Percutaneous dilatation of the pelvic and leg arteries (PTA—percutaneous transluminal angioplasty)
The procedure is also known as the PTA – Artery balloon dilatation / Artery stent implantation – “opening up” blocked arteries
Why would you need the intervention?
Stenosis or complete occlusion of the pelvic and leg arteries is caused by the formation of (atherosclerosis) fatty plaques inside an artery. A width of an artery gradually narrows and when a degree of the narrowing becomes extremely high, patients start to experience discomforts where other symptoms develop as well. The main symptom is the pain in the gluteal muscles, upper leg or calf muscle which occurs during a 100 to 200 step walk, or even earlier. It is caused by the reduced oxygenated blood flow in the leg muscles. This pain reduces patient’s walking distance so they are limited in their daily routine. The leg muscles gradually decrease in size (atrophy) due to the lack of oxygen accompanied by the atrophy of other leg structures in case of a long-term oxygen insufficiency. In the worst cases, the affected leg requires a surgical removal (amputation). All previously described problems indicate the intervention.
When would you need the intervention?
Angioplasty of the leg and pelvic arteries is indicated in patients diagnosed with an arterial stenosis or complete occlusion, verified by the AB index test, ultrasound, color flow Doppler ultrasound examination of the pelvic and leg arteries or abdominal, pelvic and leg MSCT angiography examination, who have clear symptoms e.g. muscle pains, significantly reduced walking distance which limits the patient’s everyday activities (< 250 m).
Which radiological examination is required before indicating an intervention?
Ankle-brachial pressure index test (AB index).
Ultrasound examination and Color flow Doppler of arteries.
Abdominal, pelvic and leg MSCT angiography.
What does the intervention include?
Angioplasty of the pelvic and leg arteries is performed under local anesthesia and a patient is sedated. The intervention starts with a small needle stick in the inguinal artery. A thin catheter and guide wires are threaded to the targeted narrowed or completely occluded artery. The stenotic or occluded area of the artery must be threaded by a thin wire. A physician will afterwards decide whether the artery should only be dilated by a balloon (PTA, “opened up”) or a stent should be additionally implanted (metal sheath). The physician‘s decision depends on the degree of the arterial stenosis or occlusion. The intervention is performed though one or two insertions. All significantly narrowed arteries are treated. The duration of the intervention is usually around 60-120 minutes. The intervention ends by pressuring the catheter insertion site with hands or by using an additional agent to close the insertion site.
Should a patient expect some discomforts during and after the intervention?
The only discomfort is usually a mild pain and discomfort in the inguinal insertion site, but a hematoma may occur due to spilled blood under the skin. A very rare complication of the artery insertion site is the formation of a sac-like collection with blood flow (pseudoaneurysm) which is treated by applying additional pressure or infusing a sclerosing agent. A patient can return to his daily routine 24 to 48 hours after the performed angioplasty.
What result should a patient expect from the intervention?
After the angioplasty of the pelvic and leg arteries, a patient can expect significant improvements including symptom reliefs and normalization of the walking distance, which will become unlimited. A muscle blood supply improves and the atrophy of the leg structures will stop. The intervention prevents the development of the highest degree of the disease and the need for amputation.
How to get prepared?
A patient is to come on an empty stomach and shall not smoke before the intervention (at least for 6 hours). A patient should have his groins shaved.
Related tests and examinations:
A patient should bring laboratory test results (creatinine blood and prothrombin time are obligatory).