Balloon angioplasty of the peripheral arteries

Balloon angioplasty makes it possible to widen an artery from the inside where it has narrowed or become blocked, thereby improving the blood supply to a limb. It may be considered when poor circulation significantly limits activity, hinders healing or jeopardises tissue viability.

What is balloon angioplasty?

Balloon angioplasty, also known as percutaneous transluminal angioplasty or peripheral angioplasty when performed on these arteries, is an endovascular procedure: it allows the blood vessel to be treated from the inside without the need for open surgery to gain direct access to the artery.

Thin, flexible tubes called catheters are inserted through an arterial puncture and guided through the blood vessels until they reach the narrowing or blockage. The specialist monitors their progress using real-time imaging.

At the tip of one of the catheters is a small, folded balloon. Once positioned at the site of the lesion, it is inflated in a controlled manner to widen the interior of the artery and restore blood flow to the muscles, skin and other tissues of the limb.

The balloon is then deflated and removed. Depending on the characteristics of the artery and the lesion, conventional balloons, drug-eluting balloons or other endovascular devices may be used.

Balloon and stent

In some lesions, the dilation achieved with the balloon restores adequate blood flow. In others, the artery requires additional support to maintain the result.

In such situations, a stent may be implanted – a small tubular structure that remains inside the vessel and helps to keep it open. The decision is made during the planning stage and, in many cases, after observing how the artery responds to the dilation.

Factors influencing this decision include the affected artery, the length and characteristics of the blockage, the outcome achieved with the balloon, and the stability of the arterial wall.

Indications

Peripheral angioplasty is mainly used to treat narrowings or blockages in the arteries that supply blood to the legs and, less commonly, to other limbs.

One of the conditions for which it may be considered is peripheral arterial disease with claudication, the term used to describe the pain or muscle discomfort that occurs when walking as a result of insufficient blood supply. When this limitation remains significant despite medical treatment, control of cardiovascular risk factors and a structured exercise programme, the possibility of revascularising the artery may be considered.

In such cases, the aim may be to increase the distance that can be walked, reduce the number of breaks needed during daily activities and restore functional capacity.

Angioplasty takes on a different significance when poor circulation begins to compromise the tissues of the limb. The presence of persistent pain at rest, non-healing wounds, tissue loss or gangrene may indicate chronic ischaemia threatening the limb, a situation in which restoring blood flow may be essential to promote healing and preserve the limb.

Where wounds or infection are present, revascularisation forms part of a broader strategy that may include specialised wound care, infection control, diabetes management and other measures aimed at protecting the tissues.

A sudden interruption of blood flow represents a different condition, known as acute ischaemia, which requires urgent assessment and may necessitate other treatment strategies.

Selection and treatment planning

The decision to perform angioplasty is not based solely on the identification of a narrowed artery in an imaging scan. The decision begins by assessing the impact of the reduced blood flow on the patient and the affected limb.

The specialist assesses pain on walking and its functional impact, the possible presence of discomfort at rest, ulcers or tissue changes, and the progression of the condition. They then analyse the location of the blockages, their extent and their characteristics.

The choice between medical treatment, angioplasty, other endovascular techniques, bypass surgery or combined strategies is made by integrating this information with the patient’s general health, any associated conditions, previous procedures and the likelihood of achieving a sufficiently long-lasting clinical benefit.

Assessment of circulation

A vascular examination provides information on pulses, temperature, the appearance of the skin and the general condition of the limb.

This can be supplemented by the ankle-brachial index, a measurement that compares blood pressure at the ankle with that at the arm and helps to detect reduced blood flow to the legs.

Vascular Doppler ultrasound allows blood flow to be assessed and narrowings or blockages to be identified without inserting instruments into the arteries. When a more detailed understanding of the vascular anatomy is required, computed tomography angiography, magnetic resonance angiography or conventional angiography may be used.

These tests enable us to map the circulation and plan which artery needs to be treated, where to access it, and which endovascular strategy may be most appropriate.

Preparation

Before a planned angioplasty, the diagnosis, any vascular tests carried out, medical history and regular medication are reviewed. The team explains the aim of the procedure, the available alternatives and the relevant aspects of recovery and the risks involved.

Pre-procedure blood tests may include assessment of kidney function, coagulation and haemoglobin levels. Known allergies and any history of reactions to the contrast agents used to visualise the arteries are also reviewed.

Anticoagulant or antiplatelet treatments and certain diabetes medicines may require specific planning prior to the procedure. Any adjustments must be made in accordance with the instructions of the team in charge.

When contrast is to be administered, renal function becomes particularly important, and specific measures may be taken for those at higher risk. Fasting instructions depend on the planned sedation and the care protocol.

Procedure

Angioplasty is carried out in a setting equipped for real-time vascular imaging. Depending on the characteristics of the centre and the procedure, this may be a vascular radiology suite or a hybrid operating theatre – a facility that combines the capabilities of an operating theatre with advanced imaging systems.

At the Publio Cordón Memorial Hospital, femoral and distal vessel angioplasties to treat leg ischaemia are carried out in a hybrid operating theatre with advanced angiography, as described by the hospital’s own Diabetic Foot and Lower Limb Ischaemia Unit.

Local anaesthesia is usually administered at the puncture site and, where appropriate, sedation is used to improve patient comfort during the procedure.

Access to the arterial system is usually achieved via a small puncture, frequently in the groin area, although other access points may be chosen depending on the artery to be treated and the patient’s individual anatomy.

A thin guidewire is inserted through this entry point and advanced through the arteries. Using X-ray imaging and contrast dye, the specialist guides it until it passes through the narrowed or blocked area.

The catheter containing the balloon is advanced over the guidewire. When the balloon reaches the exact site of the lesion, it is inflated for a brief, controlled period to widen the lumen of the artery.

Further imaging is then used to assess the condition of the vessel and how the blood is flowing. If the result is satisfactory, the balloon is removed. Where the artery requires additional support, a stent may be implanted or another endovascular device used.

At the end of the procedure, the catheters are removed and the access site is sealed using compression or a vascular closure device. The duration of the procedure varies depending on the number of lesions to be treated, their location and complexity, and the devices required.

Sensations during the procedure

The injection of the local anaesthetic may cause a prick and a brief stinging sensation. As the catheters are advanced, it is more common to feel pressure than pain.

The injection of contrast medium may cause a temporary sensation of warmth. When the balloon is inflated, some people feel pressure or brief discomfort in the limb.

The team will monitor these sensations throughout the procedure, and any severe pain or unexpected changes should be reported.

Benefits and outcomes

The immediate outcome is assessed by checking whether the treated artery has regained sufficient blood flow to the limb.

In people with claudication, the benefit may be reflected in an increased walking distance, the ability to carry out daily activities with fewer interruptions, and an improvement in functional capacity. The response may be gradual and varies in magnitude from person to person, particularly when the condition affects several arterial segments.

Where wounds are caused by inadequate circulation, restoring blood flow creates more favourable conditions for the tissues to receive oxygen and heal. The outcome also depends on infection control, local wound care, diabetes management, nutritional status and circulation in the smaller blood vessels.

In advanced forms of ischaemia, revascularisation forms part of a strategy aimed at preserving the limb and restoring tissue viability. The Memorial Hospital’s Diabetic Foot and Lower Limb Ischaemia Unit specifically includes femoral and distal angioplasty as part of this approach.

Over time, the treated artery may narrow again. This phenomenon is known as restenosis and is one of the reasons why vascular follow-up continues after the procedure.

Risks and possible complications

The risk profile depends on the artery being treated, the extent of the disease, the technical complexity of the procedure and the patient’s general health. The most common discomforts are related to the vascular access site. During the first few days, there may be tenderness, mild pain or a small bruise.

In some cases, more significant bleeding, a complication at the puncture site, a reaction to the contrast medium or impaired kidney function may occur. These situations may require observation or specific treatment.

The most significant vascular complications include damage to the artery wall, the formation of a clot, the displacement of material into smaller vessels or the sudden occlusion of the treated segment.

Should a complication of this nature arise, the team may need to use other devices, administer medication, perform a new endovascular procedure or resort to surgery.

Recovery and follow-up

During the first few hours, vital signs, the access site and circulation in the treated limb are monitored. The length of time required for rest depends on the artery used to access the vascular system, the method used to close the puncture site and the risk of bleeding.

In uncomplicated procedures, some people may be able to go home the same day, whilst others may need to remain under observation or be admitted for a longer period due to the complexity of the procedure or their clinical condition.

A return to normal activity is gradual. Discharge instructions specify how to care for the puncture site, when physical activity can be increased, which medication should be continued, and which changes require a consultation.

Subsequent follow-up allows us to check that blood flow is maintained and to detect any possible restenosis or the development of new lesions. During check-ups, we assess symptoms whilst walking, functional capacity, pulses and, where there are wounds, the healing of the tissues.

Depending on the individual case, the ankle-brachial index, Doppler ultrasound or other vascular tests may be repeated. Follow-up also includes monitoring of antithrombotic treatment and factors such as blood pressure, cholesterol, diabetes, smoking and physical activity.

Adjusting treatment during follow-up

If the initial improvement is partial or symptoms recur, the next step is to identify the cause. There may be restenosis in the treated artery, a new blockage in another segment, or disease affecting smaller vessels.

Based on this assessment, the treatment strategy can be adapted to include medical management and therapeutic exercise, a repeat angioplasty, stent placement, other endovascular devices, bypass surgery or specific measures for wound management.

Treatment options

Angioplasty is one of the options available to improve arterial circulation, but the decision to use it forms part of a broader vascular strategy.

In certain patients, medical treatment, structured exercise and intensive management of risk factors can reduce symptoms and improve functional capacity without the need for an intervention.

When revascularisation is required, the anatomy of the arteries and the characteristics of the disease determine whether an endovascular procedure, bypass surgery, a combination of both strategies, or other techniques is preferable.

A bypass creates a new pathway for blood to bypass the diseased segment of the artery using a vascular graft. It may offer advantages in certain anatomical situations or where the disease is widespread.

The decision is not about determining that one technique is universally better than another, but rather about selecting the strategy that offers an appropriate balance between clinical benefit, risk, durability and individual characteristics.

Situations requiring a specific assessment

Diabetes

Diabetes can contribute to more widespread arterial disease and hinder healing. Metabolic control and foot care are particularly important where there are wounds, loss of sensation or a risk of tissue damage.

Kidney disease

Renal function may influence the choice of certain imaging tests, the use of contrast agents and the planning of the procedure. Where kidney disease is present, the team adapts these decisions to the clinical situation and individual risk.

Anticoagulant or antiplatelet therapy

Anticoagulant or antiplatelet medication requires a specific assessment of the risk of bleeding and the need for protection against thrombotic events. Treatment before and after angioplasty is adjusted according to the procedure performed and each individual’s circumstances.

Pregnancy

During pregnancy, the decision to perform angioplasty requires an individual assessment of the need for the procedure, exposure to radiation, and any medicines or contrast agents that may be used.

Wounds or infection

Where wounds or infection are present, the restoration of blood flow is usually part of a broader treatment plan. This may include specialised wound care, infection control, pressure relief and, where necessary, local surgical treatment.

Frailty or reduced mobility

In people who are frail or have limited mobility, the benefit of revascularisation is assessed taking into account functional status, previous level of independence, clinical objectives and the prospects for recovery or rehabilitation.

Signs requiring medical assessment

After discharge, it is important to monitor both the vascular access site and the treated limb. Persistent bleeding at the puncture site, a rapid increase in bruising or swelling, severe or progressive pain, or the onset of a cold, pale or bluish limb require immediate assessment.

Loss of strength or sensation, fever, progressive redness or discharge from the puncture site should also be investigated. Significant breathing difficulties, chest pain, loss of consciousness or a rapid deterioration in general health require urgent medical attention.

Specialists involved

The clinical pathway for a patient who is a candidate for peripheral angioplasty begins with a specialist vascular assessment to determine the impact of the blockage, examine the arterial anatomy and decide whether it is necessary to restore blood flow using an endovascular technique or another approach.

At the Publio Cordón Memorial Hospital, the Diabetic Foot and Lower Limb Ischaemia Unit is the specialist unit for advanced forms of peripheral arterial disease, including diabetes-related ischaemia, vascular ulcers and conditions posing a risk to the limb. The unit’s range of treatments includes femoral and distal vessel angioplasty.

This unit forms part of the Department of Angiology and Vascular Surgery, a speciality within the hospital that deals with the diagnosis, treatment and follow-up of arterial and venous diseases. Its involvement enables endovascular and surgical options to be integrated into a single assessment, allowing the most appropriate revascularisation strategy to be selected for each patient’s anatomy and clinical situation.

The preliminary assessment may be supported by Diagnostic Imaging, which provides the hospital with the radiodiagnostic techniques required to characterise the vascular anatomy and provide information for treatment planning.

Interventional Radiology may be involved in certain endovascular procedures or clinical situations, depending on the vascular location and the organisation of care. The hospital offers this speciality as part of its range of services, although for lower limb angioplasty the institutional website specifically lists the procedure under Angiology and Vascular Surgery and the Diabetic Foot and Lower Limb Ischaemia Unit.

When the procedure requires sedation or a specific assessment of perioperative risk, the Department of Anaesthetology and Resuscitation is involved, being responsible for medical supervision and safety during procedures requiring anaesthetic support.

In patients with diabetes or metabolic disorders, the Department of Endocrinology and Nutrition may be involved in metabolic and nutritional management, particularly where there are complex wounds or factors affecting healing.

The specific involvement of each department is tailored to the vascular condition, the presence of wounds or diabetes, the complexity of the procedure and the patient’s subsequent progress. The core of the care pathway remains the vascular assessment, the indication for revascularisation, the performance of the procedure and the follow-up of the treated limb.

Medical information for general guidance

This information sheet aims to help you understand what peripheral artery balloon angioplasty involves, when it may be considered, how blood flow is assessed beforehand, what happens during the procedure, and how recovery and follow-up are organised. It also explains the role of the stent, the potential benefits, the risks and the main alternatives for revascularisation.

At the Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each individual through their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and participate with greater confidence in decisions about their health. This commitment to knowledge and public outreach is also part of our dedication to research and the advancement of medicine.

The information contained in this factsheet describes the general principles of peripheral angioplasty. Whether the procedure is appropriate, the type of balloon or device used, and the choice between endovascular treatment, surgery or medical treatment depend on the symptoms, the anatomy of the arteries, the condition of the limb, any associated conditions and individual circumstances.

Frequently Asked Questions about Balloon Angioplasty of the Peripheral Arteries

Is it always necessary to fit a stent?

Answer: No. In certain lesions, balloon dilatation is sufficient to achieve an adequate result. In others, the artery requires additional support and a stent may be implanted. The decision depends on the location and characteristics of the lesion, and on the artery’s response during angioplasty.

Is balloon angioplasty painful?

Answer: Local anaesthetic is usually used, along with sedation where necessary. You may feel the prick of the anaesthetic, pressure at the access site, a temporary sensation of warmth from the contrast medium, or brief discomfort whilst the balloon is being inflated.

When can you walk after an angioplasty?

Answer: The time at which you can get out of bed depends on the arterial access site used, how the puncture site has been closed, and your immediate recovery. The team will advise you when you can start moving about and how to gradually increase your activity.

Could the artery become narrowed again?

Answer: Yes. The development of a new narrowing in the treated segment is known as restenosis. Vascular follow-up allows us to assess the progress and decide whether treatment needs to be adjusted.

What is the difference between angioplasty and a bypass?

Answer: Angioplasty treats blockages from within the artery using catheters and endovascular devices. A bypass is a surgical procedure that creates a new route for the blood to bypass the diseased section. The anatomy of the artery and the patient’s clinical condition help to determine which approach is most appropriate.