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Balloon Angioplasty

Balloon angioplasty, also known as Percutaneous Transluminal Angioplasty (PTA), is a procedure performed to treat Peripheral Arterial Disease (PAD). Below, we answer some of the questions you may have about the procedure.

What is balloon angioplasty?

Balloon angioplasty is a medical procedure that is performed to open up arteries that have been narrowed by plaque. Balloon angioplasty is a safe and commonly performed procedure, and is now considered standard PAD treatment. For many types of PAD, a balloon angioplasty procedure has replaced a standard surgical procedure as first line treatment ⁽⁸⁾.

The principle of balloon angioplasty is to insert a small balloon into a narrowed section of an artery where the balloon is inflated, opening up the artery and improving blood flow.

The illustration below demonstrates the inflation of an angioplasty balloon, which will lead to the widening of the artery.

What instructions will I receive before the procedure?

You will be instructed not to eat or drink anything after midnight the night before the procedure and your doctor may give you other instructions relating to the medications you should or shouldn’t take on the morning of the procedure (especially if you have diabetes or take blood-thinning medicines). You will most likely have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure.

How is a balloon angioplasty performed?

A balloon angioplasty procedure is a safe procedure performed in a procedure room called a “catheterization laboratory”, or more commonly a “cath lab”.

The cath lab is a sterile room filled with numerous medical instruments, television monitors and other equipment. When you are brought into the cath lab, you will be asked to lie flat on a procedure table. Once you are on this table your blood pressure, pulse and other vital signs will be recorded via leads connecting you to a monitor.

A balloon angioplasty procedure is performed using local anesthesia, so you will be awake for the procedure. It is likely that your doctor will have at least one nurse assisting during the procedure.

The procedure's stages are:

To start the procedure, your doctor will locate one of the large arteries that lies in either your left or right leg. This artery is called the femoral artery and is the main artery of the leg.
Your doctor will wash the area and will insert local anesthesia into the area so that you won't feel pain during the procedure.
A special needle is used to enter the artery in your groin. Due to the local anesthesia you should not feel pain.
A harmless dye is injected at this stage into your artery, giving your doctor a better impression of the length and severity of the narrowing in your artery. The process of injecting the dye is called an angiogram.
A very thin wire called a "guide wire" will be guided to the site of the narrowed part of the artery. This makes it easier to guide the angioplasty balloon to the treatment area.
At the area of the narrowed artery, the balloon is inflated so that it presses against the plaque, compressing it against the artery wall.

At the end of the procedure, the guide wire and deflated balloon are removed. Firm pressure will be applied to the site where the catheter was inserted to stop any bleeding. You will also be bandaged.

What are the complications of balloon angioplasty?

Balloon angioplasty is considered a relatively safe procedure, and this accounts for the increase in the procedure’s popularity. However, as with all medical procedures, there is a risk that complications may occur during or after the procedure.

In approximately 5-10% of cases a complication will occur ⁽⁹⁾. Many complications are minor and include minor infections, some minor bleeding after the procedure, or slight discomfort at the procedure site. These usually resolve with minimal treatment.

When they occur, the major complications of lower limb balloon angioplasty can quickly develop into a medical emergency ⁽¹⁰⁾. One of the major complications of balloon angioplasty is caused by pieces of plaque breaking off after balloon angioplasty and traveling further down the leg towards the toes. When these pieces are large enough, they can block the arteries of the leg completely restricting blood flow. This process is called “distal embolization”.

What does the distal embolization of debris mean?

Distal embolization is a complication caused by small pieces of plaque – also called debris – entering the blood stream and traveling further down into the leg. These pieces of plaque break off as part of the normal balloon angioplasty procedure. The size of these pieces varies from microscopic pieces that cannot be seen with the naked eye to larger pieces that totally block off arteries of the leg.

The reason distal embolization is considered a major complication ⁽¹¹⁾ is because the artery can be totally blocked, preventing blood carrying oxygen and nutrients from reaching the lower parts of the leg. This can lead to amputation.

What is a stent?

The illustration on the left demonstrates an angioplasty balloon and a stent.
A stent is made of metal, and its main purpose is to provide support to an artery to keep it open. A stent is usually placed in an artery once the balloon angioplasty procedure has been completed.

Stents are used frequently and may be required in about 50% of cases ⁽¹²⁾. Sometimes after a balloon angioplasty procedure the artery that was treated may still be partly blocked. A stent is used to widen the artery even further to improve the flow of blood to the legs.

What is the difference between balloon angioplasty and surgery?

Balloon angioplasty is a much less invasive procedure than surgery. Surgery involves major incisions and general anesthesia while balloon angioplasty is performed under local anesthesia via a small puncture into an artery in the groin. Importantly, the recovery time following balloon angioplasty is much less than following surgery and there are fewer serious complications associated with balloon angioplasty ⁽¹³⁾.

Do I need to take medication after the balloon angioplasty?

Your doctor will advise you regarding the medication you will need to take following the procedure. For most patients, a blood thinning medication is standard treatment and this may be a life-long requirement. Your doctor may also prescribe medications to help control some of your risk factors such as high blood pressure and cholesterol ⁽¹⁴⁾.

Will the procedure improve my symptoms?

Balloon angioplasty is very good at improving patient symptoms, at least in the short term. One of the issues confronting patients and physicians is that Peripheral Artery Disease cannot be “cured”, and the symptoms you first experienced may recur even following your balloon angioplasty procedure. However, because balloon angioplasty is a minimally invasive procedure it can be performed repeatedly if required ⁽¹⁵⁾.

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