Angioplasty is a medical procedure performed for dilating the blood vessels that are narrowed due to abnormal deposition of cholesterol in the arterial walls, a medical condition known as atherosclerosis. Also referred to as Percutaneous Transluminal Coronary Angioplasty (PTCA), the main objective of this approach is to restore the normal function of the blood vessels and promote blood supply to the heart. In the operation, folded balloons are introduced in the blocked arteries, which are then inflated to a specific size.
Angioplasty is used for the treatment of many chronic health conditions such as coronary artery disease, carotid artery disease, peripheral artery disease, renal vascular hypertension, angina (chest pain), heart attack, venous narrowing and other heart diseases. Accordingly, the procedure may encompass other vascular intervention such as peripheral angioplasty, coronary angioplasty, carotid angioplasty and renal artery angioplasty. All these surgeries are conducted by using minimally invasive methods.
How is Angioplasty Performed?
- Prior to angioplasty, the physician analyzes the medical history of the patient regarding his/her general health, any current medications and underlying health conditions (if any) like allergies.
- The patient is instructed not to eat or drink anything for a few hours before the surgery.
- For performing balloon angioplasty, the patient is asked to lay on the examination table. The vital functions like heartbeat, blood pressure and pulse rate are monitored throughout the operation.
- The patient is then administered with general anesthesia and sedatives through intravenous injections. Following this, an area in the arm or groin is cleaned and sterilized before inserting a clinical catheter (a small flexible tube). Local anesthesia is given in order to numb this portion. The physician makes a small incision in the area. Under the guidance of X-ray monitor, the catheter is inserted through the incision, until it reaches the opening of the artery.
- A contrast dye is injected into the body through the catheter, so as to locate the site of arterial blockages or narrowing. An angiogram is taken to capture the images of the blocked arteries. This also helps in determining the affected artery and accordingly, size of the catheter and wire is decided. Following this, a guide wire (for guiding placement of balloon catheter) followed by the balloon catheter (a small flexible tube with an inflatable balloon) are introduced gently through the cut skin.
- As the balloon catheter is placed in the blocked artery, it is inflated for a few seconds to open the blood vessel. Inflation of balloon at the same site may be practiced repeatedly, or it may be positioned in another site by referring to the X-ray movie pictures.
- After the completion of angioplasty, the physician may conduct imaging tests to check for the blood flow. If blood circulation to the heart is improved, the physician removes the catheter, balloon catheter and guide wire. Bleeding at the insertion site can be prevented by applying pressure. Proper dressing of the incision is done to avoid any infection. After the procedure is completed, the patient is hospitalized for a day or so (if necessary).
Risks and Complications
It is estimated that more than one million people diagnosed with heart disease undergo angioplasty every year in the United States. Provided that the technology and equipment used are advanced and the cardiologist is highly experienced, the probability of fatality during the operation is negligible (lower than 1 percent). Hardly two to three cases out of one thousand cases require emergency bypass operation.
While PTCA is relatively safe, there are some health complications associated with it.
- The risks include reaction to the contrast dye, excess bleeding at the excision site, weakening of the arterial walls, blood clots and closing of the treated artery.
- Other rare and serious complications are punctured artery, stroke, heart attack, arrhythmia and kidney problems.
- Patients with underlying blood clotting problems are at an increased risk of heavy bleeding complication than others. Likewise, those having kidney disease or diabetes require extra precautions to avoid aggravated kidney functions.
As far as the probability of re-narrowing (restenosis) the treated arteries is concerned, it is higher among those who have prolonged atherosclerosis condition. Research is still going on to improve the effectiveness of angioplasty procedure. The studies are mostly concerned with the techniques to prevent closing of the treated arteries.