Angioplasty

SYMPTOMS

Angioplasty is done to treat arterial blockages. The blockages mainly occur due to:

• Atherosclerosis: The slow buildup of plaques in your blood vessels.
• Coronary artery diseases: The blockage of the arteries carrying oxygenated blood to heart muscles.
• Peripheral artery diseases: The narrowing of arteries in legs and arms.
• Carotid artery stenosis: The narrowing of neck arteries supplying blood to brain.
• Narrowing of arteries in chest, abdomen, pelvis, arms, and legs.
• Renal vascular hypertension: Where high blood pressure is caused by the narrowing of arteries in kidney.
• In case the dialysis fistula and grafts are narrowed or blocked.
• Angina: Severe chest pain or tightness in the chest area felt on the middle to left side of the chest. 
• Feeling short of breath.
• Heart attack.

However, it should be noted that angioplasty isn’t a treatment for all types of blockages. It is not done in case of:

• The main artery that brings blood to the left chambers of your heart is narrowed.
• If your heart muscles are weaker.
• In case you have multiple numbers of diseased blood vessels.
• In case you are diabetic, angioplasty can be carried out but with additional precaution.

In a nutshell, the decision of angioplasty is taken by the doctors depending on the extent of your heart damage and your overall medical condition. 

DIAGNOSIS

Generally the most common sign a patient experiences is angina. Depending on the nature of angina, the doctors performs cardiac tests like ECG, stress test, along with additional chest X-Ray, chest CT scan, angiogram, cardiac MRI etc.

RISK FACTORS

Common risks in angioplasty include:

• Restenosis or re-narrowing of your artery which is common in 30% of cases where stents or drug eluting stents aren’t used.
• Blood clots can form within the stents after the procedure. Thus it is important to keep taking blood thinners like aspirin, prasugrel etc. 
• Bleeding in the area where catheter was inserted is common due to bruising. However in case excessive bleeding you may need transfusion or surgeries.
• Chances of heart attack during the procedure
• In case the coronary artery is ruptured or torn during the procedure
• In patients with severe kidney problems the contrast dye which is used may result in kidney problem
• If the blood plaques break loose when the catheters are being threaded in aorta it can cause stroke
• Abnormality  in heart rhythms

POST-OPERATIVE CARE

• In case you had a non-emergency procedure, you will be released after 24 hours observation.
• In general you can return to your normal routine within a week of procedure
• in case you had an heart attack, the recovery period will be higher
• Drink plenty of fluids to flush the contrast material out of system
• Avoid any kind of strenuous activity or any kind of heavy-lifting

Call doctors for immediate help in case:

• The accession area starts to bleed or swell
• You feel certain discomfort or pain in the area
• In case of any redness, swelling, drainage or fever
• Hotness or change of color in that limb
• You feel faint or weak
• Chest pain
• Fatigue

TREATMENT

Before the procedure 

• Before scheduled angioplasty doctors will check the patient’s detailed medical history along with performing a detailed physical examination.
• A coronary angiogram is likely to be done to determine the exact nature of the blockage
• Generally you need to stop eating and drinking 6-8hours before procedure.
• Certain routine tests like chest X-ray, electrocardiogram and blood tests will be run
• You should adjust your medication before angioplasty as per doctor’s prescription 

During the procedure 

Angioplasty is not a major surgery as it is done by inserting a catheter. The steps during angioplasty are:

• You will be asked to lie flat on back on the angio table
• Your heart rate, blood pressure etc. will be constantly monitored 
• An intravenous IV line will be administered in the vein of your arm so that you are mildly sedated
• Alternatively you may receive general or localized anesthesia.
• The area in your arm of leg where the accession point will be made is cleaned, sterilized and covered with surgical drape.
• Generally the femoral artery in your groin is selected for the procedure however arm or abdomen arteries are also selected
• A small incision will be made
• Sheath will be inserted first
• Then with the guidance of live X-ray, the catheter will be inserted in vessels and will reach to the site of blockage
• Once in place the contrast material will be injected for clearer view of blockage
• Then doctor will cross the blockage with a guide wire
• This will allow the balloon tipped catheter to pass over the wire
• Once the catheter is across the wire it will be inflated for a short span
• Sometimes the balloons are needed to be inflated multiple times for easing the blood flow.
• X-rays are taken to check the improvement in blood flow
• Sometimes stents are needed to be permanently placed
•  At the end of procedure the balloon is removed
• Pressure will be applied to stop bleeding
• The opening will be dressed.

The entire process of angioplasty takes around 30-90 minutes to complete and you will able to walk within 12 hours or so after the procedure. You can fly back to your country within 4-7 days in case of uncomplicated procedures.

FACTORS AFFECTING COST

The cost of complete procedure should include:

• Cost for stent
• Surgeon fees
• Cost for 2 3 days of hospital stay
• Patient’s food 
• Cost for drugs and other consumables

Note that price might vary according to the number/type of stents implanted during angioplasty.