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Transluminal angioplasty, commonly called balloon angioplasty, was introduced by two interventional radiologists in 1964 (Charles
Dotter, MD, and Melvin Judkins, MD). It uses special catheters that are passed through the inside (lumen) of a blood vessel to an area that is narrowed or blocked. Balloons that are located near the end of the catheter are then inflated to widen the artery and improve blood flow to an extremity or organ. Angioplasty can be used to treat nearly any symptoms that are related to poor blood flow (renal vascular hypertension, pain in an extremity with exercise, angina). It can also be used to prevent potentially life-threatening events
related to vascular disease such as stroke.
Who Is Eligible?
Most patients with severe narrowing or blockage in one or more blood vessels are good candidates for the procedure, although it depends on an individual's medical history as well as on the location and number of the blockages that are present. Often these can be determined noninvasively using ultrasound or other imaging techniques such as magnetic resonance (MRI) or computerized tomography (CT). Options for diagnosis and possible treatment can be discussed with interventional radiologists at Lahey Clinic.
What Are the Benefits?
Minimally invasive interventional procedures typically have less risk and lower cost associated with them when compared to vascular
surgery. There is no surgical incision - just a small nick in the skin - and patients receive local anesthesia rather than general so they remain awake. The greatest benefit to patients, however, is the faster recovery time and the great decrease in pain. Patients undergoing angioplasty may be out of the hospital in as little as one day, and are able to resume normal activities more quickly.
How Does It Work?
Prior to the procedure, your doctors will perform a brief physical examination and obtain a history of other associated diseases or
surgeries. You may need some additional tests, such as Doppler ultrasound, electrocardiogram (ECG) and/or blood tests. You will be asked not to eat or drink anything after midnight the evening before your procedure. Your Lahey interventional radiologist will talk to you in more detail about any other precautions, such as what to do if you are taking certain medications.
During the procedure, you will be given a mild sedative through an IV in your arm. You should feel drowsy and relaxed, but will remain alert enough to follow instructions and describe sensations. Devices that monitor your heart rate, blood pressure and the effectiveness of your breathing will also be attached to your body. Depending on which artery is being used, your groin or arm will be shaved and numbed with a local anesthetic, and then a small nick will be made in the skin for the interventional radiologist to insert a catheter (thin plastic tube). Angiography will be performed initially to locate and determine the severity of all the areas of narrowing in your arteries. Angiography is performed by injecting a contrast agent through the catheter into the blood
stream, which commonly causes a very mild sensation of warmth. The radiologist will use high-resolution angiographic X-ray equipment to carefully guide the angioplasty catheter to the site of the blockage, where the balloon will be precisely positioned across the narrowing. When it is inflated to open the vessel, there is generally very little, if any, sensation. The balloon is then
deflated and removed. Angiography is repeated to determine the result.
Vascular stenting is sometimes performed at the same time as balloon angioplasty. Because most arteries are somewhat elastic, dilatation using a balloon is not always as effective as desired. Julio Palmaz, MD, an interventional radiologist, developed vascular stents in the late 1980s. A stent is a small wire mesh tube that can be placed over the balloon and is expanded when the balloon is inflated. Once the balloon is deflated, the expanded stent remains in place and prevents the artery from renarrowing. Some of the newer stents are self-expanding and do not need a balloon to be inserted (a balloon is often used after these stents are placed to completely expand them). Eventually, the stents becomes incorporated into the wall of the artery. Stents cannot guarantee against the possibility of renarrowing of the arterial lumen, but chances of renarrowing are much less common than with balloon angioplasty alone. Interventional radiologists at Lahey were the first physicians in this country to use vascular stents, and have extensive experience with this procedure.
After the procedure, which typically takes anywhere from 45 minutes to three hours, you can expect to remain in bed for six hours. You will have to hold your leg or arm straight for several hours. Most patients go home the day after the procedure, and can usually resume normal activities within one or two days. You will be provided with detailed instructions and suggestions in terms of caring for yourself after the procedure.
For more information on balloon angioplasty and stenting, see our Health Encyclopedia.
