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Leg artery angioplasty and stenting: the procedure and what to expect afterward
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Balloon angioplasty and stenting are endovascular procedures that restore blood flow in narrowed or blocked leg arteries. They are done through a needle puncture in an artery, without an incision, usually under local anesthesia. This page explains who needs the procedure, how to prepare, how it is performed in the department and what to do afterward.
What balloon angioplasty is and how it differs from stenting
In balloon angioplasty, a thin balloon on a catheter is brought to a narrowing (stenosis) or blockage (occlusion) of the artery and inflated: it presses the plaque against the wall and widens the vessel. The balloon is then removed.
A drug-coated balloon leaves a medicine on the artery wall as it inflates, which slows tissue regrowth and lowers the risk of renarrowing. These balloons are most often used in the femoral and popliteal arteries.
A stent is a mesh metal scaffold that stays in the artery and holds it open. It is placed when the wall recoils or tears (dissection) after ballooning, and in disease of the iliac arteries. Not every procedure ends with a stent: around the knee joint and in the lower-leg arteries balloon angioplasty is often enough, and a stent is placed only if needed.
This is how the iliac, femoral and popliteal arteries are treated, and also the arteries of the lower leg and foot. Angioplasty is an operation, but it is done through a puncture a few millimeters wide rather than an incision.
Who needs leg artery angioplasty, and when medicines and walking are enough
If a narrowing is found on tests but causes no symptoms, angioplasty is not performed: treatment is medicines and control of risk factors.
If the only problem is calf pain when walking (intermittent claudication), treatment starts without a procedure: antiplatelet medicines, statins, control of blood pressure and blood sugar, stopping smoking and regular structured walking. Angioplasty is considered when, after several months of this treatment, the pain still seriously limits daily life.
In limb-threatening ischemia — foot pain at rest, a wound that does not heal or a toe turning black — and in diabetic foot with artery disease, restoring blood flow is the main way to save the leg, and it is not postponed.
Angioplasty or bypass? For most lesions an endovascular procedure is considered first: it is less invasive and does not need general anesthesia. Narrowing of the common femoral artery in the groin is more often treated with open surgery — endarterectomy (removal of the plaque). For long blockages in patients with a suitable vein of their own for a bypass, open bypass surgery may give a longer-lasting result. The method is chosen individually, together with the vascular surgery department when needed.
Tests and preparation before the procedure
- A vascular surgeon's examination, duplex ultrasound of the arteries and the ankle-brachial index; CT angiography when indicated
- Blood tests, including kidney function (creatinine), and an ECG — the doctor gives you the list at the consultation
- Tell the doctor about an allergy to iodinated contrast or chronic kidney disease: CO₂ angiography without iodinated contrast may then be used
- Do not stop any medicines on your own: the doctor will tell you whether and when to pause anticoagulants, metformin or other drugs; antiplatelet medicines are usually continued
- Bring previous test results, a disc with your CT angiography, discharge summaries and a list of the medicines you take
- The day before, you will be told when to stop eating and drinking before the procedure
How the procedure is performed in the department
The procedure is performed in an angiography suite under local anesthesia; you stay awake and can talk to the doctor. After the skin is numbed, an artery is punctured — usually in the groin (femoral artery), sometimes in the arm (brachial artery) or the foot (pedal access) when that gives better access to the lesion.
A thin tube (sheath) is placed through the puncture, and under X-ray guidance a guidewire is passed through the narrowing or blockage, followed by a balloon and, if needed, a stent. Intravascular ultrasound (IVUS) makes it possible to measure the true diameter of the artery from inside, choose the size of the balloon or stent and check the result. Patients with kidney disease or a contrast allergy may have CO₂ angiography.
You may feel pressure or brief discomfort in the leg while the balloon is inflated; the most noticeable moment is usually the local anesthetic injection. The procedure takes 1–3 hours depending on complexity. At the end, the puncture is sealed with a closure device, or pressure is held on it and a pressure dressing is applied.
After the procedure: the first days and recovery
After a femoral puncture you need to lie with the leg straight for several hours — the doctor will tell you exactly how long. Walking is usually allowed the next day, discharge is usually on day 1–2, and most patients return to work within a week.
A small bruise at the puncture site is normal and fades within 1–2 weeks. For a few days avoid heavy lifting, baths and saunas. The doctor will tell you at discharge when you can drive and fly: it depends on the puncture site and your general condition.
Regular walking after the procedure is part of treatment: it trains the muscles, develops collateral vessels (natural detours around the blockage) and helps preserve the result.
Medicines after angioplasty and stenting
After the procedure you will be prescribed medicines that prevent clots in the artery and the stent (antiplatelet medicines). The doctor decides which medicines and for how long, individually. Do not stop these medicines on your own: this raises the risk of the artery or stent becoming blocked. Before any other operation or a tooth extraction, tell your doctors that you have had angioplasty or stenting and are taking antiplatelet medicines.
Statins (even with normal cholesterol), control of blood pressure and blood sugar, and stopping smoking completely are just as important. Atherosclerosis affects the whole body: these measures preserve the result of the procedure and lower the risk of heart attack and stroke.
Follow-up visits and renarrowing (restenosis)
Even after a successful procedure, the artery may narrow again over time — this is called restenosis. It most often develops within the first year, and the risk is higher after treatment of long blockages and in the lower-leg arteries.
That is why follow-up visits with duplex ultrasound are scheduled after the procedure at 1, 3 and 6 months, and then on a schedule set by your doctor. If renarrowing is found early, it can often be treated again with an endovascular procedure.
If walking pain returns, your walking distance shortens or a foot wound stops healing, book an unscheduled visit without waiting for the planned check-up.
Possible complications
- A bruise or hematoma (collection of blood) at the puncture site — usually minor and settles on its own
- Pseudoaneurysm — a pulsating lump at the puncture site; it is usually treated without surgery, under ultrasound guidance
- Bleeding from the puncture site
- An allergic reaction to contrast or worsening kidney function after contrast — the risk is higher with kidney disease, so it is assessed beforehand
- A tear in the artery wall (dissection) or plaque fragments carried into smaller arteries (distal embolization) — usually detected and treated during the same procedure
- Sudden blockage (thrombosis) of the artery or stent — rare; it needs emergency care
When to get emergency help after the procedure
Sudden pain, coldness, pallor or numbness in a leg: call an ambulance (103 in Ukraine). If these signs appear or sharply worsen over minutes or hours, especially with weakness of the foot or inability to move the toes, this may be acute limb ischemia — a sudden occlusion (blockage) of an artery. Irreversible tissue damage can develop within hours (roughly six), so do not wait until morning, do not warm the leg with a heating pad or hot water, and do not rub it.
Bleeding from the puncture site or a swelling that grows quickly: press on the puncture site and call an ambulance (103 in Ukraine). Lie down and keep pressing firmly on the puncture site with your palm until the ambulance arrives.
Redness, swelling, pus, increasing pain or a pulsating lump at the puncture site, a fever, or a foot wound getting worse after the procedure need a doctor's examination: seek medical care the same day.
Frequently asked questions
Does it hurt, and will I need general anesthesia?
The procedure is usually done under local anesthesia and you stay awake. The most noticeable moment is the anesthetic injection; while the balloon is inflated you may feel pressure or brief discomfort. General anesthesia is rarely needed.
How long does the procedure take, and how long will I stay in the hospital?
The procedure itself takes 1–3 hours depending on complexity. Discharge is usually on day 1–2.
When can I drive and fly?
The doctor gives you the timing at discharge, because it depends on the puncture site and your general condition. Driving is usually possible after a few days, once the puncture site is not painful; before flying in the first weeks after the procedure, ask your doctor.
How long does a leg stent last?
The stent stays in the artery permanently, but that does not guarantee the artery will not narrow again. The result can last for years; taking the prescribed medicines, not smoking, regular walking and follow-up visits all help. A renarrowing can often be treated again with an endovascular procedure.
Can I have an MRI with a stent in my leg?
In most cases yes: modern leg artery stents usually allow an MRI under specific conditions (they are labeled MR Conditional). Before the scan, tell the staff about the stent and show your discharge summary with the stent name; the final decision is made by the radiologist.
Is angioplasty possible with diabetes or kidney disease?
Yes. In diabetes the arteries of the lower leg and foot are often affected, and treating them is one of the department's priorities. In chronic kidney disease the amount of iodinated contrast is reduced or CO₂ angiography is used, and kidney function is checked before and after the procedure.
What should I do if the leg pain comes back?
Book an unscheduled visit with a vascular surgeon: duplex ultrasound will show whether the artery has narrowed again. If pain, coldness or numbness of the leg comes on suddenly, call an ambulance (103 in Ukraine).
Can I exercise after stenting?
Yes, regular physical activity, above all walking, is recommended. Ask your doctor about strength training and when to return to sports.
Book a consultation
Vascular surgeon consultation at the Shalimov Center, 30 Akademika Shalimova St, Kyiv. Booking and questions go through the contact doctor, Yurii Vahis. Patients from other cities and abroad can arrange an online consultation.