Balloon dilatation involves dilating a narrowed section of a vessel with a special balloon catheter. The procedure is used primarily in vascular surgery.
What is balloon dilatation?
Balloon dilatation is the use of a special balloon catheter to dilate a narrowed section of a blood vessel. The procedure is used primarily in vascular surgery. Balloon dilatation is a minimally invasive procedure. It is used to dilate narrowed blood vessels or hollow organs. The term dilation comes from Latin and means “to expand” or “to enlarge”. Balloon dilatation serves as an alternative to costly bypass surgery on the heart. For example, it can sometimes be therapeutically sufficient to dilate a narrowed coronary vessel with the aid of an inflatable catheter. Physicians also refer to balloon dilatation as percutaneous transluminal angioplasty (PTCA) or percutaneous coronary intervention (PCI).
Function, effect, and goals
The most important indications for balloon dilatation are angina pectoris or acute coronary syndrome. Arteriosclerotic vascular stenoses (narrowings) of the external arteries as well as the coronary arteries are treated. Balloon dilatation can also be performed in gastroenterology to widen the esophagus or bile ducts. In urology, the procedure is used to dilate the urethra in the prostate region, while in otolaryngology it is used to dilate the sinus excretory ducts. In the case of arteriosclerosis, however, it is not always possible to make the narrowed areas more permeable with balloon dilatation. Ultimately, the decision on the therapy method depends on the attending physician. For this purpose, the physician determines the location of the constriction and estimates the level of risk for the patient. Balloon dilatation makes sense if there is a narrowing in only one artery of the coronary arteries or if the narrowing can be reached without difficulty. The patient’s state of health also plays an important role. The chances of success are less good in the case of a severe stenosis. Balloon dilatation is performed during coronary angiography. The patient is first given a contrast medium that allows the coronary arteries to be visualized as an X-ray image on a monitor. A local anesthetic is usually administered before the procedure. After opening an artery, which is located either in the elbow or in the groin, the surgeon provides it with a sheath. This makes it easier to insert the catheter. It also allows for more effective action in the event of an emergency. Through the sheath, the surgeon inserts a flexible narrow wire into the area around the heart. After reaching the junction between the coronary vessels and the aorta, an even finer wire is inserted. This is inside the first wire and is gently pushed up to the narrow point that needs to be treated. This requires the physician to have a good sense of touch. Once this procedure has been successfully completed, the balloon catheter can be inserted as far as the constricted area. The physician uses a connected monitor to monitor whether the instruments are in the right place. If the folded balloon is in the right place, the surgeon inflates it using high pressure. After a few seconds, he lets the pressure drop again. In this way, the harmful deposits can be removed. However, it is usually not sufficient to inflate the balloon only once, which is why it must be repeated several times. If several balloon dilatations have to take place, this is usually done within one session. If the vessel walls rupture during the procedure, a so-called stent must be inserted. This is an extremely fine metal mesh. The stent can be inserted into the constriction via the guide wire. When the balloon is inflated, the metal mesh is pressed against the wall of the blood vessel. This maintains the dilated shape and allows the artery to be kept open. To complete the balloon dilatation, the balloon and catheter are removed from the body. The patient then remains in bed for a few hours and is closely monitored. If there are no more complications to worry about, the application of a pressure bandage is performed.
Risks, side effects, and hazards
Already a short time after the balloon dilatation, the positive effect of the intervention can be felt.However, in around 35 percent of all patients, arterial stenosis occurs again later, which is known as residual stenosis. As a result, those affected again suffer from angina pectoris symptoms. The physician can determine whether a residual stenosis is present by means of an exercise ECG. After implantation of a stent, follow-up treatment with medication is required for a period of three to four months. If symptoms recur, balloon dilatation can be performed again. Balloon dilatation is considered a heart procedure and is associated with certain risks or side effects. For example, the patient often experiences an unpleasant feeling of pressure during the treatment, which is caused by the balloon expanding. Cardiac arrhythmias are also within the realm of possibility during balloon dilatation. In rare cases, the blood clot can be pushed further, resulting in a heart attack. Another conceivable complication is vascular perforation, which in turn results in pericardial hemorrhage. In such a case, vascular surgery is often necessary. However, to avoid complications, the patient is constantly monitored by the physicians. In this way, they can intervene immediately if problems do indeed arise. It is important to have a balloon dilatation performed in a hospital as a matter of principle. This hospital must also have a cardiac surgery emergency team. During the procedure, there is a risk of injury to the blood vessels, intolerance to contrast media, and heart attack or stroke. In principle, however, complications from balloon dilatation are rare. Thus, only about two percent of all patients are affected by them.
