What is a peripheral artery stenting procedure?

A small metal tubular structure called a stent is inserted into a peripheral artery through a catheter under local anesthesia. The peripheral arteries supply blood flow to the legs and feet.  At the time a peripheral stent is deployed, blockage in the artery is dilated with the balloon on which the stent is mounted.  The stent acts as scaffolding, keeping the artery wall stretched open and maintaining adequate blood flow through the vessel while holding the plaque back.

When does a patient’s condition require peripheral artery stenting?

When peripheral artery disease (PAD) has caused enough narrowing, or blockage, in a peripheral artery that blood supply to the legs or feet is significantly limited, serious problems may occur. Symptoms accompanying this condition often include impotence, discoloration of the legs or feet, skin ulcerations that take longer than normal to heal, or intermittent claudication (pain) caused by inadequate oxygen supply to the leg muscles. Thus, PAD is a major cause of diminished ability to walk and can lead to leg amputation.

What tests can determine a need for peripheral artery stenting?

During a physical exam, your doctor periodically checks your peripheral pulses. Diminished or absent pulses are the first signs of blockage in the peripheral arteries.

An ABI (arterial brachial index) exam is a noninvasive test that evaluates the arterial circulation of legs and feet. The test uses blood pressure measurements and Doppler ultrasound wave forms to obtain information about the circulation of each segment of your legs. The test is performed at rest for all patients and is repeated after exercise for some patients.

Computed tomography angiography (CTA) is a type of CAT scan that uses x-ray beams taken from different angles around the patient to create pictures of cross-sections of the body. Contrast medium is injected into the veins at the time of the CT scan so that the arteries will also be visualized. Using computerized techniques, the scanner can be programmed to show pictures of only the arteries, which is a CTangiogram.

A peripheral arteryangiogram, or arteriogram, is an actual picture of the inside of the arteries of the lower extremities and is used to pinpoint the location and severity of PAD. It is an invasive procedure that involves insertion of a catheter, usually through a leg artery, into the aorta and/or vessels of the legs where contrast medium is then injected and x-rays are taken to reveal pictures of the vessels.  Because of the invasive nature of this procedure, it is not used routinely to follow the condition of patients with PAD and is reserved for special circumstances, especially when the diagnosis is in question or a need to open a blockage in an artery appears to be present.

How is peripheral artery stenting performed?

Peripheral stenting is a catheter-based procedure. The catheter acts as a guide to place the stent in the peripheral artery to open a narrowing or blockage. Stents come in a variety of strengths, sizes, and other properties. Stent selection for each procedure depends upon many factors, including the size of the artery, the location of the blockage and the extent of that blockage and blockages in other arteries.

What should be expected after peripheral artery stenting?

Peripheral stents are exposed to the blood and may cause clots to form until they become covered with tissue by the body. Powerful anticoagulants are taken during this time, and possibly longer, to prevent thrombosis (formation of blood clots). Check your anticoagulant therapy section below to determine what your cardiologist has prescribed for you to follow.  Aspirin and Plavix are almost always prescribed after peripheral stenting.

Sometimes peripheral stents may re-narrow (restenosis) within six to eight months of placement. Because of the possibility of restenosis, your cardiologist will want you to follow-up with a preplanned diagnostic testing schedule. Your testing and follow-up schedule is shown below. Call your cardiologist’s office to schedule any that are not yet arranged. Follow-up is vital to early detection of new disease or re-narrowing of the stents.

The usual recommendation for peripheral artery stent follow up is a diagnostic study at:

• at 3 months
• at 6 months & 12 months
• then annually