August 2014

Angioplasty

Angioplasty

As the years go by and atherosclerosis is not either reversed or eliminated, it continues to build up and may eventually reach the point where certain crucial arteries in the heart become partially or completely blocked. At some point the individual starts to develop symptoms. In the earliest stages the first symptoms are chest pain, shortness of breath and in ability to exert one's self. As the blockage increases the individual may develop angina pectoris, more advanced situations it can lead to a heart attack. Generally, something must be done before the individual has a heart attack, but what?

Who Is the Best Candidate For Angioplasty?

  • The individual who is not getting relief from medication.
  • The individual with the least number of blocked arteries.
  • The determination is based on the number, location and severity of the blocked vessels.
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    Why Perform Angioplasty?

    One of the more common procedures performed for returning circulation to the blocked up, oxygen and nutrient starved, heart muscle is angioplasty. The official name of this procedure is called Percutaneous Transluminal Coronary Angioplasty, or PTCA. Simply stated, angioplasty is the widening of the coronary arteries that have been significantly narrowed because of atherosclerosis.

     

    Procedure

    The procedure is performed under local anesthetic. A flexible tube known as a catheter is placed into an artery in the groin or the shoulder. The catheter is then threaded from the area of entry up into the heart and the affected artery is isolated. As the catheter nears the heart one or more small bursts of radiopaque dye may be introduced to visualize the areas of constriction.

    The catheter must be introduced slowly, under direct observation, into the artery and then advanced until it reaches the area of the blockage. A second catheter is then inserted inside the first one. When the larger catheter reaches the narrowed or blocked area, the second smaller catheter is then advanced as far as it can safely go. A balloon in the tip of this catheter is then inflated. The balloon compresses the atherosclerotic plaque and widens the arterial canal. See Diagram: 1. The balloon may be inflated and deflated several times before the artery is open

     

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    Diagram: 1.


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    Diagram: 2

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    Diagram: 3.


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    Diagram: 4.

     

    Ultimately the procedure reopens the artery allowing blood to flow through normally again. Both catheters are withdrawn at the end of procedure. At the end of the procedure more radiographic pictures may be taken to assess the results. The procedure generally takes between 30 minutes and an hour and a half.

    While the procedure is relatively safe and free of major discomfort from time to time, the patient will feel some chest pain especially when the balloon is blown up and when the catheter touches the vessel walls.

    It is also important to remember that angioplasty does not resolve the problem of atherosclerosis. Atherosclerosis is not eliminated, instead it is only compressed. If the atherosclerosis process is not stopped the plaque will like return again and the procedure will have to be repeated.

    It is always possible that this procedure will not be successful. In such cases the surgeon is generally always ready to perform a coronary bypass surgery.

    Angioplasty, has for the most part, almost entirely replaced, the older coronary bypass procedure. Coronary bypass has some major problems and is generally considered to be a much more traumatic procedure. It is very expensive.

    After the angioplasty procedure the patient is monitored very closely for the next 24-hours. It is especially important to watch for difficulties with blood pressure, heart rate or rhythm. Since it is basically a simple procedure most people are back to normal in a few days and are generally back to work within a week or less.

     

    Risks of Angioplasty

    While this procedure is generally very safe, there are some risks associated with it. 
  • Risks of local anesthesia
  • Allergic Reaction to Radiographic dye or other medications
  • Puncture of a major blood vessel
  • Puncture of a minor blood vessel
  • Local infection at the site of introduction of the catheters
  • Arrhythmia (irregularity of the heart)
  • Cardiac Arrest
  • Need for Resuscitation
  • Death
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