American Medical Association Family Medical Guide - American Medical Association [323]
A day or two after surgery, you will probably begin a cardiac rehabilitation program to help you recondition your heart, lungs, and muscles, and control your cholesterol levels. The rehabilitation program usually includes eating a low-fat diet, exercising regularly, and having lifestyle counseling designed to help you keep your heart healthy and prevent future blockages in your arteries.
Coronary angioplasty and other procedures to open arteries
Doctors perform a number of procedures to open narrowed or blocked arteries. These procedures are often used instead of bypass surgery, which is riskier and has a longer recovery time. Your doctor may recommend this type of surgery if you have angina that cannot be controlled with medication or if only one or two of your arteries are significantly blocked. Coronary angioplasty can be used to control heart disease successfully over the long term. Before any of these procedures, you will be given medication to relax you and a local anesthetic to numb the area where the medical instrument will be inserted.
• Balloon angioplasty In balloon angioplasty, the surgeon inserts a hollow needle into the femoral artery in the groin area and threads a long guide wire through the needle, up to the heart, through the aorta, and into the obstructed artery. A catheter (a thin, flexible tube) with a tiny balloon at its tip is then threaded over the guide wire and into the obstructed artery. When the catheter reaches the obstruction, the balloon is inflated and deflated several times, for several seconds each time. The inflated balloon squeezes the plaque against the artery wall, reopening the artery and restoring blood flow. The catheter and guide wire are then withdrawn.
Balloon angioplasty
• Stent placement Stent placement is essentially coronary angioplasty with one additional step. After the surgeon opens the obstructed artery with the balloon, he or she places a tiny metallic or plastic wire mesh (stent) inside the artery to keep it open. This procedure may cut the risk of reblockage (restenosis) in half.
Stent placement
• Radiation therapy Radiation therapy (also called vascular brachytherapy) may be used in addition to stent placement when an artery becomes blocked again within 6 months of angioplasty. In this case, after the stent is in place, the surgeon inserts a series of tiny radioactive pellets into the artery through the catheter. The pellets emit low-dose radiation, which helps prevent scar tissue from forming and reblocking the artery. After 5 minutes or less, the pellets are withdrawn through the catheter.
• Atherectomy In atherectomy, a catheter with a tiny surgical instrument is inserted into the femoral artery in the groin area and guided to the blocked artery. The surgical instrument shaves the plaque away in very thin layers. The shavings are then removed through the catheter.
Atherectomy
• Laser angioplasty In laser angioplasty, the doctor uses a highly concentrated beam of light (laser) to vaporize the blockage.
After any of these procedures, you will need to carefully monitor the area where the catheter was inserted into your artery. If you notice any swelling or bleeding, or if you have any numbness, tingling, or a feeling of coolness in your toes, foot, or leg, contact your doctor as soon as possible. You may have a blood clot or a bleeding problem that requires immediate treatment.
WARNING!
Bleeding After Angioplasty
If bright, red blood flows from the area where the catheter was inserted, lie down and press down firmly on that area for 20 minutes and then carefully release the pressure. If another person is with you, have him or her apply pressure to the area instead. If the bleeding does not stop, call 911 or your local emergency number.
The success rate for angioplasty procedures is about the same as that for bypass surgery. Like bypass surgery, angioplasty may have to be repeated if the blood vessels become blocked