Alt extremity is studied under peripheral arterial disease. Not every peripheral arterial stenosis or occlusion needs intervention. Whenever the symptoms caused by vascular stenosis or occlusion lead to impairment of normal activity due to claudication or whenever there is critical limb ischemia manifested as alt extremity ulcer and signs of severe hypoperfusion, intervention is needed. Intervention may be surgical or percutaneous.
Symptoms of Severe Lower Extremity Disease
Patients complain of lower extremity pain precipitated by walking and cannot walk enough distance without rest (claudication). Whenever there is critical limb ischaemia the pain may be present at rest, there may be signs of hypoperfusion like cold extremities, loss of hair, colour changes and ulcers not easily treated. In the late stage because of neurologic disorder patients may not feel any pain or sensation.
Treatment of Severe Lower Extremity Disease
Patients with symptoms but without critical ischaemia are firstly treated with medical therapy which consists of antiaggregation and vasodilatator therapy and an exercise program. If symptoms persist despite this medication and lifestyle modification then the lesions are treated with balloon angioplasty and stent when needed.
In critical limb ischaemia, peripheral angiography is indicated and the culprit vessel should be opened in order to restore tissue perfusion.
Procedure
In a catheter laboratory usually a catheter is inserted from the femoral artery ( sometimes the access site may be distal to the lesion- e.g. popliteal access in femoral artery stenosis), the culprit lesion is crossed by wires and angioplasty is done. Some sites are not suitable for stenting whereas others may be treated with stents. Stents are also used whenever there is a complication after angioplasty ( eg. dissection ).
FAQs on Lower Extremity Angiography, Angioplasty and Stent
What is lower extremity angiography?
Lower extremity angiography is a medical technique used to visualize the blood vessels in the legs and feet. A thin flexible tube called a catheter is inserted into a blood vessel, typically in the groin. A contrast dye, which can be seen on X-ray images, is injected through the catheter. X-ray images are taken as the dye flows through the blood vessels. These images can be static or dynamic, providing real-time visualization of the vessels.
Why Is Lower Extremity Angiography Done?
It helps to diagnose diseases in peripheral arteries which include blockages, aneurysms or vascular malformations.
What happens during a lower extremity angiogram?
A thin flexible tube called a catheter is inserted into a blood vessel, typically in the groin. A contrast dye, which can be seen on X-ray images, is injected through the catheter. X-ray images are taken as the dye flows through the blood vessels. These images can be static or dynamic, providing real-time visualization of the vessels.
How serious is an angiogram of the legs?
Angiogram of legs is considered a safe procedure although it has some side effects. Some individuals might have allergies to the contrast dye, although reactions are generally mild. Bleeding infection, formation of aneurysms or pseudoaneurysms at the site of catheter insertion may be seen in some patients. Adequate compression after the catheter removal is crucial to reduce these complications. Though minimal, there is exposure to radiation for both patient and operator which is considered in the context of the procedure’s benefit.
What is the difference between angioplasty and angiogram?
An angiogram is a diagnostic procedure used to visualize the blood vessels in the body, particularly the arteries. It helps in identifying blockages, narrowing and other abnormalities like aneurysms, vascular malformation, dissections, thrombus formation in the blood vessels. It only provides information but does not treat the condition.
Angioplasty is a therapeutic procedure often performed immediately after an angiogram if blockade is found. It aims to open up narrowed or blocked arteries, restoring blood flow.
What are the Types of angiography?
Angiography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and heart chambers. Here are some main types of angiography:
- Coronary angiography: The procedure involves injecting a contrast dye into the coronary arteries to check blockages, narrowings or thrombus formation inside coronary arteries.
- Cerebral angiography: It is used to visualize blood vessels in and around the brain. It can help diagnose conditions like aneurysms, blockades, arteriovenous malformations (AVMs), or other vascular abnormalities.
- Pulmonary angiography: It is used to look at the blood vessels in the lungs. It is particularly useful for diagnosing pulmonary embolism, where blood clots block blood flow in the lungs.
- Renal angiography: Focuses on the arteries supplying the kidneys, used to detect renal artery stenosis, aneurysms or to assess kidney tumors or trauma.
- Peripheral angiography: This involves imaging blood vessels of legs, arms, or other extremities to diagnose conditions like peripheral artery disease (PAD), aneurysms, or vascular malformations.
- Aortic angiography: Utilized to image the aorta. It is used to detect aneurysms, dissections, or other diseases of the aorta.
- Visceral angiography: Examines the blood vessels supplying the abdominal organs like the liver, spleen, intestines, and pancreas. It can be used to diagnose or treat conditions like gastrointestinal bleeding or tumors, blockade in arteries like coeliac artery, superior mesenteric artery etc.
- Digital subtraction angiography (DSA): A method where images are taken before and after the contrast injection, and the pre-contrast image is subtracted from a post-contrast image, leaving a clear picture of the blood vessels.
If you need further information or if you are considering whether angiography is right for you or someone you know, it is important to consult a cardiologist who can provide tailored advice based on your health circumstances.
How long does an angiogram of the leg take?
The angiogram of the leg takes about 20 minutes. If angioplasty or any other intervention is required, the procedure may last from 1 to 2 hours. The duration can vary depending on the complexity of the case and patient preparation.
What are the risks of a leg angiogram?
Here is a list of potential risks and complications you might encounter after a leg angiogram
- Allergic reaction to contrast dye
- Kidney damage due to the contrast dye, particularly in patients with pre-existing kidney issues or diabetes. This is known as contrast-induced-nephropathy
- Bleeding of hematoma in catheter insertion site
- Artery damage: Rarely, the catheter can damage the artery, which might cause dissection ( a tear in the artery wall) or lead to the formation of an aneurysm.
- Radiation exposure.
How serious is a blocked artery in the leg?
A blocked artery in the leg can range from mild to very serious depending on several factors. Mild blockade might not cause symptoms beyond mild leg pain or discomfort during physical activity ( claudication). However, moderate to severe blockage can lead to intense pain particularly when walking (intermittent claudication), cold feet, numbness, weak pulses in the legs. When there is severe blockage leading to severe pain at rest, ulcers or gangrene it is called critical limb ischemia. It is an emergency and can lead to limb loss if not treated promptly. Major complications of a blocked artery in the legs are:
- Non-healing wounds: Poor blood supply can result in non-healing wounds, increasing the risk of infection.
- Gangrene: Lack of blood flow can cause tissue death, necessitating amputation in extreme cases
- Heart attack or stroke: Blocked artery in legs and extremities is often associated with atherosclerosis elsewhere in the body, increasing the risk of cardiovascular events like heart attack and stroke.
What are the benefits of an angiogram and angioplasty?
Angiogram helps in identifying blockages, narrowing and other abnormalities like aneurysms, vascular malformation, dissections, thrombus formation in the blood vessels. It only provides information but does not treat the condition. Angioplasty, on the other hand, is a therapeutic procedure often performed immediately after an angiogram if blockade is found. It aims to open up narrowed or blocked arteries, restoring blood flow.
How do you prepare before your angiogram?
Patients are usually advised to fast for 4-6 hours before the procedure. Certain drugs like anticoagulants or blood thinners might need adjustment or cessation. Patients should bring all the medications to discuss with his/her doctor and inform the doctor about any allergies and previous health conditions. Certain laboratory tests like total blood count and kidney function tests are needed before the angiogram. The patient should be hydrated, the area of catheter insertion (groin) should be shaved and cleaned and an informed consent form should be signed before an angiogram.