Angioplasty for peripheral arterial disease of the legs
Angioplasty (also called percutaneous transluminal angioplasty, or PTA) is a procedure in which a thin, flexible tube called a catheter is inserted through an artery and guided to the place where the artery is narrowed.
When the tube reaches the narrowed artery, a small balloon at the end of the tube inflates for 20 seconds to 3 minutes. The pressure from the inflated balloon presses the fat and calcium (plaque) against the wall of the artery to improve blood flow.
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In angioplasty of the aorta (the major abdominal artery) or the iliac arteries (which branch off from the aorta), a small expandable wire-mesh tube called a stent is usually put in place at the same time. Reclosure (restenosis) of the artery is less likely to occur if a stent is used. Stents are less commonly used in angioplasty of smaller leg arteries like the femoral, popliteal, or tibial arteries because they are subject to trauma and damage in these locations.
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What To Expect After Treatment
After the procedure, you will rest in bed for 6 to 8 hours. You may have to stay overnight in the hospital. After you leave the hospital, you can most likely return to normal activities.
Why It Is Done
This procedure is commonly used to open narrowed arteries that supply blood flow to the heart. It may be used on short sections of narrowed arteries in people who have peripheral arterial disease (PAD).
How Well It Works
How well PTA works depends on the size of the blood vessel, the length of blood vessel affected, and whether the blood vessel is completely blocked. In general:
- Larger arteries in the pelvic area can be treated successfully most of the time with angioplasty. After 4 to 5 years, the blood vessel remains open in 60% to 80% of cases. The outcome may improve slightly if angioplasty is combined with a stent.1
- Angioplasty is less successful for the smaller arteries. After 4 to 5 years, the artery may remain open in about 70% of cases. The outcome may improve slightly if angioplasty is combined with a stent.1
In general, angioplasty works best in the following types of arteries:
- Larger arteries.
- Arteries with short narrowed areas.
- Narrowed, not blocked, arteries.
The success of angioplasty has improved in the smaller arteries, such as the popliteal and tibial arteries. But in some cases, bypass surgery may be the best treatment choice. This treatment choice depends on your risks with the procedure, the size of the arteries, and the number and length of the blockages or narrowing in the arteries.
Research
Researchers have looked at several groups of people who had angioplasty for peripheral arterial disease. In a few of these studies:
- People who had angioplasty had increased walking distance without leg pain after 6 months compared with those who did not have angioplasty. But after 2 years, researchers did not find a significant difference in ability to walk without leg pain between those who had angioplasty and those who did not.2
- People who had angioplasty could walk farther than people who were on a regular exercise program after 6 months. But there was not a significant difference in how far the two groups could walk after 6 years.2
- People who had angioplasty were able to walk a little longer after 6 months compared with those who were on a regular exercise program. But then the time the angioplasty group could walk began to decline. For the exercise group, walk time continued to increase and was significantly longer than the angioplasty group after 12 months.3
- People who had bypass surgery to bring the blood supply around a blocked artery had greater blood flow to the leg after 12 to 24 months. But after 4 years, blood flow was equal in the angioplasty and bypass groups.2
Risks
Angioplasty has fewer risks than surgery. Risks include:
- Rupture of the artery.
- Bleeding at the site of the catheter insertion.
- Sudden closure of the artery.
- Blood clots.
- Allergic reaction.
- Kidney damage.
What To Think About
Angioplasty may be a less expensive, safer alternative to surgery in certain cases.
In general, angioplasty works best for people who have a small number of short, narrowed areas in the arteries of the leg or pelvis. People who have many areas of blockage or a long, continuous blockage may need bypass surgery.
Angioplasty may be used more often in the blood vessels of the legs as procedures and techniques become more advanced.
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Citations
Bettmann MA, et al. (2004). Atherosclerotic vascular disease conference: Writing group VI: Revascularization. Circulation, 109(21): 2643–2650.
Cassar K (2007). Peripheral arterial disease, search date December 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Watson L, et al. (2008). Exercise for intermittent claudication. Cochrane Database of Systematic Reviews (4).
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