What is Endovascular Disease?
Endovascular disease affects the vascular system ( blood vessels
) and occurs when the blood flow through a blood vessel is restricted or blocked. Blood vessels include arteries, arterioles, capillaries, venules and veins, all of which must remain clear for the circulatory system to work properly. Blockage in a blood vessel is generally caused by atherosclerosis
(a build-up of plaque
on the inner walls of blood vessels) or a blood clot.
The blood vessels most commonly affected by endovascular disease include:
carotid arteries
(pathways for blood flow to the brain)
abdominal aorta and iliac arteries
(pathways for blood flow to the lower extremities)
renal arteries
(pathways for blood flow to the kidneys).
Progression of endovascular disease is a slow process and, like
Coronary Artery Disease
(CAD), symptoms may not appear until there is a significant blockage that can lead to serious consequences.
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What is Endovascular Catheterization?
Endovascular catheterization is the term used for any procedure (other than
Cardiac Catheterization
) that requires the insertion of a catheter
into a blood vessel.
By threading a catheter into the circulatory system, specialists can determine the location and amount of blockage present in a major vessel and can access the affected area for treatment.
The
Cardiac Catheterization Laboratory
(CCL), where endovascular catheterizations are performed, is equipped with special imaging equipment that allows the physician to view the catheter as it is threaded through the circulatory system. Once inside an artery or other vessel, X-ray pictures are taken to diagnose the severity of disease. If warranted, interventional treatment of certain conditions can be performed during the same procedure.
Endovascular Angiography
During an endovascular angiography, also called an angiogram, a catheter
is threaded to the affected area and a contrast dye is injected, allowing the blood vessels.
to be viewed so that the severity of disease or abnormalities can be assessed.
Endovascular Angioplasty
During an endovascular angioplasty, the physician guides a balloon-tipped catheter
to the narrowed or blocked blood vessel.
The balloon is then inflated and deflated several times to flatten the obstruction against the vessel wall, thereby restoring unrestricted blood flow. Since a balloon-tipped catheter is used, this is also referred to as a balloon angioplasty.
Endovascular Stent Implantation
A stent
is an expandable mesh tube (about one-half inch long) that is placed in a blood vessel
to maintain the free flow of blood following an angioplasty. The mesh-like tube is inserted (while collapsed) into the vessel by mounting it onto a balloon-tipped catheter. Once it is positioned in the area where the obstruction was compressed, the balloon is inflated. This expands the stent and implants it against the vessel wall.
Peripheral Vascular Disease (PVD)
(restriction of blood flow to the extremities)
occlusive disease
(complete obstruction of a blood vessel that blocks the flow of blood)
vasospastic disorders
(spasms of the blood vessel, resulting in a decreased size of its opening)
aneurysms
(the weakening of the inner wall of a vessel that leads to it ballooning out of shape)
malformations
fistulas
(abnormal connection between two vessels)
small vascular tumors.
Patient Preparations for an Endovascular Catheterization
Fasting Requirements
You will be instructed not to eat or drink anything after midnight prior to your procedure.
Medication Considerations
If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure.
If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure.
Patients who take anticoagulants (blood thinners), such as Coumadin, will be advised by their physicians to stop taking this medication for a period of time prior to their procedure.
Planning for Discharge
Since you will be sedated during your procedure, you must have someone drive you home, unless you are staying overnight. You should pack a small bag of overnight essentials in the event you do stay overnight. Most patients who undergo a routine angiogram will be able to go home the same day after spending some time in the Day Accommodation Room (DAR). If your physician performs an
endovascular angioplasty
or
endovascular stent implantation,
you may stay overnight for observation during your recovery period.
You will be awake during the procedure; however, you will be given sedation to make you drowsy.
Your heart rate, rhythm, and blood pressure will be continuously monitored.
The insertion area will be numbed with a local anesthetic medication. You may feel slight pressure as the sheath (a small, plastic tube used to enter a vein or artery) is inserted into the selected site.
The catheter
is inserted through the sheath and threaded to the selected blood vessel.
While the catheter is moving through your body you should feel no pain.
Dye will be injected into the blood vessel. You may experience a warm, tingly sensation as the dye is injected.
If a balloon-tipped catheter is used during your procedure, it will be inflated and deflated several times to compress the obstruction against the vessel
wall.
If an endovascular stent
is being implanted, it will be mounted on a balloon-tipped catheter to position it inside the vessel.
The estimated time that it takes for endovascular catheterizations are: 30 to 60 minutes for a routine angiogram; one to two hours for an angiography; and one to two hours for stent implantation.
What to Expect During Recovery
Once you are back in your room the instructions will vary depending on the type of endovascular catheterization that was performed.
A nurse will continue to monitor your heart rate, blood pressure, and pulses near the insertion site, which will be continually observed as well.
You will be instructed to lie flat with your head slightly elevated at a 30-degree angle. For a routine angiogram, this time period will last for two to six hours. A longer time period is required for interventional procedures.
If the insertion site was in your groin, you will be asked not to move your leg, which prevents bleeding.
It is important that you drink plenty of fluids to help flush the dye out of your body.
Depending on the type of procedure, the sheath
will be removed several hours later or the next morning. (Some patients will have a closure system placed in the insertion site, in which case, the sheath will have already been removed.)
If the sheath needs to be removed, direct pressure will be applied to the insertion site for approximately 20 minutes to prevent any internal bleeding. Sometimes a sandbag is placed on the site for this purpose. Your vital signs will continue to be monitored during this time and you will again be instructed to lie flat with your head slightly elevated for several hours and not to move your leg, if the insertion site was in your groin.
Once the bleeding has stopped, a dressing (bandage) will be applied.
Upon discharge, most patients require only minimal restrictions of their daily activities.
What Signs And Symptoms Should Be Reported Immediately?
You should immediately inform your nurse if you feel weak or dizzy; are short of breath; begin bleeding; or experience any discomfort or sudden pain at the insertion site or in the chest, neck, jaw, arms or upper back.
Your physician will discuss with you the risks of undergoing an endovascular catheterization, which are considered minimal. However, it is an invasive procedure, which is why you will be closely monitored during your recovery period.
Most of the complications associated with endovascular catheterization are minor with no long-term effects. Bruising to the area where the catheter was inserted may occur but is only temporary. Some patients experience nausea and vomiting or an allergic skin reaction. More serious complications are rare; they include damage to blood vessels, blood clots or infection.
Receiving Results
Detailed written reports are sent to your referring physician(s), but you will be told the results immediately following the procedure while you are still in the Cardiac Catheterization Laboratory where the procedures are performed. Your physician will then meet with your family member(s), who will be invited to wait in the Family Lounge located on 4 Main. The family lounge is equipped with a television and a refreshment area where free coffee and tea are available. A public phone is also located in the lounge and rest rooms are nearby.
Scheduling
An endovascular catheterization is generally scheduled through the referring physician’s office unless the patient is already in the hospital. They will inform you of the date and time of your scheduled procedure and will also arrange your pre-admission testing (blood work and an
EKG.
)
