Angioplasty & Stenting in Cyprus
Blood vessels such as arteries have a tubular structure and their main function is the transport of oxygenated blood from the heart to the rest of the body. Regardless of the cause, when a narrowing or blockage develops within an artery, there is disruption of normal blood flow and reduction of oxygen delivery to healthy tissues.
If the narrowing or blockage develops in the arteries supplying the legs then you may experience the following symptoms:
- Hair loss, poor nail growth and cold feet
- Pain (usually the calf) after walking a fixed distance known as claudication
- Pain in the foot at night (rest pain)
- Ulceration (sores)
- Gangrene (black toes)
Angioplasty & stenting is a procedure in which Dr Zertalis uses ultrasound (US) and X-Rays (fluoroscopy) to place a fine plastic tube (vascular sheath) into an artery. X-ray dye (contrast) is injected through the sheath to define the anatomy of the arteries and identify areas of narrowing
or blockage. This is known as an angiogram.
When an area of narrowing or blockage is identified, Dr Zertalis will use an angioplasty balloon to stretch that area (angioplasty). If the balloon does not improve the narrowing or blockage, Dr Zertalis will insert a stent (flexible metal mesh tube) to keep the artery open.
Benefits
The purpose of angioplasty and stenting is the restoration of normal blood flow and oxygen delivery to tissues aiming at providing symptomatic relief from pain, promoting tissue healing, minimising the risk of limb loss (amputation) and improving quality of life.
Risks
Angioplasty & stenting is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: This can vary from mild to moderate and can be managed with painkillers (analgesia).
Bleeding: Risk of bleeding that is significant is rare. Uncommonly you may get a small bruise at the needle entry point in the groin.
Infection: This is an uncommon complication. You will be monitored during and after the procedure to check for signs of infection.
Limb Loss (Amputation): Rarely (<1%) the blood vessel may be damaged or a clot (embolus) may disrupt normal blood flow and cause pain. This may require another procedure or operation to restore blood flow.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are extremely rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Failure: Very rarely, Dr Zertalis will be unable to cross an area of narrowing or blockage or despite treatment, symptoms may recure in the long term and a repeat procedure will be necessary.
If a stent is used, the stent can move out of position or become blocked.
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can still decide not to go ahead with procedure if you choose to do so.
Before the procedure
The procedure is performed under local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Where necessary a blood test may be required. A short and thin plastic tube (cannula) will be placed into a vein in your arm. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic in your groin and place a fine plastic tube (vascular sheath) into the artery (common femoral artery). X-ray dye (contrast) will be injected through the sheath to define the anatomy of the arteries and identify areas of narrowing or blockage. You may experience a warm feeling in your leg – this is normal.
Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) across a narrowing or blockage over a guidewire. A balloon will be used to dilate (stretch) the area of narrowing or blockage and you may experience tightness in your leg while the balloon is inflated for
1 to 2 minutes. The sensation wears off once the balloon is deflated.
Depending on the number and complexity of narrowings or blockages, more often than not, multiple and different types of balloons will be necessary to stretch the artery. If the balloon does not improve the narrowing or blockage, Dr Zertalis will insert a stent (flexible mesh tube) to keep the artery open.
At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin for 10-15 minutes to prevent bleeding.
Every patient is different, however, expect to be in the radiology department up to 90 minutes.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours until you have recovered and are ready to go home. Some patients may have to stay in hospital for 24 hours. Please discuss driving, return to work and exercise with Dr Zertalis as this varies between patients.
