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Angioplasty

Definition, Purpose, Precautions, Description, Risks

Angioplasty is a term describing a procedure used to widen vessels narrowed by stenoses or occlusions. There are various types of these procedures and their names are associated with the type of vessel entry and equipment used. For example, percutaneous transluminal angioplasty (PTA) describes entry through the skin (percutaneous) and navigates to the area of the vessel of interest through the same vessel or one that communicates with it (transluminal). In the case of a procedure involving the coronary arteries, the point of entry could be the femoral artery in the groin and the catheter/guidewire system is passed through the aorta to the heart and the origin of the coronary arteries at the base of the aorta just outside the aortic valve.

Purpose

In individuals with an occulsive vascular disease such as atherosclerosis, blood flow is impaired to an organ (such as the heart) or to a distal body part (such as the lower leg) by the narrowing of the vessel's lumen due to fatty deposits or calcium accumulation. This narrowing may occur in any vessel but may occur anywhere. Once the vessel has been widened, adequate blood flow is returned. The vessel may narrow again over time at the same location and the procedure could be repeated.

In balloon angioplasty, plaque is pushed out of the clogged artery by the inflation of the balloon device. (Illustration by Argosy Inc.) In balloon angioplasty, plaque is pushed out of the clogged artery by the inflation of the balloon device. (Illustration by Argosy Inc.)

Precautions

Angioplasty procedures are performed on hospital inpatients in facilities for proper monitoring and recovery. If the procedure is to be performed in a coronary artery, the patient's care is likely to be provided by specially trained physicians, nurses, and vascular specialists. Typically, patients are given anticoagulants prior to the procedure to assist in the prevention of thromboses (blood clots). Administration of anticoagulants, however, may impede the sealing of the vascular entry point. The procedure will be performed using fluoroscopic guidance and contrast media. Since the decision to perform angioplasty may have been made following a diagnostic angiogram, the patient's sensitivity to iodinated contrast media is likely to known. The procedure may then require the use of non-ionic contrast agents.

Description

Angioplasty was originally performed by dilating the vessel with the introduction of larger and larger stiff catheters through the narrowed space. Complications of this procedure caused researchers to develop means of widening the vessel using a minimally sized device. Today, catheters contain balloons that are inflated to widen the vessel and stents to provide structural support for the vessel. Lasers may be used to assist in the break up of the fat or calcium plaque. Catheters may also be equipped with spinning wires or drill tips to clean out the plaque.

Angioplasty may be performed while the patient is sedated or anesthetized, depending on the vessels involved. If a percutaneous transluminal coronary angioplasty (PTCA) is to be performed, the patient will be kept awake to report on discomfort and cough if required. PTCA procedures are performed in cardiac catheterization labs with sophisticated monitoring devices. If angioplasty is performed in the radiology department's angiographic suite, the patient may be sedated for the procedure and a nurse will monitor the patient's vital signs during the procedure. If performed by a vascular surgeon, the angioplasty procedure will be performed in an operating room or specially designed vascular procedure suite.

The site of the introduction of the angioplasty equipment is prepared as a sterile surgical site. Although many procedures are performed by puncturing the vessel through skin, many procedures are also performed by surgically exposing the site of entry. Direct view of the vessel's puncture site aids in monitoring damage to the vessel or excessive bleeding at the site. Once the vessel is punctured and the guidewire is introduced, fluoroscopy is used to monitor small injections of contrast media used to visualize the path through the vessel. If the fluoroscopy system has a feature called 'roadmap', the amount of contrast media injected will be greater in order to define the full route the guidewire will take. The fluoroscopy system will then superimpose subsequent images over the roadmap while the vessel is traversed, that is, the physician moves the guidewire along the map to the destination.

Having reached the area of stenosis, the physician will inflate the balloon on the catheter that has been passed along the guidewire. Balloons are inflated in size and duration depending on the size and location of the vessel. In some cases, the use of a stent (a mesh of wire that resembles a Chinese finger puzzle) may also be used. The vessel may be widened before, during, or after the deployment of the stent. Procedures for deploying stents are dependent on the type of stent used. In cases where the vessel is tortuous or at intersections of vessels, the use of a graph may be necessary to provide structural strength to the vessel. Stents, graphs, and balloon dilation may all be used together or separately.

The procedure is verified using fluoroscopy and contrast media to produce an angiogram or by using intravascular ultrasound or both. All equipment is withdrawn from the vessel and the puncture site repaired.

Risks

During the procedure there is a danger of puncturing the vessel with the guidewire. This is a very small risk. Patients must be monitored for hematoma or hemorrhage at the puncture site. There is also a small risk of heart attack, emboli, and although unlikely death. Hospitalization will vary in length by the patient's overall condition, any complications, and availability of home care.

Resources

BOOKS

Thomas MD MPH, Clayton L. editor. Taber's Cyclopedic Medical Dictionary. Philadelphia, PA: F.A. Davis Company, 1985.

Schneider MD, Peter A. Endovascular Skills: Guidewires, Catheters, Arteriography, Balloon Angioplasty, Stents. St. Louis, MO: Quality Medical Publishing, Inc., 1998.

Wojtowycz MD, Mryon. Handbooks in Radiology-Interventional Radiology and Agiography. Chicago, IL: Year Book Medical Publishers, Inc., 1990.

PERIODICALS

Carnall, Douglas. "Angioplasty." The Western Journal of Medicine (September 2000):v173 i3 p201

"New Imaging Technique Could Improve Outcome of Popular Heart Procedure." Heart Disease Weekly (May 13, 2001):3

"Success clearing clogged arteries." Science News (February 3, 2001):v159 i5 p72

"The angioplasty correct follow up strategy after stent implantation." Heart (April, 2001):v85 i4 p363.

OTHER

"Cardiovascular System" Miami Heart Research Institute. 2001. <http://www.miamiheartresearch.org/Learning_Center/YourCardiovascular/Cardiovascular.htm (July 5,2001).

"Coronary angioplasty: Opening clogged arteries" MayoClinic.com, Condition Centers, Treatments and tests. 2000. <http://www.mayoclinic.com> (July 5, 2001).

"Heart & Stroke Guide: Laser Angioplasty." American Heart Association online. 2000. <http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/angiol.html> (July 5,2001).

"STS Patient Information: What to Expect after your Heart Surgery." Society of Thoracic Surgeons online. 2000. <http://www.sts.org/doc/3563> (July 5, 2001).

"When you need to have Angioplast: A patient guide" Heart Information Network. 2000. <http://www.heartinfo.org/news97/gdangio111897.htm> (July 5, 2001).

Elaine R. Proseus, MBA/TM, BSRT, RT(R)

KEY TERMS


Plaque—In atherosclerosis, a swollen area in the lining of an artery formed by fatty deposits.

Cardiac catheterization—A procedure to pass a catheter to the heart and its vessels for the purpose of diagnosing coronary artery disease, assessing injury or disease of the aorta, or evaluating cardiac function.

EKG—Electrocardiogram, used to study and record the electrical activity of the heart.

Additional topics

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