Angioplasty at Leeds Hospital

What is angioplasty?

Angioplasty is a procedure to widen an artery that has become narrowed or blocked, restoring blood flow to the part of your body it supplies. A thin tube is guided to the narrowed section, where a small balloon is inflated and a short mesh tube called a stent is often left in place to help keep the artery open.

What conditions does it treat?

You might be offered an angioplasty if you have:

• coronary heart disease, where narrowed heart arteries cause chest pain (angina)
• a heart attack, where angioplasty can be used as emergency treatment to limit damage to your heart
• peripheral arterial disease, where narrowed arteries in your legs or arms cause pain, ulcers or, if untreated, gangrene
• carotid artery disease, where narrowed arteries in your neck raise your risk of stroke
• narrowed arteries supplying your kidneys, which can affect how well they work.

What are the benefits of having an angioplasty?

In most cases, angioplasty improves blood flow through the affected artery, and many people find their symptoms get significantly better afterwards. If you've had a heart attack, an emergency angioplasty can limit the damage to your heart and lower your chances of having another one in future.

For some types of blockage, angioplasty can achieve results similar to bypass surgery, with much less impact on your body since it doesn't involve open surgery.

Are there different types or surgical approaches?

Angioplasty can be carried out on different arteries around your body. Coronary angioplasty treats the arteries supplying your heart, while peripheral angioplasty treats arteries elsewhere, such as in your legs, arms, neck or kidneys.

Most procedures use a small balloon to widen the artery, and a stent (a short mesh tube) is usually left in place afterwards to help keep it open. Some stents are coated with a slow-release medicine to lower the chance of the artery narrowing again. Less commonly, a laser may be used instead of a balloon to clear the blockage.

The tube used to reach the affected artery is usually inserted through your groin, though your wrist or arm can also be used. Going in through the wrist tends to mean a smaller entry point and an easier recovery, though it isn't suitable for everyone. Your doctor will recommend the best access point for you.

What happens before the operation?

Before your angioplasty, your doctor will confirm the size and position of the blockage, often using a scan or a dye test called an angiogram. You'll usually be admitted to hospital on the day of, or the evening before, your procedure. In general, you'll need to:

• stop eating for around eight hours beforehand, though you can usually drink water and may have a light meal earlier in the day
• tell your doctor about any allergies, especially to the contrast dye used in scans, or to anaesthetic
• tell your doctor about any blood-thinning medicines you take, such as warfarin or clopidogrel, as these may need to be paused for a time before your procedure (low-dose aspirin can usually continue)
• arrange for someone to drive you home afterwards, as you won't be able to drive yourself or use public transport
• be prepared to stay in hospital overnight, depending on your procedure.

What happens during the procedure?

Angioplasty is usually done using a local anaesthetic, so you'll be awake, though you may also be offered a mild sedative to help you relax. It typically takes between 30 minutes and 2 hours. Here's what generally happens:

1. You lie on an X-ray table, and monitors keep track of your pulse, blood pressure and oxygen levels throughout.
2. The skin over the entry point, usually your groin, wrist or arm, is cleaned and numbed with local anaesthetic.
3. A thin tube called a catheter is guided through the artery to the narrowed section, using X-ray images to check its position.
4. A dye is injected through the catheter so your doctor can see the narrowing clearly on X-ray. You may feel a brief warm sensation, or feel like you need to urinate, at this point.
5. A small balloon at the tip of the catheter is inflated to widen the artery, pressing the fatty build-up against the artery wall.
6. A stent is usually put in place to hold the artery open, and the balloon is then deflated and removed.
7. The catheter is taken out, and firm pressure is applied to the entry point for several minutes to stop any bleeding, sometimes with the help of a small sealing device.

What does recovery look like?

After your procedure, you'll rest in bed for a few hours, usually between two and six hours if the tube was in your groin, while your team checks your pulse, blood pressure and the entry site regularly. If your angioplasty was planned, you may go home the same day or the next morning; if it followed an emergency such as a heart attack, you're likely to stay in hospital for several days so your team can monitor your recovery.

Once home, avoid heavy lifting, strenuous exercise and driving for about a week, or longer if you've had a heart attack or a physically demanding job. Your entry site may be bruised or tender for a week or so, which is normal, but tell your team if it becomes red, swollen or starts bleeding. If you've had a stent fitted, you'll need to take blood-thinning medicine as prescribed, without missing doses, to stop clots forming inside it.

What are the risks and complications?

Angioplasty is generally a safe procedure, and serious problems are uncommon, though as with any medical procedure there are some risks. Studies suggest the overall risk of a serious complication is around two to three in every hundred procedures, and this depends on factors including your age, general health and whether you've had a heart attack.

Possible complications include:

• bruising or bleeding at the point where the catheter was inserted
• an allergic reaction to the dye or anaesthetic used
• the artery becoming blocked again over time
• damage to a blood vessel, which occasionally needs further treatment
• a heart attack or stroke
• an irregular heartbeat
• for leg angioplasty, a small chance the leg gets worse, which very rarely may need further surgery, including amputation
• exposure to a small dose of X-ray radiation, similar to months or years of everyday background radiation.