Angioplasty and stenting of the arteries of the pelvis and lower extremities

Stenting of the lower extremities is a treatment method based on strengthening the vascular wall with a special metal structure - a stent. Critical ischemia and gangrene of the lower extremities have long been treated only with open bypass surgery. Despite all the positive qualities, bypass surgery has one drawback - it is a large open operation with incisions to access the vessels. This creates risks of complications associated with major interventions in patients with gangrene. Endovascular methods have made it possible to effectively treat critical ischemia in patients with concomitant lesions of the coronary, renal and carotid arteries of the brain.

The development of medical technologies has made it possible to minimize surgical trauma using endovascular interventions through skin puncture and without incisions. The main endovascular operations are angioplasty of the lower extremities and installation of stents in the vessel. The purpose of vascular angioplasty is to inflate a narrowed or blocked segment using a special balloon passed through a thin guide. After angioplasty, a special metal mesh, a stent, can be installed into the lumen of the restored vessel to support the wall. Historically, laser angioplasty was used to destroy plaque in blood vessels, but this has given way to new, advanced endovascular instruments.

What is angioplasty

With atherosclerosis, dense plaques of cholesterol form on the walls of the arteries of the lower extremities. They block and narrow the lumen, disrupt the blood supply to the legs, leading to complications: oxygen starvation of tissues, brain, heart muscle, necrosis, trophic ulcers.

The main signs of the disease at stages 3–4 (“critical ischemia”):

• aching or sharp pain in the leg when walking and physical activity;
• numbness, tingling in the calves;
• pale skin;
• reduction of the fat layer, muscle fiber atrophy;
• excessive hair loss;
• change in the shape of nails, keratinization on the heels and toes;
• the appearance of non-healing ulcers.

Surgical angioplasty is a minimally invasive operation that restores the lumen of a damaged vessel. The method is endovascular and does not require long-term hospitalization of the patient in a hospital. Cardiac surgeons have developed several methods to normalize blood flow without painful incisions.

Cause of illness

The cause of the disease is the formation of atherosclerotic plaques on the inner wall of the arteries and the gradual layering of salts, cholesterol, fibrin and small blood clots on them. This leads first to a narrowing of the vascular lumen, and then to complete blockage of the artery. The development of the disease can lead to:

• smoking;
• errors in nutrition;
• passion for alcohol;
• overweight, obesity;
• some endocrine disorders - diabetes mellitus, hypothyroidism;

• hereditary predisposition to hyperlipidemia (increased levels of low-density lipoproteins);
• hypertonic disease;
• constant stress and psycho-emotional overload;
• middle and old age;
• insufficient physical activity.

Obliterating atherosclerosis is a serious pathology that needs to be treated, as it can significantly reduce the quality of life. Men suffer from it more often, however, timely consultation with a doctor and correct diagnosis will help maintain health and avoid severe consequences of the disease, such as amputation or death.

Indications for angioplasty

Atherosclerosis of the lower extremities often develops in old age due to diabetes, obesity, smoking or poor nutrition. At stages 3 and 4, diabetic foot and dry gangrene often develop due to reduced blood flow. The situation requires urgent care, surgery or even amputation.

Main indications for endovascular surgery:

• narrowing of the vascular bed (stenosis);
• severe swelling;
• anemic condition;
• atherosclerotic lesion of the iliac artery;
• leg cramps;
• trophic ulcers.

Indication for stent installation is a narrowing of the lumen by 75%, a high risk of amputation of the foot due to gangrene. After this procedure, in 95% of cases, the healing of trophic ulcers is accelerated, the blood supply to the muscles is normalized, and tension pain disappears.

Possible complications

Complications after balloon angioplasty of the vessels of the lower extremities usually develop during the intervention and should be immediately eliminated. Methods for eliminating these complications are available to vascular surgeons. The most commonly observed complications are:

• Bleeding from the access site (hematoma or pseudoaneurysm) most often occurs when the patient violates bed rest. Sometimes requires open access to eliminate the source of bleeding.
• Puncture site infection is a very rare complication. It can develop with severe purulent-destructive processes on the lower limb. It is necessary to treat with antibiotics. If necessary, open the purulent focus.
• Contrast kidney injury is a rare complication from contrast media.
• Dissection (dissection) of the artery - sometimes observed with complex lesions and attempts at subintimal passage. Most often it can be eliminated by installing a stent.
• Blockage of the arterial bed with pieces of plaque can be determined during control angiography.
• Fracture of the stent in the places where it bends is a late complication associated with mechanical stress on the metal.
• Repeated narrowing at the site of stent installation (restenosis) is the process of overgrowth of the lumen of the stented segment.
• Arterial rupture is a complication that develops due to excessive balloon inflation in a severely calcified vessel. Detected during control angiography. It is often possible to stabilize the situation with prolonged exposure of the balloon; installation of a stent graft or open surgery may be required.
• Arterial spasm is a reaction to inflating a vessel with a balloon. Occurs in 10% of procedures. To eliminate spasms, medications (papaverine, nitroglycerin) can be administered.

The frequency of all complications is no more than 5% of all procedures performed and they are usually eliminated in a timely manner during the intervention.

Method of operation

The official name of the method is percutaneous transluminal balloon angioplasty, or stenting. During the operation, a special device with a miniature balloon is inserted into a vessel affected by atherosclerosis through a thin catheter. Under pressure, air enters it, the stent expands, increasing the lumen.

After inflating the balloon, the surgeon carefully removes the catheter, leaving the stent securely in place in the artery. The procedure does not remove atherosclerotic plaques in the vessels, but reduces the risk of new deposits in the operated areas. The speed and volume of blood flow increases, nutrition of soft tissues, bones, and leg joints is restored.

Stenting of the lower extremities is carried out in a minimally invasive way: the surgeon makes punctures on the skin no more than 1 cm in diameter in the groin area. The catheter easily passes through the iliac artery through the thigh to the lower leg. At the same time, using diagnostic equipment, the patient’s condition and the location of the stent are monitored.

The operation is performed under local anesthesia, which is important for older people. The patient does not experience pain or discomfort and recovers quickly after the end of stenting.

Why do they trust us and choose the CELT clinic?

• Our clinic is an expert level of cardiovascular surgery at the level of the best cardiology clinics in Europe and the world. Cardiology and cardiovascular surgery are one of the key areas of CELT.
• We have in stock almost all stents currently available on the market in Russia.
• Highly qualified doctors have more than 20 years of experience in performing endovascular operations of varying severity.
• Our specialists were the first to implant a stent in Russia - in 1993, and for a long time they were evangelists of endovascular surgery in our country, consistently proving to the cardiological community the advantages of stenting over coronary artery bypass grafting (CABG) for a wide range of indications. This is now a generally accepted fact. Most cardiovascular surgeries in Russia, as well as throughout the world, are performed using endovascular techniques.
• Many of our patients choose CELT for angioplasty and stenting operations as an alternative to treatment in Germany, Israel or the USA, not only because of the cost, which is several times lower, but also because of higher quality. It's hard to believe, but it's true!
• We perform operations even on those patients who, due to the severity of their condition, were denied coronary artery bypass grafting.

Main types of angioplasty

Depending on the symptoms and degree of damage to the large arteries, an effective and safe surgical method for humans is selected:

• Transluminal angioplasty - a special balloon is used that is inflated, preventing stenosis. It compresses the plaques on the walls, but after removal there remains a risk of relapse.
• Stenting – a metal structure in the form of a spring creates a strong frame and prevents the artery from decreasing in diameter. After removing the balloon, the stent remains fixed and blocks the accumulation of atherosclerotic plaques. The shape and size of the device are selected individually.
• Laser angioplasty is the newest method in which a quartz thread is inserted into the vessel. Laser beams act on the skin through the skin and increase the temperature, melting cholesterol deposits.

For atherosclerosis of the lower extremities, stenting is most effective. During physical activity, the device supports blood vessels from the inside, controls stretching, blood pressure, and removes swelling in the ankles and cramps in the legs.

Types of angioplastic stenting of the lower extremities:

• Reconstruction of an artery in case of complete blockage by atherosclerotic plaques, installation of an artificial vessel. It starts the blood flow bypassing the affected area.
• An operation to strengthen the stretched artery wall. The stent forms a mesh that restores firmness and elasticity, prevents stenosis, spasms, and thrombosis.
• Standard balloon angioplasty of the iliac artery.
• Administration of drugs simultaneously with the stent for the treatment of atherosclerosis, inflammation, systemic lupus.

When choosing a method, the patient’s age, the presence of contraindications, and general health are taken into account.

A few words about stents

When performing coronary angioplasty, the following are used:

• Simple metal (without drug coating) stents;
• Drug-eluting stents are stents coated with a special polymer on the stent wall in contact with the vessel and releasing a dosed drug that prevents the development of restenosis;
• Bioabsorbable (self-absorbable) stents - when installed, they expand the lumen of the artery, and within three months they release a drug that prevents the process of restenosis. And after two years, bioabsorbable stents dissolve.

Each type of stent is selected individually, according to indications, taking into account the wishes of the patient and in accordance with all the features of the course of the disease.

Main advantages and disadvantages of stenting

Surgery has many indications and is recommended for patients with allergies to anesthesia.

Unlike a standard operation, the advantages of a closed procedure are:

• average duration – from 40 minutes to 3 hours;
• rapid restoration of blood flow in the first minutes after installation of the structure;
• prevention of thrombosis, myocardial infarction, cerebral or pulmonary stroke;
• blood loss is excluded, there are no incisions, scars, scars;
• short rehabilitation period (after 4 days the patient is sent for home treatment);
• postoperative complications develop only in 4−7% of cases;
• possibility of treating patients up to 75 years of age with minimal risk.

Stenting is a gentle method that allows you to avoid surgery under general anesthesia, amputation and distal prosthetics for diabetic feet.

Among the contraindications to angioplasty:

• acute pulmonary failure;
• endocarditis;
• exacerbation of chronic joint diseases;
• liver failure;
• hemocoagulation disorder;
• hypertensive crisis;
• severe infections of the genitourinary tract and respiratory organs.

The procedure is not recommended if you are intolerant to the components of the contrast agent, which is administered to monitor the movement of the catheter. During stent installation, computed tomography is used, so the operation is not performed during pregnancy at any stage.

Scheme of laser therapy for OASNK:

A course of laser therapy for OASNK consists of 15-20 daily procedures.

The procedures are carried out alternately: one day on the left leg, one day on the right leg.

Sessions are held every other day or daily.

Laser therapy courses are recommended to be carried out 3-4 times a year.

If necessary, on the recommendation of a doctor, 3 courses of laser therapy are carried out with an interval of 1 month according to the above scheme.

Surgical treatment is used in cases where conservative treatment is ineffective and the disease progresses. Common types of surgical treatment are bypass surgery, prosthetics, endarterectomy, stenting, balloon angioplasty and others.

Preparing for surgery

Before stenting the lower extremities, the doctor must properly prepare the patient.

The following diagnostic procedures are preliminarily prescribed:

• determination of blood clotting using a coagulogram;
• clinical blood test;
• X-ray scanning of the vessels of the legs with the introduction of a contrast agent;
• electrocardiogram;
• Ultrasound of blood vessels, liver;
• duplex ultrasound scanning to assess the condition of the arteries.

For chronic diseases, it is recommended to additionally visit your doctor and adjust the dose of daily medications. If you are prone to allergies, the anesthesiologist may prescribe a contrast test.

How is the operation performed?

Patients are rarely hospitalized first: diagnosis can be done on an outpatient basis. Before the procedure, local anesthesia is administered, the patient is positioned on the operating table, and changes into a disposable gown. At the same time, the X-ray equipment is set up.

The contrast agent is administered intravenously in small doses during surgery. An incision is made with a scalpel on the inner thigh or groin to provide access to the iliac vein. A small-diameter catheter with a metal stent is slowly passed through the vessel to the blocked area.

When operating on the arteries of the lower extremities, a coronary stent system from is often used. The cobalt alloy design features an innovative RESOLUTE INTEGRITY zotarolimus coating made from a biocompatible polymer.

Its advantages:

• high degree of flexibility;
• the polymer is released within 6 months, protects the vessel from inflammation and infection;
• tight fit to the walls;
• safety in diabetes.

There is a miniature balloon inside the stent. After insertion and inflation for several minutes, the doctor monitors blood pressure readings to ensure improved blood flow.

After removing the catheters, the puncture is gently clamped for 15-20 minutes, which accelerates blood clotting. The patient is transferred to a regular ward under the supervision of a doctor.

Cost of surgeon's services

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

Dear Clients! Each case is individual and the final cost of your treatment can only be found out after an in-person visit to a GMS Hospital doctor. Prices for the most popular services are indicated with a 30% discount, which is valid when paying in cash or by credit card. You can be served under a VHI policy, pay separately for each visit, sign an agreement for an annual medical program, or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge additional payments according to the current price list. Services are provided on the basis of a concluded contract.

Plastic cards MasterCard, VISA, Maestro, MIR are accepted for payment. Contactless payment with Apple Pay, Google Pay and Android Pay cards is also available.

Fast healing and short rehabilitation period

The highest level of personnel qualifications

100% sterile

Modern medical equipment and advanced diagnostic and treatment methods

Make an appointment We will be happy to answer any questions Coordinator Oksana

Recovery after angioplasty

If there are no contraindications, the patient is recommended to get up the next day, perform simple exercises, and take a few steps around the room. He is given vasodilators and painkillers that dissolve atherosclerotic plaques in the vessels.

Rehabilitation at home helps reduce the risk of relapse:

• daily performance of a complex of physical therapy;
• method of dosed walking “health path” for training the blood vessels of the legs;
• taking medications to control blood pressure, blood sugar and cholesterol levels.

Proper and nutritious nutrition plays an important role. During recovery, it is recommended to completely avoid salty and fried foods and animal fats. The basis of the menu should be products enriched with microelements, potassium, magnesium, vitamins A and E for the elasticity of blood vessels.

Results after angioplasty

Restoring the iliac artery without anesthesia is guaranteed to relieve leg cramps and pain for 5-10 years. The patency of the blood vessel is maintained at 80−85%, which allows you to lead an active lifestyle and reduces the risk of dangerous complications for the body.

To prevent relapse, you need to visit a vascular surgeon annually, having previously undergone the following procedures:

• ultrasound examination of the arteries and veins of the lower extremities;
• tomography using a contrast agent.

Angioplasty of the lower limb artery is the only way to preserve blood circulation in the foot, prevent gangrene and the development of trophic ulcers. Installing a stent using a gentle method in combination with diet and physical activity gives a long-lasting effect and returns the ability to move without pain and restrictions.