What are Peripheral Stents?
Peripheral stents are small tubular metal devices that can be implanted inside the peripheral vessels to treat a blockage or narrowing within the arteries or veins, leading to improved blood flow. Peripheral stents are most commonly employed to treat a condition called peripheral arterial disease (PAD), also referred to as peripheral vascular disease (PVD).
Peripheral arterial disease is a condition characterised by the narrowing of the peripheral arteries supplying blood to the neck, arms, legs, lower abdomen, and kidneys. PAD is often caused by the accumulation of fatty deposits (plaques) in the arterial walls, reducing blood flow through them. When an individual develops a peripheral arterial disease, the extremities – typically the legs – do not receive sufficient blood flow to maintain the body’s requirements. This causes symptoms, most commonly pain in the leg while walking (intermittent claudication).
Peripheral stents are most often inserted together with balloon angioplasty. Peripheral angioplasty with stenting is a minimally invasive procedure performed to improve blood flow through the blocked peripheral arteries. Angioplasty is a procedure in which a catheter with a balloon is used to open up narrowed or blocked blood vessels in order to restore proper blood flow. Stenting is a procedure that is performed after angioplasty where a small metal device called a stent is used to maintain the patency of the blood vessel and prevent it from future narrowing.
Indications for Peripheral Stents
Your physician may recommend peripheral stents if you have peripheral artery disease and other conservative treatments such as medications have failed to relieve symptoms of it, such as:
- Heavy feeling in your legs
- Chronic pain in your legs
- Limitations to your activities of daily living (ADLs)
- Wounds on your feet or legs that are not healing
- Numbness, cramping, and change in colour and temperature of your arms or legs
Preparation for Peripheral Stent Placement
In general, preparation for peripheral stent placement procedure will involve the following steps:
- A review of your medical history and a physical examination are performed to check for any medical issues that need to be addressed prior to the procedure.
- You may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, contrast dye, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking certain medications, such as blood-thinners or anti-inflammatories for a defined period.
- You should not consume any solids or liquids at least 6 hours prior to the procedure.
- You should arrange for someone to drive you home after the procedure.
- A signed informed consent form will be obtained from you after the pros and cons of the procedure have been explained.
Procedure for Peripheral Stent Placement
Peripheral angioplasty and stenting are most often performed in the cardiac catheterisation laboratory with the patient under local anaesthesia. A small incision is made in the groin area. A catheter (a small hollow tube) is inserted into the artery and guided to the area of blockage with the help of an imaging procedure called fluoroscopy (live X-ray imaging). Contrast dye may be injected through the catheter to help locate the area of blockage. A guidewire is inserted through the catheter, and another catheter with a balloon at the tip is then guided to the area of blockage where the balloon is inflated relieving the blockage and allowing the free flow of blood. Your surgeon will also insert a peripheral stent along with the balloon catheter to help keep the peripheral artery open and prevent it from narrowing again. The balloon and the catheters are removed, while the stent is left in place to keep the artery wide open and allow free flow of blood. The incision in the groin is closed with a small bandage.
Post-Procedure Care and Recovery
Following the procedure, you should be able to go home the same day or may have to remain in the hospital for a day or two. You will be able to start walking in 6 to 8 hours after the procedure. You may develop swelling, pain, or bruising at the catheter insertion site. Medications are provided as needed to address these. Blood-thinning medications, such as Plavix and aspirin are also provided to prevent the formation of blood clots inside the stent. You can return to your normal activities in a week, but should refrain from lifting heavy weights or engaging in strenuous activities for a defined period. Instructions on incision site care and bathing will be provided to keep the wound clean and dry. A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Peripheral stent placement is a safe procedure; however, as with any medical procedure, some risks and complications may occur, such as:
- Blood clots
- Re-narrowing of the blood vessel
- Allergic reactions to dye or medication
- Damage to nerves or blood vessels
- Heart attack
- Kidney failure