Lower Extremity Angioplasty, Atherectomy and Stenting
Blockages due to fatty deposits and calcification in the arteries supplying the legs and feet, often referred to as peripheral artery disease (PAD), can cause cramps and pain while walking and sometimes even while at rest. The leg pain, or claudication, comes from insufficient blood flow to leg muscles. Risk factors contributing to PAD and claudication mirror some of those for heart disease and stroke, including high blood pressure, high cholesterol, diabetes and smoking.
Many patients with PAD have no symptoms. Those who have them, however, complain of intermittent cramping leg pain - especially with exercise. Symptoms occurring as the condition worsens can include weakened calf or thigh muscles, pain and/or a tingling sensation in the feet or toes, and painful ulcers or sores on the feet or toes that do not heal. For most patients with PAD, pain subsides at rest. But for those with advanced cases, rest does not alleviate the pain. Such patients are at a much higher risk for ulcers and gangrene due to poor circulation, as well as heart attacks, heart disease and stroke due to similar blockages in other blood vessels. In extreme cases, limb amputation could be necessary.
Procedures to remove plaque and open up a peripheral blood vessel that has become narrowed include balloon angioplasty and atherectomy. Often, these procedures are followed by the placement of a wire-mesh stent. All procedures involvethe use of a flexible catheter to widen a narrowed artery and to clear plaque buildup. In some cases, bypass surgery is the better option if the plaque (material that builds up on the inner surface) is too calcified or widespread in a certain artery.
Before catheterization procedures, patients are given a sedative, but not put to sleep. With balloon angioplasty, the catheter is inserted into the bloodstream through an artery in the arm or groin and is gently guided into the affected leg artery with the aid of live x-ray images (fluoroscopy). Contrast dye is passed into the artery at the blockage so the physician can see the blood flow on an x-ray monitor. A balloon on the tip of a catheter is expanded to open the plaque-clogged area of the artery. Physicians will then perform a stenting procedure. A stent - a tubular-shaped metal mesh support or scaffold - is placed at the end of the balloon catheter and expanded to prop open the opened artery and to keep it from collapsing.
Another important procedure that can be performed before angioplasty and stenting is atherectomy. This procedure uses either a laser catheter to vaporize the plaque, or a “shaver” on the end of the catheter to remove a portion of the plaque inside an artery.
Lifestyle changes to help prevent and manage PAD and claudication are very important. They include exercise, stopping smoking, and eating a healthful diet low in fats and salt to reduce blood pressure and cholesterol levels. Complications and risks from balloon angioplasty, atherectomy and stenting can include blood clots forming or breaking away, plaque eventually rebuilding within the stent (restenosis), tearing of the artery wall by the catheter, allergic reaction to the iodine-based contrast dye and the dye causing damage to the kidneys.
MDCA cardiologists perform these procedures in a full catheterization laboratory using state-of-the-art heart catheter equipment. They are experienced in assessing the full spectrum of heart conditions, and use cardiac catheterization as an important tool to assess a patient's overall heart health and to direct his or her treatment. To make an appointment with an MDCA cardiologist experienced with lower extremity angioplasty, atherectomy and stenting, please call 713-441-1100 (Pearland patients, please call 713-441-9909).