Arteriovenous fistula following femoral angioplasty

We describe a case of arteriovenous fistula developing at the site of balloon dilatation immediately after percutaneous transluminal angioplasty of the superficial femoral artery. This occurred during an otherwise uncomplicated angioplasty. The fistula was treated by inflating a slightly larger balloon with a good clinical result as confirmed by color Doppler ultrasound. This uncommon complication of angioplasty is not widely recognized.     

Percutaneous transluminal angioplasty following endarterectomy

Recurrent occlusive disease was found by noninvasive methods and confirmed arteriographically in 7 patients who had undergone endarterectomy for stenosis of one [5] or both iliac arteries [1] or the subclavian artery [1]. Three patients with iliac artery stenosis had percutaneous transluminal angioplasty (PTA) 1 to 5 years after endarterectomy. One patient with stenosis of the external iliac artery had PTA 4 years after endarterectomy, and dilatation was repeated 7 months later because of recurrence. One patient had 2 endarterectomies and 2 PTAs within 8 years for stenosis of the right common iliac artery. One patient had recanalization of the left common iliac artery 6 years after endarterectomy with low-dose streptokinase followed by PTA. Another patient underwent endarterectomy of the left subclavian artery 3 months after PTA and required further dilatation at 5 and 10 months because of recurrence. The authors conclude that endarterectomy does not preclude PTA (or vice versa) in patients with recurrent arterial occlusive disease.     

Ergotism presenting as restenosis following angioplasty

Ergotism may cause isolated lower-extremity arterial stenoses that appear amenable to angioplasty but that will recur if the causative agent is not withdrawn. A case of femoral-popliteal stenosis caused by surreptitious ergot ingestion is presented. The lesion initially responded to angioplasty but quickly recurred, whereupon discovery of ergot use and withdrawal of the compound led to the disappearance of symptoms. Deceased     

Early mobilization versus immobilization after ankle ligament stabilization

Functional outcome, stability at radiographic investigation and ankle joint torque after anatomical reconstruction of the lateral ankle ligaments were evaluated in patients with early postoperative mobilization versus those with cast immobilization. Thirty patients with chronic lateral ligament instability of the ankle underwent anatomical reconstruction of the ligaments. Postoperatively the patients were randomly allocated to two groups: Group A (n=15) were immobilized in a below-knee plaster for 6 weeks and Group B (n=15) underwent early controlled range of motion training using an Air-Cast ankle brace. The functional results were evaluated using a scoring scale and objective results using standardized stress radiographs. Also eccentric and concentric muscle torque at 60 degrees/s was measured in plantar flexion and dorsiflexion, respectively. The functional results were satisfactory in 12/15 ankles in Group A and 14/15 in Group B (n.s.). All the patients with satisfactory results regained normal range of motion. Patients with unsatisfactory results had either residual pain or recurrent instability. In Group B, the strength measurements revealed significantly higher peak torque values after three months in plantar flexion at 60 degrees/s. Six months postoperatively, the torque values did not differ significantly between the groups. Also, there was no group difference in the laxity of the ankle joint, including both anterior talar translation test and talar tilt test, at the two-year follow-up. One patient had a superficial wound infection. We conclude that after the reconstruction of chronic lateral ligament instability of the ankle the functional and stability results were equally good with early postoperative mobilization and 6-week immobilization. However, using early mobilization plantar flexion strength was regained earlier than with cast immobilization, without any risk of short- or medium-term complications, such as increased ankle laxity. We recommend early mobilization after anatomical reconstruction of the lateral ankle ligaments.     

Deterioration following delay in performing femoral angioplasty

It is not uncommon for a delay to occur between assessment arteriography and angioplasty attempt. We reviewed retrospectively the arteriograms of 61 patients where such a delay occurred to assess progression of superficial femoral artery (SFA) disease in this interval. A mean delay of 14.6 days (range 2-60 days) occurred between arteriogram and angioplasty attempt. Arteriographic deterioration was found in six of 61 patients (9.8%) and in three this precluded angioplasty. Of the six patients four had initial arteriography via the same side as the SFA disease whilst two had arteriography via the contralateral femoral approach. We discuss the aetiology of this phenomenon and suggestions are made to reduce its incidence.     

Thalamic hemorrhage following carotid angioplasty and stenting

Carotid angioplasty and stenting (CAS) has emerged as an alternative treatment of carotid stenosis for patients poorly suited for endarterectomy. Intracerebral hemorrhage following carotid revascularization is rare and thought to be related to hyperperfusion injury in most cases. Early experience suggests an increased incidence of hemorrhage following CAS as compared to endarterectomy. We describe a patient who suffered a thalamic hemorrhage following CAS. Because this hemorrhage occurred in a vascular territory unlikely to have been supplied by the treated artery, this case suggests that the mechanism of intracerebral hemorrhage following CAS may in some cases be different from the hyperperfusion hemorrhage classically described following endarterectomy.     

Percutaneous transluminal aortic angioplasty: Early and late results

Percutaneous transluminal angioplasty of the infrarenal abdominal aorta (13 patients) and its bifurcation (15 patients) was performed in 28 patients with a total of 32 dilatation procedures. The group consisted of 16 female and 12 male patients and initial successful dilatation was achieved in all Recurrence within 1 month requiring bypass surgery occurred in 1 patient. Three patients were lost to follow-up. Long-term follow-up in the remaining 24 patients ranged from 1 to 9 years with a mean of 4.5 years. During the follow-up period, repeat angioplasty of the original stenosis was performed in 3 patients and another patient underwent dilatation of a new lesion which developed in the aorta. According to clinical and noninvasive studies, these 4 patients, as well as the other 20, have maintained patency of the treated lesions and are symptom free. No immediate complications requiring surgery occurred. We conclude that angioplasty is the initial treatment of choice in focal lesions of the distal abdominal aorta and its bifurcation.     

冠状动脉腔内近距离放疗的剂量点核函数算法

近年的基础和临床研究表明,在冠状动脉血管成形术中和术后用15~30Gy剂量的腔内近距离照射能使再狭窄发生率降低。剂量点核函数的解析方法被用来计算冠状动脉及其周围组织的剂量分布。本文总结了近年来文献发表的主要剂量点核函数算法。     

“Pseudo” intramural injection following percutaneous transluminal angioplasty

An angiographic appearance of “pseudo” intramural injection is commonly produced following intraluminal balloon dilatation resulting from the dehiscence of the atheromatous intima that is an unavoidable consequence, and not a complication of angioplasty. These angioplasty-induced changes differ from true intramural dissections in that they are confined to the dilatation site and do not extend beyond this area.     

移植肾动脉狭窄的介入治疗

目的：评价经皮血管腔内成形术(PTA)对移植肾动脉狭窄(RTAS)的治疗作用。方法：对9例移植肾动脉狭窄的患者行PTA，患者的血管狭窄位于外科手术血管吻合处或吻合远端的移植肾动脉上。8例采用经股动脉入路，1例采用经肱动脉入路。疗效以临床随访、肾功能检验、超声检测为评价。结果：9例移植肾动脉狭窄的患者成功地实施了PTA，2例患者置入支架，所有病例均痊愈。结论：PTA是治疗移植肾动脉狭窄有效的首选方法。     

Changes in renal artery Doppler indexes following renal angioplasty.

Doppler indexes were measured in 14 renal arteries in 13 patients before and after percutaneous transluminal angioplasty to determine if changes in these parameters occurred after the procedure. Angioplasty was technically and clinically successful in 12 cases, and adequate Doppler signals were obtained from 13 of 14 arteries. The pulsatility index, resistive index, and acceleration of the distal main renal artery Doppler waveform increased significantly after angioplasty, while the time to systolic peak and the renal-aortic ratio remained unchanged. The former may be useful noninvasive indexes to screen patients for restenosis of the renal artery before it becomes clinically evident. A long-term follow-up study is needed to test this hypothesis.     

Renovascular hypertension following radiotherapy and chemotherapy treated by transluminal angioplasty

A man aged 33 with poorly controlled hypertension who had been treated with radiotherapy and combination chemotherapy for testicular teratoma 8 years earlier was found on arteriography to have 75% stenosis of the left renal artery and occlusion of the right renal artery. The stenosis was dilated by transluminal angioplasty and the hypertension adequately controlled. Patients who develop high blood pressure after abdominal radiotherapy with or without chemotherapy should be investigated for renal artery stenosis.     

Interventional nuclear medicine in the prevention of restenosis following angioplasty

Restenosis is an unsolved clinical and economic limitation of angioplasty. Local irradiation is a new concept to overcome this problem. The magnitude of this health problem becomes apparent when one recognizes that 166132 percutaneous transluminal coronary angioplasty (PTCA) procedures were performed in Germany in 1999. Each angioplasty has subsequent costs of 6384 DM, which can be reduced to 2161 DM by 50% restenosis reduction due to irradiation [1]. The number of diagnostic and therapeutic procedures is growing by at least 10% per year.     

Intimal dissection following percutaneous transluminal carotid angioplasty for fibromuscular dysplasia

Summary Fibromuscular dysplasia (FMD) is an unusual form of segmental arteriopathy and may affect the internal carotid artery (ICA). We report a case of carotid FMD in which percutaneous transluminal angioplasty (PTA) was complicated by an intimal tear and required surgical exploration. PTA is a useful form of treatment, but there is a risk of intimal dissection. If this occurs, it may be necessary to excise the intimal flap surgically.     

Cerebral complications following balloon angioplasty of coarctation of the aorta

A 10-month-old male child underwent balloon angioplasty for a recurrent coarctation of the aorta. Postprocedural hemorrhagic cerebral infarction led to the child's death. At necropsy, hypoplasia of the left posterior communicating artery of the circle of Willis was found. The implications of such variations in cerebral blood flow circulation on the angioplasty technique are presented and discussed.     

Percutaneous transluminal angioplasty following bypass operations on the lower extremities

To prevent bypass thrombosis, percutaneous transluminal angioplasty (PTA) was performed on 32 stenoses in 25 patients following vascular surgery. Seventeen patients showed 23 stenoses at the level of the anastomoses or in the bypass itself; 8 patients exhibited 9 stenoses proximal or distal to the bypass. Twenty-two patients underwent successful PTA and showed an increase in the ankle/arm Doppler index from 0.38 +/- 0.13 to 0.76 +/- 0.11 after PTA. The long-term patency rates at 6, 12 and 24 months were 75%, 57% and 39%, respectively. The reason for three unsuccessful PTAs are discussed.     

Increased kidney size following renal angioplasty. A 'new' observation

Percutaneous transluminal renal angioplasty was performed in nine patients (10 kidneys). Immediately following dilatation of the renal artery stenosis, seven of ten kidneys increased in length by at least 0.5 cm (0.5-1.5 cm) indicating improved renal perfusion. This is an observation that does not seem to have been described before. Another, but rare, cause of renal enlargement following angioplasty is hematoma formation which was seen in one of the cases. All of the patients responded well to the treatment and five previously hypertensive patients became normotensive shortly after dilatation.     

Intra-arterial Doppler flowmetry in the superficial femoral artery following angioplasty

The aim of the study was to assess the diagnostic value of an intravascular Doppler guidewire in patients with peripheral percutaneous angioplasty (PTA). The prognostic value was also evaluated. Measurements were done prior and following angioplasty in 22 patients with peripheral arterial occlusive disease. As additional therapy, stent insertion and peripheral (Aa. poplitea Ill/tibial) angioplasty was performed (4 patients per group). For stress testing, adenosinetriphosphate (ATP) was given intra-arterially. Follow-up was performed by angiography, colour-coded duplex ultrasound or judged by unequivocal clinical stage at follow-up to 13 months. Average (APV) and maximal peak velocity (MPV) increased following PTA, after additional treatment (peripheral PTA or stent), and after intra-arterial application of a vasodilator. Patients with peripheral lesions had markedly lower velocities prior treatment and following PTA after vasodilatation. Following peripheral PTA, the values were similar to the patients with PTA alone. Velocities after stenting were markedly increased in the stress condition. Of the 22 patients, 7 had a recurrent disease. The latter patients had higher velocities at rest prior to and following PTA. In stented lesions higher velocities seem to be linked with a worse outcome. The ratio between velocity prior to and after the application of the vasodilator seems to be of diagnostic importance. A ratio of 1.9 or more was of positive prognostic value. The Doppler guidewire is a practical and valuable tool in assessing technical success after angioplasty of peripheral lesions, critical or morphologically worse lesions. In our study the decision for stent application was made on the morphological image; however, increased velocity and changes in phasicity substantiated our decisions. Increased ratios prior to and after vasodilation (flow reserve) are of prognostic value and therefore suitable as indication for stent placement or tibial angioplasty. Received: 6 April 1998; Revised: 9 December 1998; Accepted: 24 June 1999