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Vascular Services and Intervention

Patient with Cardiac Doctor

The Vascular and Endovascular Services department at the Arizona Heart Hospital diagnoses and treats blood vessel disease.

Our highly trained vascular surgeons and clinical staff use the latest technology to provide treatment options that are minimally invasive, resulting in shorter hospitalizations and faster recovery.

Endovascular Interventions

Atherectomy
In this nonsurgical procedure, atherectomy catheters either cut or pulverize the material adhering to the arterial wall, enlarging the opening so blood can flow freely. These devices are effective in both soft and hard calcified plaque. Four different types of atherectomy devices are currently being used in both heart and leg arteries. Some of these devices are capable of suctioning the debris from the artery, thereby eliminating any chance that plaque fragments will be carried by the blood to other parts of the body.

Balloon Angioplasty
A balloon is used to compress plaque and stretch an artery, in order to provide a wider passageway for blood flow.

Laser Angioplasty
A technique that uses a high-intensity laser to open coronary arteries by vaporizing plaque.

Endoluminal Grafting
An endoluminal graft (ELG) is made of a combination of a synthetic graft and metal stents. It is inserted nonsurgically through an artery in the groin area and positioned inside the vessel at the site of the problem. X-ray and ultrasound technologies projected on to a television monitor are used to create a map for the doctor to locate the aneurysm. Once the problem area is found, the stent is then expanded to keep the device in place. By lining the inside of the artery with a graft, the ELG allows for normal blood flow, effectively eliminating the diseased area. In treating aneurysms, ELG's are used to restore blood flow and prevent a possible rupture.

The use of an ELG has many benefits. Since this procedure requires only a small incision in the groin, patients usually spend just 48 to 72 hours in the hospital, compared to the 7 to 14 day hospital stay in the past for traditional abdominal aortic aneurysm surgery. Best of all, patients can get back to their normal activities almost immediately.

Rotoblator Ablation
A way of disintegrating plaque with a drill, useful in long blockages with calcium deposits.

Stenting
Stents are expandable, wire mesh tubes designed to line the inner walls of an artery, holding it open and maintaining normal blood flow. Stents are often used in conjunction with balloon angioplasty to help prevent restenosis, a renarrowing of the artery that can occur following angioplasty.

The patient is prepped in the same manner as for angioplasty and is awake during the procedure. A sedative is administered to help decrease anxiety. In addition, for stent placement in the peripheral arteries (e.g., in the legs), epidural anesthesia may be given to numb the lower part of the body. Standard balloon angioplasty is usually performed before the stent is placed. Under X-ray guidance, a balloon catheter is introduced through an artery in the groin or arm and advanced to the site of the blockage, where it is inflated. This compresses the plaque against the walls of the artery to create an opening.

Next, the balloon is removed and an unexpanded stent mounted on a deflated balloon catheter is directed to the site of the earlier blockage. The balloon is then inflated, causing the stent to expand. After a few seconds, the balloon is deflated and removed, leaving the stent in place and restoring normal blood flow.

A dye visible on X-ray is injected into the vessel and films are taken showing the stent's exact placement. The expanded stent remains in place permanently. The procedure, which takes approximately two hours, involves little to moderate pain and the patient may experience some discomfort during the first few hours following the procedure.

The patient is admitted on the day of the stent procedure and will remain in the hospital an average of 24 to 48 hours. Under a physician's direction, the patient is required to take an anticoagulant, or blood thinner, for two weeks to one month following the procedure.

Routine clinical examinations are completed at one week and six months. Further examinations are conducted on an as-needed basis. A stent placement procedure carries the same risks as angioplasty, which include chest discomfort, kidney dysfunction, abdominal bleeding, stroke, and, in very rare cases, death. An additional risk is the formation of blood clots in the first 10 days following the procedure. To reduce this risk, the physician may prescribe aspirin, platelet inhibitors, or both. Will the Stent Create Problems with Metal Detectors?

Stents are so small that they do not activate metal detectors. However, they can cause distortion of an image obtained during a magnetic resonance imaging (MRI) scan. These distortions are about the same as those caused by metal surgical clips. For both stents and surgical clips, the risk is considered negligible. However, the patient should not undergo an MRI scan until the stent has adequately healed, which takes about six months. This will minimize the risk of movement of the stent when subjected to the strong magnetic field. Following the procedure, patients receive a wallet-size card identifying them as a stent implant recipient.

Although stents have revolutionized the treatment of atherosclerosis, physicians and patients still battle the problem of in-stent restenosis. This reblockage, which occurs in as many as 25 percent of patients, happens when scar tissue grows rapidly inside the stent and eventually narrows the artery.

Until now, physicians have had few options for preventing restenosis. New devices called drug-eluting stents are transforming the way physicians use stents to treat atherosclerosis, a fibrous plaque thickening of the vessels. The devices, which consist of a stainless steel stent covered with a plastic coating, slowly release a medication that blocks inflammatory processes in the vessel wall and limits the overgrowth of normal tissue during the healing process. Patients should discuss this possible treatment option with their physician.

Thrombolysis
Thrombolytic therapy involves the injection of clot-dissolving medications into a blood vessel. These medications can be delivered to the area of a clot through a catheter, which may also carry special attachments to mechanically break up the clot.

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