is recommended that patients avoid eating several hours before the intervention and only drink small amounts of liquid. Most medications can continue to be taken as normal, but blood-thinning medication should be temporarily stopped after consultation with your doctor. In diabetics, doses of insulin and medication for blood sugar regulation should be adjusted beforehand by a doctor. Patients with advanced renal insufficiency or allergies may require special preparation under medical supervision.

Aftercare and recovery

You should strictly follow a healthy lifestyle in order to keep the progression of arteriosclerosis as slow as possible. This includes:

• A balanced and healthy diet
• Regular exercise
• Quitting smoking

After a balloon angioplasty or stent placement, you should be able to resume all normal daily activities after a week. A few more weeks are needed before you will have reached full performance again for heavier tasks.

The success rate of transluminal angioplasty is very high and lies between 85–95%. Sometimes, scarring in the vessel results in renewed stenosis in the same area a few months later. If this is the case, the intervention can be repeated without any issues.

Potential complications or risks

Both PTA and PTCA are usually without complications and are considered low-risk procedures. While the potential complications of the two interventions are similar, there are a few differences as different vascular regions are treated. The potential complications they share include:

• Vascular injuries
• Blood clots (thrombosis)
• Restenosis (renewed constriction)
• Bleeding
• Infections

Specific complications with PTA

In rare cases, PTA can cause an acute circulatory disorder in the treated limbs. Particularly with advanced PAOD, complications can occur, which can necessitate an amputation in the worst case.

Specific complications with PTCA

In rare cases, the balloon catheter cannot be pushed through the constricted area, or vascular closure can occur during the treatment, which can trigger a heart attack. Should this rare situation arise, an immediate bypass operation is performed.