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Angioplasty of the leg arteries

Angioplasty is a procedure used to open narrowed or blocked blood vessels called arteries.

You will meet the radiologist carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Angioplasty of the leg arteries is a procedure used to unblock the arteries in your legs to allow blood to flow more freely. It can help treat a condition called peripheral arterial disease.

An angioplasty is done by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions).

Image showing a blood vessel treated with balloon angioplasty and stent

Details

  • Preparation Preparing for angioplasty of the leg arteries

    Your radiologist will explain how to prepare for your angioplasty. For example, if you smoke, you will be asked to stop. Smoking increases your risk of the artery blocking again and slows your recovery.

    Angioplasty is usually done under local anaesthesia. You will have an injection of local anaesthetic in the area where the needle will be inserted, usually in your groin. This completely blocks pain in the area and you will stay awake during the procedure. You may also be offered a sedative, which will help you to relax.

    If you're having an angioplasty, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about four to six hours beforehand. However, it’s important to follow your radiologist’s advice.

    Your nurse may check your heart rate and blood pressure before and during the procedure. The procedure is usually done through a large artery in your groin. Therefore, you may be asked to shave the area where the needle will be inserted. It’s important that you don’t shave this area unless you are asked to do so.

    Your radiologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.Tell your radiologist before the procedure if you know that you’re allergic to iodine or X-ray dye.

  • Alternatives What are the alternatives to angioplasty?

    Symptoms of peripheral arterial disease can often be reduced by antiplatelet drugs, such as statins, or an exercise programme. You will only be offered an angioplasty if your symptoms are severe, and other treatments don’t work or aren’t suitable for you.

    If an angioplasty doesn’t work or isn’t suitable for you, you may need to have bypass surgery. This is an operation to make your blood flow around the blocked artery instead of through it. The operation involves attaching a graft artery to your blood vessel above and below the blocked area.

    If you decide not to have angioplasty or bypass surgery, your doctor may prescribe you medicines.

  • The procedure What happens during angioplasty of the leg arteries?

    Angioplasty usually takes between 30 and 60 minutes. It's typically done in the X-ray department of a hospital.

    Your radiologist will make a small cut in your groin and thread a thin flexible tube (called a catheter) into an artery in your groin. They will inject a special dye (called contrast medium) into the catheter. This helps to show any narrowing or blockages in the blood vessels in your leg. You shouldn't feel the catheter inside your blood vessels, but you may feel a warm sensation when the contrast medium is injected.

    Using live X-ray pictures, your radiologist will guide the catheter to the blocked artery. Your radiologist will then pass a thin wire with a balloon on the tip through the blocked or narrowed part of your artery. Once it’s in place, he or she will inflate the balloon. It may be inflated more than once to make sure your artery is open and allows blood to flow more easily.

    Sometimes, a very small wire mesh tube (called a stent) is used to keep your artery open. A collapsed stent is inserted along with the balloon. When the balloon is inflated the stent expands to fit against your artery walls. The balloon is deflated and removed, leaving the opened stent in place.

    Stents are usually made of metal (known as bare-metal stents) and some have a drug coating on them (called drug-eluting stents). The drug is released slowly into your artery to stop it closing up again. Your radiologist will inform you about the the type of stent he or she is using.

    After the procedure, your radiologist will remove the balloon, guide wire and catheter.

    Your radiologist may use a collagen plug or similar device to seal the hole in your artery. Alternatively, he or she may press on the area for 10 minutes to make sure that the artery closes and any bleeding stops.

    The procedure shouldn't be painful, but may feel slightly uncomfortable.

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  • Aftercare What to expect afterwards

    You'll need to lie flat on the bed for the first hour after the procedure, and typically stay in bed for three hours to recover. However, your recovery time may be shorter if your radiologist is using a plug to stop the bleeding in your groin.

    Your nurse will check your blood pressure and pulse regularly. They will check the puncture area (where the catheter was inserted) to make sure there isn't any bleeding. You may also have a blood test.

    You may need to stay in hospital overnight. But you will probably be able to go home the same day as the procedure.

    You will need to arrange for someone to drive you home. Make sure you have a friend or relative stay with you for the first 24 hours.

    If you have had a sedative, it will temporarily affect your co-ordination and reasoning skills. Therefore, you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer, so that you're aware of their recommendations, and always follow your doctor's advice.

    Your doctor may prescribe medicines to help prevent clots forming on your stent.

    Your nurse will give you some advice before you go home. This may include information about:

    • medicines, such as those that help to stop blood clots forming around the stent
    • how you can improve your diet and lifestyle

    You may also be given a date for a follow-up appointment.

  • Recovery Recovering from angioplasty of the leg arteries

    If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Depending on the type of work you do, you may be able to return to work after a few days.
    You shouldn't lift anything heavy for the first week after your angioplasty. You can usually shower 24 hours after your procedure, but you shouldn’t have a bath for at least a few days.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with angioplasty of the leg arteries. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted, but mostly temporary effects you may get after having the procedure.

    You may have some bruising around your groin where the catheter was inserted. If you have any redness, swelling or widespread bruising when you get home, contact the X-ray department where you had the procedure or your GP.

    Complications

    Complications are when problems occur during or after the angioplasty.

    Specific complications of angioplasty are rare, but possible complications are listed below.

    • Bleeding from your wound can sometimes be severe. If this happens, you may need to have a small operation to repair the artery.
    • Arteries treated with a stent can become narrow again. This is called restenosis. This is more likely to happen in the first few months after the procedure, when the cells covering the stent grow too quickly. If this happens, you may need to have another angioplasty.
    • You might have an allergic reaction to the dye used during the procedure. This could be a rash, or it could be a more severe reaction, which causes swelling and can affect your breathing. Your doctor will treat this quickly if it happens.
    • Your artery may become completely blocked during or soon after the procedure. You may need to have the angioplasty done again.
    • The tip of the catheter can dislodge a clot of blood or fatty material from the wall of a blood vessel.
    • The blood vessel being treated can be torn during the procedure. This may need an operation to repair it.
  • FAQs FAQs

    How can I reduce my risk of my blood vessels narrowing after an angioplasty?

    Answer

    The best way to improve the blood flow in your body and reduce your risk of your blood vessels narrowing is to lead a healthier lifestyle and keep active.

    Explanation

    An angioplasty opens up your arteries and improves blood supply to your legs, but it isn’t a cure for peripheral arterial disease. It can’t stop the build up of more fatty deposits in the future.

    However, there are many things you can do that will help to keep your blood vessels healthy.

    • Quit smoking. If you need help giving up, ask a pharmacist or your GP for advice.
    • Keep physically active. Choose something you enjoy and build activity into your day-to-day life, such as walking to the shops and taking the stairs instead of the lift.
    • Maintain a healthy weight and eat a healthy, balanced diet. Eat at least five portions of fruit and vegetables a day. Eat foods that are low in fat and salt, and have two portions of fish a week (one of them an oily fish, for example, salmon or mackerel).

    If you have long-term conditions, such as high blood pressure or diabetes, managing them correctly will help to reduce your risk of blood clots forming.

    Is it safe for me to exercise after having leg angioplasty?

    Answer

    Yes, but it's best to take things easy for the first few days after your angioplasty. After that, you can gradually increase the amount of activity you do. Your doctor will be able to tell you how much to do.

    Explanation

    Regular exercise is not only safe to do after an angioplasty, but also very important, helping to improve the blood flow in your legs.

    You should spend the first few days after your angioplasty resting and doing gentle activity only, such as gentle walking or going up and down the stairs. After a few days, you can gradually build up the amount of activity you do and aim to do a little bit more each day.

    Walking is a great way to do this and you can build up the distance you walk as the days go by. After a few weeks, you might want to try riding a bike or going for a gentle jog.

    A nurse, physiotherapist or exercise specialist can design an exercise programme for you, which will help to improve your fitness and health.

    How soon can I fly after having a leg angioplasty?

    Answer

    You can fly two days after your procedure. But it’s important that you get medical advice before making any travel plans.

    Explanation

    If you have angioplasty of the legs and don’t have any complications, you can fly two days after your procedure. However, it’s important that you talk to your doctor before you fly so that you’re aware of your risk of developing a blood clot. It’s also a good idea to speak to the company you have travel insurance with.

    There are steps you can take to reduce your risk of developing a blood clot in your legs. These include the following.

    • Take short walks – walk up and down the aisle of the plane.
    • Regularly bend and straighten your toes, ankles and legs to help improve the blood flow in your legs.
    • Wear loose-fitting clothes.
    • Keep hydrated by making sure you drink enough water.
    • Don’t drink too much alcohol.
    • Wear compression stockings.

    If you develop swelling or pain in your calf or thigh during, or within a few days after your flight, seek urgent medical attention. Likewise, if you have breathing problems or chest pain after travelling, see a medical professional as soon as possible.

    What happens if angioplasty doesn’t work?

    Answer

    An angioplasty is usually very successful at reducing your symptoms and improving blood flow in your legs. But this varies depending on how severe the narrowing or blockage of your artery is. If angioplasty doesn’t work for you, your surgeon may suggest bypass surgery.

    Explanation

    An angioplasty is generally very successful at reducing your symptoms and improving blood flow in your legs. However, it does vary depending on the severity of peripheral arterial disease. An angioplasty isn’t suitable if the narrowed section of your artery is too long, or if the artery is severely hardened.

    If an angioplasty isn’t suitable or doesn’t work for you, you may need to have artery bypass surgery to treat peripheral arterial disease instead. This is an operation to make your blood flow around the narrowed area of your artery, instead of through it. Your surgeon will do this by attaching a new blood vessel to your artery just above and below the blocked area. Your surgeon may use another vein taken from the same leg or an artificial blood vessel.

    For more information about bypass surgery, speak to your doctor.

  • Resources Resources

    Further information

    Sources

    • Angioplasty and stent. Circulation Foundation. www.circulationfoundation.org.uk, accessed 23 October 2013
    • Lower limb peripheral arterial disease: diagnosis and management. National Institute for Health and Care Excellence (NICE), August 2012. www.nice.org.uk
    • ESC guidelines on the diagnosis and treatment of peripheral artery diseases. European Heart J 2011; 32:2851–906. doi:10.1093/eurheartj/ehr211
    • Angioplasty and stenting. British Society of Interventional Radiology. www.bsir.org, accessed 23 October 2013
    • Diagnosis and management of peripheral arterial disease. Scottish Intercollegiate Guidelines Network (SIGN), October 2006. www.sign.ac.uk
    • Au TB, Golledge J, Walker PG, et al. Peripheral artery disease – diagnosis and management in general practice. Royal Australian College of General Practitioners 2013; 42(6):397–400
    • Guidelines for percutenous transluminal angioplasty. Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2003;14:S209–17 doi:10.1097/01.RVI.0000094586.83406.ac
    • Peripheral arterial disease – secondary care investigations. Management of intermittent claudication. Map of Medicine. www.mapofmedicine.com, published 11 June 2013
    • Recovery after an interventional procedure. The Society for Cardiovascular Angiography and Interventions. www.scai.org, accessed 24 October 2013
    • Angioplasty and stenting. Society for Vascular Surgery. www.vascularweb.org, accessed 24 October 2013
    • Pentecost MJ, Criqui MH, Gerald Dorros G, et al. Guidelines for peripheral percutaneous transluminal angioplasty of the abdominal aorta and lower extremity vessels. J Vasc Interv Radiol 2003; 14:S495–515
    • Fitness to fly for passengers with cardiovascular disease. Produced by British Cardiovascular Society. Heart 2010; 96:ii1-16. doi:10.1136/hrt.2010.20309
    • DVT prevention for travellers. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2013
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    Reviewed by Alice Rossiter, Bupa Health Information Team, January 2014.

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