Angioplasty Surgery

Listed below is the step by step procedure of angioplasty:

  1. What is Angioplasty Surgery?
  2. Why is Angioplasty Surgery Required?
  3. Pre-operative Preparation
  4. Day Before Surgery
  5. Procedure Day
  6. Methods/Techniques of Angioplasty Surgery
  7. Post Procedure
  8. Risks and Complications
  9. FAQs

What is Angioplasty Surgery?

Coronary angioplasty or percutaneous coronary intervention, is used to open clogged heart arteries. It involves temporary insertion and inflation of a tiny balloon where an artery is clogged for widening it. Upon suffering from a heart attack, ideally the patient needs to be subjected to an angioplasty within the first 1 to 1.5 hours. This time is known as golden hour. Beyond this time frame, heart muscle cells get irreversibly damaged.

what is angioplasty

This type of angioplasty is known as primary angioplasty. In cases where angioplasty is not possible, an intravenous clot buster is given as an alternative. Even though using this clot buster is an easy option, it is less effective than angioplasty.

Why is Angioplasty Surgery Required?

Angioplasty surgery helps in improving symptoms of blocked arteries. These symptoms include shortness of breath and chest pain. It is useful during a heart attack for quick opening of a blocked artery. It helps in reducing the heart damage. It also helps in clearing of plaque from coronary arteries. Angioplasty surgery is beneficial as the artery returns back to normal size without need of major surgery.

Indications for Angioplasty Surgery

An emergency angioplasty with or without stenting is carried out normally as the first treatment of choice for the patients of heart attack. Given below are the cases where an angioplasty is required to be carried out

  • Severe angina on frequent basis with no response to medications
  • Ischemia of heart muscles
  • Narrowed or blocked artery

Pre-operative Preparation

Prior to angioplasty, following tests are required to be done.

  • Medical history and basic examinations, such as blood pressure, heart rate and weight
  • Blood tests
  • EKG (electrocardiagram)
  • Chest X-ray
Specific instructions will be given by the surgeon prior to the surgery procedure. Few hours before surgery, patients are not allowed to eat or drink anything.

Day Before Surgery

In case of emergency angioplasty, the patient cannot be made to wait for a day to undergo the procedure. But in case of planned angioplasty, the patient should follow certain restrictions since a day prior to surgery. It is not advisable to consume food since midnight prior to surgery. The patient may consume liquids depending on the surgeon's instructions. The patient should avoid undergoing physical stress prior to surgery.

Procedure Day

An angioplasty is carried out in a catheterization laboratory. It starts with an insertion of catheter through previously inserted sheath into an artery of the arm or the leg. For better visibility of coronary arteries, a radio-opaque dye is given through injection to the patients. Blood pressure from the various parts of the heart is recorded. Functioning of valves is also examined. Using specialized cameras, images of the heart can be captured during the process. A balloon catheter is placed at the location of blockage and slowly used for inflation of fatty plaque deposits. This helps in free flow of the blood to the heart muscle.

Stent insertion by a cardiologist into the blockage site and expansion of the same with the help of balloon gives better results. Stent provides better medium for blood flow via artery. This gives long-term better results.

Methods/Techniques of Angioplasty Surgery

Angioplasty is one of the minor surgeries used for treatment of clogged blood vessels which help in restoring normal blood flow to the heart and throughout the body of the patient. For patients who are at the risk of heart disease or stroke, surgeon may recommend to go for an angioplasty instead of bypass surgery. Based on the patient's condition, type of angioplasty is decided. Given below are the main types used for angioplasty surgery.

  • Balloon Angioplasty
  • Laser Angioplasty
  • Atherectomy

Balloon Angioplasty

Balloon angioplasty is a commonly used angioplasty method. It involves passing of a thin and long tube called catheter into an artery (obstructed) via a small incision in the arm or the thigh of the patient. With the help of X-ray, guidance is provided to the catheter so that it can travel smoothly through the blood vessels into an artery. Upon entry into the narrowed artery, balloon attached to the catheter tip is inflated. The balloon in expanded state presses and flattens the plaque and widens the artery. Once the artery gets clear, blood flow is restored back.

ballon angioplasty

After insertion of balloon, it is normal to experience discomfort in the chest by the patient. Stents are commonly used during balloon angioplasty. These are small devices made up of metal which can be placed with the help of catheter after completion of angioplasty process. It remains inside the artery under treatment for preventing narrowing of the artery.

Most of the times, patients with stent insertion, find it beneficial. Sometimes, patients with weak heart may develop blood clots as a result of stent insertion. In most cases, stents have proven to be beneficial for those who receive them, but in rare cases, when someone has a weak heart, blood clots can develop due to the stent.

Laser Angioplasty

In laser angioplasty, catheter is used, but instead of balloon, laser is used. The laser is then moved to the plaque and blockage gets vaporized. It is common to use balloon and laser angioplasty one after the other. While balloon is used first for the destruction of hard plaque, remaining plaque is removed by the laser. Time interval between both procedures is decided by the cardiologist.

laser angioplasty

Even though this is the case, laser angioplasty is not used frequently as compared to other angioplasty methods.

Atherectomy

This procedure is done when the plaque is so hard that it cannot be removed with balloon angioplasty or laser angioplasty. The plaque is then cut completely using a surgical blade. The blade helps to shave off the plaque from the walls of the affected artery.

Rotational Atherectomy

This type of atherectomy involves use of a diamond-tipped high speed drill for the destruction of plaques deposits. Excessively hard plaque is removed by this method.

Extraction Atherectomy

For cutting the plaque deposits present inside the walls of artery, a small rotating blade similar to that of food processor cutter is used in an extraction atherectomy.

Directional Atherectomy

In this method, balloon and shaving blade are used in combination for shaving the plaque away.

Post Procedure

In case of non-emergency angioplasty surgery, patient remains hospitalized based on the health condition. Usually, patients can return back to normal routine after a week post angioplasty. In case of angioplasty and stenting during heart attack, hospitalization period and recovery time can increase.

Recovery at Home

After returning home, patients need to drink plenty of fluids for flushing out the contrast dye from the body. Strenuous exercise and heavy weight lifting needs to be avoided post angioplasty surgery. Rest of the activities are required to be followed as per recommendation of the surgeon. Post angioplasty, if following symptoms are observed, patients need to inform to the surgeon immediately.

  • Pain and discomfort at the site of catheter insertion
  • Infection signs such as fever, redness or drainage
  • Swelling or bleeding at the site of insertion of catheter
  • Temperature fluctuations
  • Fatigue or weakness
  • Chest pain
  • Shortness of breath

Use of Blood Thinners Post Angioplasty

It is very essential for patients to follow recommendations of surgeons regarding medications after angioplasty. Most of the times, the angioplasty patients need to take Aspirin indefinitely post surgery. Patients with stent placement will require a blood-thinning medication. Clopidogrel is given in such cases for a period of an year or longer.

It is very essential to keep the heart healthy post angioplasty. Given below are the guidelines required to be followed after angioplasty surgery.

  • Avoid smoking
  • Maintain cholesterol levels
  • Maintain healthy weight
  • Regular exercise

Risks and Complications

Factors increasing the risk of angioplasty complications are listed below.

  • Age of the patient - With old age, risk increases.
  • Type of treatment procedure - An emergency process is risky always since there is less time for planning than well-planned procedure.
  • Presence of kidney diseases - Kidney damage can happen as a result of contrast agent used during angioplasty.
  • Abnormal heart rhythms - During angioplasty procedure, the heart beats increase or become slow. Heart rhythm problems are short-lived usually , while in some cases a temporary pacemaker insertion or medications are required.

Complications

  • Bruising or bleeding on the skin at the site of catheter insertion
  • Damage to the artery at the site of sheath insertion
  • Coronary artery rupture can take place during angioplasty which may need an emergency bypass surgery.
  • Allergic reactions to contrast agent used in angioplasty procedure - For allergic patients, limited amount of contrast agent is used by surgeons and it is made sure that patient is well-hydrated.
  • Excessive bleeding can occur during angioplasty procedure.
  • Heart attack - it is possible that patient going through an angioplasty may experience a heart attack during the procedure in rare cases.
  • Stroke - A stroke can be rarely experienced by the patient during angioplasty procedure. This happens as a result of loosening of plaque while catheters are inserted via aorta. In such cases, blood thinners are used for reducing the risk of stroke.

FAQs

  1. How an angioplasty cannot work sometimes?

    A. When a vessel is split inside or gets dissected, an angioplasty fails immediately. A hardened artery cannot be broken by angioplasty when artery is not getting recoiled.

  2. What happens if an angioplasty is not successful?

    A. In cases where angioplasty does not give desired results, a bypass surgery is carried out for preventing heart damage.

  3. In which cases an angioplasty works the best?

    A. In case of large blood vessels with shorter narrowing, an angioplasty gives best results. Angioplasty has less advantages when the blood vessels are blocked or unevenly narrowed.

  4. How lengthy is an angioplasty surgery?

    A. Angioplasty is not time consuming. It takes approximately an hour. But post angioplasty, additional 12-16 hours are required for recovery. Post surgery, patient needs to be hospitalized overnight and can be discharged on the following day. Hospitalization duration depends on the condition of the patient.

Having angioplasty and stenting placement is not the sign of complete cure of heart disease. Healthy lifestyle habits need to be continued to keep the heart healthy. Along with medications, exercise and diet needs to be followed as per recommendations of the surgeon. With necessary precautions and proper care, a heart patient can live a quality life even after angioplasty surgery.



More Information related to Angioplasty
Cost of Angioplasty in India and top cities
List of best Cardiologists in India and top cities
List of best Cardiology Hospitals in India and top cities

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