Peripheral Artery Angioplasty and Stenting

Introduction

The inner lining of healthy leg arteries is smooth, allowing blood to flow freely. However, as we age, coupled with unhealthy diets and lifestyles, cholesterol and other substances can accumulate on the artery walls, causing them to narrow and become rough. This condition is known as atherosclerosis. In severe cases, it can lead to arterial occlusion, obstructing blood flow. This deprives the leg tissues of essential nutrients and oxygen, resulting in leg pain and even tissue necrosis. Angioplasty (with stenting) can improve blood circulation.

Surgical procedure

This surgery can be performed under local, regional, or general anaesthesia. If performed under local anaesthesia, you will be awake during the procedure, but a small dose of sedative will be prescribed to help you relax. The doctor will inject a local anaesthetic into your groin and then perform a subcutaneous puncture in the same area. A catheter will be inserted, and contrast dye will be injected. Under X-ray guidance, a catheter with a balloon at its tip will be guided to the narrowed part of the artery. The balloon will then be inflated to compress the atherosclerotic plaque within the blood vessel, widening the artery and improving blood flow. If necessary and depending on the situation, a metal stent will be inserted to support the narrowed area within the blood vessel. This small, tube-like stent will remain in your body permanently. You can expect to be discharged from hospital approximately 2-3 days after the surgery.

Surgical risks or complications

1. The estimated mortality rate attributable to the operation is less than 1–21 TP3T
2. Systemic complications
3. Cardiovascular complications: myocardial infarction, arrhythmia, congestive heart failure
4. Respiratory complications: pneumonia, respiratory failure
5. Renal failure - contrast medium
6. Allergy or anaphylactic shock
7. Other: Stroke, Deep vein thrombosis, Pulmonary embolism
8. Localised complications
9. Graft: Infection, Embolism
10. Haemorrhage, pseudoaneurysm
11. Lower limb major artery ischaemia
12. Wound infection or poor healing

Pre-operative preparation

1. For elective surgery, you will usually be admitted to hospital the day before your operation for pre-operative checks, which include blood tests, an X-ray or electrocardiogram.
2. The doctor will explain the procedure to you and your family in detail, and you will need to sign a consent form.
3. The night before your operation, you will need to shower and shampoo your hair. We will help you to shave the hair from the surgical area, such as your groin or pubic region.
4. You will need to stop eating and drinking approximately 6 hours before your surgery. The nursing staff will inform you of the time you need to stop eating and drinking.
5. Before going into the operating theatre, you must change into a surgical gown, wear a surgical cap, and put on surgical socks (removing your own clothing, including underwear, false teeth, and jewellery, etc.).
6. You may need to have an intravenous drip (saline drip), and to take or receive injections of pre-operative medication.

Post-operative instructions
Post-operative general condition

1. If you have had a general anaesthetic, you may feel tired, weak, or dizzy; these are post-anaesthetic symptoms which will gradually wear off.
2. After a general anaesthetic, you may experience throat discomfort or phlegm. You should follow instructions to take deep breaths and practise coughing to help reduce the risk of lung infection.
3. Healthcare professionals will regularly measure your blood pressure, pulse and check your wounds.

Activity

1. You must remain in bed and avoid strenuous movement of the operated limb for the first 12 hours after surgery.
2. Twelve hours after surgery, you may get out of bed to sit or walk. Getting up and moving around as soon as possible will help you recover quickly, but you should gradually increase your activity each day as guided by your healthcare provider.
3. Within a week of your operation, please avoid strenuous exercise and lifting heavy objects as much as possible.
4. Full recovery depends on individual circumstances and may take varying amounts of time.

Wound dressing

1. After surgery, your wound has been covered with a sterile dressing and tape. Please remember to keep the wound dressing clean and dry.
2. Please be aware of any redness, swelling, pain, or bleeding from the wound. If any of these symptoms occur, please inform a healthcare professional.
3. If the wound is painful, please inform the medical staff.

Food and drink

1. The doctor will assess your condition after surgery, and you will gradually return to a normal diet.
2. Except for patients with kidney disease, diabetes, and the like who need to diet, general patients can eat a normal diet.

Post-discharge instructions

1. The following measures must be continuously taken to control atherosclerosis:
2. Stop smoking.
3. Pay attention to a balanced diet; avoid foods high in salt, fat, and sugar.
4. Control blood pressure, blood sugar, and cholesterol with medication prescribed by a doctor.
5. Foot care: Take good care of your feet.
6. Exercise therapy: Daily walking exercise therapy.
7. Medical Treatment: Take antiplatelet medication (e.g., aspirin) as prescribed by your doctor.
8. Please attend the hospital for your follow-up appointment and ultrasound scan on the specified date and time.

Notes

This leaflet provides only basic information about the surgery, and not all possible risks or complications can be listed. The risk level also varies for different types of patients. Please contact your doctor if you have any questions.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/vascularsurg_peripheralangioplastystentforatheroscleroticocclusivediseaseofthelowerextremities_0179_chi.pdf