What is Angioplasty Surgery? - Types, How to Prepare & Cost

Angioplasty surgery is one of India's most advanced treatment procedures that have helped millions cure artery blockages. This article highlights all the crucial aspects of angioplasty, which will help to create awareness for the people seeking solutions.

The angioplasty procedure is primarily performed for the improvement of blood flow in coronary arteries which have been blocked. The function of coronary arteries is to transfer oxygen-filled blood to the heart. In most cases, the interruption of this transfer is due to plaque formation, which is a barrier that builds up around the coronary arteries.

Angioplasty treats the chronic formation of plaque which is a combination of fat and cholesterol. This condition is atherosclerosis and can occur in any part of a body consisting of arteries. Here is a list of common diseases that instigates the need for angioplasty surgery:

• Peripheral Artery Disease: This type of condition is associated with the treatment of atherosclerosis in primary arteries present in the arms, legs and pelvis.
• Chronic Kidney Disease: Patients suffering from chronic kidney blockage due to plaque accumulation in their kidneys undergo angioplasty. In this case, specialists perform renal artery angioplasty to ensure that the necessary amount of oxygen reaches the kidneys.
• Coronary Artery Disease: In case of coronary artery blockage, coronary angioplasty or percutaneous coronary procedure helps with these ailments. This treatment ensures smooth passage of oxygen flow in the heart and offers relief from chest pain. 
• Carotid Artery Disease: Carotid artery disease occurs in the neck and requires the same kind of medical attention. The prolonged blocked arteries in the neck can lead to brain stroke by blocking the flow of oxygen in the brain. In this case, angioplasty is an ideal medical procedure that a doctor recommends.

All these ailments mentioned above are the most common conditions for which doctors across the world suggest angioplasty patients. However, there are other rare conditions for which this surgical procedure can take place.

There are predominantly two types of Angioplasty that one can opt for.

1. Stents angioplasty

In stent angioplasty, a stent or tube made of wire mesh is placed in the opened space of the channel, that holds the artery from shutting or narrowing again. Most of the stents are covered with medication to prevent the scar tissue from starting the frame inside the stent. These stents, known as drug-eluting stents (DES), discharge medication inside the vein, easing back the growth of tissue inside it.

• Benefits:
  • Stenting can help to lower heart muscle damage by improving blood flow. It can also cure symptoms of heart disease.
  • Stenting can curb the need for coronary bypass surgery.
  • It can also stimulate blood flow to legs, thereby forestalling gangrene and discards the need for amputation.
  • Stents angioplasty minimises the risk of stroke and regulates the proper functioning of the kidneys.
• Survival rate after surgery: 
  • Around 89.7% of angioplasty patients lives after going through the medical procedure.
• Cost of surgery:
  • Approximately  ₹ 1.2 lakhs to  ₹ 1.6 lakhs

2. Balloon angioplasty

In a balloon angioplasty, a specially designed catheter is placed towards the blockage and is then inflated to extend the opening. It helps  to clear plaque and keep arteries blockage free. Doctors opt for balloon angioplasty when they cannot place a stent. This type of angioplasty acts like a platform to keep the vein open and facilitates the bloodstream.

• Benefits:
  • As these catheters reduce the narrowing of the artery, leading to enhanced blood flow.
  • Patients can get back to doing normal activities after a short span of undergoing the procedure.
  • Balloon angioplasty involves the use of local anaesthesia, resulting in fewer risks than that involved with general anaesthesia.
    
    
• Cost of surgery:
  • Approximately  ₹ 1.2 lakhs to ₹ 3.68 lakhs

One must prepare themselves in the following ways to see a significant outcome.

• Convey important information: Individuals must notify their physicians regarding all the medications and remedies that they follow before undergoing an angioplasty. For instance, one who is diabetic and needs insulin must seek doctors' recommendations regarding the dosage of insulin before undergoing diagnosis. Furthermore, one must inform if they are on blood thinners, as it must be stopped before treatment.
• Follow certain eating patterns: One must not eat any food in less than six hours before angioplasty. However, one is allowed to have fluids like water, tea, and apple juice before two hours prior to the treatment.
• Quit smoking: Individuals must not smoke for at least 24 hours before undergoing the procedure. After the treatment gets over, one must keep in mind the following things. Outpatients must stay in the hospital for at least for 4 to 6 hours after the treatment. This will help patients avoid unnecessary complications. Impatiens will have to be under the observation of the medical staff. Moreover, patients must not drive after an angioplasty.

Though angioplasty does not include any serious complications, however, there can be some additional risks. People going through a coronary artery bypass graft soon after or before angioplasty procedures might experience some discomfort like blood clotting, bleeding, infection in the wounded area, chest pain, etc.

Apart from this, there are other complications that patients undergoing angioplasty experience as follows:

• Infection due to contrast dye
• Divergent heart beating 
• Stroke 
• Heart attack 
• Damage in the blood vessels of the kidney
• An additional blockage around an affected area

The complications mentioned above are extremely prevalent in older people who already have several conditions of multiple arteries blockages, kidney ailments, or a history of a heart attack. Moreover, these health conditions make angioplasty surgery difficult. To prevent this, one can start maintaining a healthy lifestyle with regular exercise and consumption of food that will lower saturated fats and trans fat. One can successfully achieve great health by adding good habits and mindfulness to daily activities.

Before beginning an angioplasty procedure, a specialist doctor will recommend you stop drinking or eating for a few hours. The patients can choose the angioplasty schedule and plan accordingly as per their condition.

Before this procedure, a patient must communicate any previous prescription medicine they are consuming for other complications to the doctors. A healthcare professional will also find out if a patient is allergic to any elements. Finally, a doctor will put an IV in the arm to start the medication to prevent blood clotting.

Angioplasty surgery for blockage of coronary arteries or any other arteries occurs in the same way. The only difference is the placement of a catheter or tube in different arteries depending on the blockage. Here is the following step-by-step process of the angioplasty procedure that most doctors perform:

Step 1: In this initial step, a tube or catheter passes into blood vessels through the skin. This tube is either placed in the wrist or groin (an area between the lower abdomen and the upper thigh). The patient passes through anaesthesia or sedation to prevent any sensation of the tube passing through the skin.

Step 2: The specialist doctor uses X-rays to locate the exact spot of blocked coronary or peripheral arteries for putting a catheter through the blood vessels. A patient undergoing this procedure might feel warm due to the passing of dye material to see the blood vessels clearly.

Step 3: Once a doctor notices an actual area, a specialist doctor will put another catheter with the balloon at the end.

Step 4: The catheter with the balloon is inflated inside an affected artery. This moves the plaque to the side of a wall and makes a passage for the blood to pass through. Doctors might put a stent which is a mesh-like metal scaffold which helps to keep an artery open upon the removal of the balloon.

In this angioplasty surgery, once the stent is put inside the artery, it expands and locks in the same position enabling continuous oxygen flow. The doctors coat this stent with necessary medication, which prevents this instrument from narrowing down.

If a patient is getting this surgical procedure for the blockage of the peripheral artery, the inflated balloon contains medications for the artery wall. After the completion of a surgical procedure, a doctor performs an angiogram showing an X-ray image of blood vessels to check the before and after the blood flow condition.

After the completion of a surgical procedure, a doctor may ask a patient to stay in observation to monitor vital areas like the insertion site, blood circulation or healing capacity of the insertion area. This can initiate the patient to stay in a hospital after a surgical procedure.

A patient with this surgical procedure must follow the same:

• The doctors recommend that patients immediately communicate chest pain, tightness or bleeding, or pain in an insertion area.
• Depending on a patient’s condition, the doctor will recommend 2 to 6 hours of bed rest.
• During this stage, a patient might feel the need to urinate frequently, which is the effect of the contrast dye and an excessive amount of fluid intake. If you have gone through angioplasty for peripheral artery blockage, then an excess movement of limbs can be dangerous. For this purpose, use a bedpan or urinal whenever necessary.

Apart from this, a doctor will advise drinking plenty of water and other fluids to help the dye exit from the body. In addition, a proper diet and necessary medication are necessary for a speedy recovery.

Individuals must reach out to the doctor if they see the following symptoms.

• Squeezing chest pain
• Arm or leg pain
• Swelling in legs
• Skin changes
• Slow-healing skin wounds
• Symptoms of stroke, which include difficulty in walking and dizziness.

In case the symptoms are grave and are not curable even after opting for conservative therapy, one must opt for angioplasty.

The most effective alternative to standard angioplasty is a coronary artery bypass graft (CABG). In this type of surgery, grafts (parts of healthy blood vessels) that are generally taken from arteries of arms, chest etc. are used to form a new channel. These new channels are then used to transfer blood  to the part where the artery is blocked. Through these alternatives, more blood can be pumped into the heart muscle.

There are no serious threats of heart attack or stroke related to this procedure. CABG is generally recommended if numerous arteries are narrowed and blocked. However, before opting for this method, one must be well versed in the ins and outs of the technique. The recovery time for a coronary artery bypass graft is generally longer than that of coronary angioplasty.