Carotid angioplasty is a treatment for carotid artery disease – a procedure performed on carotid arteries when they become clogged or narrowed by an atherosclerotic plaque. The procedure involves the placement of an antiembolic protection filter past the narrowing, followed by the placement of a nitinol-stent at the level of the narrowing. The stent maintains the artery open and prevents it from narrowing again. Carotid angioplasty is an alternative to open surgery, being used when the traditional surgical procedures are not feasible or pose a high risk.
Thromboembolic disease is caracterized, especially, by clots formation in deep venous system of legs and their migration in the pulmonary arteries.
There are many causes of clots formation, wich are included in three categories:
- blood stagnation in legs ( because of insuficiency of venous circulatory system, after surgical procedures associated with prolonged bed repose, but also in case of prolonged travels – including plane, car)
- affecting of vein’s walls – veins of legs or pelvic veins ( this condition may be associated with pregnancy and birth)
- hypercoagulable state ( tendency of blood to form clots) – there are some genetic disorders, such as: factor V Leyden mutation, prothrombin gene mutation, low activity of some proteins wich are natural inhibitors of clots formation. This condition can be also acquired – in pregnancy, in case of use of oral contraceptives drugs, especially associated with smoking, but also in neoplastic diseases.
When clots are formed in veins of legs you feel observe leg’s swelling (because the blood’s stagnation), pain in rest but also associated with movements, local warmth and, in some severe cases, the arterial circulation of legs may be afected and this is leading to ischemic lesions of legs. Clots can migrate through venous system reaching right heart chambers and from this point, clots they can migrate in pulmonary arteries, condition know as pulmonary embolism. Because of the clots, blood can’t pass from pulmonary arteries in capillary vessels, pulmonary veins and forward in left heart, so there will be a low cardiac debit, wich can be life threatening.
Thromboembolic disease can evoluate without any symptom and can lead to sudden death. We all know about people who have traveled with plane long distances, for 10-12 hours and after they have died because of pulmonary embolism.
Pulmonary embolism treatment is deppending of disease’s severity. So, some patients ( whit low blood pressure secondary to low cardiac debit) may beneffit by thrombolitic treatment or surgical remove of clots from pulmonary arteries. Anyway, most of patients diagnosed with pulmmonary embolism are eligible for anticoagulant treatment, wich helps the body to disolve clots – this is a long process ( weeks – months).
deep vein thrombosis in patients with contraindications or complications of anticoagulant treatment, but also at high risk for development or recurrence of pulmonary embolism. Vena cava filters decrease the risk of pulmmonary embolism, but they don’t decrease the risk of deep vein thrombosis.
Because there is not a certain indiccation for vena cava filters implantation, you shloud know that every case has his particularity, so the decision for vena cava filters placement will be made according to case, but also patient’s particularities:
• deep vein thrombosis involving ileo-cava veins ( there is a high risk for clots migrations in pulmonary arteries)
• a mobile, big thrombus
• hard to maintain an anticoagulated status in thromb
• Vena cava filters placement can be also prophylactic: for patients at high risk to develop deep vein thrombosis, such as neoplastic patients, patient with indication for majore surgicals procedures.
addBefore procedure - Preparation
Hospitalization for 24 hours is required. You will be admitted the day before the intervention. You will be asked to fast for eight hours before the procedure, generally after midnight.
Prior to the intervention, your doctor must be prevented about any history of allergic reactions. Blood tests are taken including hemoglobin level, coagulation, renal function, and other specific tests.
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives permission to do the procedure.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general). Also, do not interrupt your anticcoagulant treatment.
addAfter procedure - Recovery time
You will be conducted to your room and connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication.
You can move after 1 hour. The dressing will be also removed after 1 hour.
You should also drink a lot of fluids.
Is it painful?
The doctor will use local anesthesia, with xilin, wich may induced local warmth for 10-20 seconds. You will not feel any pain associated with all puncture manoeuvres. You may also feel some disturbance when the filter is released and fixed, but this sensation is transient.
How long does it take?
The procedure lasts between 30minutes and 1 hour.
Next: Read about the Doctors