Trusted medical platform in Jordan
علاج انسداد الشرايين الطرفية بالقسطرة
Endovascular treatment of peripheral arterial disease is a procedure in which a narrowed or blocked artery in the leg or pelvis is treated from inside the vessel itself, without a large surgical incision. Under X-ray guidance the doctor passes a fine wire and catheter through a small puncture in the groin or arm artery, widens the narrowed segment with a balloon, and may place a stent to hold the widening open; specialised balloons or plaque-removing devices may be used depending on the nature and length of the blockage. The main indications are pain or heaviness in the leg on walking that eases with rest and returns with movement, known as intermittent claudication, when it limits the patient's life despite medical treatment and a walking programme; pain that appears at rest and at night; or a non-healing ulcer or discoloured toes threatening loss of the limb. The decision is built on clinical examination, palpation of pulses, ankle and arm pressure measurement, and vascular imaging by ultrasound, CT or MR angiography; suitability is determined by that assessment rather than by reading a page. The limits must be stated openly. Angioplasty treats the narrowing, not the cause of arterial disease. Without stopping smoking and controlling diabetes, blood pressure and lipids, the blockage may return in the same place or appear in another artery. It does not bring back tissue that has died, nor repair a nerve damaged by poor perfusion or diabetes, and it does not replace antiplatelet and statin therapy or the structured walking programme that remains one of the strongest ways to improve walking distance. In certain patterns of disease, bypass surgery or surgical repair is a better option than a catheter, and that is a team decision. Finally, not every leg pain is arterial blockage; spinal, nerve, venous and muscular pain can mimic it, and examination with pressure measurement distinguishes them. The disease is therefore diagnosed before it is treated, and the whole patient is treated rather than the image alone.
Pulses are examined at the groin, knee, ankle and foot, ankle pressure is measured against the arm, and the skin, nails and any ulcer are assessed. Duplex ultrasound is requested, sometimes with CT or MR angiography, to map the site and length of the blockage and the state of the arteries beyond it, since this determines whether a catheter or surgery is the better route.
Medicines are reviewed, particularly anticoagulants, antiplatelet agents and diabetes drugs, and kidney function is measured because contrast dye can strain the kidneys, so protective fluids are given and the contrast volume minimised where needed. Previous contrast allergy is asked about, the puncture site is prepared, and fasting is requested for a period the team specifies before sedation.
The puncture site is anaesthetised locally with light sedation, and a short sheath is inserted into the artery through a small opening. Contrast is injected and the artery imaged with X-ray to define the blockage precisely before treating it. You remain awake in most cases and may be asked to hold still or hold a breath to improve image quality, and you should report any pain or burning to the team.
A fine wire is passed across the narrowed segment, then a balloon is inflated briefly to widen it, which may feel like a stretch or a passing pain. If the widening does not hold or a tear appears in the inner layer, a metal stent is deployed. Contrast is repeated to confirm blood flow, and the pulse and the condition of the foot are checked before the procedure ends.
The sheath is removed and the puncture closed by manual pressure or a closure device, and you are asked to lie flat without bending the hip for some hours. The site and the foot's pulse, colour, warmth and sensation are checked at intervals, and urine output and kidney function are watched if a large contrast volume was used. Before discharge you are told exactly what to watch for at home and when to return immediately.
Tell the team about all your medicines, especially anticoagulants, antiplatelet drugs and diabetes treatment, because some are adjusted before the procedure on medical advice and must never be stopped on your own. Report any previous reaction to contrast dye or iodine, any kidney disease, and any possibility of pregnancy. Bring your duplex and imaging reports and your kidney and glucose results. Stop smoking immediately, since it is the strongest accelerator of arterial blockage and the greatest threat to a successful result. Follow the fasting instructions before sedation exactly, and drink fluids well beforehand if your doctor allows, to protect the kidneys. Wear comfortable clothing, arrange transport both ways because you must not drive afterwards, and inspect your feet and tell the team about any wound, crack or fungal infection before the date.
Lie flat and avoid bending the hip for the period the team specifies, then get up gradually with help. Drink enough fluid to clear the contrast unless your doctor has restricted fluids. Keep the puncture site clean and dry, and avoid heavy lifting, vigorous exercise, hot baths and swimming for several days as instructed. Take your antiplatelet and statin medicines exactly as prescribed and never stop them yourself, since stopping them puts the treated artery at risk. Start the agreed walking programme and keep controlling diabetes, blood pressure and lipids while staying off tobacco, and inspect your feet daily, especially if you have diabetes. **Attend emergency care immediately for a cold, pale or bluish foot, numbness or weakness of movement, increasing pain not relieved by analgesia, or at the puncture site: rapidly increasing swelling, a pulsatile lump, a quickly enlarging bruise, bleeding that does not stop with pressure, or severe pain; and also for fever and chills, redness or pus, a marked fall in urine output, or chest pain or breathlessness.**
The procedure usually takes 45 minutes to two hours depending on how many arteries are treated and the length and calcification of the blockage. It is generally performed under local anaesthesia with light sedation. Monitoring afterwards is typically 4 to 6 hours, with discharge the same day or after one night, and a return to light activity within days as the team advises.
Dr. Imad Al Haddad practices cardiology and interventional cardiovascular medicine at Jordan Hospital. His work includes complex coronary disease and assessment…
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