Outcome in patients with failed percutaneous transluminal angioplasty for peripheral vascular disease

The outcome in 299 patients having 321 percutaneous transluminal angioplasty (PTA) procedures for peripheral vascular disease was analysed. Technical failure occurred in 21 patients (7%) but in none was the limb ischemia made worse by the failed PTA attempt; nine of these (3%) had been considered unsuitable for arterial reconstruction and proceeded to primary amputation, while 12 (4%) did not have subsequent management compromised by the failed PTA attempt. Complications occurred in seven patients (2.3%); four of these (1.3%) had worsening ischemia but were able to be satisfactorily managed by surgical intervention. There were 71 patients (23.7%) who had an initially successful PTA procedure which subsequently failed; 20 of these (6.7%) had been considered unsuitable for arterial reconstruction and proceeded to amputation, while five patients suitable for arterial reconstruction (1.7%) came to amputation, four following failed bypass surgery and one following multiple trauma from a motor vehicle accident. The remaining 46 patients (15.3%) did not have subsequent management compromised by the late failure of PTA. Early and late failure of PTA in patients presenting with peripheral vascular disease does not compromise subsequent management.     

Percutaneous transluminal angioplasty as an adjunct to the surgical management of peripheral vascular disease.

Percutaneous transluminal angioplasty (PTA) was performed as an adjunct to an operation in 43 patients with peripheral arterial insufficiency. This represents 26% of patients undergoing PTA over the past 44 months. In 23 patients PTA was done in conjunction with planned vascular reconstruction. It was successful in all 23 patients, and patency of the vascular graft was maintained in 22 patients during a mean follow-up period of nine months. Fourteen patients had PTA after operation. It was successful in 13 of them, and vascular patency was maintained in all 13 during a mean follow-up period of four months. Six patients had PTA prior to a distal amputation or a skin graft. All healed promptly. The overall initial success rate of PTA was 98%, the complication rate was 2%, with a late failure rate of 2%. It is concluded that PTA is a valuable adjunct to vascular surgery to improve inflow or outflow for bypass grafts, to reduce the extent of the operation in poor risk patients, to facilitate the healing of distal amputations, and to manage late graft stenosis.     

药物治疗对外周动脉硬化闭塞症支架术后再狭窄的影响

目的 研究沙格雷酯在预防外周动脉支架术后支架内再狭窄( in-stent restenosis,ISR)中的治疗效果.方法 对因外周血管狭窄或闭塞行首次支架术治疗的患者68例分为2组,沙格雷酯组:口服沙格雷酯+阿司匹林;双抗组:口服氯吡格雷+阿司匹林.术后即开始分组治疗,6个月后复查血管彩超,比较2组患者支架内再狭窄的发生情况.结果 试验共完成随访62例患者.沙格雷酯组和双抗组各病变部位的狭窄率分别为7.0％比18.1％ (P =0.036),平均峰值流速比(peaksystolic velocity ratio,PSVR)分别为1.34比2.08(P=0.010),ISR发生例数为1比10 (P =0.005),差异均有统计学意义.所有随访患者均未观察到严重不良事件.结论 沙格雷酯与阿司匹林联用,安全有效.沙格雷酯+阿司匹林与双抗治疗相比,可以显著降低外周动脉支架术后的再狭窄发生率,同时显著减少支架内内膜增殖.     

Changes in peripheral hemodynamics after percutaneous transluminal angioplasty

We measured ankle/arm pressure indexes and blood flow rates before and after performing percutaneous transluminal angioplasty in 36 extremities. Flow rates through the leg were determined with a magnetic resonance blood flow scanner. All patients had claudication; one had gangrene, another had an ulcer, and two complained of rest pain. The median age was 65 years, and 72% were men. There were 25 dilations of the iliac artery, 12 of the superficial femoral artery, and eight of the popliteal arteries; nine patients had two arterial segments dilated. Nineteen legs had ankle/arm pressure indexes before percutaneous transluminal angioplasty of less than 0.80 (range 0.51 to 0.75); their flow rates averaged 40 +/- 20 (SD) ml/min. After percutaneous transluminal angioplasty flow and pressure increased significantly in 14 of these 19 legs, and three had no hemodynamic improvement; in one leg only pressure and in another only flow increased significantly. The remaining 17 extremities had ankle/arm pressure indexes before percutaneous transluminal angioplasty ranging from 0.81 to 1.09; their flow rates averaged 53 +/- 27 (SD) ml/min. Abnormal flow rates were detected in 15 of these 17 extremities. With near-normal ankle/arm pressure indexes no significant increase in pressure was anticipated. Flow rates augmented to 75 +/- 28 (SD) ml/min after percutaneous transluminal angioplasty; a significant increase in flow was noted in 12 legs (71%). For patients with ankle/arm indexes before percutaneous transluminal angioplasty of less than 0.80, either pressure or flow measurements should corroborate the benefits of the operation, whereas if the ankle arm index is greater than 0.80, flow measurements are most likely to substantiate changes in peripheral hemodynamics.     

Complications after percutaneous transluminal angioplasty and vascular surgery

Percutaneous transluminal angioplasty (PTA) is an accepted technique in the treatment of occlusive vascular disease. We report complications associated with balloon catheter dilatation and their treatment in the period from 1. 1. 1986 to 31. 3. 1990. Complications were found at the site of dilatation and the site of insertion of the catheter, mostly in the pelvic and femoral region. Surgical correction was successful in all patients, however three patients died postoperatively of acute myocardial ischemia. To avoid these complications close co-operation between the radiologist performing the dilatation and the vascular surgeon managing the complications should be assured.     

腔内血管成形术治疗膝下动脉缺血的临床研究

目的 评价腔内血管成形术(PTA)治疗膝下动脉闭塞性疾病的疗效及通畅情况.方法 对47例(54肢)膝下动脉缺血患者进行膝下动脉缺血PTA,将其治疗前后踝眩指数(ABI)、治疗后临床疗效及动脉通畅率等进行统计学分析.结果 全组术前ABI平均值为O.34±O.04;术后14天为O.86±O.03.本组无围手术期死亡,术后并发症发生率为7.7%,其动脉累积通畅率1年、2年一期通畅率分别为88.5%及65.2%;二期通畅率分别为96.2%及83.3%;救肢率为100%.结论 PTA作为膝下动脉缺血的治疗方法是可行、安全、有效的,推荐PTA作为首选的治疗方法,其长期通畅性有待进一步观察.     

Postcatheterization vascular complications associated with percutaneous transluminal coronary angioplasty

The threat of a vascular complication exists in association with any percutaneous arterial catheterization, but is greater in the more complex interventional techniques. During a 3 1/2-year period from January 1985 through June 1988, 4988 percutaneous transluminal coronary angioplasty procedures were performed at Emory University Hospital. All patients were given heparin during the cardiac intervention, and all had a catheter introducer left in place for several hours after completion of the procedure. Fifty-five iatrogenic vascular complications developed in 52 patients (1%), resulting in 54 corrective operations. Pseudoaneurysm, the most frequent complication, was seen in 35 patients (64%). This was followed by arteriovenous fistula in eight (15%), uncontrolled hemorrhage in six (11%), arterial thrombosis in three (6%), peripheral embolization in two (4%), and bowel ischemia in one patient. The outcome of surgical therapy in the entire group was quite acceptable with no operative mortality, no extremity amputation, and a 7.4% complication rate. Variables that correlated with an increased risk of peripheral vascular problems after percutaneous transluminal coronary angioplasty included advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation. Variables that did not appear to correlate were hypertension, diabetes, prior percutaneous transluminal coronary angioplasty, antiplatelet therapy, or the size of the guiding catheter used.     

The changing pattern of vascular surgery: the effect of percutaneous transluminal angioplasty

The pattern of vascular surgery at Westmead Hospital from 1979 to 1985 has been reviewed. There has been an upward trend in the number of patients having repair of abdominal aortic aneurysm and carotid endarterectomy. However, the number of operations for peripheral vascular disease has not increased. This may be due to the increasing use of percutaneous transluminal angioplasty (PTA), but it may also be associated with the increasing difficulty in obtaining hospital admission for patients with conditions not immediately life or limb threatening.     

Patient sex and success of peripheral percutaneous transluminal arterial angioplasty

HYPOTHESIS: Female sex negatively affects the durability of percutaneous angioplasty of native arteries supplying the lower extremity. DESIGN: Outcome analysis of the results of percutaneous angioplasty of lower extremity arteries in a single vascular surgery practice. SETTING: University-affiliated community hospital. PATIENTS: All patients undergoing percutaneous intervention on lower extremity arteries during 10 years. INTERVENTIONS: Indication for intervention, anatomic site of intervention, placement of percutaneous stents, and length of lesion undergoing angioplasty were noted. Patient demographics and risk factors were identified. MAIN OUTCOME MEASURES: Results were analyzed by sex. Kaplan-Meier life tables were plotted and differences between groups tested by the log-rank method. A Cox proportional hazards regression model was used to perform the multivariate analysis. RESULTS: During 10 years, 351 angioplasties were performed in 248 patients, 173 in women and 178 in men. There was no difference between men and women in indication for intervention, length and type of lesion treated, or quality of distal runoff. Univariate survival analysis identified a difference in duration of patency between men and women (P = .047). However, multivariate analysis demonstrated no significant difference in duration of patency between men and women (P = .18). Iliac angioplasty and adequate distal runoff were positive predictors of long-term patency (P<.001 for both). CONCLUSIONS: There appears to be no significant difference in the durability of angioplasty between men and women. However, location of angioplasty and adequacy of distal runoff may be useful in determining when to use angioplasty.     

Color Doppler ultrasonography percutaneous transluminal angioplasty of vascular access grafts

Percutaneous transluminal angioplasty (PTA) is a possible treatment for stenosis. This study aimed to verify the impact of a vascular access (VA) surveillance protocol, based on the detection of functional changes and their correction by a new PTA method for VA performed under color Doppler ultrasonography (CDU) guidance. We divided the patients into two groups: group A, before May 1999 (retrospective study) without the surveillance protocol, and group B, from 1 May 1999 to January 2001 (prospective study) with the surveillance protocol. Access blood flow (Qa) was assessed every 4 weeks by ultrasound velocity dilution. In cases of a reduction of >or=35% from the baseline value, VA was examined using CDU: if a stenosis >50% was detected, angioplasty was performed. In cases of Qa reduction <35% we continued monitoring. By Coxs multivariate analyses, only the use of PTA with or without stenting reduced the relative risk of thrombosis by 64% during the follow-up (p=0.017 confidence intervals 88%-15%) in group B patients. Secondary patency was 80% for VA in which we performed PTA with or without stenting at 18 months, and 58% at 18 months in which we did not perform PTA. Our data show how PTA under CDU is useful to maintain and to improve graft patency. This PTA under CDU guidance allows patients to avoid surgical intervention, hospitalization, and adverse reactions to contrast media and exposure to ionizing radiation, with reduced cost and with better graft survival.     

Management of renal vascular disease in neurofibromatosis type 1 and the role of percutaneous transluminal angioplasty.

BACKGROUND: The effectiveness of percutaneous transluminal angioplasty (PTA) in renal artery stenosis (RAS) associated with neurofibromatosis type 1 (NF1) has not been established. A review of the literature revealed 14 studies, mainly case reports, of which a total of 16 patients had been treated with PTA, all prior to any surgery being undertaken. METHODS: A retrospective case review of 10 children with renal vascular disease secondary to NF was conducted to evaluate the outcome of different treatment modalities, including PTA. Four patients had unilateral disease, while six had bilateral disease, which was associated with middle aortic syndrome in three. Treatment was a combination of antihypertensive drug therapy, PTA and surgery. PTA was performed 15 times on six patients, nine procedures prior to surgery. RESULTS: The success rate for PTA on primary stenoses was 33% with improvement in blood pressure (BP) control in another 33%. Angioplasties performed on stenoses post-surgery had a success rate of 67%. There were no major complications and PTA had no adverse effect on subsequent surgery. The pre-surgery results obtained at a tertiary referral centre are consistent with those reported in the literature. CONCLUSION: PTA is a safe and moderately effective treatment modality for RAS secondary to NF1. Although there is only limited success in primary stenoses as there is no adverse effect on subsequent surgery we feel it should be considered as first line management when clinically indicated.     

Efficacy of percutaneous transluminal angioplasty in the management of chronic hemodialysis patients

Percutaneous transluminal angioplasty (PTA) has gained wide acceptance as an effective technique for the dilatation of stenoses in the arterial tree. We evaluated the long-term results of vascular access in a group undergoing hemodialysis, in particular the effects of PTA. Twenty-four percutaneous procedures were performed on 18 patients. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations performed at dialysis. The initial success rate was 87.5%, with 1-, 6-, and 18-month patency rates of 82.6, 67.5, and 38.5%, respectively. There was no difference between primary and secondary patency rates. The assisted primary patency rates for PTA and surgical revision were not significantly different. Although neither surgical nor endovascular management resulted in long-term function for the majority of shunts after stenosis or thrombosis, endovascular treatment can extend the life of dialysis shunts with results similar to surgical revision. Transluminal dilatation may be performed in appropriate cases to obviate the need for surgery.     

Percutaneous transluminal angioplasty. The radiologist's contribution to the treatment of vascular disease

Percutaneous transluminal angioplasty is a nonsurgical treatment for vascular disease. It is relatively safe and economical and may be an alternative, or an adjunct, to surgery, or may be helpful where no surgical alternative exists. Percutaneous transluminal angioplasty is applicable to nearly every system, except the carotid bifurcation plaque.