Angioplasty is a minimally-invasive surgical procedure used to expand the size of blocked or narrowed veins, usually to treat cardiovascular varicose veins (veins that narrow in the body's blood vessels). This procedure involves the use of a balloon catheter inserted into a vein, which is inflated to create an erection. The resulting angioplasty balloons create a "balloon" effect that forces the blood through the narrowed vein, which enlarges it.
Balloon angioplasty is an extremely successful procedure for most patients who have it. Recently, there have been attempts to convert angioplasty balloons into scoring and cutting systems. For instance, in June 2020, Transit Scientific announced the U.S. Food and Drug Administration (FDA) cleared the XO Score Percutaneous Transluminal Angioplasty (PTA) Scoring Sheath platform for use in iliac, ilio-femoral, popliteal, infra-popliteal and renal arterial plus synthetic and/or native arteriovenous hemodialysis fistula.
However, there are a few instances in which the procedure could fail - and technical failure might be the only reason a patient receives inadequate results. When this occurs, there are several different ways in which the angioplasty balloon can fail. Here is a look at the most common technical failure of angioplasty balloons, along with possible ways to prevent and repair the damage if it occurs.
First, technical failure occurs when the inflated balloon doesn't go through the vessel and into the wall of the rectum. While this is rarely the case, in some cases insufficient vasoconstriction has caused the balloon to get too far into the tissue and collapse - sometimes causing a full inflation of the vessel. This can cause serious hemorrhaging, diarrhea, and cramping, so if it occurs during the angioplasty procedure it is important to fix the problem immediately.
Another issue that can cause a balloon to fail is excessive valve muscle contraction. This is rare but has been known to occur in certain circumstances, such as when the angioplasty balloons inflate too much due to improper inflation. In this situation, the valve muscle becomes abnormally tight, causing the inflated balloon to get stuck in the tissue. This causes the vessel wall to contract tightly, which causes a full-blown vasoconstriction event - a condition that results in either a decreased blood vessel wall thickness or cramping.
A final, albeit unlikely, technical issue that can occur is fibrillation. If a fibril exists within a catheter during an angioplasty procedure, it can cause serious problems for both the patient and the surgeon. As the fibril contracts, it can potentially damage the sensitive blood vessels located in the anal canal and rectum. While rare, in some cases a fibrillar clot can also be present in the wall of the artery supplying the anal canal. The clot will decrease the effectiveness of the angioplasty procedure and can even prevent the catheter from working altogether. When this happens, the patient may require a second procedure to fix the problem.
Patients who are contemplating bypass surgery, whether it is performed inside the abdomen or on the thighs, should be aware of the risks associated with angioplasty. Though rare, some complications do occur and should be discussed in detail with your surgeon before you make any decisions regarding your procedure. By paying attention to your end result, as well as to the details of your particular case, you can ensure that you achieve the results that you desire - safe, comfortable, and effective!
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