Angioplasty for Peripheral Arterial Disease of the Legs

Angioplasty  (also called percutaneous transluminal angioplasty, or PTA) is a procedure in which a thin, flexible tube called a catheter is inserted through an artery and guided to the place where the artery is narrowed.

When the tube reaches the narrowed artery, a small balloon at the end of the tube inflates for a short time. The pressure from the inflated balloon presses the fat and calcium (plaque) against the wall of the artery to improve blood flow.

In angioplasty of the aorta (the major abdominal artery) or the iliac arteries (which branch off from the aorta), a small, expandable tube called a stent is usually put in place at the same time. Reclosure (restenosis) of the artery is less likely to occur if a stent is used. Stents are less commonly used in angioplasty of smaller leg arteries like the femoral, popliteal, or tibial arteries, because they are subject to trauma and damage in these locations.

What To Expect After Treatment

After the procedure, you will rest in bed for 6 to 8 hours. You may have to stay overnight in the hospital. After you leave the hospital, you can most likely return to normal activities.

Why It Is Done

This procedure is commonly used to open narrowed arteries that supply blood flow to the heart. It may be used on short sections of narrowed arteries in people who have peripheral arterial disease(PAD).

How Well It Works

Angioplasty can restore blood flow and relieve intermittent claudication.1 Angioplasty can help you walk farther without leg pain than you did before the procedure.2

How well angioplasty works depends on the size of the blood vessel, the length of blood vessel affected, and whether the blood vessel is completely blocked.

In general, angioplasty works best in the following types of arteries:

  • Larger arteries.
  • Arteries with short narrowed areas.
  • Narrowed, not blocked, arteries.

Risks

Complications related to the catheter include:

  • Pain, swelling, and tenderness at the catheter insertion site.
  • Irritation of the vein by the catheter (superficial thrombophlebitis).
  • Bleeding at the catheter site.
  • bruise where the catheter was inserted. This usually goes away in a few days.

Serious complications are rare. These complications may include:

  • Sudden closure of the artery.
  • Blood clots.
  • A small tear in the inner lining of the artery.
  • An allergic reaction to the contrast material used to view the arteries.
  • Kidney damage. In rare cases, the contrast material can damage the kidneys, possibly causing kidney failure.

Radiation risk

There is always a slight risk of damage to cells or tissues from being exposed to any radiation, including the low levels of X-ray used for this test. But the risk of damage from the X-rays is usually very low compared with the potential benefits of the test.

What To Think About

In some cases, bypass surgery may be the best treatment choice. This treatment choice depends on your risks with the procedure, the size of the arteries, and the number and length of the blockages or narrowing in the arteries.

Your doctor may recommend that you try an exercise program and medicine before he or she recommends that you have angioplasty.

Pulse volume recording

What is a pulse volume recording (PVR) study?

A PVR study is a noninvasive vascular test in which blood pressure cuffs and a hand-held ultrasound device (called a Doppler or transducer) are used to obtain information about arterial blood flow in the arms and legs. Noninvasive means the procedure does not require the use of needles, dyes, radiation or anesthesia. The blood pressure cuffs and Doppler are used to determine the presence, severity and general location of peripheral arterial occlusive disease.

A PVR may also be called a vascular study or Doppler segmental pressure study.

Types of PVRs

There are several types of PVRs, including:

Ankle Brachial Index (ABI)

The ABI is a measurement of the blood pressure in the lower leg compared to the blood pressure in the arm. Your physician will compare the two numbers to determine your ABI. Normally, the blood pressures in your ankle and arm should be about equal. But if your ankle pressure is half your arm pressure (or lower), it could be a sign that your leg arteries are narrowed.

The blood pressure cuffs are placed on the arm and leg and inflated, while the Doppler is used to listen to the blood flow in the leg and arm. The ABI helps your physician diagnose arterial disease in the legs, but it does not identify which arteries are blocked.

Exercise Testing PVR

During the exercise testing PVR, the patient walks on a treadmill to try to reproduce the symptoms he or she has experienced. Then, the blood pressure cuffs are placed on the patient’s arms, legs, thighs, ankles, calves and feet. The blood pressures are measured again to determine the location of the potential blockage or narrowed area.

Thoracic Outlet Testing

During thoracic outlet testing, blood pressure cuffs are placed on the patient’s upper arms. The test is performed while the patient is sitting in a chair. The technologist will move the patient’s arms in different positions and take a blood pressure measurement at each position.

Why do I need this test?

Your physician has recommended that you have this test to evaluate the blood flow in your arms and legs. This test is used to evaluate the presence of peripheral arterial disease.

How long is the test?

The test takes 30 to 90 minutes to complete. Please plan to arrive about 15 minutes before your scheduled appointment to complete the registration process.