Angioplasty of the leg arteries

Expert reviewer, Mr Alok Tiwari, Consultant Vascular and Endovascular Surgeon
Next review due August 2022

An angioplasty is a procedure that can be used to open up narrowed or blocked arteries (blood vessels) in your leg to improve blood flow. It’s one treatment option for a condition called peripheral arterial disease.

Angioplasties are also used for other parts of your body such as the arteries supplying your heart (coronary angioplasty) or your kidney (renal angioplasty). In this topic, we just describe what happens in an angioplasty of your leg arteries.

Image showing a blood vessel treated with balloon angioplasty and stent

About angioplasty of the leg arteries

An angioplasty is a minimally invasive or ‘keyhole’ procedure. This means it’s carried out through a very small incision (cut) in your skin. You may be offered it if you’re getting pains in your legs, particularly when you walk. This can be due to peripheral arterial disease – a condition in which the arteries in your legs narrow or become blocked. In the procedure, a doctor inserts a fine tube (sometimes called a catheter or sheath) into the affected artery using X-rays to guide it. The narrowed or blocked artery is then stretched and opened using a balloon, and sometimes a stent (a wire mesh tube). It’s usually done under local anaesthesia, which means you’ll be awake but shouldn’t feel any pain in the area. It may just feel slightly uncomfortable at times.

Your doctor will usually only recommend an angioplasty if you’ve tried other treatment options for peripheral arterial disease and you’re still having pains in your legs. Other options include measures such as stopping smoking, taking medicines to lower cholesterol and stop blood clotting, and completing an exercise programme. You'll usually be referred to a specialist, who will assess whether or not an angioplasty will help. They may ask you to have tests, including an ultrasound and an angiogram, to get a clear picture of the blood vessels in your legs.

If your doctor recommends that you have an angioplasty, they’ll go through exactly what’s involved with you – including what happens before, during and after the procedure. They’ll explain any risks involved and why they think an angioplasty would help you. If you’re happy to go ahead, you’ll need to give your consent by signing a form.

Preparing for angioplasty of the leg arteries

Your doctor will explain how to prepare for your angioplasty. This may involve stopping taking certain medicines for a set amount of time before your procedure. Your doctor will tell you about this. You should tell your doctor if you know you’re allergic to anaesthetics or iodine or any other X-ray dye. You should also let them know about any other recent illnesses or medical conditions you’ve had or if there’s any possibility you might be pregnant.

You’ll need to come in for a pre-admission appointment, a few weeks before the procedure, to check that you’re fit and well enough to go ahead. This is a good opportunity to ask any final questions you may have.

Often, you can go home the same day as having an angioplasty, but there’s a chance you may need to stay in hospital overnight. If this is the case for you, you should be told in advance so you can make the necessary preparations. You might be asked to stop eating and drinking for several hours before the procedure. But follow any advice given to you by your hospital. You should still be able to drink water.

What happens during angioplasty of the leg arteries?

Angioplasty usually takes about 30 to 45 minutes to perform, but it can be longer depending on how complex your procedure is. It might be carried out by a radiologist (a doctor who carries out procedures using X-rays) or a vascular surgeon.

You’ll be asked to lie on an examination table. You may be connected to various monitors, to keep track of your heart rate, blood pressure and pulse during the procedure. You may be offered a sedative to help you relax during the procedure. This will be given via a drip into a vein in your hand or arm.

Your doctor will clean the area of skin where they’ll be accessing your artery (usually your groin) and numb it with local anaesthetic. They’ll then make a small cut, and place a small tube into your artery. They’ll inject a dye (called contrast medium) into the tube. This will show up the narrowing or blockages in the blood vessels in your leg on X-ray images. You shouldn't feel the tube inside your blood vessels, but you might feel a warm sensation when they inject the dye.

Your doctor will then pass a wire and a catheter with a balloon on the tip through the tube to the blocked or narrowed part of your artery. Once it’s in place, they’ll inflate the balloon to stretch your artery. This might feel a bit uncomfortable but it shouldn’t be painful. The balloon will be deflated after a minute or two, before being removed. Sometimes, your doctor may insert a very small wire mesh tube called a stent in your artery to keep it open.

At the end of the procedure, your doctor will check if it’s worked by taking some more images of your blood vessels. They will then remove the wire, catheter and balloon. Your doctor or nurse will apply pressure to the area where the catheter was inserted for several minutes, until any bleeding stops. Sometimes, they might use a ‘plug’ to seal the hole in your artery.

What to expect afterwards

After your angioplasty procedure, you'll need to lie flat in bed for a while – sometimes for several hours. This is to stop the artery from bleeding again.

It’s likely to feel a bit sore around the area where the tube was inserted, and you may have some bruising. You can take painkillers to manage this. It’s possible that you’ll need to stay in hospital overnight but most people go home the same day as the procedure.

Before you go home, you may be prescribed some medicines to help prevent blood clots. Your doctor will usually discuss the results of the treatment with you before you go home. You may also be given a date for a follow-up appointment.

When you’re ready to go home, you’ll need someone to take you. If you’ve had a sedative, you might find that you’re not so co-ordinated or that it’s difficult to think clearly for the first 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or make any important decisions. It’s a good idea to have someone to stay with you overnight while you recover.

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Recovering from angioplasty of the leg arteries

You’ll need to take it easy for the first 24 hours when you get home. Make sure you rest and drink plenty of fluids. You shouldn’t lift anything heavy or do any strenuous exercise at first. Check with your doctor for how long, and when you can get back to your usual activities such as driving and returning to work.

Contact the hospital if you have any concerns about your leg when you get home. For instance, if it becomes red and swollen, it might be a sign of an infection. If your leg becomes cold, pale, painful or numb or you can’t move your leg, it could be a sign that the blood supply to your leg has become blocked. Contact the hospital urgently or call an ambulance if this happens. See the complications section for more information.

It’s possible that your artery may become narrowed or blocked again after the procedure. This is known as restenosis or reocclusion. You may need to have another angioplasty, or a bypass procedure instead, if this happens. It’s really important to make some lifestyle changes after your operation, to reduce the risk of your arteries getting narrowed or blocked again. See our FAQ: Will angioplasty cure my peripheral arterial disease?

Complications of angioplasty of the leg arteries

As with any procedure, there is a risk of complications associated with angioplasty of the leg arteries. Complications are problems that may occur during or after the angioplasty. Although they’re rare, possible complications are listed below.

  • The hole made in your artery may bleed, and blood may collect here (this is called a haematoma). On rare occasions, you may need an operation to remove the haematoma and repair the artery.
  • The artery that’s being treated can be damaged or torn during the procedure. There might be significant bleeding from your artery, or sometimes a clot may form, blocking the artery. This is very rare, but if it happens, you may need to have an operation to repair your artery.
  • It’s possible for your artery to become completely blocked during or soon after the procedure. If this happens, you will need another procedure to re-open the artery.
  • You might have an allergic reaction to the dye used during the procedure. For most people, this is just a minor reaction, but very rarely it could be a more severe reaction that will require urgent treatment.
  • The site where the catheter was inserted may become infected. Signs of an infection include your leg becoming red and swollen, and possibly a foul-smelling discharge or bleeding from the puncture site. Seek urgent medical advice if this happens.
  • It’s possible for the wires and tubes used in the procedure to dislodge fragments of the blockage as they’re being passed through. You may need another procedure to remove these fragments.

Frequently asked questions

  • An angioplasty opens up your arteries and improves blood supply to your legs. But it isn’t a cure for peripheral arterial disease – the underlying condition that caused the blockage. If fatty deposits continue to build up, it’s possible that they’ll cause more blockages in the future. But there are lots of things you can do to reduce the risk of needing more treatment. These include the following.

    • If you smoke, it’s really important to stop. If you need help giving up, ask a pharmacist or your GP for advice.
    • Eat a healthy, balanced diet, low in saturated fat.
    • Keep active. Choose something you enjoy and build activity into your day-to-day life.
    • Aim to keep to a healthy weight.
    • Take any medicines you have been prescribed to reduce your cholesterol and prevent blood clots.

    If you have high blood pressure or high cholesterol, taking medication to manage it will help to reduce the narrowing and furring up of your arteries. Your GP will be able to support you with this.

  • If you don’t have any complications from an angioplasty, you should be able to fly about a week to two weeks after your procedure. But check with the doctor carrying out the procedure before you make any travel plans. It’s also a good idea to speak to your travel insurance company.

  • An angioplasty usually works very well in treating the blocked artery. If the initial procedure to stretch your artery doesn’t work, your doctor may discuss trying again, but this time using a stent to keep it open. This is successful for most people.

    If angioplasty doesn’t work for you or your arteries keep becoming narrowed or blocked, your doctor may suggest you have bypass surgery. This is an operation to make your blood flow around the narrowed area of your artery, instead of through it. Your doctor will do this by attaching a new vessel to your artery just above and below the blocked area. They may use a vein from the same leg, or an artificial blood vessel. Your doctor will go through everything in detail with you and answer any questions you may have.

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Related information

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    • Peripheral vascular stent insertion. Medscape., updated 19 January 2018
    • Peripheral arterial disease: diagnosis and management. National Institute for Health and Care Excellence (NICE), August 2012.
    • Angioplasty and stenting. Vascular Society., accessed 28 February 2019
    • Angioplasty and vascular stenting. Radiological Society of North America., reviewed 10 April 2018
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    • Sedation explained. Royal College of Anaesthetists, 2018.
    • Angiography. MSD manuals., last full review/revision January 2015
    • Personal communication, Mr Alok Tiwari, Consultant Vascular and Endovascular Surgeon, 7 August 2019
    • Information for Health Professionals on assessing fitness to fly. Surgical conditions. Civil Aviation Authority., accessed 1 March 2019
    • Femoropopliteal and femorodistal bypass. Circulation Foundation., last accessed 1 March 2019
  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2019
    Expert reviewer, Mr Alok Tiwari, Consultant Vascular and Endovascular Surgeon
    Next review due August 2022