Peripheral Vascular Disease (cont.)
Francisco Talavera, PharmD, PhD
Percutaneous (through the skin) balloon angioplasty, or just "angioplasty," is a technique for enlarging an artery that is blocked or narrowed without surgery.
- A diagnostic angiogram is done first to locate the blockage or narrowing and determine the severity, because, for instance, minor blockages are treated medically.
- A thin plastic tube called a catheter is inserted into the affected artery through a needle under local anesthesia. X-ray dye or contrast is injected, x-ray films are taken and studied by the doctor. If the obstruction is significant, especially in a larger more proximal artery, angioplasty may be reasonable. The angioplasty catheter has a tiny balloon attached to the end. The balloon is inflated, pushing aside the plaque and widening the artery so that it no longer restricts blood flow.
- The balloon is then deflated and removed from the artery.
Angioplasty is not a permanent solution for most people. Stenting is a technique for arteries that are very severely blocked or begin to close up again after angioplasty.
- Generally, after the stent is placed, angioplasty is carried out. Stenting and angioplasty are very useful if the obstructive lesions are localized and involve a small portion of the vessel. The majority of peripheral vascular lesions can be managed by placement of a stent, a small metal mesh sleeve that is fixed inside the narrowed artery.
- The stent holds the artery open.
- Eventually, new tissue grows over the stent. A bare metal stent was the initial approach. However, development of restenosis or fibrous scar tissue growth inside the stent leads to recurrent obstruction.
- A new generation of drug-eluting stents is especially exciting, since a drug is attached to the metal sleeve that dissolves into the blood and prevents growth factors acting to develop scar tissue. The rate of restenosis has decreased.
- Atherectomy is removal of an atherosclerotic plaque. A tiny cutting blade is inserted into the artery to cut the plaque away.
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