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VASCULAR
STENTING
Procedure
Description
 As
many as 8 million people in the United States have peripheral
vascular disease (PVD), a common problem of the circulatory
system. PVD, often called atherosclerosis or hardening of
the arteries, is a gradual process whereby cholesterol and
scar tissue build up as plaque, which narrows or completely
blocks arteries in the body. These arteries carry blood to
various parts of the body such as the arms, legs, kidneys,
or brain. Therefore, patients may have a variety of symptoms
depending on the arteries affected, including: leg/hip pain
or cramping, particularly with walking, leg numbness or weakness,
cold extremities, high blood pressure, kidney failure, poorly
healing leg ulcers, and dizziness or other stroke symptoms.
When patients have any of these symptoms, their physician
will often ask an interventional radiologist to perform an
angiogram (also called an arteriogram). If possible and if
in the patient’s best interest, the interventional radiologist
will treat the narrowing with an angioplasty or possibly a
stent.
An
angiogram is a special X-ray of the artery performed by interventional
radiologists in dedicated peripheral vascular catheterization
rooms at most hospitals. During the angiogram, the doctor
places a small tube, similar to an IV catheter but longer,
into the artery after making a small nick about the size of
a pencil point in the skin. After injecting a very safe contrast
agent (X-ray dye), the interventional radiologist can see
and evaluate the blood vessels of interest using special X-ray
equipment.
An
angioplasty is a procedure that helps reopen the artery so
blood can flow more freely through it. In many cases, the
interventional radiologist can use the same nick in the skin
made for the angiogram to open blocked or narrowed blood vessels
caused by peripheral vascular disease. In angioplasty, a special
catheter with a small balloon attached to it is threaded across
the blockage or narrowing using the x-rays and contrast as
a road map to guide the doctor. As the balloon is inflated,
it stretches the artery open. After the balloon is removed,
the artery usually stays stretched open, and blood flows through
it better.
A
stent may sometimes be used if the artery closes back down
after the angioplasty. A stent is a small tube made of metal
mesh similar to the spring in a ballpoint pen. It can also
be inserted through the same nick in the skin used for the
angiogram or the angioplasty. The interventional radiologist,
using experience and knowledge of the medical literature,
may sometimes not perform an initial angioplasty and instead
stent the vein or artery straight away.
Patient
Preparation for the Procedure
A nurse from the Interventional Radiology section will call
you the day before your scheduled procedure and give you complete
instructions on where to go and how to prepare. You will be
asked to have clear liquids only after midnight the day of
the procedure.
Generally,
you will take your usual medications with a sip of water the
morning of your procedure, with the exception of some blood
thinners and diabetes medications. The blood thinner Coumadin
is typically stopped for about 5 days. Be prepared to tell
our medical staff about any allergies you have as well as
all medications you take, and bring all medications you would
normally take for a 6- to 24-hour stay.
The
procedures generally take 1 to 2 hours to perform. Often,
after 6 hours of observation, the patient can get up and walk
and then be driven home by a family member or friend. Some
stenting procedures require a bit larger catheter or additional
blood thinners, and it will be safer to keep the patient overnight
on a 23-hour-or-less admission basis. Kidney or renal angioplasty
will also typically require an overnight stay to adjust blood
pressure medications.
Driving
is not permitted for 24 hours, and the patient should not
lift anything over 10 pounds until 48 hours after the procedure.
Frequently
Asked Questions about Vascular Stenting
Q:
Am I at risk for peripheral vascular disease?
Your answers to these questions will help you know if you
are at risk.
-
Do
you have cardiovascular (heart) problems such as high blood
pressure, heart attack, or stroke?
-
Do
you have diabetes?
-
Do
you have a family history of diabetes or cardiovascular
problems (immediate family such as parent, sister, brother)?
-
Do
you have aching, cramping, or pain in your legs when you
walk or exercise, but then the pain goes away when you rest?
-
Do
you have pain in your toes or feet at night?
-
Do
you have any ulcers or sores on your feet or legs that are
slow in healing?
-
Do
you smoke?
-
Have
you ever smoked?
-
Are
you more than 25 pounds overweight?
-
Do
you eat fried or fatty foods three times a week or more?
-
Do
you have an inactive lifestyle?
The
more “Yes” answers you have, the more important it
is for you to see your doctor.
Q:
Does the procedure hurt?
Angiography, angioplasty, and stenting procedures are typically
performed with local anesthesia and occasionally a mild sedative
if there is no contraindication. The procedure has about the
same amount of discomfort as an IV. After the procedure, usually
no pain medication is required. Occasionally, any mild bruising
is treated with Tylenol (acetaminophen) or Advil (ibuprofen).
Q:
What are the risks or complications?
Angiography, angioplasty, and vascular stenting procedures
are, in general, very safe with few overall complications.
As with any medical procedure, the possibility of complication
will vary with the individual. The doctor performing your
procedure will discuss with you and your accompanying family/significant
others the risks, benefits, and alternatives of your procedure.
You will also have the opportunity to ask any questions at
that time, and every effort will be made to answer them.
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