Angioplasty

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Angioplasty- aka heart surgery, heart balloon surgery, coronary artery surgery

 

 

What is it?

Angioplasty is a procedure that will widen the vessels that have been narrowed by occlusion or stenoses.  There are a few types of angioplasty.  The names that are used for these procedures are taken from the path of entry and the equipment that is used.  An example is percutaneous transluminal angioplasty, which simply means that the blood vessel is entered through the person’s skin and that the catheter will be moved into the vessel through the same vessel or a vessel that is communicating with it.   When the angioplasty involves coronary arteries, it often uses the femoral artery and has a system that uses a guide wire and catheter. 

 

 

The Operation

 

For an angioplasty, the patient may either be under anaesthesia or simply sedated - this depends on what blood vessels are going to be involved.  In the percutaneous transluminal coronary angioplasty, the patient will simply be sedated.  This is so that she or he can let the doctor know if they are having discomfort and they are able to cough if it’s needed.  This type of procedure is performed in the laboratories used for cardiac catheterization, because they have monitoring devices that are sophisticated.   If the angioplasty is done in an angiographic suite of a radiology department, the patient is possibly sedated and a nurse will monitor his or her vital signs.  When an angioplasty is performed by a vascular surgeon, it’s done in an operating room or a vascular procedure suite that is specially designed. 

 

Usually, the patient will be given a medication to thin their blood before the procedure so that there is less chance of blood clots.  Another thing that a patient may be given is a calcium blocker and a nitrate.  These medications will make it less likely that he or she will have a vascular spasm.  During the procedure, contrast media and fluoroscopic guidance will be used.  If a patient is known to have problems with the iodine based contrast, the patient will be given contrast that doesn’t contain iodine. 

Before the procedure begins, the doctor will clean the skin of the patient with an antiseptic solution where the catheter will be inserted, and then drape the area. Even though a lot of angioplasties are done by puncturing a blood vessel through the patient’s skin, others are performed by exposing the site of entry surgically. When the doctor has a direct view of the vessel’s puncture, they can carefully monitor the vessel’s damage and watch for excessive bleeding.  Once the puncture has taken place and the guide wire has been inserted, the contrast media is going to be monitored by the fluoroscope.  This will allow the surgeon to see the movement of the guide wire as it goes through the vessel.   If the surgeon is using a fluoroscope that has a ‘roadmap’ feature, there will be a greater amount of contrast injected so that the surgeon can see the route that the guide wire is going to take.  The fluoroscope is then going to superimpose images over top of the ‘roadmap’ while the surgeon is moving the guide wire to the final destination.

Once the surgeon has reached the location of the known stenosis, she or he will inflate the balloon that is on the catheter that was passed along on the guide wire.  How big the balloon is and how long it’s inflated will depend on how big the vessel is and where it is.  A surgeon may also opt to use a stent, which will be expanded or opened in the blood vessel once it has arrived at the right location. The widening of the blood vessel may happen after, before or during the time when the stent is opened up.  In some cases, when the surgeon is dealing with a twisted vessel or it’s an intersection of vessels, it may be necessary for the surgeon to place a graft in order to strength the blood vessel’s walls.  Balloon dilation, stents, and grafts may all be used in conjunction with one another or separately. It’s also possible that radiation will be used when a stent is placed.

Once the blood vessel has been widened by the surgeon, she or he is going to verify its patency by the use of fluoroscopy and contrast media in order to make an angiogram.  This may be done by using an intravascular ultrasound.  Once the imaging studies are completed, the equipment will be removed and the surgeon will close the wound.

 

 

 

Alternatives to surgery

As this is a diagnostic test, there really are no alternatives to this surgery.

 

 

 

After the Operation - In the Hospital

After the procedure, the patient will be monitored closely to make sure that they aren’t developing a hematoma and that there isn’t any haemorrhaging.  The amount of time that a patient spends in the hospital following this procedure will depend on a number of factors, including the patient’s overall health and complications.

 

After the operation - At home

The doctor will give the patient specific instructions that are for their case.  Each person is different when it comes to this type of test. 

 

 

 

Possible Complications

As it is with anything that has to do with the blood vessels, there are always risks. Some of the risks that are included with this procedure are:

Heart attack

Stroke

Bleeding
Hematoma
Problems from anaesthesia

 

General Advice

This is an important test that a doctor may order so that they will know more about a patient’s condition.

 

 

 

 

Estimated Cost

 

Country Estimated Cost
USA $57,000
Singapore $20,000-30,000
Malaysia $12,000-20,000
India $15,000-20,000
Thailand $13,000

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