Peripheral vascular disease or peripheral artery disease is caused by the same atherosclerotic plaque that causes coronary artery disease. Frequently, atherosclerosis is not confined to one artery buy may involve arteries in other areas as well. Some of the more commonly affected peripheral areas are the arteries in the legs, arms, kidneys and neck. Some patients may have both coronary artery disease and peripheral vascular disease. As the internal lining of the artery thickens from the atherosclerotic plaque, the blood vessel becomes increasingly constricted and blood flow diminishes. Therefore, the symptoms you may experience depend on what artery is affected and how severely the blood flow is reduced. Some of the symptoms you may experience in the affected areas are:
Buttock pain Numbness or tingling in leg, foot or toes Changes in skin color (pale, bluish or reddish discoloration) Changes in skin temperature, coolness Impotence Infection/sores that do not heal Ulceration or gangrene Uncontrolled hypertension Renal failure
Percutaneous Transluminal Angioplasty (PTA)
What other terms are used to describe Percutaneous Transluminal Angioplasty?
Why is an Angioplasty done?
- The rate of restenosis (renarrowing) is 25-80 % within the first six months.
How is a Balloon Angioplasty done?
- The patient is given a mild sedative to help relax but remains awake during the procedure to allow him to answer questions regarding his comfort level. - A small area of the groin or arm is shaved and cleaned where the catheter is inserted. - Medication is used to anesthetize (numb) the area so a small incision can be made where the catheter will be inserted. - A catheter with a deflated balloon on the tip is inserted through the artery in the groin or arm. X-ray is used to guide the catheter. - The catheter is threaded up into the narrowed artery. The balloon is then inflated and deflated several times to squeeze the plaque deposit against the wall of the artery. - The test takes 1-2 hours.
What symptoms may be experienced during the procedure?
- Slight discomfort or pressure as the catheter is being inserted.
What happens after the procedure is completed?
- A sheath (IV) is usually left in place in the leg for several hours until the blood thinning medications are discontinued and your clotting time returns to normal. - A bandaid or pressure dressing will be placed over the area where the catheter was inserted. - When the sheath is removed from the groin firm pressure is applied to the sheath insertion site for 15-30 minutes until the bleeding stops. - If an artery in the arm is used, pressure will be applied over sheath insertion site for 15-30 minutes also. - The insertion site will be checked frequently for signs of bleeding. - Blood pressure and the pulse in the leg (or arm) used will be checked frequently. - A knot may occur under the skin where the catheter was inserted. This is only temporary. - Bruising may occur in the area of the leg/groin where the catheter was inserted and may spread down the leg and is only temporary. - Most patients are discharged 8 hours after the sheath is removed with minimal activity restrictions.
What precautions should be observed following the procedure?
- Hold the bandaid firmly if you need to cough or sneeze. - Avoid bending or using the arm for several hours if it was used for the insertion of the catheter.
What signs and symptoms should be reported immediately?
- A warm, moist and sticky feeling or bleeding.
What follow up can be expected?
What preparation is needed?
- It is important for the patient to ask his doctor: - Plan to be admitted to the hospital overnight. - Make arrangements to be driven home the following day. Atherectomy is a technique by which a catheter with a small mechanically-driven cutter shaves the plaque and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn. Mechanical rotational atherectomy is a technique that uses a diamond-shaped burr that rotates and shaves the plaque into tiny particles, which then pass through the circulatory system.
What is a stent?
- The actual procedure for placement of the stent is the same as an angioplasty with the addition of the stent placement.
Why is a stent used?
- In some cases, stents are used when blocked bypass vein grafts are opened through angioplasty.
How is a stent placed?
- After the artery is opened, a catheter, which has a stent over a deflated balloon on the tip, is reinserted into the artery up to the area previously opened by angioplasty. - Once in place, the balloon is inflated, expanding the stent and pressing it against the artery wall. - The balloon is deflated and the catheter and balloon are removed, but the stent remains expanded and in place to help keep the narrowed portion open after angioplasty. - The stent will remain in the artery permanently. - The artery will heal around the stent. - The procedure lasts one to two hours.
What symptoms may be experienced during the procedure?
- Slight discomfort or pressure as the catheter is being inserted. - Slight nausea and or, extra heartbeats. - Chest pain may occur as the balloon catheter is being inflated, but it is temporary.
What happens after the procedure is completed?
- A sheath (IV) is usually left in place in the leg for several hours until the blood thinning medications are discontinued and your clotting time returns to normal. - A bandaid or pressure dressing will be placed over the area where the catheter was inserted. - You will be admitted to a special cardiac care unit to be monitored closely. - When the sheath is removed from the groin firm pressure is applied to the sheath insertion site for 15-30 minutes until the bleeding stops. - If an artery in the arm is used, pressure will be applied over sheath insertion site for 15-30 minutes also. - The insertion site will be checked frequently for signs of bleeding. - Blood pressure and the pulse in the leg (or arm) used will be checked frequently. - A knot may occur under the skin where the catheter was inserted. This is only temporary. - Bruising may occur in the area of the leg/groin where the catheter was inserted and may spread down the leg and is only temporary. - Most patients are discharged 8 hours after the sheath is removed with minimal activity restrictions.
What precautions should be observed following the procedure?
- Hold the bandaid firmly if you need to cough or sneeze. - Avoid bending or using the arm for several hours if it was used for the insertion of the catheter.
What signs and symptoms should be reported immediately?
- A warm, moist and sticky feeling or bleeding. - Any discomfort in chest, neck, jaw, arms or upper back, shortness of breath, weakness or dizziness.
What follow up can be expected?
What preparation is needed?
- It is important for the patient to ask his doctor: - Plan to be admitted to the hospital overnight. - Make arrangements to be driven home the following day.
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