Dr Hagley uses minimally invasive (keyhole) techniques where possible. Balloons and stents are medical devices used to help improve blood flow through arteries which have become narrowed or blocked by the build-up of plaque (fatty deposits) inside the arteries, a feature of Peripheral Artery Disease (PAD).
The procedure is referred to as angioplasty or balloon angioplasty or percutaneous transluminal angioplasty (PTA), and is a procedure to re-open or improve the blood flow. It is carried out in a specific radiology suite and is performed under X-ray guidance. The procedure is generally performed under a local anaesthetic (the patient is awake, but experiences no pain) and patients go home the same day or early the next morning.
In most cases this is performed as a ‘percutaneous’ procedure (no large cut and no stitches), where a thin tube called a catheter is inserted into the large artery in the groin (the femoral artery) and then manoeuvred over a guidewire through the various arteries to the section where the narrowing/blockage is situated.
Next the (uninflated) balloon is manoeuvred over the guidewire through the blocked or narrowed section. The balloon is then inflated, then deflated and removed, to open up the narrowed section.
At this point a ‘stent’ may also be inserted into the blood vessel to keep it open. A stent is a very small expandable metal mesh tube, generally made of either medical grade stainless steel or a nickel titanium alloy. The stent is expanded into position and then remains in place when the balloon and catheter are removed. A stent will help stop the blood vessel from narrowing and/or closing again - a process known as ‘restenosis’.
Left: Uninflated stent in position. Right: Inflated stent prior to removal of the balloon.
Recent technological advances include the use of special drug coatings to the outside of balloons and stents (drug coated balloons (DCB), drug eluting balloons (DEB) or drug eluting stents (DES)). These coatings slowly release medication into the artery wall to help prevent restenosis.
Recent clinical trials indicate that these stents may help reduce restenosis considerably. Like all therapies these have their advantages and disadvantages and Dr Hagley will discuss this with you.
Balloons and stents have been in use for over twenty years, with stents now fitted to millions of patients around the world.