Peripheral artery disease is caused by a buildup of plaque in your arteries in the legs and hands, blocking blood flow to them and often leading to ulcers or amputations. But PAD can be halted and treated with peripheral angioplasty or surgery if caught early enough.
Peripheral angioplasty treats PAD by opening up and cleaning out clogged arteries that negatively impact circulation. If you have PAD, this may be the treatment option for you, so read on to learn more about peripheral angioplasty and the procedure that can save your life.
Treatment of Peripheral Artery Disease with Peripheral Angioplasty
Peripheral artery disease (PAD) can be limb-threatening, but PAD can be managed and, in some cases, reversed with the proper treatment. Peripheral Angioplasty, or percutaneous transluminal Angioplasty (PTA), is one such treatment method that can open up the arteries to your limbs and prevent you from suffering from any associated symptoms.
Peripheral artery disease, or PAD, can be treated with angioplasty, but the earlier the procedure, the better the results.
Atherosclerosis:
Atherosclerosis is caused by plaque buildup in your arteries that restricts blood flow. If this affects the legs or hands, this is called PAD.
PAD can affect your legs or arms, but legs are commonly affected. Hence leg angioplasty is often used synonymously with peripheral angioplasty.
This can cause leg pain and sometimes leg ulceration. Few individuals even develop gangrene and subsequent amputation.
What are the symptoms of peripheral artery disease?
Patients with PAD may be silent or present with a variety of symptoms and signs. PAD can present with intermittent claudication, pain at rest, or with nonhealing wounds, ulceration, or gangrene
Intermittent claudication: Patients with PAD may complain of pain in the calf, thigh, or buttock brought on with activity and relieved with rest. It can affect the buttocks, hips, or calf. According it is called:
- Buttock and hip claudication
- Thigh claudication
- Calf claudication
- Foot claudication
Ischemic rest pain: It can occur when limb perfusion is severely reduced. Ischemic rest discomfort usually affects the forefoot and toes
It is quite challenging to treat the pain with pain killers. Elevation of the leg exacerbates the pain.
Non-healing wound/ulcer: Ischemic ulcers which often begin as mild traumatic wounds that do not heal may become large and septic if neglected.
What are the risk factors for PAD?
The following factors are considered risk factors for PAD
Diabetes
Smoking
Older age
Male sex
Being a Black person
Family history
High blood pressure
Obesity
High cholesterol
Homocysteinemia
Benefits vs. Risks in Peripheral Angioplasty and Stent Procedure
For those that suffer from peripheral artery disease, one solution for leg pain is to undergo a peripheral angioplasty and stent procedure. The procedure will treat symptoms associated with claudication by inserting a graft or Stent into an obstructed artery to restore blood flow to improve circulation. Although there are benefits to having an angioplasty, there are also risks associated with undergoing a procedure like a peripheral angioplasty.
Benefits:
- Restore the blood flow
- Reduces leg pain or claudication pain
- Heals the ulcer quickly
- Prevents gangren and amputaion
Risks:
- Bleeding
- Rupture of blood vessels
- Infection
- Kidney damage
- Early and late blockages in the treated area: Narrowed portion which has been opened with angioplasty can again become narrow in the future.
- Distal embolization: Plaques from the diseased portion can migrate to another area and block its blood supply. This can happen when meddling with the diseased area.
The cost of Peripheral Angioplasty and Stent Procedure in Hyderabad, India?
Your doctor can tell you how much a peripheral angioplasty and stent procedure will cost. The average estimate in 2022 was about 1.25 lakhs, but it varies based on your area and type of the hospital. Some cardiologists offer discounted rates for cash-paying patients or those who have good health insurance coverage. Plain old balloon angioplasty is cheaper than angioplasty followed by the stent. Stents available for the leg are of different types and have different price ranges. The use of atherectomy devices increases the cost further. Dr. Malleswara Rao is an expert in peripheral angioplasty in Hyderabad and charges around one lakh for balloon angioplasty.
What are the tests done before peripheral angioplasty?
1. Ankle-brachial index
An abnormal ankle-brachial index is defined as ABI =0.9
2. Duplex ultrasound :
It is typically the first imaging study to evaluate PAD. It is widely available, noninvasive, and affordable. Another advantage is it does not use ionizing radiation or iodinated contrast material.
3. Computed tomographic (CT) angiography:
It provides complete imaging of the arterial tree, severity, and extent of PAD.
4. Magnetic resonance (MR) angiography :
It has the advantage of imaging the arterial tree without ionizing radiation or iodinated contrast material. The cost of MR angiography is higher, and availability may be limited. Patients with kidney disease may benefit from MR angiography.
Digital subtraction angiography (DSA) :
It is still the gold standard for assessing arterial anatomy. It is done like a conventional angiogram.
What happens during Peripheral Angioplasty and Stent Procedure
How to prepare for Peripheral Angioplasty and Stent Procedure
For peripheral angioplasty and stent procedures, it is recommended that you schedule a visit with your cardiologist to discuss any lifestyle changes and steps that you can take to prevent gangrene. These changes may include losing weight, exercising more frequently, adjusting your diet (e.g., avoiding fatty foods), quitting smoking, and/or drinking alcohol excessively. These steps will help prevent further complications and potential future health problems related to peripheral artery disease.
Procedure for leg angioplasty
Typically, a single dosage of intravenous antibiotics is given at the start of the procedure. Peripheral angioplasty is typically performed under conscious sedation.
During a peripheral angioplasty, your doctor or cardiologist guides a thin, flexible tube called a catheter into your leg artery. Using X-ray images for guidance (fluoroscopy), they thread it through a branch of your femoral artery and into your arterial branches. At that point, an interventional cardiologist guides the catheter to block off problematic areas that may be causing claudication pain and helps restore blood flow to muscles and tissues in your leg.
Common femoral artery
The stent is commonly needed. Plain old balloon angioplasty gives poor long-term results. Stent in this area remains patent at about 75 percent at the end of one year.
Femoropopliteal
1. For patients with short lesions (<5 cm) – Plain balloon angioplasty (PBA) without a Stent is recommended
2. Stent implantation may be considered for patients with 5 to 10 cm long lesions.
3. For lesions >10 cm in length, stent placement is a must.
Infrapopliteal
Balloon angioplasty is the most common procedure in the infrapopliteal arteries. DCBs and DESs are better than balloon angioplasty, but the benefits are not robust. They are more expensive than plain balloon angioplasty. Bare metal stents are not better than balloon angioplasty.
How long do leg angioplasty stents last
Long-term success for balloon angioplasty without a stent in the femoropopliteal segment is poor. At the end of one year, only 28 percent remains patent, and the rest closes again.
Self-expanding nitinol stents are more durable than balloon-expandable stainless steel stents. Hence angioplasty with nitinol stent placement is the recommended treatment for prolonged diseases. One year patency improved to 64 percent. Three years of primary patency is also better at 62 percent.
Few cardiologists prefer heparin-bonded polytetrafluoroethylene (PTFE)-covered stents. Patients with significant thrombus loads and distal embolization and those who develop in-stent restenosis should use covered stents.
Recovery after Peripheral Angioplasty and Stent Procedure
Recovery is generally rapid and uncomplicated after a peripheral angioplasty and stent procedure. Once you are discharged from the hospital following your procedure, you will be given a prescription for an anti-clotting medication like aspirin or clopidogrel to take indefinitely. Blood thinners should not be stopped without consulting your physician.
Can stents be removed and replaced?
No. Stent, once deployed, cannot be removed and replaced.
What are the types of stents available for leg angioplasty?
Stents keep the artery open by preventing recoil over the long term. Recoil is quite common with plain balloon angioplasty.
Stents are of different types such as
1. Balloon expandable Vs. Self-expanding
2. Bare Vs. Covered Stent
Bare metal stents are made of nitinol (an alloy of nickel and titanium), stainless steel, cobalt-chromium, and others.
Covered stents comprise polytetrafluoroethylene (ePTFE), polyurethane, or silicone coverings.
Balloon-expandable stents (bare stents, covered stents, stent-grafts) are better suitable for the aortoiliac locations.
Self-expanding stents (bare stents, covered stents) are superior for the femoropopliteal segment and have improved primary patency rates.
When balloon angioplasty fails, drug-coated balloon-expandable coronary stents have been utilized selectively at the infrapopliteal level.
What is the role of atherectomy during leg angioplasty?
Whereas balloon and stent displace existing blockages, is there any way to debulk the blockage? Yes. Atherectomy does the same. An atherectomy removes plaque from a blood artery using a sharp blade on the end of a catheter.
Directional atherectomy: rotating Cutting blade in directional atherectomy devices shaves the plaque by the cutting blade.
Rotational and orbital atherectomy: Instead of a blade, A burr is used to sever plaque into very minute fragments.
Laser atherectomy: An excimer laser is used to ablate soft plaque instead of blade or bur.
These three are high-end equipment and are considered to be expensive. Doctors use them case by case depending on the complexity of the disease.
What are DCBs or drug-coated balloons?
Normal balloons do not contain drugs. A normal stent contains metal, ballon, and drugs. DCBs are the balloons coated with drugs.
DCB angioplasty is shown to be better than plain balloon angioplasty. One of the benefits of DCBs is that they do not require stents.
Life after peripheral angioplasty
Apart from taking blood-thinning medicines regularly, you should follow these six steps for healthy legs
· Quit smoking
· Keep your blood sugar under reasonable control.
· Exercise regularly
· Lower your blood pressure and cholesterol
· Eat healthy foods ( low in saturated fat, low in simple sugars).
· Maintain a healthy weight.
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