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Angioplasty With Stent Implantation Surgery
Relevant information about Angioplasty With Stent Implantation Surgery.
Angioplasty with or without vascular stenting is a minimally invasive procedure performed to improve blood flow in the body's arteries and veins. An empty and collapsed balloon on a guide wire -balloon catheter- is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon is inflated to open the vessel, deflated and removed. During angioplasty, a small wire mesh tube called a stent may be permanently placed in the newly opened artery or vein to help it remain open.
Angioplasty is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body. Blockages in the arteries may be caused by smoking, high cholesterol levels, diets high in saturated fats, and cardiovascular disease and removing them is done with angioplasty.
The most common medical cases of blockage of arteries are: narrowing of large arteries (aorta and its branches), peripheral artery disease (PAD), renal vascular hypertension, carotid artery disease, coronary artery disease (CAD), venous narrowing involving the central veins (in the chest or the pelvis), narrowing in dialysis fistula or grafts.
Angioplasty can improve some of the symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
Coronary artery disease (CAD) affects almost 1.3 million of people in the U.S. It’s the most common form of heart disease in that country. CAD most often results from atherosclerosis, which happens when a waxy substance forms inside the arteries that supply blood to your heart. Cholesterol, calcium, and fibrous tissue make up plaque. As more plaque builds up, your arteries can narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow through your arteries causing pain or damage to the part of the body that the artery supplies. Usually, the symptoms of artery disease are pain or ulceration, in one of your limbs.
- Angioplasty vs Bypass, comparison
In particular circumstances, the angioplasty can become an alternative to bypass surgery, which also treats narrowed arteries. For certain types of blockages, angioplasty has some advantages when compared to bypass surgery. In all medical cases, the choice of angioplasty or bypass surgery is based on physician and patient preference, as well as patient-specific characteristics, such as diabetes or heart failure, which may favor one strategy over another.
Angioplasty should be considered when one, two or even three arteries have become narrowed, provided that the arteries are suitable for angioplasty. When there is significant narrowing of the left main coronary artery or of all three major coronary arteries, CABG should be considered. CABG is preferable in the presence of diabetes and/or heart failure when two or three coronary arteries are narrowed. On the other hand, angioplasty does not require a large incision. Because of this, angioplasty patients usually spend less time in the hospital and recover at home faster than bypass surgery patients. Also, your physician can usually perform angioplasty while you are awake, whereas bypass surgery requires general or regional anesthesia. One thing important is: angioplasties are safer than bypass surgeries and according to statistics less than 1% of people die from complications after this procedure.
Angioplasty is often combined with the placement of a small metal coil called a stent in the clogged artery to help prop the artery open and decrease the chance of it narrowing again (restenosis). The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain). Over 70 percent of coronary angioplasty procedures include stenting.
There are two broad types of stents -bare metal stents (the original kind) and drug-eluting stents (DES). DES are coated with drugs that are slowly released and help keep the blood vessel from reclosing. Stents that are not coated with drugs are called bare metal stents. As detailed below, it is very important that patients with either type of stent take their anti-clotting medicines as directed. The use of bare metal reduced the risk of late restenosis from roughly 30% to 15%, in the other hand DES reduces that risk further to about 10%.
- How is the surgery performed
The Angioplasty involves local anesthesia. That’s the one of the principal difference between Angioplasty and Bypass surgery. The night before the procedure, patients are usually told not to eat or drink anything after midnight. If the patient has diabetes, the physician must indicate the food and insulin intake. 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 blocked artery.
An angiogram is taken to capture the images of the blocked arteries. When the blocked arteries are identified, a guide wire followed by a balloon catheter -a small flexible tube with a balloon- is introduced gently through the incision. The balloon catheter is placed in the blocked artery and it is inflated for a few seconds. The inflation of the balloon at the same site may be practiced repeatedly or it may be positioned in another site by referring the X-ray monitor. Then, the physician must check the blood flow before removing catheter, balloon catheter and guide wire. After the angioplasty procedure, the patient is hospitalized if necessary.
- How is the post-surgery process. Possible complications
In the early days after the procedure, the patient must drink plenty of fluids and avoid driving, bathing, and smoking for 1 or 2 days. Also, patient should avoid standing or walking for long periods for at least 2 days after the procedure. If the patient received a stent, must avoid vigorous exercise for 30 days. The patient must take an aspirin every day for the rest of his life. And in case the patient has a stent placed, he needs to take a blood-thinning medicine or antiplatelet therapy for a year or longer.
There are not so much risks in the procedure. Angioplasty is safe because it’s a minimally invasive procedure. Nevertheless, few complications are possible: reactions to the contrast dye, bleeding at the angioplasty site, weakening of the arterial walls, bleeding at the vessel due to excess puncture, closing of the treated artery and kidney problems.
There are two kinds of complications. At first, acute complications, which happen during the procedure or immediately afterwards. In second place, long-term complications: even when the procedure is made without problems, the artery can narrow again months afterwards. This complication is called restenosis. The chances for reblocking the treated arteries are higher among those who have prolonged atherosclerosis condition. Medical researches are ongoing to improve the effectiveness of angioplasty. The studies are mostly concerned with the techniques to prevent the closing of the treated arteries.
Restenosis is a particular condition. About 35% to 40% of patients have restenosis after the procedure -20% in patients with stents-. The reason that makes it appear –within 6 months after procedure- is not known. However, there are several conditions that increase the risk of this long term complication. These conditions are: high blood pressure; diabetes; temporary angina, both unstable and stable; kidney disease requiring dialysis. Also, there is a theory that Angioplasty activates cytomegalovirus (CMV), a herpes virus that is common in older people but is usually dormant. Eventually, CMV can narrow the artery again. If restenosis occurs, patients may need to have another balloon angioplasty or stent procedure.
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