Catheter techniques for restoring proper vessel shape

Angioplasty is technique for expanding and reopening arteries (or sometimes other types of vessels) that have become narrowed or closed.  Interventional radiologists use this technique, also called “percutaneous transluminal angioplasty,” to improve blood flow in arteries that most often have been compromised by atherosclerosis, though the effects of blood clots, scar tissue, vascular malformations, abnormal growths, and other conditions may also be reduced this way.  Narrowed arteries can decrease or stop blood flood, which can compromise the function of vital organs and other areas of the body.

Angioplasty has been of the great breakthroughs in care of vascular conditions in recent decades.

Arteries that are narrowed or blocked due to any cause are potentially subject to opening by this technique, in which specialists introduce a catheter (thin, plastic tube) through a small incision in a primary artery (usually the femoral artery in the groin), advance the catheter to the compromised area of the targeted artery, and then inflate a tiny balloon at the tip of the catheter to push the artery open again.  In atherosclerotic arteries, this presses the built-up plaque against the wall of the artery.  The doctor will inflate and deflate the balloon several times to press back the obstruction. When the balloon is deflated and removed, the plaque remains compressed, leaving open the interior (lumen) of the artery for improved blood flow.  Before closing the catheter access, the physician will sometimes implant a stent to hold the area open.   The technique is the same as that used by cardiologists to open coronary arteries in the heart.  (Angioplasty may also be used in combination with interventional blood clot treatments.)

Interventional radiologists at Aria offer angioplasty treatment for a variety of sites in the body:

- the arteries of the extremities.  Poor circulation caused by narrowed arteries and inadequate blood flow in the arms, hands, legs, and feet is called peripheral vascular disease (PVD).  Interventional radiologists can often successfully open even very tiny arteries providing blood to these areas, to correct the condition.  They may likewise treat the iliac artery in the pelvis to enhance blood flow to the legs.  Or, they may perform angioplasty on the arteries of the arms to improve access for kidney dialysis, as part of dialysis catheter placement and maintenance (dialysis graft maintenance to open blocked grafts for hemodialysis).

- the renal (kidney) arteries.  If one or both of the main arteries that supply blood to the kidneys are narrowed, the result may be a form of high blood pressure called renal vascular hypertension.  When the opening of these arteries is reduced, interventional radiologists can use angioplasty to widen them again and increase blood flow, which is helpful in some patients.

- vessels supplying the liver.  The primary arteries of the liver can become narrowed as a result of complications of liver transplantation, of liver-artery catheter placement for chemotherapy, and other causes.  Interventionalists open these vessels to restore circulation to and from the liver.  Most often the target is the hepatic artery or hepatic portal vein.  This treatment can prevent the need for retransplantation in liver-transplant patients.

For an angioplasty procedure, the IR team will sedate the patient and use angiography to produce an image of the vessel that requires dilation and of the vascular pathway to it.  Typically the team will insert the catheter into the femoral artery, through a small incision in the groin.  Most patients will remain for just one night in the hospital, though some can return home the same day of their procedure.  They will resume normal activities shortly thereafter. 

Interventionalists may also work with vascular surgeons on certain cases.  For example, a vascular surgeon may perform a bypass surgery on a vessel in the body, and the interventional radiologist may subsequently perform an angioplasty on the new vessel to remove any blockages that have occurred in it.

In addition, IR specialists may sometimes be called on to use balloon catheters to dilate strictures in ducts or tubes of the body.  They may, for instance, use percutaneous balloon dilation when providing interventional care for conditions of the biliary duct or to open the ureter in urologic blockages (including as part of treatment for kidney stones or in patients with kidney transplants).   

Angioplasties are among minimally invasive, low-cost, low-risk, interventional procedures that are helping many patients avoid the risk and recovery involved in surgery that would otherwise have to be employed for these purposes.  Specialists can repeat angioplasty procedures if an artery or other vessel becomes closed again.