Angioplasty of the leg arteries

An angioplasty is a procedure that can open up narrowed or blocked arteries (blood vessels). You can have it in your leg arteries to treat a condition called peripheral arterial disease and improve blood flow to your legs. It’s called a femoral angioplasty when it’s below your groin (in your legs).

About angioplasty of the leg arteries

Your doctor may offer you an angioplasty if you’re getting pains in your legs when you walk due to peripheral arterial disease. This is a condition in which the arteries in your legs narrow or become blocked, reducing the blood supply. The procedure involves your doctor inflating a balloon inside your narrowed artery to open it up. It’s a minimally invasive procedure, which means it doesn’t involve surgery. Instead, it’s carried out by placing a very fine tube in your artery.

Your doctor will usually suggest other measures for peripheral arterial disease before considering angioplasty. These include stopping smoking and managing your diet and weight. You should also take any medicines you’re prescribed to control cholesterol, blood pressure and diabetes, and to stop blood clotting. They’ll also usually ask you to complete an exercise programme to see if this helps. If these measures don’t improve your symptoms, your doctor may refer you to a specialist, to assess whether an angioplasty may help. 

If your doctor thinks you could benefit from an angioplasty, they’ll go through exactly what to expect. This includes what happens before, during and after the procedure and any risks involved. If you’re happy to go ahead, you’ll need to sign a consent form.

Preparing for angioplasty of the leg arteries

Your doctor will explain how to prepare for your angioplasty. This may involve stopping certain medicines before your procedure. The procedure involves having a local anaesthetic and an X-ray dye to show up your blocked arteries. You should tell your doctor if you have a known allergy to anaesthetics or any X-ray dye. You should also let them know about any medical conditions you have or if there’s any possibility you might be pregnant.

You may be asked to come in for a pre-admission appointment a few weeks before your procedure. This is to check that you’re fit and well enough for it to go ahead. It’s also a good opportunity to ask any final questions you may have.

You can usually go home the same day as having an angioplasty, but there’s a chance you may need to stay in hospital overnight. If this is a possibility, you should be told in advance so you can make the necessary preparations. An angioplasty is usually carried out under local anaesthesia and sedation. This means the area where you have the procedure will be numb, and you may feel sleepy from the sedative. You might be asked to stop eating and drinking for several hours before the procedure. Follow any advice given to you by your hospital. 

What happens during angioplasty of the leg arteries?

Angioplasty usually takes about 45 minutes to an hour to perform, but it can be longer depending on how complex your procedure is. A specialist doctor will carry out the procedure. This may be a radiologist (a doctor who specialises in imaging techniques), a heart specialist or a vascular surgeon.

Your doctor will clean the area of skin where they’ll be performing the procedure (usually your groin) and numb it with local anaesthetic. They’ll place a small needle through your skin to access your artery, before replacing this with a small tube (catheter). Your doctor can inject a dye (contrast medium) into the tube and use X-rays to show up the narrowing or blockages in your blood vessels. 

Your doctor will pass a thin guidewire through to the affected section of your artery. They insert a catheter containing a deflated balloon over this. Once it’s in place, your doctor will inflate the balloon to open up your artery. This might feel a bit uncomfortable but it shouldn’t be painful. The balloon will be deflated after a minute or two, before being removed. Your doctor will use X-ray imaging to check whether your artery has stayed open. If necessary, they may insert a very small wire mesh tube called a stent into your artery to keep it open.

At the end of the procedure, your doctor will remove the catheter. Your doctor or nurse will apply pressure to the area where the catheter was inserted for several minutes, until any bleeding stops. Sometimes, they might use a device to seal the hole in your artery instead.

What to expect afterwards

After your angioplasty procedure, you'll need to lie flat down flat for a while – sometimes for several hours. This is to stop the artery from bleeding.

It’s likely to feel a bit sore around the area where the tube was inserted, and you may have some bruising. You can take painkillers to manage this. It’s possible that you’ll need to stay in hospital overnight but most people go home the same day as the procedure.

Your doctor will usually discuss the results of the treatment with you before you go home. They may prescribe you some medicines to help prevent blood clots and avoid future problems.

When you’re ready to go home, you’ll need someone to take you. If you’ve had a sedative, you might find that you’re not so coordinated or that it’s difficult to think clearly for the first 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or make any important decisions. It’s a good idea to have someone to stay with you overnight while you recover.

Recovering from angioplasty of the leg arteries

Take it easy while you’re recovering from an angioplasty. You’ll usually be able to walk around after the first day. It might take about a week to get back to your usual activities, including returning to work. You’ll need to be able to perform an emergency stop before you’re safe to drive. Check your doctor about your own individual circumstances. 

Contact the hospital if you have any concerns about your leg when you get home. For instance, if it becomes red and swollen, it might be a sign of an infection. There are some signs that the blood supply to your leg has become blocked. These include your leg becoming cold, pale, painful or numb or if you can’t move your leg. Contact the hospital urgently or call an ambulance if this happens. See the Complications section for more information.

The success rate for leg angioplasty is quite high initially. The procedure is effective in about nine in 10 people. But it’s possible that your artery may become narrowed or blocked again over time. This is known as restenosis or re-occlusion. See your doctor if you develop more leg pain after an angioplasty. You may need to have another angioplasty, or a bypass procedure instead, if this happens.

Making some lifestyle changes after your operation can reduce the risk of your arteries getting narrowed or blocked again and needing more treatment. These include the following

• Stopping smoking if you smoke. 
• Eating a healthy, balanced diet, low in saturated fat. 
• Keeping active. Choose something you enjoy and build activity into your day-to-day life.
• Keeping to a healthy weight.
• Taking any medicines you’ve been prescribed to reduce your cholesterol, treat high blood pressure, and to prevent blood clots. 

Complications of angioplasty of the leg arteries

As with any procedure, there is a risk of complications associated with angioplasty of the leg arteries. Complications are problems that may occur during or after your angioplasty. Specific angioplasty complications include the following.

• You may have bleeding at the site where your artery was pierced with the catheter. This may cause a blood clot, called a haematoma. Occasionally, you may need an operation to remove the haematoma and repair the artery.
• The artery that’s being treated can be damaged or torn during the procedure. This is very rare, but if it happens, you may need to have an urgent operation to repair your artery.
• It’s possible for your artery to become completely blocked during or soon after the procedure. If this happens, you will need another procedure to re-open the artery.
• You might have an allergic reaction to the dye used during the procedure. For most people, this is just a minor reaction, but very rarely it could be a more severe reaction that will require urgent treatment.
• The site where the catheter was inserted may become infected. Signs of an infection include your leg becoming red and swollen, and possibly a foul-smelling discharge or bleeding from the puncture site. Seek urgent medical advice if this happens.
• It’s possible for the wires and tubes used in the procedure to dislodge fragments of the blockage as they’re being passed through. These may go on to cause blockages elsewhere and you may need another procedure to remove these fragments.