Endovascular Therapy for Peripheral Arterial Disease

What is Endovascular Therapy for Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a condition in which the arteries that supply blood to the arms and legs (limbs) are too narrow. The narrowing is due to plaque buildup (atherosclerosis). Plaque is made up of fat, cholesterol, calcium, or other substances that can build up inside blood vessels. PAD can cause pain and numbness due to lack of blood flow, particularly in the legs.

Endovascular therapy is a procedure to widen a narrowed blood vessel and improve blood flow. Endovascular means the procedure is done inside your artery, using a long, thin tube (catheter). The catheter is inserted into an incision in your leg and moved up your artery until it reaches the narrow part. A balloon or a small metal tube (stent) may be used to help widen the narrow artery and keep it open.

Your health care provider may recommend endovascular therapy if lifestyle changes and medicines are not enough to improve your PAD. In some cases—such as when more than one artery is affected—you may need more than one procedure.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines, materials, or dyes.
• Damage to other structures or organs.
• Heart attack.
• Stroke.
• Blood clots.
• Kidney problems.
• Nerve damage.
• The stent moving out of place, becoming blocked, or not working.
• Loss of your affected arm or leg.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Follow instructions from your health care provider about eating or drinking restrictions.
• You will have blood tests and a physical exam. You may have other tests, such as:
  • Ankle-brachial index (ABI). This test compares blood pressure in your ankle and arm. This can indicate narrowing or blockage in your leg arteries.
  • Doppler ultrasound. This test uses sound waves to check blood flow.
  • CT scan. This test uses dye to check blood flow and blockages in your leg arteries.
  • MRI.
  • Electrocardiogram (ECG) to check the electrical patterns and rhythms of the heart.
• You may be asked to shower with a germ-killing soap.
• Ask your health care provider how your surgical site will be marked or identified.
• Plan to have someone take you home from the hospital.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area for the procedure (local anesthetic).
• A puncture will be made in your upper thigh area, in the femoral artery or the iliac artery. Rarely, a puncture may be made in the ankle area. A small incision may be made instead of a puncture.
• A small wire will be inserted into the artery and moved through the artery.
• Dye will be injected into your artery, and X-rays will be used to help identify where the blockage is. The dye helps to make the blood flow visible on X-rays.
• A catheter will be inserted into the same spot as the small wire. It will be moved up the artery to reach the blocked or narrow part.
• A small, deflated balloon will be inserted over the wire and into the catheter. It will be moved up the artery to reach the blocked or narrow part.
• The small balloon will be filled with air (inflated) to widen the narrow part of the artery.
• The balloon will be deflated.
• A stent may be placed in the widened part of the artery to keep the artery open.
• The wire and catheter will be removed.
• A small catheter (urinary catheter) may be placed to drain urine from your bladder. This catheter may be used temporarily to drain urine during or after the procedure.
• Your puncture or incision may be closed with a stitch (suture) or skin glue.
• Your puncture or incision may be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will need to stay in bed as directed.
• You may continue to have a catheter draining your urine.
• You will be encouraged to drink fluids to wash (flush) the dye out of your body.
• You will be given pain medicine as needed.
• If you were given a sedative, do notdrive for 24 hours or until your health care provider says that driving is safe for you.

Summary

• Endovascular therapy is a procedure to widen a narrowed blood vessel and improve blood flow.
• This procedure may be recommended if lifestyle changes and medicines are not enough to improve your peripheral arterial disease (PAD).
• After the procedure, you will need to stay in bed and you will be encouraged to drink fluids to wash (flush) dye out of your body.

Endovascular Therapy for Peripheral Arterial Disease, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Soreness and bruising around your puncture or incision (access site).
• Fatigue.

Follow these instructions at home:

Access site care

• Follow instructions from your health care provider about how to take care of your access site. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips or skin glue completely unless your health care provider tells you to do that.
• Check your access site every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • A lump or bump.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. You may need to take medicines to prevent blood clots and to lower your cholesterol.
• If you were prescribed antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Driving

• Do notdrive until your health care provider approves. You should:
  • Not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
  • Notdrive or use heavy machinery while taking prescription pain medicine.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe. You may have this lifting limit for several days.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Avoid activity that requires a lot of energy, such as exercise and sports, as told by your health care provider.
  • Avoid sexual activity until your health care provider says it is safe.
• Follow your exercise plan as told by your health care provider.

Eating and drinking

• Drink fluids as instructed to help wash (flush) dye used during the procedure out of your body.
• Follow instructions from your health care provider about eating or drinking restrictions. You may need to eat a diet that is low in salt (sodium) and fat.

Avoid drinking alcohol.

General instructions

• Do nottake baths, swim, or use a hot tub until your health care provider approves. You may take showers.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have severe pain that does not get better with medicine.
• You have redness, swelling, or pain around your access site.
• You have a fever.
• You have a lump or bump at your access site.

Get help right away if:

• You have fluid or blood coming from your access site. If this happens, lie down on your back and apply pressure to the area.
• You have chest pain.
• You have problems breathing.
• You have pain, numbness, or tingling in your legs.
• You faint.
• You have any symptoms of a stroke. “BE FAST”is an easy way to remember the main warning signs of a stroke:
  • B – Balance.Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes.Signs are trouble seeing or a sudden change in vision.
  • F – Face.Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms.Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech.Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time.Time to call emergency services. Write down what time symptoms started.
• You have other signs of a stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• After the procedure, it is common to have pain and soreness near your puncture or incision (access site).
• Check your access site every day for signs of infection, such as redness, swelling, or pain.
• You may need to take medicines to prevent blood clots and to lower your cholesterol.
• If you have any signs of a stroke, get help right away.