Percutaneous transluminal angioplasty of the subclavian artery: Early and late results

Percutaneous transluminal angioplasty of 23 subclavian arteries was attempted in 22 patients. Dilatation was successful in 3 of 4 right subclavian artery stenoses and 18 of 19 left subclavian artery stenoses. The primary clinical indication was posterior fossa ischemia in 11 patients, upper limb ischemia in 14 and both symptoms in 6. In 2 patients, dilatation of an asymptomatic high-degree left subclavian artery stenosis was performed before coronary artery bypass surgery using the internal mammary artery. Eighteen patients on follow-up over 6–60 months (mean 25 months) are free of symptoms with equivalent systolic blood pressures in both arms. Three patients showed relapse of the stenosis after 8, 12, and 15 months; one was successfully treated with a second dilatation. Complications consisted of an occlusion at the left axillary artery puncture site and a distal embolus to a finger artery. Percutaneous transluminal angioplasty appears safe and efficient therapy for subclavian artery stenoses with excellent short- and long-term results.     

Percutaneous transluminal angioplasty of abdominal aortic stenoses

Percutaneous transluminal angioplasty (PTA) was performed on 25 patients with localized distal abdominal aortic stenoses. All patients were smokers and all complained of bilateral lower limb claudication. Eleven patients had small distal aortas and iliac vessels. Technically successful dilatation was achieved in all patients. Long-term follow-up was available on 17 of the patients. The mean follow-up period was 38 months. Cumulative patency at 5 years was 70%. Thirteen patients remain asymptomatic 15–83 months following PTA. Late failure occurred in 4 patients, 1–38 months following PTA. No complications related to PTA were experienced. PTA of localized aortic stenoses is a safe alternative to surgery and should be the treatment of choice in this condition.     

Percutaneous transluminal angioplasty for occlusion of the subclavian artery: Short-and long-term results

Percutaneous transluminal angioplasty was performed in 8 symptomatic patients with proximal occlusion of the left subclavian artery. Technical and short-term clinical success was achieved in 7 cases. Nonoccluding embolization to the distal subclavian artery and stenosis of the brachial artery after a combined femoral/brachial approach occurred as complications in 2 patients. Three patients are asymptomatic with a patent subclavian artery 25, 28, and 37 months after angioplasty. Reobstructions in 4 patients occurring after 8, 12, and 16 months were retreated by angioplasty (3 patients) and stent implantation (1 patient with a second restenosis) with good technical and clinical success. Long-term patency was less than 50%, but successful retreatment is feasible. Therefore, we consider percutaneous transluminal angioplasty a reasonable therapeutic option in patients who are not surgical candidates.     

Percutaneous transluminal angioplasty of peripheral vascular disease: A two-year experience

Over a 23-month period, 172 successful peripheral angioplasties were performed. Life-table analysis gave a two-year patency rate for the total series of 80%. The patency rate for aorto-iliac and femoral-popliteal lesions was 86% and 70%, respectively. Only one late failure occurred in the group of 44 arteries follwed for longer than eight months.     

Local thrombolysis in femoropopliteal occlusion: Early and late results

The early and late results of local thrombolysis with low-dose streptokinase followed by balloon dialatation in 64 patients with an occluded femoropopliteal artery are reviewed. The primary success rate was 77% for the native arteries; it was higher (80%) for short (<10 cm) as compared with long occlusion (40%) and for patients with claudication as compared with those with advanced ischemia (89% versus 48%). Eleven complications were observed in 10 patients, most frequently a local hematoma at the puncture site. Ascending thrombosis and absence of lysis or incomplete lysis were the main reasons for failure. The cumulative patency rate after 1 and 2 years follow-up was 87% and 82%, respectively.     

Percutaneous transluminal angioplasty in diabetic patients: An effective treatment modality

Percutaneous transluminal angioplasty (PTA) was performed for nonhealing ulcers, severe claudication, or rest pain in 10 patients with diabetes mellitus. Twenty-two atherosclerotic lesions were dilated in 15 extremities, including 16 iliofemoral arteries and 6 superficial femoral arteries. The procedure was technically successful in all patients and 8 of 9 (89%) with clinical follow-up showed improvement clinically after the procedure. Diabetes is not a contraindication to PTA; rather this modality can be used effectively to control and treat peripheral vascular insufficiency in diabetic patients.     

Percutaneous transluminal angioplasty of renal artery fibromuscular dysplasia: mid-term results.

OBJECTIVE: To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD). MATERIALS AND METHODS: Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated. RESULTS: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA. CONCLUSION: Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.     

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.     

Iatrogenic arterial dissection: Treatment by percutaneous transluminal angioplasty

Iatrogenic arterial dissection may require intervention, depending on the severity of resulting stenosis and the degree of symptoms. We present 5 cases of iatrogenic arterial dissection: 1 with dissection of the lower abdominal aorta, common iliac artery, and external iliac artery, and 3 with external iliac artery dissections, all managed with percutaneous transfemoral transluminal angioplasty; and 1 with dissection of the superior mesenteric artery with angioplasty performed by the translumbar approach. Four of the 5 patients had no additional therapy; 1 patient eventually underwent surgery for an asymptomatic residual pseudoaneurysm seen on abdominal computed tomography. Angiographic follow-up in 2 patients demonstrated persistent improvement in stenosis, 1 at 2 weeks after angioplasty, and the other, 6 weeks following angioplasty. None of the 5 patients required further therapy for recurrence of symptoms on clinical follow-up obtained up to 1 year after angioplasty. Though the incidence of recurrent arterial stenosis following angioplasty for dissection may be greater than that incurred after intravascular stent placement or surgery, angioplasty may be effective, and has the advantage of being less expensive than both of these treatment modalities, and, more widely available and applicable than intravascular stents.     

Percutaneous transluminal angioplasty in segmental obstruction of the hepatic inferior vena cava: Long-term results

Percutaneous transluminal angioplasty (PTA) was performed in 8 patients with segmental obstruction of the hepatic inferior vena cava. Using Grüntzig balloon catheters, canalization and dilatation were initially successful in all 8 patients without any complications. In long-term observation of 12–48 months, recurrence of obstruction was confirmed in 5 patients. These were recanalized easily by repeat PTA. Long-term patency was obtained in 3 patients in whom the lumen was opened to 13 mm or more in diameter as seen in lateral views of the vena cavogram.     

Experimental and clinical results with a pulsed dye laser for angioplasty

We investigated a pulsed 504 nm dye laser at a pulse duration of 1.44 and a pulse rate of 10 Hz for its angioplasty capabilities. Laser energy was delivered via 9 F multi-fiber ring catheters. Our experimental data showed effective ablation of atheroma and disruption of calcified plaques at an energy fluence of 9.5 J/cm² under saline and blood. Histologically, there was only minimal thermal injury to adjacent tissues. Irregular tissue borders after radiant energy exposure of 12.7 J/cm², under blood, provide strong evidence for ablation by a shock-or pressure-wave mechanism.Percutaneous peripheral laser-assisted angioplasty was performed in 25 patients with arterial occlusive disease of the iliac and femoro-poplteal arteries (mean occlusion length 7.2 cm). All lesions were initially traversed by a guide-wire. Technical success was achieved in 24 out of 25 patients (96%). Laser angioplasty decreased the mean stenosis rate from 100% to 51± 12% (P < 0.01). The ankle-brachial index (ABI) rose from 0.48±0.16 before to 0.88±0.10 after intervention (P < 0.01) with a value of 0.82±0.15 at 6 months follow-up. The overall success rate, judged clinically and by ABI determinations in all patients, was 84% at a mean follow-up period of 7.9 months. The number of stand-alone laser procedure was 21%. Clinical application of the delivery devices proved to be safe due to the over-the-wire approach. Our prelimanary clinical data encourage further refinement of pulsed dye laser angioplasty for more efficacious debulking of atheroma. Correspondence to: S. H. Duda     

Laser-assisted balloon angioplasty in complete femoropopliteal occlusions: Preliminary results

Laser-assisted balloon angioplasty (LA) using a Nd-YAG laser with a sapphire tip probe was performed in 40 selected patients with complete chronic femoropopliteal occlusions (SFA n=30, PA n=10), in whom the lesion was resistent to conventional guidewire/catheter traversal. Overall technical success rate was 77.5% (31/40). Technical failure occurred in nine cases due to calcifications (n=2), imminent perforation (n=5), or complete perforation (n=4). In I case a Simpson atherectomy was done following LA. In addition, 3 cases of peripheral embolizations were managed successfully by selective fibrinolysis and thrombus aspiration. Follow-up studies up to 14 months demonstrated a clinical improvement in 87% (27/31). Early reocclusion rate was 4/31; after 2–14 months, reocclusion rate was 7/31. Our results demonstrate that LA may be recommended for chronic occlusions resistent to conventional guidewire or catheter traversal in spite of a relatively high rate of technical failure and complications, and recurrence.     

Percutaneous transluminal atherectomy: Preliminary results

Percutaneous transluminal atherectomy with the Simpson atherectomy catheter was performed in 10 patients with 14 severe atheromatous stenoses of the femoropopliteal arteries. Removal of plaque material with restoration of vessel patency was successful in all patients without complication. Further clinical follow-up will have to determine whether the recurrence rate of stenoses will be lower with this method than with conventional balloon angioplasty.     

Renal vein injury during percutaneous transluminal renal angioplasty in nonspecific aortoarteritis

Percutaneous transluminal renal angioplasty of a right renal artery stenosis in a patient with nonspecific arteritis, (Takayasu's arteritis) was performed for the treatment of renovascular hypertension and led to ipsilateral renal vein perforation and massive retroperitoneal bleeding. The mechanism of injury and its relationship to nonspecific arteritis remains obscure. Awareness of this potentially lethal complication is essential because early diagnosis is mandatory for definitive management.     

Infrapopliteal percutaneous transluminal angioplasty for limb salvage

Purpose:
To evaluate long-term results of infrapopliteal percutaneous transluminal angioplasty (PTA) for limb salvage.
Material and Methods:
A retrospective study of 71 consecutive infrapopliteal PTAs in 49 patients with rest pain (n=20) or ulceration (n=29) was conducted. In 18 patients, surgical minor amputation or debridment was also performed.
Results:
Technical success was achieved in 45 patients. Four failures necessitated 2 amputations. One patient died in the postoperative course. Global morbidity rate was 16%, including minor complications in 5 patients and major vascular complications in 3 patients. After technical success during the follow-up (median duration 21 months), restenoses occurred in 4 patients, of whom 3 had a successfull re-PTA (clinical success rate 72%). Survival, primary patency, secondary patency and limb salvage rates were, respectively, 75%, 81%, 88% and 87% after 3 years. The only positive predictive factor for primary patency was the presence of diabetes mellitus.
Conclusion:
Infrapopliteal PTA is a safe and effective procedure, allowing good patency and limb salvage rates with low mortality and morbidity.     

Catheter lysis and percutaneous transluminal angioplasty below the knee via the popliteal artery in a patient with femoral artery obstruction: Technical note

Acutely occluded lower leg arteries in a patient with a chronically obstructed superficial femoral artery were successfully treated by catheter lysis and dilatation via the popliteal artery.     

Influence of angiographic morphology on the acute and longer-term outcome of percutaneous transluminal angioplasty in patients with aortic stenosis due to nonspecific aortitis

Purpose We studied the relationship of initial angiographic morphology in patients with aortic stenosis due to nonspecific aortitis and its relationship to immediate and later outcome following percutaneous transluminal angioplasty (PTA).Methods Correlation was performed in 10 successive patients by retrospective analysis. All had clinically inactive nonspecific aortitis and hemodynamically significant aortic stenosis resulting in hypertension or lower limb claudication. Five patients had discrete concentric stenosis; the other five had eccentric stenosis with diseased aortic segments adjacent to the stenosis.Results The five patients with concentric stenosis (Group I) had primarily successful and uncomplicated PTA with sustained improvement. The five patients (Group II) with eccentric stenosis had initial success in three patients and two initial treatment failures with one patient showing late improvement. Four of these patients developed large intimal flaps. One of these had an aneurysm during follow-up. Follow-up angiograms in five patients showed remodelling with further angiographic and clinical improvement.Conclusion Eccentricity of the stenosis and diffuse aortic disease correlate unfavorably with immediate outcome of PTA but late improvement may still be seen.     

经皮腔内血管成形及支架植入术治疗颈动脉狭窄103例疗效观察

文献报道约25%的缺血性脑卒中与颈内动脉的狭窄或闭塞有关[1,2]。经皮腔内颈动脉血管成形与支架植入术(prcutaneoustransluminalcarotid angioplastyandstenting,PTCAS)可有效解除颅外颈动脉的狭窄。目前PTCAS甚至已逐渐取代颈动脉内膜切除术(CEA)[3,4]。我科自2003年3月以来共开展PTCAS治疗缺血性脑血管疾病患者103例,共植入支架112个。我们对所有患者进行了系统随访,报道如下。材料与方法一、临床资料103例颈动脉狭窄患者均为我科住院患者,其中男83例,女20例,年龄为36～78岁,平均(63±9)岁。诊断为脑梗死80例,短暂脑缺血发作(T1A)…     

Percutaneous transluminal coronary angioplasty: Analysis of unsuccessful procedures as a guide toward improved results

Technical success in percutaneous transluminal coronary angioplasty (PTCA) is a function of patient selection, operator experience, and the capabilities of the angioplasty equipment employed. When unsuccessful PTCA occurs, it is the result of one several factors: (1) a failure to cross the stenosis: (2) a failure to dilate the stenosis; (3) an ischemic complication; or (4) a late recurrence of the anginal syndrome. In this paper, we discuss the relative frequency of these types of failure, and the ways in which improvements in technique and/or equipment may be employed to improve the chance of a successful procedure.     

Percutaneous transluminal angioplasty in fibromuscular dysplasia of the internal carotid artery: One year clinical and morphological follow-up

A case of fibromuscular dysplasia (FMD) of the internal carotid artery was treated by percutaneous transluminal angioplasty (PTA) using a Grüntzig balloon. A control angiographic study performed with intravenous digital subtraction angiography (IV DSA) showed a completely patent dilated vessel. This result, together with the total relief of clinical signs and symptoms, is evidence of the value of PTA in the treatment of FMD of the internal carotid artery.