Peripheral angioplasty for leg arteries: what happens, risks and recovery

Peripheral arterial disease means fatty deposits have narrowed the arteries that carry blood to the legs. The typical symptom is cramping pain in the calf or thigh that comes on with walking and eases with rest. Leaflets from two hospitals add that when the narrowing is severe the foot can hurt even at rest, especially at night, and skin ulceration can follow.

For many people, a scan or an angiogram showing a narrowing does not on its own mean a procedure is required. The NHS treatment page for peripheral arterial disease puts regular walking exercise and stopping smoking first, and describes statins, blood pressure medicines and antiplatelet medicines as the usual backbone of treatment. It says revascularisation is considered when leg pain is so severe that it prevents everyday activities, or when conservative treatment has failed.

That framing matters when you are deciding. If your walking distance is limited but you can live with it, a supervised exercise programme is a legitimate first answer. If your foot is painful at rest, has a sore that is not healing, or you cannot do things that matter to you, angioplasty or a bypass operation becomes a more reasonable conversation to have with a vascular team.

The NHS describes two revascularisation options. Angioplasty is the less invasive of the two and is done under local anaesthetic with the possibility of going home the same day. Bypass graft surgery is more invasive but is described as giving longer-lasting results. Which is more suitable depends on where the artery is narrowed, how long the narrowing is and how fit you are for an operation.

It is reasonable to ask your vascular team what the alternative would be for you and why it is not being recommended. A balloon alone, a balloon with a stent and a bypass can each be sensible, and the answer can change from one leg segment to another.

Hospital leaflets set out a consistent preparation routine. A Plymouth leaflet says you may eat and drink as normal unless sedation has been discussed, while a Cambridge guide allows a light meal beforehand. Because rules differ between units, follow the instructions in your own appointment letter.

Blood-thinning medicines need a plan. The Cambridge leaflet advises stopping medicines such as warfarin and clopidogrel only as instructed by the doctor and notes that aspirin 75 mg is safe to continue; the Plymouth leaflet lists warfarin, rivaroxaban, apixaban and ticagrelor among those stopped beforehand. Do not stop anything unless the team has told you to.

• Tell staff about allergies, especially any previous reaction to X-ray contrast dye.

• Bring all your medicines and repeat prescriptions.

• Blood pressure, kidney function and diabetes medicines are checked before the procedure, according to the Plymouth leaflet.

• Pregnancy must be mentioned because X-rays are used.

• Arrange for a responsible adult to collect you and to stay overnight if you go home the same day.

You lie on an X-ray table and the skin over the artery that will be used, most often in the groin and sometimes in the arm, is numbed. The Cambridge leaflet warns the local anaesthetic may sting a little as it goes in.

A thin catheter with a deflated balloon on its tip is guided along the artery to the narrowing under X-ray. The balloon is inflated briefly to stretch the artery open and then deflated and withdrawn. Occasionally a stent, a small metal mesh tube, is left in place to keep the artery open.

Afterwards nurses check your pulse, blood pressure and the puncture site while you lie flat. Cambridge describes two to six hours of bed rest and says some people stay overnight; Plymouth describes lying flat for two hours at first and a possible overnight stay in certain circumstances.

The commonest problem is bruising at the puncture site, which both Plymouth and Cambridge describe as relatively common or normal. A larger collection of blood that might need draining, and a false aneurysm at the puncture, are described as occasional to rare.

Rarer problems named in the leaflets include a clot or tear in the treated artery needing emergency surgery, worsening of the leg circulation, and, very rarely, amputation. Contrast dye can affect the kidneys, mainly if kidney function is already poor, and allergic reactions to it are described as rare. The Plymouth leaflet puts the radiation risk in context by saying it is much lower than the lifetime cancer risk everyone already carries, which it gives as around 1 in 3; the Cambridge leaflet mentions a small risk of skin reddening or burns with longer procedures.

The procedure may also simply not improve blood flow enough, so ask your team about how likely that is for the segment of artery involved. The leaflets retrieved do not give individual percentages, so none are quoted here.

A Kingston and Richmond leaflet advises resting and avoiding strenuous activity for 24 to 48 hours, keeping the puncture dressing clean and dry, and removing it after 48 hours so you can shower normally. Short walks are fine and activity is built up gradually, but heavy lifting and long periods of standing are discouraged early on.

If a stent was placed, the same leaflet says to take dual antiplatelet therapy, aspirin and clopidogrel, exactly as directed. Follow-up in that trust included a telephone clinic at 48 hours, an ultrasound within one to two weeks and a vascular review at six weeks; other units will differ.

The procedure does not remove the cause of the arterial disease. The NHS emphasises stopping smoking, which it says reduces the risk of the disease getting worse, along with regular walking and medicines.

While you are still in hospital, tell the nurse straight away about increasing pain, bleeding, swelling or bruising at the groin, or numbness or tingling in the leg. At home, the Kingston leaflet lists increasing redness, swelling or discharge at the site, numbness or tingling in the leg or foot, severe leg pain, breathlessness, chest pain, dizziness or fever as reasons to seek urgent care.

Use the contact number on your discharge paperwork for non-urgent questions, NHS 111 or your GP if you are unsure, and 999 or A&E for chest pain, breathlessness, heavy bleeding that does not stop with firm pressure, or a leg that becomes cold, pale and very painful.

• Which artery segments are narrowed, and is a balloon alone or a stent planned?

• What would a bypass offer me instead, and why is it not being advised?

• Which of my medicines will I stop or start, and for how long?

• What should my walking programme look like afterwards?

• How will you check that the artery stays open, and when?

The balloon technique and the stents available are broadly the same in both settings, and in many areas the same vascular surgeons and radiologists work across both. Differences are practical: the waiting time, whether you can choose your operator, and how follow-up scans and supervised exercise are arranged. If you are paying, ask what happens, and who bears the cost, if a second procedure or a bypass becomes necessary.