• Atherectomy/Angioplasty of Noncoronary Vessel

    (Nonsurgical Revascularization of Noncoronary Vessel)

    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 occlusion. Once there, 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 ischemia (lack of oxygen). 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
    Factors that may increase the risk of complications include:
    • Smoking
    • Your overall health or illness
    • Extent of disease in your arteries
    • Blood clotting problems
    Be sure to tell your doctor if you are allergic to shellfish, iodine, or contrast dye.

    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 (eg, CTA or MRA ) to identify the area or areas 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, such as clopidogrel (Plavix) or warfarin (Coumadin)

    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 as well as an array 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 catheter (tube) 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 require 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 stent (mesh frame) will be placed in the vessel to support the walls.
    • Atherectomy—The plaque is removed by 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. Your doctor may choose to keep you longer if complications arise.

    Post-procedure Care

    • 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.
    After the procedure, be sure to follow your doctor's instructions .

    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 http://www.ptca.org/

    Society for Vascular Surgery http://www.vascularweb.org/

    CANADIAN RESOURCES

    Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/

    Public Health Agency of Canada http://www.phac-aspc.gc.ca/

    References

    Angioplasty.org website. Available at: http://www.ptca.org/devices5.html . Accessed August 19, 2005.

    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.

    Society of Interventional Radiology website. Available at: http://www.radiologyinfo.org/content/interventional/angioplasty.htm . Accessed August 21, 2005.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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.

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