Peripheral angioplasty (lower limbs)
What is it?
The procedure involves percutaneous/surgical catheterization of the femoro-popliteal axis and dilation of the stenotic artery with eventual stent placement, depending on the type of district to be treated.
When is this procedure indicated?
Narrowing of the arteries that carry blood to the legs results in pain/cramps in the calf or thigh, forcing the patient to stop while walking or, in severe cases, pain at rest, pallor and cold extremities up to gangrene and subsequent amputation. The free walking interval becomes subjectively disabling and defines the severity of the pathology and the priority and degree of urgency of eventual treatment.
How is it performed?
An angiographic study is performed, and in case of narrowing limited to short segments, especially of the iliac arteries, it is possible to treat these disorders with balloon dilatation and stent implantation inserted through percutaneous or surgical femoral or radial access, under local anesthesia. The indication for stent placement is not performed on arteries that are located in districts exposed to the mechanical stress of bending movements (knee).
Recovery
The postoperative clinical course includes a period of observation of 1-2 days, during which the blood count is monitored and the echocolordoppler control of the percutaneous accesses is performed after about 12 hours. If the procedure was performed by surgical access, the quality and quantity of the material collected in the drain placed in the surgical access is evaluated and the patient is indicated for removal, after which he is discharged, in the absence of complications.
Short-term complications
Vascular thrombosis or peripheral embolization conditioning the need for surgical intervention, even concomitant to the procedure or late. Post-procedural thrombosis or distal embolization causing ischemia of the limb, sometimes leading to ischemic necrosis in the most severe cases with the need for amputation. Adverse reactions to contrast medium: allergic reactions up to the development of anaphylactic shock (sometimes fatal), renal failure (sometimes serious enough to require dialysis treatment). Complications during arterial catheterization: dissection of the vessel, thrombosis: events capable of causing ischemia of the limb with the need for surgical correction. Bleeding, sometimes requiring haemotransfusion. Occurrence of hematomas and / or edema in the lower limbs and scrotal level. Nervous lesions conditioning the onset of permanent sensory-motor disorders. Venous lesions; deep venous thrombosis; subsequent definitive "post-thrombotic syndrome", pulmonary embolism. Formation, even late, of pseudoaneurysms requiring treatment by ultrasound-guided compression and/or surgery. Formation of athero-venous fistulas similarly requiring surgical revision.
Long-term complications
Restenosis of vessels or anastomotic stenosis due to recurrence of atherosclerotic disease or intimal hyperplasia requiring to repeat procedure or intervention.
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