Angioplasty of the leg arteries

About angioplasty of the leg arteries

Angioplasty is a procedure used to widen narrowed arteries to allow blood to flow through normally. It can be used to treat a condition called peripheral arterial disease, where the arteries carrying blood to your limbs are narrowed (see our common questions for more information).

An angioplasty is done by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions).

Diagnosis of peripheral arterial disease

Your doctor will ask you about your symptoms and examine you. You will usually have an ultrasound scan of your legs. An ultrasound scan uses sound waves to produce an image of the inside of your legs. You may also have an angiography, where your radiographer (a health professional trained to perform imaging procedures) will inject a dye (called contrast medium) into your blood vessels to make them visible on X-ray images.

What are the alternatives to angioplasty?

Medicines can be used to treat peripheral arterial disease in some people. You will only be offered an angioplasty if medicines don’t work or aren’t suitable for you.

If an angioplasty hasn’t been successful, you may need to have coronary artery bypass graft surgery.

Preparing for angioplasty of the leg arteries

Your radiologist will explain how to prepare for your angioplasty. If you're having an angioplasty, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your radiologist’s advice.

The procedure is usually done through a large artery in your groin, so you may be asked to shave this area. It’s important that you don’t shave this area unless you are asked to do so.

It's possible to have an allergic reaction to contrast medium (the dye used during the procedure). Tell your radiologist if you know you’re allergic to contrast medium. Medicines are available to treat any allergic reaction.

Your radiologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

About the procedure

Angioplasty usually takes between 30 and 45 minutes. It's typically done in the X-ray department of a hospital.

You will lie flat on your back on an X-ray table. Your radiologist may put a needle put into a vein in your arm to give you a sedative or painkillers if you need them.

You will have a local anaesthetic injection into the skin over the artery in your groin. This will completely block feeling from the area and you will stay awake during the procedure.

Your radiologist will insert a needle into the large artery in your groin. He or she will put a guide wire through the needle. Your radiologist will then remove the needle and place a thin tube called a catheter over the wire into your artery. He or she will inject contrast medium through the catheter. You may have a warm feeling when the contrast medium is injected. Your radiologist will then pass a catheter with a balloon on the tip through the blocked or narrowed part of your artery. Once it’s in place, he or she will inflate the balloon. It may be inflated more than once to make sure your artery is wide enough.

Sometimes, your radiologist will put a collapsed wire mesh tube (called a stent) over the balloon at the end of the catheter, and insert it into your artery with the catheter. When the balloon is inflated it opens the stent up. When your radiologist removes the catheter the stent stays in place to keep your artery open.

After the procedure, your radiologist will remove the balloon and catheter.

Your radiologist may put a plug over the hole in your artery, or will press on the area where the catheter was inserted to stop it bleeding.

The procedure shouldn't be painful but may feel slightly uncomfortable. If you do feel pain, tell your radiologist or a nurse who may be able to give you some painkillers.

What to expect afterwards

You will need to lie flat on the bed for the first hour and stay in bed for several hours to recover.

Nurses will check your blood pressure and pulse. They will check your skin where the catheter was inserted to make sure there isn't any more bleeding.

You will probably be able to go home the same day as the procedure. Sometimes you may need to stay in hospital overnight.

Recovering from the procedure

Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor’s advice.

Your doctor may give you a medicine to take to help prevent clots forming in your arteries. You can get back to your normal activities as soon as you get home.

What are the risks?

As with every procedure, there are some risks associated with angioplasty of the leg arteries. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted, but mostly temporary effects you may get after having the procedure.

You may have some bruising around your groin where the catheter was inserted.

Complications

Complications are when problems occur during or after the angioplasty.

Specific complications of angioplasty are rare, but possible complications are listed below.

  • Small parts of the lining of your artery may break away and become stuck in your artery, causing a reduced blood supply.
  • There may be severe bleeding from your artery.
  • You may get a wound infection, which can be treated with antibiotics.
  • There may be damage to the arteries.
  • You may get blood leaking out under your skin if the hole in your artery isn’t closed properly.
  • Your artery may not open up as much as hoped.
  • You may have an allergic reaction to contrast medium.

How can I prevent peripheral arterial disease?

Answer

The best way to prevent peripheral arterial disease is to reduce the risk factors for atherosclerosis.

Explanation

Peripheral arterial disease usually happens when fatty deposits (plaques) build up in the walls of your arteries. This is called atherosclerosis. The fatty deposits cause your arteries to become narrower, restricting blood flow. The best way to prevent peripheral arterial disease is to reduce the risk factors for atherosclerosis.

Try to:

  • quit smoking – if you need help giving up, ask your GP for advice
  • do regular physical activity
  • keep a healthy weight, and reduce the amount of fat in your diet

Doing these things will also help to reduce high blood pressure, which can contribute to peripheral arterial disease.

Even if you already have peripheral arterial disease, making these lifestyle changes can improve your symptoms and stop it getting worse. If you have peripheral arterial disease your GP may prescribe you medicines if you have high blood pressure. He or she may also prescribe medicines to lower the amount of cholesterol in your blood, as this is one of the main causes of atherosclerosis, and to reduce the risk of blood clots forming.

Will I have symptoms of peripheral arterial disease?

Answer

You may not have any symptoms of peripheral arterial disease. If it gets worse, you may have pain in your legs when you walk.

Explanation

Usually the blood flow in your artery is greatly reduced before you notice the symptoms of peripheral arterial disease. Some people don't even notice that they have it.

If the blood supply to your lower legs is reduced, you may feel pain, aching, tiredness and cramps in your lower legs, which comes on after walking or other exercise and goes away after rest. This is called intermittent claudication and it's the most common symptom of peripheral arterial disease. If you have these symptoms, contact your GP.

You may have thin, pale skin and hair loss on your legs. If an artery in your leg suddenly becomes totally blocked, it can cause sudden severe pain, coldness and numbness in your leg. This is a medical emergency and you must seek help immediately.

How successful is angioplasty?

Answer

Angioplasty is usually very successful at treating narrowing of your arteries. But this varies depending on how severe the narrowing or blockage of your artery is.

Explanation

Angioplasty is generally very successful at treating narrowing of your arteries, but it does vary depending on the severity of peripheral arterial disease. Angioplasty isn’t suitable if the narrowed section of your artery is too long, or if the artery is severely hardened.

If angioplasty isn’t suitable or doesn’t work for you, you may need to have coronary artery bypass graft surgery to treat peripheral arterial disease instead. This is an operation to make your blood flow around the narrowed area of your artery, instead of through it. Your surgeon will do this by attaching a graft artery to your blood vessel above and below the blocked area.