Endovascular dilatation (angioplasty)
Last reviewed: 23.04.2024
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Endovascular dilatation, or angioplasty, is one of the most effective ways of treating limited segmental vascular lesions - stenosis and occlusion.
The question of whether to conduct a specific patient's dilation or reconstructive surgery is decided jointly by the surgeon and radiologist. The range of indications to dilatation has considerably expanded in recent years. It is performed with atherosclerotic narrowing of the coronary vessels and brachiocephalic branches of the aorta, stenosis of the renal arteries accompanied by renousvascular hypertension, and arteries of the transplanted kidney, narrowing of the visceral branches of the abdominal aorta, various occlusive processes in the iliac arteries and vessels of the lower limbs.
The dilatation procedure begins with the introduction of a standard angiographic catheter into the affected vessel. Through it, a contrast agent is introduced to accurately determine the topography, severity and nature of stenosis. Then, a therapeutic double-lumen catheter with a can is injected into the lumen of the diagnostic catheter. The end of the catheter is placed in front of the narrowed portion of the vessel. The angiographic catheter is removed, the conductor of the therapeutic catheter is carefully advanced into the stenosis zone. After that, a diluted contrast medium is poured into the balloon with a syringe equipped with a manometer, as a result of which the can is uniformly stretched and presses the walls of the tapered section of the vessel. As a result of this, small intimal ruptures occur and the middle shell of the vessel is stretched; can be damaged and crushed atheromatous plaque. The dilation is repeated several times, after which the catheter is removed.
In order to prevent re-constriction of the vessel (restenosis), x-ray endovascular prosthesis is often performed. To this end, a metal (for example, nitinol) prosthesis (the so-called stent) is inserted into the vessel section expanded with a canister. In passing, we note that stenting is currently used not only for angioplasty, but also for preventing the narrowing of the pushevod with its cancer lesion, the pylorus canal, bile ducts, trachea and major bronchi, ureter, nasolacrimal canal.
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