Angioplasty & Stents for PAD - Procedure & Risks

How do I prepare for the procedure?

Be sure your doctor knows about all medications you are taking, including prescription medication, over-the counter drugs, and any dietary or herbal supplements. Some medications, such as the anti-clotting drug warfarin (Coumadin), can increase your risk of bleeding, and you may be instructed to stop taking it for a few days before the procedure.

Women with diabetes should discuss with their doctor how to maintain blood sugar control before and after the procedure. In addition, some diabetes medications can interact with the dye used to view the arteries during the procedure, so you may be instructed to stop taking your medications until the dye is cleared from your system in a day or two.

To prevent clots from forming during and after the procedure, you may need to take blood-thinning medication, such as aspirin and clopidogrel, in the days leading up to the procedure.

You should not eat or drink anything after midnight the night before your procedure. Tell the nurse or doctor if you have ever had an allergic reaction to the dye used during a contrast angiogram, or if you are allergic to shellfish, iodine, or strawberries (the dye may contain similar compounds).

What happens during the procedure?

The day of the procedure you will be taken to a special operating room called the catheterization lab. The nurse will insert an intravenous (IV) line into your arm so that drugs to prevent blood clots and other medication can be given. Small sticky patches attached to wires will be taped to your body to monitor your heart rhythm using an ECG, and your blood pressure and oxygen levels will be monitored.

You will be awake during the procedure, but you may be given a mild sedative to help you relax. The area where the catheter is inserted (usually in your groin, but sometimes in your arm) will be cleaned, shaved, disinfected, and numbed with a local anesthetic.

A small puncture (that you will not feel) will be made in the artery, and a long, thin tube called a catheter will be inserted and guided through your arteries to the location of the blockage. An X-ray dye will be injected as part of a contrast angiogram to view the narrowed artery. There may be mild discomfort as the catheter moves through your arteries, but let the nurse or doctor know if you feel any pain.

Once the catheter is in place, a balloon is used to open the artery, and a stent may be left in place to prop the artery open. Another angiogram will be performed to make sure blood is flowing smoothly, and then the catheter will be removed and the incision will be sewn closed.

The angioplasty procedure can last anywhere from 1 to 3 hours, depending on how severe your blockages are and how many different areas need to be treated.

What happens after the procedure?

After the procedure is finished, you will be transferred to a recovery room. You may feel groggy if you have received any sedation, and the catheter insertion site may be bruised and sore. If the groin was used as the point of catheter insertion, you will be instructed to lie in bed with your legs out straight.

As you recover in the hospital, the place where the catheter was inserted will be checked for bleeding, swelling, or inflammation and your vital signs will be continuously monitored. You should drink plenty of fluids to flush out the dye used in the procedure.

Some women can go home the same day as the procedure, but you may be asked to stay overnight for observation. Most patients can safely walk around within 6 hours after the procedure, and return to normal activities within a week. You should avoid strenuous physical activity or heavy lifting for the first few days. Your doctor or nurse may give you other special instructions.

If you had a stent implanted, you will need to take the blood-thinning drug clopidogrel for at least 30 days to prevent clots, and you may need to take daily aspirin for the rest of your life. In about a month, you may need to return for tests (such as an ankle-brachial index) to make sure the procedure was successful.

What are the risks of the procedure?

Angioplasty and stenting for PAD are relatively safe, but as with any procedure, there are risks. Serious complications occur in about 1 in 25 patients, and may include heart attack, stroke, or kidney damage.⁸ The risk of dying during the procedure is less than 1%.⁹

The most common complications are requiring an additional procedure immediately (7.6% of patients) and excessive bleeding related to the blood-thinning drugs you were given (less than 5% of patients).⁹ Other rare complications include blood vessel damage and infections at the catheter insertion site.

Contact your doctor immediately if you have swelling, pain, or bleeding at the insertion site, or if you develop a fever, dizziness or faintness, or feel chest pain or shortness of breath.

References

1. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. Mar 21 2006;113(11):e463-654.
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8. Axisa B, Fishwick G, Bolia A, et al. Complications following peripheral angioplasty. Ann R Coll Surg Engl. Jan 2002;84(1):39-42.
9. Shammas NW, Lemke JH, Dippel EJ, et al. In-hospital complications of peripheral vascular interventions using unfractionated heparin as the primary anticoagulant. J Invasive Cardiol. May 2003;15(5):242-246.