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Endovascular dilatation (angioplasty)
Last reviewed: 05.07.2025
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Endovascular dilation, or angioplasty, is one of the most effective methods of treating limited segmental vascular lesions - stenosis and occlusion.
The question of whether to perform dilation or reconstructive surgery for a specific patient is decided jointly by the surgeon and radiologist. The range of indications for dilation has expanded significantly in recent years. It is performed in cases of atherosclerotic stenosis of the coronary vessels and brachiocephalic branches of the aorta, stenosis of the renal arteries accompanied by renovascular 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 extremities.
The dilation procedure begins with the introduction of a standard angiographic catheter into the affected vessel. A contrast agent is injected through it to accurately determine the topography, severity, and nature of the stenosis. Then a therapeutic double-lumen catheter with a balloon is inserted into the lumen of the diagnostic catheter. The end of the catheter is positioned in front of the narrowed section of the vessel. The angiographic catheter is removed, and the guidewire of the therapeutic catheter is carefully advanced into the stenosis area. After this, a diluted contrast agent is poured into the balloon using a syringe equipped with a manometer, as a result of which the balloon is uniformly stretched and exerts pressure on the walls of the narrowed section of the vessel. As a result, small ruptures of the intima occur and the middle layer of the vessel is stretched; the atheromatous plaque may be damaged and crushed. Dilation is repeated several times, after which the catheter is removed.
In order to prevent recurrent narrowing of the vessel (restenosis), X-ray endovascular prosthetics is often performed. For this purpose, a metal (for example, nitinol) prosthesis (the so-called stent) is inserted into the section of the vessel expanded by the balloon. Incidentally, we note that stenting is currently used not only in angioplasty, but also to prevent narrowing of the esophagus in case of its cancerous lesion, the pyloric canal, bile ducts, trachea and large bronchi, ureter, nasolacrimal canal.
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