Leg: PVD in the Iliac Arteries
Preparing for the Procedure
If your physician refers you for angioplasty and stenting, you will be admitted to the hospital for the procedure. You will probably have undergone tests such as iliac artery ultrasound, angiography and routine blood tests. Be sure to tell your doctor what medications you are currently taking and any allergies you might have.
You will probably be asked not to eat or drink anything after midnight on the night before your procedure. You may be asked to take aspirin for one to two days prior to the procedure. If you are a patient who requires the use of medications called antacids or H-2 antagonists, please ensure that your doctor is aware of this. Your doctor will be able to advise you whether or not to stop this medication.
Your doctor will have also discussed the procedure in detail with you in addition to the approximate time the procedure is scheduled. The possible risks and benefits will be explained to you and any questions you have should be answered.
The procedure itself will usually involve little to moderate pain in addition to the discomfort usually experienced during the first few hours following angioplasty. During the procedure, you most likely will be injected with the same dye you were given during the diagnostic angiogram you might have received. Although rare, dye injection may produce an allergic type reaction causing low blood pressure and breathing difficulties.
Speak to your doctor about possible risks involved with angioplasty and stent procedures.
The Angioplasty Procedure
Your procedure will be performed in a room equipped with special instruments and x-ray equipment. Once you enter this room, you will be moved onto an x-ray table. You will be covered with sterile sheets and the area where the catheter will be inserted (groin, arm or wrist) will be shaved and washed with an antiseptic solution to prevent infection. A numbing medication (local anesthetic) will be used at the site where the catheter is inserted.
You may feel a stinging sensation during the administration of the medication. After the medication takes effect, you should only feel dull pressure where the doctor is working with the catheters. If the insertion is made in your inner thigh, a small tube called a sheath will be inserted into the vessel. The balloon catheter will then be placed through the sheath. If your incision is made in your arm or wrist, a guiding catheter will be inserted into the artery and advanced to the iliac arteries. Dye injected through the catheter will allow the doctor to see the area of blockage in your vessels.
An x-ray machine called a fluoroscope with a TV screen allows the doctor to see your vessels and the catheter as it is moved forward in your vessel. Your doctor may ask you to take a deep breath and hold it for a few seconds. When the catheter reaches the diseased area to be treated, a tiny balloon on the tip of the catheter will be inflated.
The balloon applies pressure to the plaque in the vessel, causing the vessel to open and increase blood flow. It is normal to experience some pain during the balloon inflation. Please tell your doctor if you feel any pain during the procedure.
You will be awake during your procedure. Your doctor or a hospital member may give you instructions. It is important to listen for these instructions and do what is asked.
Stent Implantation Procedure
The procedure for stent implantation is similar to a standard angiogram procedure. The stent is introduced into the iliac artery on a catheter-based delivery system and advanced to the blocked area of the artery. The stent is self-expanding and will open to fit the artery.
One or more stents may be implanted in the iliac artery depending on the extent of the disease. The delivery system is withdrawn from the body, while the expanded stent(s) remain(s) in the iliac artery.
Your doctor may choose to further expand the stent with a balloon catheter similar to the one used in the angioplasty procedure. This procedure is called post-dilatation and ensures that the stent is in full contact with the vessel wall. The stent stays in place permanently, holding the vessel open and improving the flow of blood.
The angioplasty and stent procedure will usually take approximately 60 to 90 minutes.