Peripheral Intravascular Stent Placement

What you should know

• A peripheral intravascular stent is a metal tube that is placed into an artery in your leg. It can be placed in the iliac, femoral, popliteal, or tibial arteries. It is used to hold open your artery, so that blood can flow through it. An artery is a blood vessel that carries blood with oxygen to parts of your body. When an artery in your leg is narrow or blocked, blood cannot get past the blocked area to your foot. This is often caused by a disease called atherosclerosis. Atherosclerosis is when fat or cholesterol (plaque) builds up on the inside of your artery walls. When your artery is blocked, you may feel pain when you move your legs or when you are at rest. You may have sores on your feet that do not heal. Your skin color may change to very dark or black.
  
  
• Angioplasty is sometimes used to place a stent. With angioplasty, a balloon on a catheter (tube) is used to dilate (enlarge) your artery. The balloon is inflated (blown up) to widen your artery. The catheter has a stent on it, which is placed in your artery to hold the artery open. You may need more than one stent if a large area of the artery is blocked. When the stent is placed it stays in your artery for the rest of your life. Having a stent placed in your leg artery may decrease your leg pain. After this procedure, you may be able to walk farther and faster.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• After the procedure, you may still have the same kind of pain you had before. You may get an infection at the wound (surgery area). You may bleed a large amount, and blood may pool under your skin. Your stent may break, blocking or cutting into your artery. You may have an allergy to the contrast dye. Your kidneys may get damaged from the dye. You may have a stroke or heart attack. You may need to have your procedure done again if your artery gets blocked again.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If you do not have the angioplasty and stent placement, your pain may get worse. You may have pain at rest. Over time, you may not be able to walk as well or as far as you were once able. You may get infected sores on your foot that will not heal, or develop gangrene (dead tissue). For these reasons, you may need to have parts of your leg or foot amputated (cut off by surgery). Call your caregiver if you are worried or have questions about your procedure, or these risks.

Getting Ready

Before your procedure:

• You may need to have a Doppler study or ankle-brachial index test (ABI). Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Your caregiver may give you aspirin or other blood thinning medicines before your procedure. These medicines can make you bleed more than usual.
  
  
• Tell your caregiver about any over-the-counter medicines you are taking such as vitamins, herbs, food supplements, or laxatives. Your caregivers can find out if these medicines are okay to be taken with medicines that you may need during your procedure.
  
  
• During the stent placement procedure, contrast (dye) is used to show the blocked artery better on x-rays. Some dyes have iodine in them. Tell your caregiver if you are allergic to iodine, or to shellfish. Tell your caregiver if you are allergic to nickel, or if you have any other allergies.
  
  
• Ask someone to drive you home after your procedure.

The night before your procedure:

• Ask caregivers about directions for eating and drinking.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your procedure. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before the procedure. You may need to check your blood sugar more often before and after having your procedure.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will check that your medicines will not interact poorly with the medicine you need for surgery.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will get local anesthesia in your groin (the crease between your thigh and your hip bone). This is a shot of medicine to numb the area to decrease pain. You may also get medicine in your IV (a tube placed in your arm) to help make you sleepy or calm. Your caregiver will make a small incision (cut) in your groin, and put a sheath (tube) into your artery. He will put contrast dye through the sheath, and take an x-ray to see where the blockage is.
  
  
• He may put in a balloon on a catheter, and fill it with air. This squeezes the plaque against the artery walls to widen the artery. He will remove the balloon and put in one or more stents to hold your artery open. Caregivers will put in more contrast dye, and take another x-ray to check that the stents are open and in the right place.

After your procedure:

You will be taken to a room where caregivers will watch you. A bandage will cover the area in your groin over the wound to keep the area clean and dry. Pressure will be placed on your groin. Do not get out of bed until your caregiver says it is okay. You will then be taken back to your hospital room or allowed to go home.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You have a fever.
  
  
• You cannot make it to your procedure on time.

Seek Care Immediately if

• You have a nose bleed or any other bleeding that does not stop.
  
  
• Your leg or foot pain suddenly gets worse.
  
  
• You have new pain, such as pain at rest.
  
  
• Your toes or foot suddenly become darker in color.
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.