Percutaneous transluminary angioplasty (PTA) is a medical technique that allows for expansion through a balloon of a portion of a partially blocked blood vessel, usually due to atherosclerotic plaques. Angioplasty is mainly used in hemodynamic cardiology to dilate the coronary arteries restricted or occluded (PTCA), both in urgency in people with a heart attack in place, both in people with a ischemic heart disease not symptomatic.
Given that each artery can theoretically be treated by an angioplasty procedure, the other sites typically treated are the carotid arteries and the arteries of lower limbs. THE risks of this technique are mainly related to hemorrhages or damage to the walls of the affected blood vessels, but generally if this procedure is proposed, the benefits are far greater than possible complications.
There duration the procedure lasts from a few tens of minutes to a few hours, and usually requires a short hospitalization for monitoring after the exam is performed.
What is an angioplasty and how is it done?
L'angioplasty percutaneous transluminary (PTA) is a medical technique that allows the dilation of a portion of a partially blocked blood vessel, usually due to atheromatic plaques. L'atherosclerosis it is a vascular disease typical of adulthood and advanced age. It is a chronic inflammation of the innermost part of the blood vessels (the one in direct contact with the blood), specifically of the medium and large arteries.
L'atherosclerosis not to be confused withatherosclerosis, which is nothing more than the normal progressive hardening of the arteries in adults and the elderly. In any case, the two diseases are often both present in people of advanced age.
The accumulation of fat and white blood cells on the inner walls of the artery (atheromas or atherosclerotic plaques) over time it can generate serious pathologies, such as heart attack, stroke, angina pectoris.
Atherosclerosis is a rather common disease, in Italy and in industrialized countries, due to eating and living habits that favor its onset.
THE dangers of atherosclerosis are manifold: a partial occlusion of a blood vessel can cause disruption of normal circulatory flow and therefore heart attacks or stroke, furthermore, if portions of these atherosclerotic plaques detach from their origin, they enter the bloodstream and can create thrombosis or embolisms.
Angioplasty is a less invasive surgical technique than other interventions aimed at reduce stenosis (narrowing) of the blood vessel.
Regardless of the arteries involved (coronary, femoral, popliteal, carotid), the procedure of percutaneous transluminary angioplasty is performed with a catheter (balloon) flowing through the blood vessel to the point of the arterial lesion and plaque to be eliminated. At the stenosis (shrinkage of the vessel) the balloon is inflated and restores the lumen (diameter) of the artery favoring the normal flow of blood inside it.
The condition and exact position of the arteries is revealed with two extremely precise tests: angiography of arterial vessels e arterial ultrasound doppler is venous. Unlike angiography, arterial and venous doppler does not involve the use of rays X nor of half of contrast which can cause allergic reactions, nausea, discomfort, etc, but use one probe to ultrasound (ultrasound probe), which are not dangerous for the patient.
In any case, angioplasty is always performed simultaneously with a angiographic examination, which allows to accurately highlight the course and shape of blood vessels.
Most frequent types of angioplasty
The most frequent angioplasties mainly involve:
- the coronary arteries, that is, the arteries that lead oxygen-rich blood to the heart;
- the iliac arteries, which arise from the main artery of the body, theaorta, from which they begin at the navel;
- the femoral arteries, which are the continuation of the external iliac arteries starting behind the inguinal ligament and ending almost at the knee where they become popliteal arteries;
- the popliteal arteries;
- the carotid arteries, responsible together to the vertebral artery the central nervous system and facial structure.
Coronary angioplasty it is the least invasive way to intervene on the coronary tracts blocked by atherosclerotic plaques. Furthermore, in the event of a heart attack, it is the best modality of heart surgery to reopen the artery, quickly restore blood flow and reduce the damage due to the temporary lack of blood.
Coronary arteries can be divided into two main arterial vessels originating from the aorta: right coronary artery and left coronary artery.
- The left coronary artery branches into anterior interventricular artery (or anterior descendant) and supplies the left atrium and ventricle of the heart.
- The right coronary artery supplies the right atrium and ventricle of the heart.
To perform coronary angioplasty, it is necessary to pinpoint the exact location of the plaques obstructing blood flow.
There coronary angiography (coronary angiography or coronary heart catheterization) uses a contrast medium and X-rays to see exactly the arteries inside them. Generally from the pelvic area (groin, at the height of the femoral artery) small tubes are introduced (catheters) that flow up to the coronaries. The contrast medium injected into the catheter allows to detect, through X-rays, the position and size of any obstructions.
For coronary angioplasty (PTCA) another catheter is inserted, said catheter to balloon, which is inflated at the plaque pushing it towards the artery wall and causing it to rupture with consequent enlargement of the vessel lumen and increased blood flow.
Coronary angioplasty is preferred, where possible, to heart surgery coronary artery bypass grafting for various reasons. It does not require incisions or general anesthesia and the hospitalization and recovery time is considerably reduced.
However, with angioplasty it is possible for the plaques to reappear: to minimize this risk, a balloon catheter is placed around the balloon catheter. stent, that is a little tube a retiform structure that supports the artery wall. The medicated stent it is a stent with gradually and steadily releasing drugs into the artery to prevent the formation of a new obstruction.
Angioplasty of the lower limbs
Angioplasty of lower limbs (femoral THA is Popliteal THA) takes place in the angiography room. Just like coronary angiography, lower limb angiography takes place via a catheter inserted into the bloodstream. There is no general anesthesia, but local anesthesia at the inguinal level.
Through the contrast medium contained in the catheter, lower limb angiography allows the visualization with X-rays of any occlusions or narrowings. Also in this case, the insertion of a catheter with a balloon will allow, once the occlusion is reached, to push the plaque against the arterial wall and to increase the size of the lumen of the artery, with consequent improvement of circulation.
To avoid further obstructions following surgery, a stent can be introduced with the catheter, i.e. the aforementioned metal prosthesis that supports the artery walls and minimizes the formation of new plaques.
Lower limb angioplasty is minimally invasive and painless. A slight annoyance it can be felt by injecting the anesthetic into the groin area or at the occlusion of the blood vessel when the balloon is inflated.
For the study of the arteries and veins of the lower limbs and carotids, arterial and venous ultrasound doppler provides extremely detailed information about blood flow in a less invasive way than angiography. Depending on the patient's condition, the doctor evaluates which method is most suitable.
Carotid angioplasty allows you to remove any occlusions at the level of carotids. Arterial and venous angiography or doppler detects the occlusion and then the balloon catheter is inserted into the bloodstream at the plaque and inflated to widen the lumen of the carotid artery. The insertion of the stent reduces the risk of new plaques forming in these arteries, which are essential for proper oxygenation of the brain.
Risks of an angioplasty
Despite being a minimally invasive and extremely tested methodology, angioplasty is not an intervention without it risks. During the surgery, some complications general or specific, depending on the type of angioplasty. Regarding the general risks, during angioplasty can occur:
- hemorrhages – bleeding
- development of hematomas in the area where the catheter is inserted
- drilling of the affected artery with the complication of a possible hemorrhage
- allergic reactions the contrast medium can be mild but can also cause (in severe cases) respiratory problems and anaphylactic shock.
- in some cases, the nephrotoxic effect of contrast fluid can cause the development of kidney failure.
Further risks concern the destruction of the atheromatic plaque: during rupture, it may happen that fragments - emboli - start to circulate in the bloodstream causing other occlusions with serious consequences. An occlusion in the coronary arteries can lead to myocardial ischaemia (temporary absence of blood) or a heart attack.
An occlusion in the carotid arteries can cause a brain stroke. Finally, a late complication can occur which consists of obstruction of the artery treated with angioplasty. For this reason, following the angioplasty, the patient is prescribed a therapy with antiplatelet drugs. Antiplatelet agents act on platelets reducing the risk of thrombus forming in the bloodstream.
Duration of surgery and average hospital stay
As this is a minimally invasive operation, generally the duration angioplasty ranges from 30 minutes to two hours, barring complications.
There hospitalization in the hospital it is short, one or two days.
The total recovery occurs in about a week; the times inevitably dilate if the angioplasty was performed as an emergency intervention, for example following a myocardial infarction.