[Ask Dr Chiu] Understanding angioplasty surgery – Process, risks, costs, and post-op care!

[Ask Dr Chiu] Understanding angioplasty surgery – Process, risks, costs, and post-op care!

[Ask Dr Chiu] Understanding angioplasty surgery – Process, risks, costs, and post-op care!

Health

2024-07-17

5  Mins Read

Heart disease is the third leading cause of death in Hong Kong, with coronary heart disease being a major culprit. This condition occurs when cholesterol and fatty deposits build up on the inner walls of the coronary arteries, hindering normal blood flow to the heart. However, thanks to advancements in medical science, the mortality rate for coronary heart disease has been gradually declining. One of the treatments frequently mentioned is the ‘angioplasty’ procedure. This surgery can restore blood flow through the arteries, helping patients regain heart function.

In this article, I will delve into the process, risks, costs, and post-operative care of angioplasty.

 Who needs angioplasty?

Coronary artery narrowing or blockage: Patients with myocardial infarction or coronary artery blockage causing insufficient blood supply to the heart may need angioplasty. A blockage of 70% is a common threshold for considering this surgery. Doctors assess the specific condition of each patient, including the location and size of the blockage. If the blockage doesn't significantly affect blood flow or heart function and is asymptomatic, angioplasty might not be necessary.

Myocardial ischemia: Coronary heart disease can lead to myocardial ischemia due to inadequate blood supply, increasing the risk of myocardial infarction. Angioplasty can improve blood flow to the heart muscle, reducing ischemia and the risk of heart attack.

High-risk patients: For those with multiple cardiovascular risk factors, such as hypertension, high cholesterol, or diabetes, angioplasty can help lower the risk of heart attacks.

What is angioplasty?

The medical term for angioplasty or coronary artery bypass surgery, commonly known as a stent procedure, is percutaneous coronary intervention (PCI). This is a minimally invasive procedure with a high success rate and minimal risk of serious complications. The process involves inserting a fine catheter through an artery into the patient's wrist or thigh and guiding it to the affected area of the heart. A small balloon is then inflated to open up the narrowed blood vessel. A stent is implanted to keep the vessel open and prevent it from narrowing again. This allows the previously blocked or narrowed artery to restore normal blood flow, improving the supply of oxygen to the heart muscle. The stents used in angioplasty are coated with polymers and medication, which are gradually absorbed by the blood vessel over a period of about six months to a year. The coating reduces the likelihood of restenosis, which is the recurrence of blockage in the stented blood vessel. Patients are also required to take dual antiplatelet therapy to prevent the formation of blood clots within the vessel, thereby reducing the risk of further blockage.

The entire procedure typically takes place in a catheterisation lab, under local anaesthesia or sedation, and usually completes within two hours. Patients with severe artery blockages may be discharged within one to two days post-operation, experiencing significant symptom relief and reduced angina. 

  

Risks of angioplasty

While angioplasty is a well-developed technique, it does carry certain risks and potential complications. Minor issues can include bruising and swelling at the catheter insertion site, while more serious complications may involve stent thrombosis or damage to the blood vessels.

Before undergoing angioplasty, patients should discuss the procedure and its potential risks with their doctor. A thorough cardiovascular assessment, including an electrocardiogram (ECG), echocardiogram, chest X-ray, and blood tests, may be necessary to ensure the patient is a suitable candidate for the procedure. If the risks outweigh the benefits, the doctor will not recommend the surgery. It's important to note that angioplasty is not the only treatment option for coronary artery disease. Stable chronic coronary artery disease can often be managed effectively with medication, as well as strict control of blood sugar and blood pressure levels. In many cases, these measures can lead to significant improvement in the patient's condition.

Post-operative care for angioplasty

Regular check-ups: Patients should have regular follow-ups to monitor heart function and detect any complications early.

Adhere to medical advice: Follow the doctor’s instructions meticulously, including medication adherence, avoiding strenuous activities, and maintaining a healthy diet.

Weight and diet management: Proper weight control and a heart-healthy diet are crucial. Patients should avoid excessive intake of saturated and trans fats and consume more fibre-rich foods like vegetables, fruits, and whole grains.

Stress management: Adequate rest and relaxation are essential for heart health. Patients should avoid prolonged stress and anxiety and learn effective stress management techniques.

Moderate exercise: Under medical supervision, patients should engage in moderate exercise to enhance heart function and circulation while avoiding overexertion.

Psychological support: Angioplasty can affect a patient’s mental health, especially during recovery. Regular psychological counselling can help manage post-operative emotional fluctuations and stress.

Costs of angioplasty

The cost of angioplasty varies across different hospitals and doctors and is influenced by various factors. Typically, the cost includes medical equipment, operating room fees, physician and anaesthetist fees, and hospital care during the stay. Complications or additional treatments can also increase costs. Private hospital fees range from HKD 100,000 to HKD 300,000, while public hospital charges are between HKD 40,000 and HKD 80,000, though the waiting time may be longer. 

  

Prevention is better than cure

Given that coronary heart disease is one of Hong Kong's leading causes of death, regular health check-ups can help detect issues early, reducing the risk of severe disease progression and associated costs. Maintaining healthy lifestyle habits is crucial as health is our greatest wealth.

Some insurance policies now cover not only critical illnesses but also specific treatments like angioplasty and other coronary artery procedures. Early insurance coverage can mitigate financial burdens and allow for peace of mind in the face of potential health challenges.

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