Angioplasty in this context refers to the use of an expandable balloon inserted into a target artery from a remote site, usually the groin, in order to expand a narrowed or blocked segment of the artery. This technique can be accomplished under local anaesthesia and often requires only a few hours of stay in the hospital. In some cases a metallic stent is used to support the area of the artery that was treated in order to stabilize the plaque that has been stretched open. The decision to use a stent is made at the time of the procedure. This approach is often referred to as endovascular treatment since it is performed entirely inside the blood vessel.
In order to optimize treatment more complex cases may be managed by a combination of open techniques plus an endovascular procedure. This approach is often referred to as a hybrid procedure and is employed when more than one segment of a the arterial tree is being treated. An example would be a patient with a narrowing of the iliac artery located above the groin in the pelvis who also has a blocked femoral artery (in the thigh). This would be treated by an angioplasty/stent of the iliac artery plus a bypass of the leg artery.
The advantages of endovascular techniques are:
- Lower risk of major complications
- Lower risk of fatal complications in some cases
- Shorter recovery times
The disadvantages are:
- not appropriate for certain types of blockage
- less durable and more prone to early failure (particularly in the leg) than open operations including bypass.
Although less invasive than open surgery, there are risks involved.
- Bleeding from the access (puncture) site requiring surgery to control 1-2%
- Collapse of the plaque and blockage of the artery requiring surgical repair or bypass 1-2%
- Kidney damage from the contrast used (in patients with pre existing kidney problems
- Need for repeat intervention in up to 20% of cases over 5 years in the arteries above the groin and up to 50% in the first year for leg arteries.
Careful evaluation of the extent of the arterial disease based on tests including CT angiography as well as a risk assessment based on the overall health of the patient will be used to determine the most appropriate treatment plan for the individual