What Actually Happens During a Leg Artery Procedure

By the time someone is offered a procedure to reopen a leg artery, they usually understand why. The calf cramps after two blocks. The foot is cold. A sore is taking months instead of weeks. What almost nobody has been told is the ordinary part: what the day itself is like, how long it takes, whether it hurts, and what you can and cannot do afterward.

That is what this article is for. It walks through a leg angioplasty from the week before to the weeks after, in the order you will experience it. If you want to know how the procedure reopens the artery, the treatment page explains the mechanism with an animation. What follows here is the day.

What a leg angioplasty is, in plain terms

MedlinePlus describes it simply: angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs, using a medical balloon that presses against the inside wall of the artery to open the space and improve blood flow. A stent, a small metal mesh tube, is often placed across the artery wall afterward to keep it from narrowing again.

There is no large cut. The whole thing is done through a needle puncture, usually in the groin, with thin tubes passed up inside the artery itself. That is why it is called minimally invasive, and it is the reason most people go home quickly.

It can be done at several levels of the leg: the main artery from the heart, the artery in the hip or pelvis, the thigh, behind the knee, or the lower leg. Where your narrowing sits affects how straightforward the procedure is and how well the result tends to hold, which is one of the things a specialist weighs when deciding whether you are a candidate.

It is also not the first thing tried. The National Heart, Lung, and Blood Institute puts procedures after lifestyle changes, a structured exercise program and medicines, recommending one if lifestyle changes, an exercise program, and medicines do not work well enough. MedlinePlus lists the usual reasons for going ahead: symptoms that stop you doing daily tasks and have not improved with other treatment, a wound or ulcer on the leg that is not healing, an infection or gangrene, or pain in the leg even at rest. A change in the color of the foot or lower leg often sits alongside those.

Before the day: what you are asked to do

Preparation is mostly paperwork and medicines, and the medicine part matters.

Tell them what you take. That means everything: prescriptions, over-the-counter tablets, supplements and herbal remedies. It also specifically includes drugs such as sildenafil, vardenafil and tadalafil, which interact with medicines used around the procedure.

Say if you have ever reacted to X-ray dye, iodine or seafood. Contrast dye is used to see the artery, so a previous reaction changes how the team prepares you.

Expect instructions about blood thinners. You may be asked to stop medicines that keep the blood from clotting for a while beforehand, including aspirin, ibuprofen, naproxen and vitamin E. Never stop a prescribed one on your own; the instruction has to come from the team doing the procedure.

Mention any illness. A cold, flu, fever or other infection in the days before can mean postponing.

Arrange a lift home, and follow the fasting instructions. You will be told when to stop eating and drinking, and which tablets to take with a small sip of water on the morning itself.

Before any of this, you will have had tests to map the blockage. Usually that means an ankle-brachial index, which compares the blood pressure at your ankle with your arm, and an ultrasound scan, sometimes followed by a more detailed scan of the arteries.

The five steps, start to finish

Most leg angioplasty procedures follow the same sequence. MedlinePlus sets it out step by step, and it is worth knowing in advance, because almost all of it happens while you are awake.

1. You are settled and given something to relax you. You lie on your back on a padded table. You are given medicine to help you relax, and you may be given a blood thinner to stop a clot forming during the procedure. As MedlinePlus puts it, you will be awake, but sleepy.

2. The skin is numbed and a needle goes into the artery. Local anesthetic is injected where the team will work, most often the groin, so you do not feel pain there. A small needle goes into the blood vessel, and a fine wire is passed through it. This is the only part that involves anything sharp.

3. Dye is injected so the artery can be seen. The team works under live X-ray pictures. Contrast dye is injected to show the blood moving through your arteries and to make the blocked stretch stand out. Many people feel a brief warm flush when it goes in.

4. A balloon opens the narrowed section. A thin tube called a catheter is guided to the blockage, a guide wire is passed through it, and a second catheter carrying a small balloon is threaded over that wire into the narrowed part. The balloon is inflated, which opens the vessel and restores blood flow.

5. A stent may be left behind, and everything else comes out. If a stent is used, it is carried in on the same balloon catheter and expands as the balloon inflates, then stays in place to hold the artery open. The balloon and all the wires are removed, and the puncture site is closed and held with firm pressure.

How long it takes depends on how many narrowings are treated and how awkward they are to reach, so ask your team for their estimate rather than a general figure. A procedure that runs longer than expected is not in itself a sign that something has gone wrong.

What it actually feels like

This is the part people most want to know and least often ask.

You are awake but drowsy. The medicine takes the edge off without putting you to sleep, and many people remember the day only in patches. You can usually speak to the team throughout.

The numbing injection stings briefly. After that, the groin is numb, and what you feel from the catheter is usually pressure and movement rather than pain.

The dye can feel warm. A spreading warmth, sometimes with an odd taste, is normal and passes in moments.

The balloon can ache. While it is inflated, some people feel a deep cramping ache in the leg for those seconds. It settles as soon as the balloon comes down. Say so if it is strong; there is no prize for silence.

Lying still is the hard part. Afterward you may need to lie flat for a while so the puncture seals, and for people with a bad back that is often the least comfortable part of the day.

Going home, and the weeks after

MedlinePlus is reassuring on timing: many people are able to go home from the hospital in 2 days or less, and some may not even have to stay overnight, with most able to walk around within 6 to 8 hours of the procedure.

The discharge guidance from the same source sets out what the following weeks look like.

The groin will be sore for several days, and the leg on that side may be swollen for a few days or weeks as blood flow settles.

Walk, but build up slowly. Short walks on the flat, three or four times a day, increasing gradually. Stairs are limited to about twice a day for the first two or three days.

No driving, yard work or sport for at least two days, or longer if you are told so.

Care for the puncture site as instructed, and rest with your legs raised on pillows above the level of your heart.

Full recovery takes about 6 to 8 weeks, even though you will feel better in the leg far sooner than that.

Two things are worth being clear about. The first is medicine: you may be prescribed aspirin or clopidogrel to keep clots from forming in the artery and the stent, and those should not be stopped without speaking to the person who prescribed them. The second is the bigger picture. Angioplasty does not cure the cause of the blockage, and arteries can narrow again. What lowers that risk is the unglamorous list: stopping smoking, eating well, staying active, and taking cholesterol, blood pressure and diabetes medicines as prescribed. That is also what makes treating the underlying peripheral artery disease a longer project than the procedure itself.

When to call after a leg angioplasty

Most recoveries are uneventful. These are the signs that need a call to your team, or emergency care, rather than waiting for the follow-up appointment.

• Bleeding at the puncture site that does not stop when you lie down and press firmly on it for 30 minutes
• The leg below the puncture turning pale, cool to the touch, numb or a different color
• Swelling at the site, or redness, pain, or yellow or green discharge from the small cut
• Chest pain or shortness of breath that does not settle with rest, or dizziness, fainting or extreme tiredness
• Chills, or a fever over 101 degrees Fahrenheit

For bleeding that does not stop or is getting worse, MedlinePlus advises returning to the hospital or calling 911. The second item matters because it can mean the treated artery has closed again, and it is the one to act on fastest.

A leg angioplasty is a bigger deal than a blood test and a much smaller one than surgery. Knowing the shape of the day, that you will be awake, that the sharp part is one injection, that you will likely sleep at home that night, tends to make the decision easier to weigh than a leaflet about balloons and stents ever does.

If you are still deciding whether to be assessed at all, leg pain that comes on when you walk and a sore that will not heal are the two symptoms most worth acting on, and what Medicare covers answers the question that usually comes next.

If you are not sure where you stand, a short symptom check takes about ninety seconds and will tell you whether it is worth booking.