Process

The angioplasty can be performed through surgical incision or the percutaneous method:

• The angioplasty performed through incision uses a portion/fragment of a healthy vein (usually taken from the patient's shank) or of synthetic tissue (patch) that is used to restore the diseased part after the longitudinal incision made in the vein's wall.
• Percutaneous angioplasty uses a probe with an inflatable balloon. This method is used only for localized narrowings and it cannot be used on totally obstructed artery fragments. By injecting an iodine-based contrast substance that can be seen in X-rays, we can identify and locate the narrowing and control the position of the probe. The probe is inserted into the sick vein indirectly, through a peripheral vein (e.g. the femoral artery). Then, the balloon that is placed in the region of the arterial narrowing is inflated in order do dilate the segment. After obtaining a satisfactory result (the disappearance of the entire stenosis or the persistence of a minimal stenosis that does not obstruct the blood flow), the probe and the balloon are retracted.

The procedure usually takes between 1 hour and a half and 2 hours and a half, but the preparation and recovery makes it longer. After undergoing an angioplasty, the patient can remain in the hospital overnight for observation.

What are the complications?

Severe complications of percutaneous angioplasties (the obstruction of the artery through the wall cleavage or hematoma, hemorrhage) are very rare. Sometimes, after a while, a new narrowing might occur (restenosis); however it is usually treated successfully through another angioplasty.

In case of coronary restenosis, which is relatively frequent, the repairing techniques have diversified nowadays:

• Using a laser, a rotablator (high speed pivoting mill);
• Applying a stent (intra-arterial reinforcement).

The majority of patients require:

• Pulmonary X-ray;
• Blood work;
• Electrocardiogram;
• Urinalysis before the intervention.

These tests might require separate appointments and are usually performed one day prior to the intervention. The patient who requires an interventional procedure is not allowed to eat or drink after midnight, prior to the day of the intervention. If the patient has false teeth, a hearing aid or glasses, it is best to have them with him/her on the day of the intervention, in order to be able to communicate better with the medical personnel.

Moreover, the patient should notify the physician or the nurse if s/he is undergoing treatment with anticoagulants, insulin or diuretics, or if s/he is allergic to any substances, especially iodine, seafood, contrast substances used for X-rays, latex or rubber (such as rubber gloves or balloons) or medicines belonging to the class of penicillin.

The patient will have to take aspirin before the procedure; therefore s/he should tell the physician or the nurse if s/he did not take the aspirin. The patient will remain awake during the intervention, but s/he will be administered medicines in order to relax.

What happens after the procedure?

The patient must remain stretched out (e.g. without bending his/her knees) as long as the inguinal muff is still in place. A folded sheet can be placed alongside the leg in order to remind the patient not to bend the knee.

After the inguinal muff is removed, the patient must remain stretched out for another six hours in order to prevent bleeding; however, after two hours a nurse can place a pillow under his/her head. The nurse will also tell the patient when s/he can get out of bed accompanied by someone, six to eight hours after the inguinal muff has been removed (or even sooner if a collagen plug has been placed in the artery).

The patient should not eat or drink anything other than clear liquids until the inguinal muff is removed, because during this time, nausea can occur. Once the patient is allowed to eat, s/he is recommended to follow a diet that is low in cholesterol and salt.

The patient can be held under observation until the next day. The physician or the nurse must be immediately informed if the patient is feverish, feels chest pains, pain or tumefaction in the inguinal area or in the leg. If, after being discharged, the patient bleeds in the inguinal area, s/he should call an ambulance, lie down immediately, get undressed and keep pressure on the affected area, where s/he feels the pulse.

If during the angioplasty a stent was placed, then the patient should take anticoagulants in order to reduce the likelihood of blood clots occurring in the stent area. When the patient has recovered sufficiently and has spoken to his/her physician about the care s/he will require, the patient is ready to go home.

In the first few days after the intervention, the patient needs a lot of rest. The patient will be able to climb up the stairs, but at a slow pace and s/he should not force the time of bowel movements. The patient's level of activity will increase gradually, until it reaches the normal level of activity. This usually takes place at the end of the first week after the intervention.

What happens after the procedure?

Even though the procedure performed during the coronary angioplasty will open the obstructed artery, it will not heal the coronary disease. The lifestyle factors that can aggravate coronary disease, such as smoking or a diet rich in fat, must be changed. We also recommend a regular program of physical exercises in order to improve the heart's health.