Endovascular surgery (angioplasty and stenting)

Angioplasty means treating the blocked area of a vessel (an arterial stenosis) from inside the vessel, with the help of a balloon that is inflated. Sometimes the widened vessel has to be kept open with a small metal tube called a stent. The balloon is introduced into the artery through a needle in the groin, under local anaesthesia — the whole manoeuvre is minimally invasive, without open surgery.

Angioplasty and stenting at a glance

• Type of procedure: endovascular, minimally invasive — treatment from inside the vessel
• Anaesthesia: local, at the site of the groin puncture
• Arterial indications: arteriopathy of the lower or upper limbs
• Venous indications: post-thrombotic syndrome, Nutcracker syndrome
• Advantages: no surgical incisions, fast recovery, immediate improvement of the flow

What is angioplasty?

Angioplasty is a minimally invasive endovascular procedure used to widen arteries or veins that are narrowed or obstructed, usually to treat arterial atherosclerosis — the deposition of fat in the wall of the vessel. It restores the blood flow without open surgical intervention and can be performed even in emergency situations.

What is stenting?

Sometimes the widened vessel tends to narrow again after the balloon is withdrawn. In these cases, a stent is placed at the moment of ballooning — an expandable metal tube that stays in the vessel and keeps it open long term.

Who is angioplasty recommended for?

• Arteriopathy of the lower or upper limbs — the deposition of fat in the wall of the arteries, with symptoms such as claudication, pain at rest or wounds that will not heal.
• Selected venous conditions — angioplasty can also be performed at the level of the veins: in post-thrombotic syndrome (the after-effects of a deep vein thrombosis) or in Nutcracker syndrome — the compression of the left renal vein, associated with pelvic varicose veins.

The exact indication is established after the vascular evaluation and the imaging investigations (Doppler ultrasound, CT angiography or arteriography).

How does the procedure work, step by step?

1. Local anaesthesia — the groin area is anaesthetised, at the site of the puncture.
2. Arterial puncture — the artery is punctured with a needle; a thin guide wire is introduced through it.
3. Positioning the balloon — a deflated balloon, attached to a catheter, is passed over the guide wire up to the narrowed area, under imaging control.
4. Inflating the balloon — the balloon is inflated to a fixed size and forces the expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow.
5. Stenting (where needed) — a stent can be introduced at the moment of ballooning, to make sure the vessel stays open; the balloon is then deflated and withdrawn.
6. The end — the catheter is withdrawn and the puncture site is compressed. No surgical incisions are needed.

What advantages does endovascular surgery have?

• no open surgery and no incisions — only an arterial puncture
• local anaesthesia, without the risks of general anaesthesia
• immediate improvement of the blood flow
• short hospitalisation and fast recovery
• can be repeated if needed and combined with other procedures

What is the recovery like?

After the procedure, rest is recommended for the punctured limb for the interval indicated by the doctor, to prevent bleeding at the puncture site. Hospitalisation is short and normal activities are resumed quickly. The doctor establishes the maintenance medication (including antiplatelet drugs, where indicated) and the check-up schedule, through which the patency of the treated vessel is verified.

Frequently asked questions

Does angioplasty hurt?

The procedure is done under local anaesthesia at the puncture site; discomfort is minimal and pain after the procedure is low. You stay awake throughout the intervention.

Does the stent stay in the vessel permanently?

Yes, the stent stays permanently and keeps the vessel open. Periodic check-ups verify how it works over time, and the prescribed medication helps maintain patency.

Angioplasty or bypass?

Short, accessible lesions usually respond well to angioplasty; long or complex lesions may require a surgical bypass. The decision is taken after the imaging investigations.

Can the procedure be repeated?

Yes. If the vessel narrows again over time, angioplasty can be repeated or completed with other solutions — an advantage of the endovascular approach, which does not “use up” the later surgical options. See also all the arterial conditions treated.