We have heard the term many times, the "cardiovascular system." It is a subject that is a mainstay among our health and biology courses throughout our formative education years. Yet even though we studied this vital system, its diseases and possible treatments can still be a source of confusion.
The label “cardiovascular" usually has us gravitating toward the first part of the word and what it references, the heart. However, while we have become quite familiar with coronary diseases, the vascular system is not as well understood.
Arterial stents are placed after an angioplasty procedure. The stent is a metal mesh tube to open arteries for better blood flow.
What is the Vascular System?
The vascular system, also known as the circulatory system, is the highly complex network of vessels throughout the body that act as the conduit to transfer oxygen and nutrient-rich blood to the tissues while carrying waste products out and away from the cells.
The arteries act as the delivery apparatus, carrying blood from the heart to all parts of the body. The veins transfer blood back to the heart and lungs to dispel waste and then be enriched with oxygen to renew the process once again. Beyond delivering oxygen and nutrients and the excretion of waste, the vascular system also plays a crucial role in regulating body temperature.
Like many intricate biological functions, the vascular system can affect different parts of the body in a vast array of ways. Adding to this complexity is the vastness of the network and the locations of arteries and veins. Their location also plays a central role in the effects of a disease and how it impacts one’s health.
What is Peripheral Artery Disease and Its Symptoms?
Peripheral artery disease (PAD) is a vascular disease that affects the blood flow specifically to the extremities, usually the legs. The Center for Disease Control estimates that between 12 to 20% of people over the age of 60 have some form of PAD, and is the most common of the arterial diseases.
Frequently occurring signs are numbness and cramping, coldness in the lower leg and foot, soreness in the toes and ankles, discoloration of the skin, hair loss in the lower extremities, and a weakening or loss of pulse in the lower extremities. These conditions can be progressive, meaning, over time, they can increase in severity.
As the disease evolves, the discomfort may cease being solely related to movement and may start appearing while at rest. Known as ischemic pain, it can result in sores and ulcers to the lower legs and feet. If showing any of these symptoms, it is essential to seek out a PAD specialist immediately.
Treatments: What is Arterial Stent?
The focus of treatment in PAD or vascular disease cases is to remove the blockage and restore blood flow to the affected area. The procedure to clear the blockage is known as an angioplasty. In most cases, this is done through the insertion of a wire into the blood vessel until it reaches the blockage site.
A deflated balloon, via the wire, is introduced to the affected area and then inflated to open the vessel and restore blood flow. Then the balloon is removed.
If the artery remains partially blocked after removing the balloon, a metal stent or scaffold is placed in the area to ensure a healthy flow of blood. The collapsed stent is placed over the wire or catheter and then moved into the partially blocked region.
Once in the appropriate area, the stent is then opened and detached from the catheter, keeping the artery walls from closing to allow the desired blood flow and prevent future blockages from occurring. The process may need only one stent or require multiple ones, depending on the blockage's size and length.
What to Expect During an Arterial Stent Procedure
What to expect?
Preoperative Clinical instructions
Detailed history needs to be obtained:
- Previous malignant disease
- Previous surgical history including history of venous catheterization or trauma
- Previous history of radiation
- Family history of venous disease
Careful physical examination is mandatory
- Pulses in affected extremity
- Diameter discrepancy between affected/unaffected extremity
- Ulcerations or skin changes
- Various examinations to rule out any other possible vascular conditions.
What to expect during this procedure?
This is a minimally invasive outpatient procedure requiring no hospital stay with a short recovery period. Most procedures allow patients to return to normal activity within a few days.
Medicine will be administered through an IV to keep you comfortable but awake. Local anesthetic is usually given in the groin area where a needle will be inserted. The catheter is threaded through this needle. You will feel brief pain when the needle breaks the skin, but the passage of the catheter through the blood vessel is painless.
During the Angiogram procedure you will be asked to stay still and not move so that the images that are taken will be clear.
The dye allows the doctor to view your arteries on an X-ray monitor. A device with a small balloon on its tip is then inserted through an artery in your leg or arm and threaded through the arteries until it reaches the desired area. The balloon is inflated to flatten the plaque against the wall of the artery, opening the artery and restoring blood flow. Then the balloon is deflated and removed from your body.
Lower level anesthesia: Patients receive minimal anesthesia delivery under constant monitoring.
Arterial stent procedures are usually used along with balloon angioplasty.
When doctors see the artery into which the catheter will go, a special needle is used to penetrate it. Doctors usually put the catheter into an artery in your leg, arm, or wrist. Many doctors use the artery in the leg; however, radial artery access (through the wrist) is becoming common practice. You should not feel pain during this part of the procedure.
Doctors gently thread the catheter through the artery and into your lower extremities. Once the catheter reaches the blocked artery, a harmless dye is injected, and the doctor will take a picture of the arteries, called an angiogram. The angiogram helps the doctor see the size and location of the blockage.
Once doctors know the exact location of the blockage, they thread what is called a guidewire through the same artery in the leg and advance it across the blockage. Then, the balloon-tipped catheter is slipped over the guidewire and advanced to the blockage. When this catheter reaches the blockage, the balloon is inflated. As the balloon expands, it presses against the plaque, compressing it against the artery wall. The balloon is then deflated. Doctors may inflate and deflate the balloon a number of times. The catheter, guidewire, and deflated balloon are then removed.
If doctors are placing a stent in the artery, the stent is put at the tip of the catheter, over the balloon. When the catheter is positioned at the blockage, the balloon is inflated, expanding the stent. Once the stent is open, the balloon is deflated. The catheter, guidewire, and deflated balloon are then removed, leaving the stent behind to hold the artery open.
Firm pressure will be applied to the site where the catheter was inserted to stop any bleeding. You will also be bandaged.
Refrain from any heavy lifting (i.e. no more than 10 pounts), straining, pushing or impact exercises (i.e. running, jogging, cycling) for the first 3 days. You may walk, climb steps and even drive, so long as you do not have excessive bruising, swelling or pain at the puncture site.
You will be discharged with a dressing over the puncture site. This may be removed the next morning. Please inspect the puncture site daily for the first few days and notify us for any significant changes. Bruising around the area may be present. If you notice bleeding, swelling, or increase in bruising apply constant direct pressure over the area and seek medical attention IMMEDIATELY.
Refrain from soaking in a bathtub or hot-tub or pool until puncture is healed.
Benefits of Angioplasty with CVM
Minimally invasive procedure that requires no hospital stay with a short recovery period. This means most procedures allow patients to return to normal activity within a few days. Other benefits includes:
- Smaller incisions
- Less pain
- Minimal to no scars
- Less blood loss
- Lower rate of complications
Risks of Endovascular Procedures
Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. The chance of any of these events occurring is less than one percent.
Allergy to X-ray Contrast Material
Patients may have an allergic reaction to the x-ray contrast material used during endovascular procedures. THese episodes range from mild itching to severe reactions that can affect breathing or blood pressure. Patients having procedures are carefully monitored by a physician and a nurse during the procedure.
Endovascular procedures are done under x-ray. Exposure levels usually are well below those where adverse effects on the patient or future children would be a concern.
Potential Adverse Effects on the Kidneys
Patients with a history of poor kidney functions are at higher risk of further damage. Blood work will be drawn to help identify patients at risk and levels will be monitored accordingly. IV fluids will also be given during and after the procedure to dilute the dye and filter the dye through the kidneys. In very rare cases additional medication may need to be given.
Medications to avoid
Outside of certain blood thinning agents, most medications can be continued immediately following your procedure. Medications such as Coumadin (Warfarin) and injectable Heparin/Lovenox are potent blood thinners that can cause delayed bleeding from teh puncture site. We usually ask that these blood thinners be held for 1-2 days following the procedure, we will specify when to begin use of these medications.
If you take aspirin, Plavix or Aggrenox, you may continue use of these medications so long as there are no signs of delayed bleeding or swelling at the puncture site.
The Importance of a Specialist
Suppose you are experiencing any of the symptoms of PAD. In that case, you must seek out a specialist who understands and has expertise in diagnosing and treating peripheral vascular diseases.
This specific type of affliction of the lower extremities has special conditions and needs different from those experienced in other parts of the body. A doctor who is a specialist in angioplasty techniques, including catheter and stent placement in the legs and pelvic region, is imperative in getting the best results.
The sooner you address the symptoms you are experiencing; the more effective your treatment will be. Fortunately, consulting an expert at the Center for Vascular Medicine can get the answers you seek and the treatment you need to improve your quality of life.