This procedure is performed to assess and improve arterial blood supply to the limb.
Why do I need a femoral angioplasty?
In general, this procedure is used to improve the blood supply to your legs to help alleviate pain, help in the healing of ulcers, or other skin problems or because of difficulty with walking (severe intermittent claudication) caused by diminished blood supply. The purpose of the procedure is to improve the blood flow to help relieve any symptoms you are experiencing.
Preparation
You will usually be admitted to the hospital the day before your procedure or on the morning of surgery (DOSA "Day of Surgery Admission"). You should fast (no food or drink) from midnight the night before or for at least six hours before the procedure. This is because the contrast (“dye”) injection can make some people feel sick adn in case any additional procedure is required at the same time. Your doctor will arrange to stop any medications that could interact with the contrast used during the procedure (e.g. glucophage). Medications that increase the risk of bleeding – such as warfarin or Plavix (Clopidogrel) - may also need to be stopped. However, do not stop any medication unless you are told to do so. If you are in doubt, please ask or contact your surgilca team for advice.
Procedure
The procedure is performed in the operating theatre and you will be brought there by a porter and your nurse on a hospital trolley. Regardless of which leg is affected, either leg may be used for the procedure. Usually the procedure is performed under local anaesthesia and the area chosen will be ‘frozen’ using an injection of local anaesthetic. Sometimes, a sedative injection will be given if this is safe, but this is not always necessary. Occasionally, the procedure is performed under General or Spinal Anaesthesia.
A needle is inserted into the artery, a wire passed through it and this is used to guide a tube (catheter) into the place that will allow the surgeon to take the best pictures of your blood vessels.
During the procedure, x-ray contrast is injected into the catheter and you may get a warm feeling in you legs and feet. You may also get the urge to pass water. This is normal and it is important to stay still during the injection. Feel free to tell the surgeon/anaesthetist if you are worried or uncomfortable. The procedure takes approximately 30-60 minutes.
When the narrowing in the artery has been located, a balloon is passed through the blockage and inflated to restore normal blood flow. You will receive a heparin injection during the procedure to prevent blood clotting.
When the catheter is removed, a doctor will press on the groin for up to 30 minutes to prevent bleeding. You will be brought back to the ward on a trolley and asked to lie flat in bed for up to 6 hours after the procedure to prevent bleeding. Your regular medication (where it has been withheld) will be restarted when it is safe to do so. You may return to the ward with a constant heparin infusion that will be stopped when deemed safe to do so. You may require regular blood tests while on this medication.
Are there any risks with the procedure?
Bruising and a little soreness are common after the procedure. More serious complications occur rarely and include:
* Significant bleeding may occur rarely and if this should happen, you may require an emergency operation.
* Occasionally, the little hole in the artery may fail to seal closed (pseudoaneurysm) and further treatment or an operation may be required. Rarely, the site may also become infected.
* If one of the arm arteries is used, the tube will pass one or more of the arteries supplying the brain. There is a small risk that a blood clot could form and cause a stroke.
* The contrast used in the procedure can sometimes cause an allergic reaction. This is severe in approximately 1 in 3000 cases.
* The contrast can also interfere with kidney function, especially in diabetics or if kidney function is already reduced. Occasionally, this may mean that the kidneys stop working and dialysis is required.
* The procedure can also put additional stress on the heart and rarely patients can suffer a heart attack during or after an angioplasty – this could put your life at risk. Rarely, some patients may die as a result of these complications.
It my not be possible to improve the blood flow or the vessel may become blocked again soon afterwards. Occasionally circulation may become very reduced and put your leg in danger. Surgery or other treatment may be necessary in this case. It is not always possible to correct the problem and rarely it may not be possible to save your leg. In this situation, you may require an amputation of the leg to save your life.
Recovery
After six hours (or sooner if your doctor or nurse tells you) you may sit up and start moving around. The groin may be a little sore afterwards but if you have any concerns, notice any swelling, severe pain, or have any new pain or numbness in your leg, please draw this to the attention of your doctor or nurse. Usually, it will be possible to go home the next day.
Credits:
Images from Society for Vascular Surgery
2020