Atherectomy/Angioplasty of Noncoronary Vessel
En Español (Spanish Version)

Definition
Atherectomy and angioplasty are methods that can be used to open arteries without surgery.

There are several different devices that can be threaded through blood vessels to the site of a narrowing or blockage. These devices remove the obstruction so that blood flow is restored.

Balloon Angioplasty

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Reasons for Procedure
Most often, these procedures are done when an artery is narrowed by atherosclerosis . If the artery is too narrow, blood is no longer able to pass through. The body part then suffers from lack of oxygen, also called ischemia. This can cause different symptoms, depending on the part of the body that is not getting enough oxygen.

Possible Complications
If you are planning to have an atherectomy or angioplasty, your doctor will review a list of possible complications, which may include:

  • The artery may close again after the procedure
  • Damage to the artery
  • Bleeding
  • Infection
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
Your risk of complications may also be increased if you have blood clotting problems.

What to Expect
Prior to Procedure
You will be thoroughly evaluated before deciding on the best procedure. This may involve contrast x-rays, ultrasound, or computerized scans to identify the area of concern. You will be asked not to eat or drink anything for several hours before the procedure.

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Aspirin or other anti-inflammatory drugs
  • Blood thinners
Anesthesia
You will most likely be sedated, but not put to sleep. A local anesthetic will numb the site of insertion of the device.

Description of the Procedure
You will be lying down. The room will have x-ray machines and a variety of surgical equipment. Depending on the artery to be opened, a blood vessel in your groin or arm will be prepared and covered with sterile drapes. Your doctor will puncture your numbed skin. A tube called a catheter will be placed into your blood vessel and passed to the site of the obstruction. Contrast material may be injected through the catheter to visualize the obstruction on the x-rays. There may be more than one location that requires opening. The device used will depend on the type of obstruction and location in the vessel. Possible approaches include:

  • Angioplasty —A balloon is inflated to open the vessel.
  • Angioplasty and stent placement —After the balloon is used, a mesh frame called a stent will be placed in the vessel to support the walls.
  • Atherectomy—The plaque is removed using a rotating shaver or laser.
Immediately After Procedure
Recovery time is minimal. You will be moved to another room to recover.

How Long Will It Take?
Between 30 minutes and two hours

How Much Will It Hurt?
Some minor discomfort may accompany the procedure.

Average Hospital Stay
This procedure is done in a hospital setting. You may need to stay overnight. You may be kept longer if complications arise.

Post-procedure Care
At the hospital:

  • You will need to lie flat for a period of time if the groin was used as an entry site.
  • You may need to have pressure applied to the entry site to control bleeding.
  • If you notice any swelling, bleeding, black and blue marks, or pain where the catheter was inserted, tell the nurse.
  • You will be encouraged to drink a lot of fluids to flush the contrast material from your system.
  • There will be a bandage over the puncture site. You may be prescribed a blood thinner, such as aspirin. Certain strenuous activities will be limited. Other activities, including exercises and fluid intake, may be encouraged. Your doctor will want to see you several days or weeks later.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
Call Your Doctor
Depending on the site of your procedure, call your doctor if you experience the following:

  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the point of catheter insertion
  • Signs of infection, including fever and/or chills
  • Extreme sweating, nausea, or vomiting
  • Leg or arm feels cold, turns white or blue, or becomes numb or tingly
  • Extreme pain, including chest pain
  • Difficulty breathing
In case of an emergency, call for medical help right away.




RESOURCES:
Angioplasty.org

Society for Vascular Surgery

CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada

Public Health Agency of Canada

References:
Atherectomy. Angioplasty.org website. Available at: http://www.ptca.org/devices5.html. Accessed May 3, 2013.

Bettmann MA, et al. Carotid stenting and angioplasty: a statement for healthcare professionals from the Councils on Cardiovascular Radiology, Stroke, Cardio-Thoracic and Vascular Surgery, Epidemiology, and Prevention, and Clinical Cardiology, American Heart Association. Circulation. 1998;97:121-123.

Angioplasty and vascular stenting. Society of Interventional Radiology website. Available at: http://www.radiologyinfo.org/content/interventional/angioplasty.htm. Updated August 31, 2012. Accessed May 3, 2013.

6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Last Reviewed May 2013



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