Angiography/balloon angioplasty procedure

I had been having trouble with my left leg for years. Thinking it was arthritis, I kinda accepted the fact that I would have to live with it. The latter part of November 1997 it became progressively worse, making it difficult to keep up on busy nights. I also noticed that the pain went away almost immediately when I set down. Arthritis would not act this way... but a reduced blood flow certainly would.

On Thursday, 23 December 1997, I had an ultrasound done of my legs. The calf pressure in the left leg was 88, while the right leg was 128. Imaging of my abdominal aorta and iliacs showed a 90-95% restriction on my left side, and 80-85% on the right side.

I worked Xmas Eve and Xmas night, and somewhere around 03:00 on Xmas night something happened; my left leg was hurting when I stood up, before I even started walking, and both legs were tingling when I was at rest. I started to get worried about clots forming and occluding the arteries completely.

I did not want to come into the Emergency room with a cold leg, so I decided to get something done about it on Friday. I called the Doctor's office at 08:30 and they said that they would get the ultrasound report and call me back. I went to sleep, and they called back about 10:30 and told me that they had arranged an appointment with Dr. Halley, a vascular surgeon, at 14:00.

Dr. Halley's office called a little later, and changed the appointment to 15:00, so Karen and I and the grandkids went to Taco Villa and ate. We then took Kim and the kids home and headed to the dr's office.

We didn't have to wait very long. Dr halley examined me and declared that we probably could wait over the weekend before we did anything, but he wanted to see the ultrasound report. He came back in a few minutes, and he'd changed his mind. So... we went across the street to Stormont-Vail, where the angiogram and balloon dialation would be done.

It took an hour of so to get checked in and everything, and Dr Allen, one of my favorite radiologists, came in to tell me about the procedure. He was very surprised to see me, he said that he had only glanced at the name on the chart. I was certainly glad to see him; there are some other guys in the group that I don't like nearly so much....

Dr. Allen wheeled me down to the special procedures lab, and I met the tech, three pretty girls. I have known one of them since she and I were pups. We had a good time joking around and everything before we had to get serious.

Soon I was lying on the table, covered from my neck down with sterile swathing. My groin was prepped with Betadine and the left side was then injected with a local anesthetic; the next part was getting the needle into my femoral artery. This proved to be fairly difficult due to the reduced flow and caliber of the vessel, but Dr. Allen finally hit it. He then inserted a guide wire and withdrew the needle, leaving the wire in the artery. Next, he nicked the skin around the guide wire with a scalpel to facilitate the insertion of a catheter over the guide wire into the artery. When the catheter was in place in the aorta, the wire was withdrawn.

So... it was time to shoot some pictures. Dr Allen injected contrast material while the camera was going. (fig 1)

Figure 1 scout film

I could feel the "heat" of the contrast material passing through the arteries, not especially unpleasant but rather unsettling. The warm feeling infuses my body from the umbelicus on down, especially heating up those parts with rich blood supplies. The heat is short-lived, though, rapidly passing.

The aortagram shows the defects in the iliac arteries; the narrowing is pointed to with the white lines and arrows. The big vessel, the aorta, is in the center of the picture and is labeled with black letters.

The defects are pretty close to the origins of the iliacs, and if a single balloon is used, it will extend into the aorta and not put the proper pressure on the inside ot the artery. Dr Allen decides to put in two balloons at the same time; this means that the right femoral artery needs to be punctured also. The same procedure is followed on that side, only the artery is even harder to find, due to scar tissue. I've had catheters put into the right side four different times. After Dr Allen hits the artery, the same procedure is followed as on the other side.

To insert the balloon catheters, the guide wire is inserted into the original catheter and threaded into the aorta. The original catheter is withdrawn and the balloon catheter is threaded into the aorta over the guide wire.

Once both balloons are in place, they are "blown up" with an injection of contrast material and the inflated state is held for a certain amount of time. (fig 2)

Figure 2 Both wires in place

I would normally be able to remember the time, but that is all kinda fuzzy due to the drugs I received. Essentially, the plaque is pressed against the sides of the blood vessel; it will then eventually disappear. This doesn't work for everyone, but I am one of the lucky ones. Lesions that I had ballooned in 1989 are still open. If they close up, it is usually within a matter of days.

There is an additional lesion down further in the left iliac artery. Dr. Allen moves the balloon down and re-inflates it. (fig 3)

Figure 3 Balloons in both iliacs inflated

The insides of arteries are not ennervated: you cannot feel anything that goes on inside of an artery. So inflating the balloons is not painful, in and of itself. However, whatever is being supplied with blood is deprived of that blood when the balloon in inflated, and this can (and does) produce some pain. For instance, I found out that my right testicle is supplied with blood from my left iliac.

Fig 4-lower left iliac lesion with balloon inflated

Next came the aortagram and runoff: a large amount of contrast material is injected via the cather with a power injector. Well, I had experienced the warmth of the hand injections, and it didn't really bother me. So, this would be just a little more, and last a little longer. NOT! I damned near came off of the table, forewarned as I was, because I was expecting warmth, not BURN! But Burn it was, from the middle of my back down to my knees. And the worse part... the film changer didn't fire, so we had to do it again. Same thing, except for this time I requested and received drugs beforehand. Still the same sledge-hammer fire, but this time I just gritted my teeth for the ten seconds (or eternity, I forget which) and we were done. The films showed no lesions between my feet and the ones that he had ballooned in my iliacs.

All done!

So... all done. I was slid off of the table, and Dr allen put some patch things into and over the holes in my arteries. These plugs reduced the flat time from six hours clear down to 1 1/2 hours. That is wonderful; I had not been looking forward to those six hours of not moving!

So, I was done and ready to go at 22:00 when Karen showed up to take me home. And I was ready to get home. It was suggested that I go to bed, and I did, after Karen fixed me a sandwich. Dr Allen called on Saturday morning; I had told him that I wanted to go back to work on Sunday night, and he suggested that I wait until Monday night, at the earliest.

Modern medicine is wonderful. Ten years ago, I would have had to have surgery and been off for eight weeks, assuming I survived the surgery: about 10% didn't.

This is a wonderful and exciting period to be living!