- Comprehensive assessment, including medical history, physical examination, and review of medications.
- Blood tests and other diagnostic tests to assess the patient’s overall health.
The harley street vascular
Angioplasty and stenting for Peripheral arterial disease
Our primary mission as Circulation Specialists is to help you achieve the healthiest circulation possible for your stage in life.
Whatever your lifestyle, genetic predisposition or individual health aspirations – Your Circulation is your Lifeline.
The harley street vascular
Introduction to Peripheral Arterial Disease
Peripheral Arterial Disease (PAD) is a common circulatory problem where narrowed arteries reduce blood flow to the limbs. This condition primarily affects the legs, leading to symptoms like leg pain when walking (claudication). Diabetes, smoking, high blood pressure and high blood cholesterol are common predisposing factors.
PAD is often caused by atherosclerosis, where fatty deposits build up in the arterial walls, reducing blood flow. Angioplasty and stenting are key treatments to restore blood flow and manage symptoms.
What are Angioplasty and Stenting?
Angioplasty and stenting are minimally invasive procedures designed to open narrowed or blocked arteries. They are primarily used in the treatment of Peripheral Arterial Disease (PAD), and are similar to the coronary angioplasty performed by cardiologists for coronary artery disease. This procedure is typically performed under local anaesthesia, using imaging techniques to guide the balloon and stent to the precise location.
Angioplasty involves inserting a tiny balloon into the affected artery, which is then inflated to widen the artery and restore blood flow. After the balloon is inflated, a stent, which is a small wire mesh tube, may be placed in the artery to help keep it open in the long term and prevent it from narrowing again.
Indications for Angioplasty and Stenting in Peripheral Arterial Disease
Angioplasty and stenting are considered for Peripheral Arterial Disease (PAD) patients based on specific clinical indications such as:
Symptomatic PAD
- Patients experience leg pain while walking or at rest that has a significant effect on their daily lifestyle or activities.
- Those with limb-threatening ischemia are marked by pain at rest, non-healing wounds, or gangrene.
Severe Artery Narrowing or Blockage
- Identified through diagnostic imaging and testing.
- Particularly when lifestyle changes and medication do not improve symptoms.
Chronic Limb Threatening Ischemia (CLTI)
- A severe form of PAD where there is a significant risk of limb loss.
- Patients with CLTI often have a poor prognosis without intervention.
Failure of Conservative Treatments
- When lifestyle modifications, exercise, and medication fail to manage PAD symptoms effectively.
Risk of PAD Complications
- People at high risk of PAD complications, including limb loss from an amputation, recurrent leg ulcers or persistent pain at rest, may benefit from proactive intervention.
Pre-Procedure Preparation
Effective preparation for angioplasty and stenting ensures the safety and success of the procedure. Patients are given specific instructions to follow:
Medical Evaluation
Medication Adjustment
- Possible adjustment of current medications, including blood thinners.
- Instructions on medication pauses or particular pre-procedure medications.
Fasting
- Patients are typically required to fast for a certain period before the procedure.
Allergy Precautions
- Assessment for allergies, particularly to contrast dye or iodine, which may be used in imaging during the procedure.
The Procedure: A Step-by-Step Guide
The angioplasty and stenting procedure for Peripheral Arterial Disease (PAD) involves several key steps, performed usually under local anaesthesia with the patient awake:
1. Accessing the Artery
A small incision is made, usually in the groin, to access the artery. A catheter is then inserted through this incision into the affected artery.
2. Guiding the Angioplasty Catheter
The catheter, with a deflated balloon at its tip, is guided to the narrowed section of the artery using imaging techniques.
3. Inflating the Balloon
Once in position, the balloon is inflated to widen the artery by pushing the plaque against the artery walls.
4. Stenting
If a stent is to be placed, it is done so after or during balloon inflation, deploying the stent to keep the artery open.
5. Final Checks and Closure
Imaging ensures the artery is open and blood flow is restored. The catheter is removed, and the incision is closed and a simple dressing applied.
Post-Procedure Care and Monitoring
After angioplasty and stenting, proper care and monitoring ensure a successful recovery and minimise the risk of complications.
- Immediate Post-Procedure Care
Patients are monitored for several hours to ensure there are no immediate complications. - Activity Restrictions
Physical activities are limited for a short period post-procedure and a gradual return to normal activities. - Medication
Antiplatelet or anticoagulant medications are often prescribed to prevent blood clots within the stent. - Follow-Up Appointments
Scheduled to monitor the success of the procedure and the patient’s overall health. This may include imaging tests to ensure the stent remains open.
Risks and Complications
While angioplasty and stenting are generally safe, they carry potential risks and complications:
- Bleeding at the catheter insertion site.
- Infection at the incision site.
- Damage to the artery by the catheter or balloon.
- Blood clots or artery blockage near the stent.
- Kidney damage from contrast dye is rare but can occur, particularly in patients with pre-existing kidney issues.
- Stroke, although this is a rare outcome.
- Restenosis, where the artery narrows again, possibly requires another procedure.
- Stent thrombosis is a rare but serious condition where a clot forms inside the stent, and may require urgent re-intervention.
Frequently Asked Questions
What is the recovery time for angioplasty and stenting?
Recovery times can vary, but many patients return to normal activities within a week. Complete recovery and the resumption of more strenuous activities might take several weeks.
Can I travel after having an angioplasty and stenting?
Patients are generally advised to wait for a certain period before flying or undertaking long journeys, typically discussed during post-procedure follow-ups.
How long do stents last?
Stents are designed to be permanent fixtures. However, some new stents called bio-vascular scaffolds are now available that will be absorbed over time so that no implant is left behind in the longer term. However, the longevity of their effectiveness varies based on patient-specific factors and lifestyle choices.
How often will I need check-ups after the procedure?
The frequency of follow-up appointments varies but usually includes visits at 1 month, 6 months, and annually after the procedure to monitor the patient’s progress and the stent’s integrity.
you are covered
We are on the panel with most insurers in Singapore and with many international insurers; We also offer convenient options for self-paying patients.
