The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on balloon angioplasty with or without stenting for coarctation or recoarctation of the aorta in adults and children.
Aortic coarctation is a congenital narrowing of part of the aorta, most commonly the aortic arch, usually close to the origin of the left subclavian artery.
Balloon angioplasty of aortic coarctation is a minimally invasive procedure which involves inserting a catheter into a large blood vessel, usually in the groin, and passing it up to the area of narrowing under X-ray control. A balloon is then inflated within the narrowing. A stent (a small tube) may be placed within the narrowing to keep it dilated. Balloon angioplasty and stenting may be carried out as a first treatment (in 'native' coarctation) or if previous surgical or angioplastic treatment fails and coarctation recurs ('recoarctation').
The standard treatment for native and recurrent coarctation involves open chest surgery.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.