Peripheral stents are small tubular metal scaffolds that can be inserted into peripheral vessels to treat narrowing or blockage in arteries or veins in the limbs, resulting in increased blood flow.
- Peripheral stents are available as bare-metal stents. Stents are frequently made from nitinol and can be plain, drug-coated, or covered with prosthetic material.
- They are classified into two types based on their release modes: self-expanding peripheral stents and balloon-expanding peripheral stents.
- In most cases, a balloon (angioplasty) is used first to flatten the blockage against the vessel walls so that the stent can open more easily.
- Peripheral stents are the most common endovascular devices used to treat peripheral vascular diseases (blockage of a blood vessel in the arm or leg).
- A stent is a wire mesh tube that can help keep affected arteries open after balloon angioplasty.
- Stents are wrapped around a catheter and guided to the affected artery, where they expand and stay in place after the catheter is removed.
- The inside lining of the artery will grow over the metal surface of the stent over time.
What is peripheral artery disease (PAD)?
Peripheral artery disease (PAD), also called peripheral vascular disease (PVD), is the narrowing of the arteries that supply blood to the limbs. This condition generally worsens over time.
Calcium and fat deposits accumulate within the artery walls, narrowing, blocking, or weakening them. Though the term PAD is generally used for decreased blood flow to the limbs, it includes blood vessel diseases at other places as well, such as the neck, kidneys, and stomach.
Not everyone suffering from peripheral artery disease will experience symptoms. Doctors estimate that only about half the people with PAD will experience any symptoms.
If a person does experience symptoms, they will most likely be in the legs and include:
- Leg pain in the calves, thighs, or hips
- Intermittent pain in one or both legs
- Pain that worsens when they walk or go upstairs, but subsides when they get off their legs and rest
- Leg cramps, tightness, or heaviness in the leg muscles are a few other common symptoms
Other symptoms may include the following:
- Tingling, numbness, or weakness in the legs
- Pain in the buttocks when walking
- Sores on the legs or feet that do not heal
- Pain in the toes or feet that aches or burns when the affected person rests or goes to bed at night
- Hair loss on the legs
- Change of color in one or both feet or legs (color changes in the legs may look pale, blue, or black)
- Erectile dysfunction (when a person cannot get or hold an erection)
Peripheral stenting is used to treat symptoms caused by:
- Peripheral vascular disease: Symptoms of claudication, such as pain or cramping in the legs on walking or using the arm or cold feet.
- Carotid artery disease (narrowing of the artery in the neck): Symptoms of syncope or fainting, dizziness, or blurring of vision.
- Renal artery disease (narrowing of arteries in the kidney): Symptoms of high blood pressure.
Risk factors of PAD may include:
- Family history
- Alcohol consumption
- Sedentary lifestyle
- High blood pressure
- High cholesterol
How is peripheral artery disease (PAD) diagnosed?
First, the doctor will ask about general health, medical history, and symptoms, and perform a physical exam. The doctor will want to know when and how frequently the symptoms occur, as well as where they occur.
Following that, the doctor will order tests to determine how much plaque has accumulated in the arteries. These tests can help the doctor determine whether angioplasty or another type of treatment is required. The type of test used is determined by the blood vessel in question, and not all tests must be used in every situation.
These tests may include:
- Routine blood tests
- Pulse volume recordings
- Duplex ultrasound
- Magnetic resonance angiography
- Computed tomography scan
If these tests reveal that the arteries are moderate to severely narrowed, the vascular surgeon may recommend an angiography procedure.
- An angiogram shows the blood vessels directly on an X-ray and may help treat the narrowing with angioplasty at the time of the angiogram.
- Angiography is performed by inserting a long, thin tube called a catheter into an artery in the groin or arm after numbing the area with local anesthesia.
- The doctor will then use X-ray guidance to guide the catheter through the blood vessels to the blocked area and inject a dye that will allow the arteries to be seen on the X-ray.
- After being filtered out, the dye is eventually eliminated through the urine.
Depending on the circumstances, the angioplasty procedure may sometimes be performed at the time of the initial angiogram or later as a separate procedure.
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What is a peripheral vascular intervention?
Peripheral vascular intervention is an outpatient, minimally invasive procedure used to treat peripheral artery disease. The goal of peripheral vascular intervention is to restore blood flow to the lower extremities, thereby eliminating pain, numbness, and the need for amputation.
Doctors use two distinct approaches.
- Angioplasty and stents:
- Angioplasty is a minimally invasive procedure performed under local anesthesia to open blood vessels that are narrowed or blocked and supply blood to the legs.
- An intravenous line placed in the arm or hand will provide enough sedation to make the procedure as comfortable as possible.
- A balloon-tipped catheter (a thin, hollow tube) will be inserted into a blood vessel in the upper thigh (groin) by the doctor.
- The catheter is positioned in the treated artery using continuous X-ray guidance.
- Once the catheter is in place, the balloon is briefly inflated, compressing the plaque outward against the artery wall, widening the artery, and restoring blood flow.
- Following that, the balloon will be deflated, and the catheter will be removed from the body.
- Stents are frequently implanted in conjunction with balloon angioplasty.
- The stent is inserted into the affected artery via a specially designed catheter, providing internal structural support to maintain circulation more effectively in the treated vessel.
- The stent is left in place, allowing blood to flow through the previously blocked artery.
- Atherectomy: An atherectomy, like angioplasty and stent placement, uses a catheter and X-ray guidance. However, instead of inserting a balloon, the catheter used for atherectomy has a sharp blade on the end that is designed to remove and collect plaque from the blood vessel. The catheter is removed once enough plaque has been removed.
Risks of procedure
- Allergic reaction to the drug used in a stent that releases medicine into the body
- Allergic reaction to the X-ray dye
- Bleeding or clotting in the area where the catheter was inserted
- Blood clot in the legs or the lungs
- Damage to a blood vessel
- Damage to a nerve could cause pain or numbness
- Damage to the artery in the groin may need urgent surgery
- Heart attack
- Kidney damage
- Stent displacement
- Stroke (this is rare)
After the procedure
- Many people can leave the hospital in two days or less. Some people might not even be required to stay overnight.
- Within six to eight hours of the procedure, one may be able to walk around. The doctor and nurse will inform the patient about after-care.
- Angioplasty improves artery blood flow in most people. The results will vary depending on the location of the blockage, the size of the blood vessel, and the amount of blockage in other arteries.
- If a person has angioplasty, they may not need open bypass surgery.
- If the procedure is ineffective, the surgeon may have to perform open bypass surgery or even amputation.
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Mueller DK. Peripheral Vascular Stent Insertion. Medscape. https://emedicine.medscape.com/article/1839716-overview
Medical Advisory Secretariat. Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(18):1-88. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377569/
The Society for Cardiovascular Angiography and Interventions. Angioplasty and Stenting for Peripheral Artery Disease (PAD). http://www.secondscount.org/treatments/treatments-detail-2/angioplasty-stenting-peripheral-artery-disease-pad#.Yebvl_54S5c
Society for Vascular Surgery. Peripheral Arterial Disease. https://vascular.org/patient-resources/vascular-conditions/peripheral-arterial-disease
Effective Health Care. Treatment Strategies for Patients With Peripheral Artery Disease (PAD). https://effectivehealthcare.ahrq.gov/products/peripheral-artery-disease-treatment/research-protocol
Krans B. Peripheral Artery Angioplasty and Stent Placement. Healthline. https://www.healthline.com/health/angioplasty-and-stent-placement-peripheral-arteries
HeartPlace. Peripheral stenting. https://www.heartplace.com/services-peripheral-stent#:
Heart Care Center. What Is a Peripheral Stent? https://www.theheartcarecenter.com/contents/procedures/stents/peripheral-stent
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