Percutaneous transluminal angioplasty for treatment of renal artery stenosis in children

Angioplasty was carried out in four children with hypertension and renal artery stenosis, including one patient with neurofibromatosis and one patient with multiple arterial stenoses. Two patients did not respond. In the patient with neurofibromatosis the stenosis persisted unchanged despite multiple balloon inflations. In one patient hypertension persisted despite successful dilatation, and was probably related to longstanding contralateral kidney disease. Two patients had excellent blood pressure response to dilatation. One of these patients required redilatation of bilateral recurrent stenoses.     

Transluminal urethroplasty. Preliminary experience in 15 cases

Thirteen patients with urethral stenoses of different etiopathology underwent TUP with an angioplasty balloon catheter. At follow-up, more than 10 months later, 8 out of 10 patients had normal urinary function. Excluding cases of urethral compression due to prostatic hyperplasia, 90% of the stenoses were successfully dilated. The gradualness of the dilatation, the application of a Foley catheter to maintain the dilatation obtained and the prevention of urinary infections are important factors for the success of this method.     

Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan)

The endovascular treatment of atherosclerotic intracranial arterial stenoses has previously been based on balloon dilatation or the deployment of a balloon expandable stent. Both methods have advantages (balloon: flexibility; balloon expandable stent: high radial force) and drawbacks (balloon: risk of elastic recoil and dissection; balloon expandable stent: limited flexibility, risk of injury to the vessel due to excessive straightening, overexpansion at ends of stent). A new combination of balloon dilatation, followed by the deployment of a self-expanding microstent has been applied in 15 patients with atherosclerotic arterial stenoses, symptomatic despite medical treatment. An anatomically and clinically adequate result was achieved in all patients. The initial degree of stenosis was 72% (mean). Balloon dilatation resulted in an average residual stenosis of 54% (mean), reduced further to a mean of 38% after stent deployment. Arterial dissection, occlusion of the target artery or symptomatic distal emboli was not encountered. In one patient, a side branch occlusion occurred after dilatation of a M1 stenosis, with complete neurological recovery. All patients were either stable or improved 4 weeks after the treatment. Recurrent TIA did not occur in any patient. Balloon dilatation and subsequent deployment of a self-expandable stent for the treatment of symptomatic intracranial arterial stenoses combines the advantages of both techniques and allows a rapid, clinically effective and technically safe treatment of these frequently challenging lesions.     

Experience with dilatation of tight esophageal stenoses using a balloon catheter

The dilatation of oesophageal stenoses with balloon catheters was made in 38 patients with 44 stenoses of different origin. The most frequent stenosis was localized in oesophagogastric or oesophagocolic anastomosis after oesophagectomy, postcorrosive stenoses an those after reflux oesophagitis. The stenoses were mostly of filiform type, the diameter being 1-3 mm (79%) less frequently 4-7 mm (21%). It became possible to dilate 37 stenoses up to 10 to 20 mm, four stenoses to 22 mm. In only three cases the stenosis was dilated to less than 10 mm. In six patients it proved necessary to repeat the dilatation within one to six-month intervals. The dilatation failed to give positive in one case.     

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.     

Esophageal stenosis: treatment with balloon catheters

We have performed 84 balloon dilatations in 40 patients who had esophageal strictures. Of these patients, 31 who had benign diseases improved, and the procedure proved to be safe, reliable, and easy to perform; in 77% of these patients, only one or two dilatations were necessary. In 10 patients who had previously undergone treatment with bougienage, the symptom-free interval of 9.3 months following balloon dilatation is four times longer than that experienced following bougienage. In patients who have malignant disease, though the symptom-free intervals are short, the procedure can be repeated easily and is accepted well by patients so that palliation can be achieved. Since only readily controlled transverse forces act in the balloon therapy, rupture is virtually eliminated, while the use of a flexible angiographic guidewire to traverse the strictures practically excludes perforation. Balloon dilatation offers distinct advantages compared with bougienage for the treatment of esophageal strictures.     

食管吻合口狭窄气囊导管扩张术与放置内支架疗效对比

目的对比评价食管贲门癌术后吻合口狭窄单纯气囊导管扩张术与辅以食管支架置入术的治疗效果。方法两种病例共103例吻合口狭窄均作了气囊导管扩张术,其中79例作单纯气囊导管扩张术,24例作气囊导管扩张术辅以支架置入术(5例为裸支架,19例为覆膜支架)。结果全部103例作单纯气囊导管扩张术后经4～38个月随访观察,有效者79例,占76.7%;另24例扩张无效者辅以放置食管支架,经4～38个月随访,有效者17例,有效率70.8%;与单纯作气囊导管扩张术比较差异无统计学意义(χ2=0.36,P>0.05)。结论食管贲门癌术后吻合口狭窄,应以气囊导管扩张术作为首选的治疗方法,气囊导管扩张无效者再考虑辅以放置食管支架作为治疗的补救措施。     

Severe esophageal strictures: indications for balloon catheter dilatation

Bougienage of esophageal strictures is a traditional method of therapy for patients who present with a stricture sufficiently large to permit passage of a mercury-weighted rubber bougie. However, when the residual lumen is smaller than 12 mm diameter, bougie dilatation acquires a prohibitively high risk of esophageal perforation. Twenty patients who had severe esophageal strictures have undergone surgical repair or Eder-Puestow dilatation assisted by guidewire. Fluoroscopic balloon catheter dilatation obviated surgery and allowed subsequent standard bougienage both in hospital and at home performed by the patient. We discuss indications, technique, results, and complications.     

Balloon catheter dilatation of benign esophageal strictures in children

PURPOSE: This retrospective study evaluated the safety and efficacy of fluoroscopically guided balloon dilatation of benign pediatric esophageal strictures. MATERIALS AND METHODS: Between 2000 and 2005, 272 esophageal balloon dilatations were performed in 49 children, aged 18 days to 18 years. Chart and primary physician record reviews were used to assess complications, age-appropriate food intake, and dysphagia. Efficacy was calculated by time to recurrent symptoms requiring repeat balloon dilatation. Durability was assessed by the frequency of dilatations. RESULTS: Seventy-seven percent of patients required a second dilatation within 9 months. Survival analysis (Kaplan-Meier) demonstrated no significant difference for efficacy in relation to patient age (P = .76) or stricture cause (P = .56). A decrease in the number of dilatations occurred over time to achieve longer symptom-free intervals. Patients underwent an average of 5.6 dilatations with an average total intervention time of 2 years. Patients were able to remain symptom free for a mean of 110 days. The procedure had a success rate of 100%, the only major complication being an esophageal perforation (complication rate, 0.37%) in a patient with a stricture secondary to correction of a tracheoesophageal fistula. CONCLUSIONS: Balloon esophageal dilatation in children is an effective and safe first-line therapy. Complications are quite rare and manageable. Although cures are unusual, most children require less than one dilatation every 6 months. It is concluded that fluoroscopically guided balloon dilatation should be the primary method of treating benign esophageal strictures.     

Balloon dilatation of esophageal stenosis in children

Balloon dilatation of benign esophageal strictures is an accepted mode of therapy in adults. This report describes balloon dilatation in 20 consecutive infants and children. The lesions treated include 11 strictures at surgical anastomotic sites, seven restrictive Nissen fundoplications, and three nonanastomotic esophageal strictures. One patient had two lesions. Most dilatations were performed on an outpatient basis without anesthesia. All strictures responded immediately to dilatation. In most cases, long-term resolution occurred after three or fewer procedures. A subgroup of patients was identified in which a prolonged course of treatment was needed. These included patients with long strictures due to esophageal atresia, patients with chronic severe esophagitis, and patients with strictures at the site of esophageal perforation. No significant complications were encountered. Balloon dilatation of esophageal stenosis in children is effective and safe and should be considered before other methods of treatment are used.     

金属内支架治疗食管恶性狭窄和球囊扩张治疗食管良性狭窄的随访研究

目的 研究食管恶性狭窄内支架治疗和食性狭窄球囊扩张的疗效。材料与方法 191例有较完整的随访资料，其中149例食管恶性狭窄置入内支架，93例置入支架前后作了放射治疗或化学药物治疗（占65％）；42例良性食管狭窄作了球囊扩张治疗。门诊行食管造影和／胃内镜检查随访115例，通过电话或信伴随访34例。结果 随访观察1－56个，其中3野架发生轻度移位，但仍能改善病变全长，未作特殊处理。42例死亡，均为食管癌患者。术后生存时间2－34个月，平均9．5个月。恶性食管狭窄内支架置入再狭窄29例，因食物在支架内阻塞1例，因肿瘤生长发生狭窄24例，因支架上端组织增生发生狭窄4例。发生再狭窄的29例均再次作了内支架置入或球囊扩张治疗。结论 内支架置入治疗恶性食管狭窄能有效解除吞咽困难；应用带膜支架和同时作放化疗，可防止因肿瘤生长发生再狭窄，并能有效封堵食管气管瘘；吻合口和贲门癌狭窄应用返流支架，可预防返流性食管炎的发生。球囊扩张治疗良性食管狭窄，只要扩张充分，临床效果良好。     

Selective thrombolysis with low-dose urokinase in chronic arteriosclerotic obstructions

Twenty-one patients, 15 males and 6 females aged 52–75 years, with angiographically demonstrated occlusions of the superficial femoral or popliteal arteries, were treated by low-dose urokinase intraarterial infusion. The obstructions were 2–12 months old and from 7 to 18 cm in length. Urokinase was infused at 50,000 U/h; heparin was simultaneously administered by intravenous route in doses of 800 U/h. The average duration of treatment was 18 h. Effective clot lysis was accomplished in 18 cases (85%); 15 patients had underlying stenoses treated by balloon dilatation to prevent rethrombosis. Of the primarily recanalized arteries, two reoccluted within 4 weeks.     

Esophageal stricture following high-dose-rate intracavitary irradiation for esophageal cancer

Severe esophageal stricture developed in four of 12 patients who survived for more than 2 years after treatment for esophageal cancer consisting of external irradiation followed by high-dose-rate intracavitary irradiation. The strictures were seen between 13 and 21 months after initiation of radiation therapy. The length of the strictures appeared to relate to the length of the tumor before treatment and to the magnitude of the intracavitary dose. One of the four patients was helped by balloon dilatation.     

Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty.

Vascular complications after liver transplantation include occlusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. From our experience with more than 600 liver transplants, vascular stenoses have been identified in 10 patients and treated by balloon angioplasty in nine. Three patients with hepatic artery stenosis and deteriorating graft function were treated by balloon angioplasty with a coaxial technique. A specially designed catheter facilitated a successful femoral artery approach. Portal vein stenoses in three patients resulted in portal hypertension. These were treated by balloon dilatation via transhepatic catheterization of the portal vein. Stenoses of the suprahepatic caval anastomosis were dilated in three patients with severe lower limb edema. Technical success was achieved in all three cases of hepatic artery stenosis with improvement in graft function. Recurrent stenoses in two patients were successfully treated with repeated dilatations. Portal hypertension resolved in two of three patients after portal venoplasty. Dilatation of a caval stenosis resulted in the resolution of leg edema in all three cases. Repeated dilatation was required in one case. No reduction in the portal venous pressure gradient occurred after venoplasty in one case, and an ultimately fatal caval thrombosis developed in one patient with caval stenosis before venoplasty could be performed. Our experience suggests that balloon angioplasty of arterial and venous stenoses complicating hepatic transplantation carries little risk and is a useful procedure for the treatment of these problems.     

Balloon catheter dilatation of stenotic renal artery anastomoses. Experiments in the pig

Stenotic renal artery anastomoses were produced in pigs in order to investigate the effects of transluminal angioplasty. Six weeks after surgery unilateral dilatation with a modern balloon catheter was performed in 8 pigs. These animals were reexamined with angiography and pressure gradient recording 8 to 10 weeks after dilatation and with post-mortem angiography 8 to 10 weeks later. Only 2 arteries had minimal residual stenoses, while in 6 arteries the stenoses were completely eliminated. Microscopic examination showed thinning of the fibrotic vessel wall, with defects in the internal elastic lamina.     

Balloon angioplasty of venous structures

Percutaneous transluminal angioplasty was attempted in 20 patients with stenoses of venous structures. It concerned one stenosis in a native subclavian vein, 12 stenoses in venous bypass grafts and 7 stenoses in hemodialysis-access fistulas. Primary results were excellent for the procedures in the native vein and the venous bypass grafts with success in all patients (13/13). In the arteriovenous fistulas for hemodialysis, dilatation of the venous stenoses was only possible in 5 out of 7 patients. The subclavian vein stenosis did not recur within a follow-up period of 3 years. Of the stenoses in the venous bypass grafts, two lesions reoccluded within one week and 6 lesions recurred within one year. Two of these lesions were successfully redilated so that 6 lesions remain patent with a follow-up of more than one year. Of the 5 successful dilatations in hemodialysis-access fistulas, two lesions recurred within 2 months. Only 3 veins are still accessible for hemodialysis. It is concluded that attempts at balloon dilatation of stenoses in venous bypass grafts or hemodialysis-access fistulas are meaningful in order to prolong the life of these surgical procedures. Recurrence of stenoses is however likely to occur within one or two years.     

Dilatation technic in esophageal stenoses using a balloon catheter

In dilating oesophageal stenoses by balloon catheters it becomes necessary to adapt the technique of the intervention to the type and degree of stenosis and condition of the patient. The dilatation may be successfully performed even in very narrow postinflammation, postoperation and postcorrosion stenoses. The dilatation is usually performed for the period of 30 minutes, the shortest period between interventions being twice in a week, being followed by weekly or several weeks intervals. In a careful application of the balloon catheters transnasally or transorally it becomes possible to decrease the unpleasant feelings of the patient and possible complications to a minimum.     

The esophagus after endoscopic pneumatic balloon dilatation for achalasia

The changes seen on contrast esophagrams after endoscopic pneumatic balloon dilation for the treatment of achalasia are described and illustrated. Sixteen patients had esophagrams within 24 hr after dilation and follow-up esophagrams were obtained 6-24 months later. The radiographic features evaluated in the early postdilation period included detection of esophageal perforation, diameter of the esophagogastric channel, proximal esophageal dilatation, mucosal integrity, and emptying dynamics of the esophagus. Fourteen patients (88%) had immediate symptomatic improvement of dysphagia. The mean increase in diameter of the esophagogastric channel was 6.5 mm (range, 4.8-9 mm) relative to a pretreatment esophagram. Emptying dynamics of the esophagus improved significantly in 12 patients (75%). One patient developed esophageal perforation requiring surgery. On the follow-up esophagrams obtained 6-24 months later, the evaluation was for sustained dilatation of esophagogastric channel, decrease in esophageal dilatation, and improved emptying dynamics of the esophagus. The effective esophagogastric channel diameter of 8-10 mm correlated well with improved clinical response in 88% of the patients.     

Percutaneous incision of stenotic uroenteric anastomoses with a cutting balloon catheter: long-term results

PURPOSE: To describe the technique and results of incision of strictures in anastomotic urinary diversions with a commercially available cutting balloon catheter. MATERIALS AND METHODS: Thirty-seven stenoses were treated in 32 patients. Most (28 [88%]) of the patients had undergone surgery for bladder cancer 17.7 months +/- 17.4 (SD) (range, 3-72 months) before incision. Thirteen patients had undergone ileal conduit diversion, and nineteen had undergone enterocystoplasty. All stenoses were shorter than 3 cm. The presence of adjacent ileal loops and/or iliac vessels was assessed with computed tomography before incision. The cutting wire was oriented anteriorly or anterolaterally, and the balloon was inflated with diluted contrast material during the incision. A Kaplan-Meier survival curve was constructed to illustrate the success rates over time. RESULTS: No major complications occurred. Twelve (32%) stenoses recurred in nine patients 15 months +/- 10 (range, 6-36 months) after stent removal; the failure rate was 53% (eight of 15 stenoses) for ileal conduits and 18% (four of 22 stenoses) for enterocystoplasties. Late failure (>12 months) was observed in four patients. The patency of the other 25 stenoses (23 patients) was checked 25 months +/- 11 after stent removal (range, 5-43 months). The actuarial patency rate was 77% at 1 year, 68% at 2 years, and 62% at 3 years. CONCLUSION: Cutting balloon incision is a safe and simple alternative to surgery, particularly when the urinary diversion is enterocystoplasty.     

Cutting Balloon-Assisted Angioplasty of an Anastomotic Carotid-Brachial Bypass Graft Stenosis: A Case Report

Neointimal hyperplasia leads to anastomotic stenosis in bypass grafts. These stenoses are often resistant to conventional balloon dilatation. We present a case of a carotid-brachial bypass graft stenosis, which was treated by a 5-mm cutting balloon angioplasty with a good angiographic and clinical result.