Popliteal artery branches: percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty of the branches of the popliteal artery was performed in six patients, two of whom also had femoropopliteal angioplasty. Dilatation was performed with catheters ranging from 5.5 to 7 French. None of the popliteal branch dilatations was performed with an inflated balloon. Excellent dilatation, as documented by angiography and Doppler ultrasound pressure recordings, was obtained in four cases and moderate and slight improvement in one case each. Two of the four patients with excellent results had prompt healing of toe amputations and are doing well at 19 and 22 months after angioplasty. In the other two patients with excellent results, below-knee amputation was necessary despite patency of the dilated segment in one. In the other patient with initially excellent results, reocclusion occurred 4 months after angioplasty. In the patients who had moderate and slight improvement on angiography and in distal pressures, no significant clinical course change occurred. No patient had clinical deterioration after angioplasty and no significant complications occurred.     

Renal transplant artery stenosis and percutaneous transluminal angioplasty

Ten patients with renal transplant artery stenosis were treated with percutaneous transluminal angioplasty (PTA). All patients suffered from hypertension refractory to drug treatment. PTA was successful in five patients. Blood pressure improved significantly and the antihypertensive medication could be reduced or withdrawn. Acute angulation at the anastomosis prevented successful PTA in four patients. One inaccessible stenosis was corrected surgically. No significant complications arose. If a renal transplant artery stenosis is haemodynamically significant, PTA should be considered the method of first choice for correction.     

Subclavian artery steal syndrome: treatment by percutaneous transluminal angioplasty

We present our experience with 24 patients in whom percutaneous transluminal angioplasty was performed in the proximal subclavian artery. Seventeen patients had symptoms of subclavian steal syndrome, and seven had symptoms of upper extremity ischemia. Eighteen (75%) had excellent clinical results, with 80-100% restoration of the expected lumen diameter. Three patients required repeat dilatation because of recurrent symptoms. The only complication was a single case of brachial artery occlusion. Our results suggest that subclavian artery angioplasty is a safe and effective method for treating subclavian artery steal syndrome and upper extremity ischemia.     

Transient hypertension after percutaneous transluminal renal artery angioplasty

A retrospective analysis of 128 technically successful percutaneous transluminal renal angioplasty (PTRA) procedures was performed. After the procedures, transient systemic hypertension (TSH) developed in 39 patients. The phenomenon usually occurred within 30 minutes of balloon dilation and always within 2 hours of PTRA. TSH lasted less than 5 hours in 35 patients and never persisted for more than 24 hours. TSH is a self-limiting process and should not be confused with the more sustained hypertension that arises from a complication of balloon angioplasty.     

Gortex graft-external carotid artery anastomotic stricture treated by percutaneous transluminal angioplasty

We describe successful percutaneous transluminal angioplasty (PTA) of a gortex-right external carotid artery anastomotic stricture in a 49-year-old man with amaurosis fugax and occlusion of the right internal carotid artery. No neurological complications occurred during the procedure. The patient had had three previous carotid operations, and PTA enabled successful transcranial arterial bypass surgery to be carried out, with complete relief of symptoms.     

Outpatient percutaneous transluminal renal artery angioplasty: a Canadian experience

PURPOSE: The authors performed a retrospective study of their experience and complication rate while performing outpatient percutaneous transluminal renal artery angioplasty (PTRA) during a 5-year period. MATERIALS AND METHODS: From July 1992 to July 1997, 87 PTRAs were performed. Of these, 62 PTRA procedures were performed on 53 outpatients. In total, 66 arteries were dilated in 62 PTRA sessions using standard, established techniques. During the same period, only 25 PTRAs were performed on inpatients. Angioplasties were performed on those patients with demonstrated renal artery stenosis and poorly controlled hypertension and/or renal failure. Patients chosen for PTRA were picked by a team that included a vascular surgeon, a nephrologist, and a radiologist. Patients who were deemed suitable for an outpatient procedure were recommended by a nephrologist. Radiological input was sought at that time. Specific guidelines were used to select these patients who were otherwise healthy, well-orientated, and able to respond to an emergency situation. None of the subjects had significant risk factors. All were accompanied by an adult for the first 24 hours and all lived no more than an hour's travel time from a hospital. All were stable on discharge and were seen within 24 hours by a nephrologist. RESULTS: The technical success rate, defined as a residual stenosis on imaging of less than 30% and/or by a pressure gradient of less than 10 mm Hg across the stenosis, was 85%. The early complication rate was 5.6%, including two patients who developed a localized hematoma. In all, four patients were admitted to the hospital rather than being discharged to home after an average of 4.2 hours of observation. The late complication rate was 3% and involved two patients. One patient, who reported pain after balloon deflation, was readmitted 6 hours after discharge with hypotension, and a diagnosis of renal artery rupture was confirmed with computed tomography. Another patient developed peripheral atheroemboli 20 days after the procedure. CONCLUSION: Outpatient PTRA can be performed on selected patients. In this study, late complications occurred in only 3% of patients. Early complications were readily recognized in 5.6% of patients, and these patients were admitted for observation after the procedure.     

Delayed rupture of renal artery after renal percutaneous transluminal angioplasty

Two cases are reported in which rupture of the renal artery occurred many hours after renal percutaneous transluminal angioplasty. Delayed rupture can be recognized by the angiographic appearance and by the presence of persistent flank pain. The typical angiographic finding is a poorly defined zone of contrast medium at the site of perforation.     

Renal artery stenosis: anatomic classification for percutaneous transluminal angioplasty

Most lesions that decrease renal blood flow originate within the renal artery; however; large, aortic, atherosclerotic plaques can overhang the renal ostium producing a functional renal artery stenosis. At the Hospital of the University of Pennsylvania, 45 consecutive percutaneous transluminal angioplasties were examined retrospectively and classified as to site of the obstructing lesions and clinical outcome. Stenoses within the renal artery responded very well to angioplasty, with 83% of patients showing either an excellent or good result. Conversely, when aortic plaques were responsible for inflow obstruction, 76% of patients responded poorly or not at all to balloon dilatation. It is proposed that this disparity of response reflects the anatomic differences in the orientation of elastic and collagen fibers of the muscularis and advential layers of the renal artery and the aorta.     

Focal renal artery stenosis caused by fibromuscular dysplasia: treatment by percutaneous transluminal angioplasty

We performed percutaneous transluminal angioplasty of the renal artery in five hypertensive patients with focal renal artery stenoses caused by fibromuscular dysplasia. In four patients, the hypertension decreased or resolved. In all patients, the stenoses displayed considerable resistance to dilatation, requiring maximum inflation of the angioplasty balloon with 10 atm of pressure (10.1 x 10(5) Pa). In two patients, the stenoses were extremely firm with a persistent waist noted in the maximally inflated balloon. One of these patients was left with a residual 40-50% stenosis after initial angioplasty, and a second attempt at dilatation after restenosis was also unsuccessful. This patient's blood pressure did not improve. When the results of our experience in these five patients were combined with 22 cases reported in the literature, we found that 23 (85%) of the 27 patients with focal renal artery stenoses caused by fibromuscular dysplasia had a decrease in blood pressure after percutaneous dilatation. Percutaneous transluminal angioplasty is an effective treatment for patients with renovascular hypertension caused by focal renal artery stenoses resulting from fibromuscular dysplasia.     

Results of percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty (Dotter technique) was used in 2,942 cases of iliofemoral atheromatous disease. Results varied with the characteristics of the obstructing lesion (length and location) and the clinical stage of ischemia (claudication, rest pain, gangrene). Based on the foregoing, angioplasty is done either as the preferred primary treatment or for the relief of clinically advanced disease in patients unsuitable for high risk surgery. Success is favored by the use of aggregation inhibitors and single-use Teflon or balloon catheters; complications are few.     

Direct percutaneous transluminal angioplasty for acute middle cerebral artery occlusion.

PURPOSEWe review our initial experience with direct percutaneous transluminal angioplasty (PTA) as a reperfusion treatment for acute occlusion of the middle cerebral artery.METHODSTen patients in whom successful thrombolysis might not be expected because of the risk of hemorrhagic complications or reocclusion were treated with direct PTA. When early ischemic findings were present on the initial CT scans and/or when lenticulostriate arteries were involved, we performed direct PTA rather than thrombolytic therapy. Direct PTA was also performed when superselective local angiography via a Tracker catheter advanced just distal to the occlusion site showed the presence of a large embolus or high-grade stenosis suggestive of thrombosis. Angioplasty was performed with a Stealth balloon catheter with a maximum diameter of 2.0 to 2.5 mm. The balloon catheter was advanced into the site of occlusion and inflated to 2 atm initially, and subsequently up to 3 atm. Two to six inflations, each of 30 seconds'' duration, were performed.RESULTSAlthough the rate of initial recanalization was 100% (10 of 10), reocclusion occurred in two patients with atherothrombotic M2 occlusion. The final angiographic success rate of direct PTA was 80% (8 of 10). There were no hemorrhagic or technical complications, and five of 10 patients showed marked clinical improvement. In two of seven patients with cardioembolic M1 trunk occlusion, crushed fragments of the embolus obstructed M2 portions after direct PTA, necessitating local thrombolysis.CONCLUSIONDirect PTA may be performed safely as an alternative to thrombolytic therapy in patients with acute occlusion of the middle cerebral artery when early CT findings and/or lenticulostriate artery involvement are present or when superselective local angiography shows the presence of a large embolus or high-grade stenosis.     

Persistent sciatic artery: Bilateral percutaneous transluminal angioplasty in ischemic disease

Persistent sciatic artery (PSA) is a rare vascular anomaly that results from failure of an embryonal artery to the lower extremities to regress during fetal development. Aneurysm formation, thromboembolism, and arterial occlusions may complicate this abnormality. We report a patient with complete bilateral PSA and intermittent claudication who was treated by bilateral percutaneous angioplasty.