Peripheral Angioplasty & Stenting - Procedure, Risks, Results

Peripheral angioplasty and stenting are minimally invasive treatments for narrowed or blocked peripheral arteries in the legs or arms. The surgery involves inflating a balloon to widen the artery. Next, a stent (a small, metal mesh tube) is placed to keep the artery open.

Peripheral angioplasty is primarily used to treat peripheral artery disease (PAD). It occurs when the arteries farthest from the heart, like those in the arms and legs, become narrowed or blocked by plaque. This phenomenon of fat accumulation, known as atherosclerosis, can reduce blood flow to the limbs. 

Angioplasty helps restore the flow of blood through these arteries.

Lifestyle modifications and medications are usually the primary treatments for peripheral artery disease. If non-invasive treatments fail to offer relief, doctors may recommend a surgical procedure. Peripheral angioplasty indications are as follows: 

1. Claudication (leg pain or cramps during walking or exercise) that interferes with daily activities.

2. Persistent skin ulcers or wounds on the leg.

3. Infection or gangrene (tissue death due to lack of blood flow) on the leg.

Peripheral angioplasty and stenting take 1-3 hours, depending on the number of blockages treated. Patients are awake during the procedure as it is performed under local anaesthesia. The steps involved are as follows: 

1. The procedure begins with a small incision in the groyne or hip to access an artery.

2. A catheter (a flexible, thin tube) is inserted through the incision into the artery. It is carefully guided to the site of the blockage, using real-time X-ray imaging for precision.

3. A small balloon attached to the catheter tip is inflated. It helps compress the plaque against the artery walls, widening the artery to improve blood flow.

4. The surgeon places a stent at the blockage site to keep the artery open. It expands as the balloon inflates. 

5. Once the stent is in place, the balloon and catheter are removed. 

6. The incision site is closed and bandaged.

Peripheral angioplasty is minimally invasive and prevents the need for complex procedures like bypass surgery. It offers various benefits over traditional surgical approaches for treating peripheral arterial disease. These include: 

1. A small puncture, avoiding the need for long incisions 

2. Minimises damage to muscle and surrounding tissue 

3. Shorter hospital stays (most individuals can return home within a day)

4. Quick recovery times, allowing for a return to normal activities in a week

Preparing for peripheral angioplasty requires knowing the necessary steps before and on the day of the procedure to ensure positive results. Patients should adhere strictly to their doctor’s guidance.

Before Peripheral Angioplasty

This preparation is important to make sure that the patient is ready for the treatment. It involves the following steps: 

On the Day of Peripheral Angioplasty 

Patients arrive at the hospital or clinic, where final checks are performed before the procedure. They can expect the following on the day of the surgery: 

Angioplasty, like any surgery, has its risks. However, peripheral angioplasty complications are relatively rare, occurring in about 1-2% of cases. Potential risks include:

1. Bleeding 

2. Blood clots  

3. Rupture or damage to the artery

4. Re-narrowing of the artery  

5. Allergic reaction to dye 

6. Infection 

When to call a doctor?

After peripheral angioplasty, it is important to know when to seek medical advice. Prompt communication can address complications early and ensure a smooth recovery. Patients should contact their doctor if they experience the following:

1. Increasing pain, swelling, redness, or bleeding at the catheter insertion site

2. Signs of infection, like fever or discharge from the insertion site

3. Changes in the colour, temperature, or sensation in the limb that was treated

4. Excessive swelling in the legs 

5. Shortness of breath or chest pain 

6. Dizziness or fainting 

7. Coughing up blood 

8. Weakness, slurred speech, or inability to get out of bed

Patients may experience bruising or soreness at the incision site for the first few days post-procedure. It may take six to eight weeks to recover fully. During this time, individuals should follow these instructions for recovery: 

Recovery in Hospital 

Depending on their condition, patients can return home the same day or may need to stay in the hospital for two days or less. Here’s what one can expect in the hospital: 

1. The patient will be moved to a recovery room where a nurse will monitor their vital signs like breathing, blood pressure, heart rate, etc. 

2. Once their condition stabilises, they will be shifted to a general ward or private room. 

3. The doctor may prescribe medications to manage pain and infections. 

4. Patients will be able to walk 6-8 hours after surgery. 

At-home Recovery 

Before discharge, the doctor will provide various instructions regarding recovery at home. These self-care guidelines are as follows: 

1. Keep the wound clean and dry to prevent infection.

2. Walk 3 to 4 times a day for short distances on a flat surface.

3. Limit climbing up and down the stairs to two times a day for 2-3 days after the procedure.

4. Do not drive, play sports, or engage in yard work for at least two days or as advised by the doctor. 

5. When resting, patients should keep their legs raised above the heart level.

6. Take prescribed medications to prevent blood clots and manage other conditions like high blood pressure or cholesterol.

First Follow-Up Appointment 

After peripheral angioplasty, follow-up appointments will be scheduled every three months for a year. It helps monitor recovery and ensure the long-term success of the procedure. These visits include the following: 

1. The doctor assesses the healing of the catheter insertion site and addresses any immediate complications.

2. Diagnostic tests like ultrasound or angiography are performed to visualise blood flow.

3. They inquire about the symptoms the patient has experienced since the procedure.

4. Medications prescribed post-surgery are reviewed.

Delaying peripheral angioplasty when it is recommended can lead to several complications in people with peripheral artery disease. These include: 

1. Compromised blood circulation can lead to wounds that heal slowly or not at all.

2. Pain or discomfort in the affected limb can severely limit mobility and negatively impact quality of life.

3. Individuals with PVD who do not get treatment are three times more likely to experience a stroke.

4. The risk of amputation (losing a limb) increases in case of gangrene as blood flow continues to diminish without intervention.

Cost of Peripheral Angioplasty 

The peripheral angioplasty cost in India varies widely depending on several factors. It generally ranges between ₹ 1,35,000 and ₹ 4,10,000. The average price of the procedure is ₹ 3,30,000. 

Note: These expenses are approximate. Patients should talk to HexaHealth consultants for accurate costs. 

Factors that influence the price of a peripheral angioplasty procedure include:

1. Hospital Location: Facilities in metropolitan areas or those with specialised vascular departments may charge more than those in smaller cities or rural areas.

2. Surgeon’s Expertise: Highly experienced surgeons charge a higher fee for their services. 

3. Material Costs: The price of medical supplies, including the catheters and stents, can impact the total expense.

4. Pre- and Post-Procedure Care: Costs associated with diagnostic tests, follow-up visits, and rehabilitation can contribute to the final bill.

5. Insurance: The extent of insurance coverage can significantly affect patient expenditure.

Peripheral angioplasty is a crucial, minimally invasive procedure for those suffering from peripheral artery disease. It offers significant improvements in blood flow and quality of life. The procedure reduces symptoms like leg pain and increases mobility, with a relatively low risk of complications. 

For those who want to understand peripheral angioplasty indications, HexaHealth offers comprehensive support and guidance. Our team also helps you find the best doctors and hospitals to undergo successful procedures. Contact us today to get assistance throughout your angioplasty surgery, from hospital admissions to postoperative recovery.