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Abstract
Conventional aortic surgery carries a significant mortality and morbidity. Transfemoral endoluminal aortic management (TEAM) offers a minimally invasive alternative. This article reports seven cases of TEAM for aortoiliac disease and abdominal aortic aneurysms with a patency rate of 100% at 24 months. Our data suggests that primary stenting can achieve excellent physiologic results and restoration of blood flow in selected patients with aortoiliac disease. Long-term study and follow-up is essential to determine the place of TEAM in the field of vascular surgery.
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Affiliation(s)
| | | | | | | | - Gregor Shanik
- Department of Vascular Surgery, St. James's Hospital, Dublin, Ireland
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2
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Uberoi R, Tsetis D. Standards for the Endovascular Management of Aortic Occlusive Disease. Cardiovasc Intervent Radiol 2007; 30:814-9. [PMID: 17659423 DOI: 10.1007/s00270-007-9123-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 05/19/2007] [Indexed: 11/29/2022]
Abstract
Occlusive disease of the infrarenal aorta and aorto-iliac arteries can be safely treated by minimally invasive therapy and is now widely available. The aim of this article is to produce standards for the management of these patients using current endovascular techniques.
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Affiliation(s)
- Raman Uberoi
- Department of Radiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
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3
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Poncyljusz W, Falkowski A, Garncarek J, Karasek M, England S, Zawierucha D. Primary stenting in the treatment of focal atherosclerotic abdominal aortic stenoses. Clin Radiol 2006; 61:691-5. [PMID: 16843753 DOI: 10.1016/j.crad.2006.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 03/20/2006] [Accepted: 04/12/2006] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the results of primary stent placement in focal atherosclerotic aortic stenoses using balloon expandable stents. MATERIALS AND METHODS Twenty-six primary balloon expandable stent placements in the abdominal aorta were performed and reviewed. All the aortic stenoses were atherosclerotic. Patients were followed up by ankle/brachial pressure indices (ABPI) and Doppler ultrasound (US) at 24h after procedure and at 12 and 24 months. Follow-up angiograms were performed at 12 months. RESULTS Twenty-six stents in 26 patients were placed in the infrarenal aorta. All procedures were technically successful and immediate clinical success was obtained. The mean ABPI significantly improved from 0.52+/-0.10 to 0.94+/-0.09 within 24h after procedure, and remained at 0.90+/-0.12 between 12 and 24 months follow-up (mean 18 months). There was full haemodynamic success at hospital discharge and at 12 and 24 months after the procedure. Clinical success at 12 and 24 months (mean 18 months) was defined as an improvement in the Fontaine classification by at least one class compared with the pre-procedure class and was shown to be 100%. CONCLUSION In summary, we report that primary stenting is a safe and effective alternative to surgery in cases of symptomatic stenosis of the infrarenal abdominal aorta. The excellent intermediate term results suggested that we would recommend primary stenting as the treatment of choice for focal atherosclerotic stenoses of the infrarenal aorta in selected patients.
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Affiliation(s)
- W Poncyljusz
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University of Szczecin, SPSK-1, Unii Lubelskiej 1, 71-252, Szczecin, Poland.
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4
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d'Othée BJ, Haulon S, Mounier-Vehier C, Beregi JP, Jabourek O, Willoteaux S. Percutaneous endovascular treatment for stenoses and occlusions of infrarenal aorta and aortoiliac bifurcation: midterm results. Eur J Vasc Endovasc Surg 2002; 24:516-23. [PMID: 12443747 DOI: 10.1053/ejvs.2002.1751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE evaluation and comparison of the endovascular treatment of isolated aortic and aortoiliac atherosclerotic lesions (stenoses and occlusions). METHODS a percutaneous endovascular procedure was performed in 52 patients (38 men and 14 women) with a mean age of 52 years (range, 25-85 years). The baseline angiogram showed 35 aortic lesions (31 stenoses, 4 occlusions) and 17 aortoiliac lesions (14 stenoses, 3 occlusions). Percutaneous techniques used in this series included variable combinations of transluminal angioplasty and stenting. All stents placements were performed over-the-wire using the transfemoral route (most often bilateral approach). Clinical examination and Duplex-scan were performed at discharge, 1 month, 6 months, 12 months, and then yearly. RESULTS technical success was 100% for aortic and aortoiliac lesions. Angiographic success rates were comparable for aortic (91%) and aortoiliac (94%) lesions. No death occurred during or early after the endovascular intervention. Duplex-scan confirmed 100% patency rate at discharge. There was no significant difference between the aortic (94%) and aortoiliac (96%) groups regarding immediate clinical improvement. Mean follow-up was 34+/-31 months (range, 0-130 months). The cumulative primary patency rate at 36 months was 85% in the aortic group and 86% in the aortoiliac group. Clinical success, defined as a symptom-free status at the end of follow-up, was also similar in both groups. CONCLUSION endovascular treatment of isolated aortic lesions of the infra-renal aorta has favorable outcomes comparable to those of aortoiliac lesions.
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Affiliation(s)
- B J d'Othée
- Department of Vascular Radiology, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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Morales PA, Heuser RR. Peripheral vascular disease: perspectives on aortoiliac, renal, and femoral treatments using catheter-based techniques. J Interv Cardiol 2001; 14:629-37. [PMID: 12053385 DOI: 10.1111/j.1540-8183.2001.tb00382.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The percutaneous treatment of peripheral vascular disease has advanced over the past two decades and is fast becoming the preferred treatment of choice. Stents have positively altered the clinical outcomes in peripheral revascularizations. Anatomic variability is an important factor in determining if the patient is an ideal percutaneous interventional candidate. Future technological developments in percutaneous interventions will help include new patients with peripheral vascular disease previously considered nonideal percutaneous candidates.
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Affiliation(s)
- P A Morales
- Phoenix Heart Center, St. Luke's Medical Center, 525 North 18th St., Suite 504, Phoenix, AZ 85006, USA
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6
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Abstract
Historically reconstructive vascular surgery, has been a cornerstone of treatment for symptomatic obliterative aortoiliac disease. Surgical results include a reported aortobifemoral bypass 5-year patency rate from 85% to 90% and a 10-year patency rate of 70% to 75%. Operative mortality for aortoiliac reconstruction ranges from 1.6% to 3.3%, with an aggregated systemic morbidity of 8.3%. Clinical indications for surgical intervention are well-established and are limited primarily to severe claudication and limb-threatening ischemia. Broader application of surgical intervention is not recommended because of significant morbidity and mortality associated with the procedure. As balloon angioplasty and endovascular stenting technologies evolve, they are proving to be an effective modality for the treatment of aortoiliac disease. These lower risk procedures have allowed expansion of traditional indications for intervention. Treatment is recommended presently for patients with clinical symptoms that impact lifestyle and professional requirements. Less conventional indications include allowing access for coronary intervention or for placement of an intra-aortic balloon pump, or improving inflow prior to a distal surgical bypass procedure. Results of aortoiliac percutaneous interventions are difficult to compare with surgical data since methods and technology continue to improve and evolve, and randomized studies are limited. It is clear that as long as outcomes of percutaneous interventions are predictable and secondary patency rates acceptable, the low complication rates of a percutaneous intervention are clearly preferable to a riskier surgical alternative.
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Affiliation(s)
- F G St Goar
- Cardiovascular Institute, El Camino Hospital, 2660 Grant Road, Mountain View, CA 94040, USA
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Therasse E, Côté G, Oliva VL, Cusson JR, Wistaff R, Nguyen PV, Bui BT, Perreault P, Lamarre L, Soulez G. Infrarenal Aortic Stenosis: Value of Stent Placement after Percutaneous Transluminal Angioplasty Failure. Radiology 2001; 219:655-62. [PMID: 11376250 DOI: 10.1148/radiology.219.3.r01jn19655] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the long-term clinical and hemodynamic effectiveness of aortic stent placement in cases of failure of intended infrarenal percutaneous transluminal aortic angioplasty (PTAA). MATERIALS AND METHODS Fifty-three patients who underwent technically successful PTAA were compared with 24 patients who underwent aortic stent placement because of PTAA failure (19 patients) or ulcerated lesions (five patients) that otherwise would have been treated surgically because of the embolization hazard associated with PTAA alone. Clinical patency was defined as the absence or improvement of symptoms after the intervention. Hemodynamic patency was defined as a normal Doppler waveform in the common femoral arteries, an ankle-brachial index greater than 0.95, or the absence of a thigh-brachial pressure gradient. RESULTS Three-year clinical and hemodynamic patency rates, respectively, were 85% and 79% for PTAA and 69% and 43% for aortic stent placement. No morbidity was encountered. With use of the Cox proportional hazards model, two significant risk factors were retained for restenosis: unchanged smoking habit (P =.04) and small dilatation diameter (P =.001). Aortic stent placement, performed in patients with a smaller aortic diameter (10.3 vs. 12.7 mm for PTAA), appeared to be a predictive factor for restenosis by using univariate analysis. By using the Cox proportional hazards model, however, the restenosis rates after PTAA and aortic stent placement were not significantly different. CONCLUSION When aortic diameter is taken into consideration, there is no evidence that clinical outcome after secondary aortic stent placement would be poorer than technically successful PTAA.
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Affiliation(s)
- E Therasse
- Depts of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 3840 St Urbain St, Montreal, Quebec, Canada.
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8
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Rosset E, Malikov S, Magnan PE, Poirier M, Valerio N, Ede B, Branchereau A. Endovascular treatment of occlusive lesions in the distal aorta: mid-term results in a series of 31 consecutive patients. Ann Vasc Surg 2001; 15:140-7. [PMID: 11265076 DOI: 10.1007/s100160010046] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the early and mid-term results of endovascular treatment of occlusive lesions in the distal aorta in a consecutive series of patients. Between February 1996 and March 1999, a total of 31 patients underwent transluminal procedures for treatment of occlusive atherosclerotic lesions located at the lower end of the aorta. Thirty patients presented with intermittent claudication and one had critical ischemia. Manifestations were bilateral in 26 cases and unilateral in 5. The lesion was confined to the lower aorta in 3 patients and extended to the common iliac arteries in 19, with predominant proximal lesions of the common iliac artery occurring in 9 patients. Fourteen patients had concurrent infracrural occlusive lesions. All patients underwent exclusive endovascular treatment without any associated open surgical procedure. The three patients with isolated aortic lesions were treated by angioplasty, followed by stent placement in two cases. The 19 patients with aortobiiliac lesions were treated by bilateral common iliac artery angioplasty according to the "kissing-balloon" technique; 7 of these patients also underwent aortic angioplasty. In these 19 patients, aortic stenting was performed in 3 cases and bilateral iliac stenting in 10 cases, including 3 in association with aortic stenting. The nine patients with a proximal lesion of the common iliac arteries were treated by angioplasty, followed by bilateral stenting in three cases and unilateral stenting in three cases. The findings of this study show that the mid-term anatomical and functional results of endovascular treatment for atherosclerotic lesions of the distal aorta are satisfactory. We recommend it as the initial treatment modality.
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Affiliation(s)
- E Rosset
- Service de Chirurgie Vasculaire, Hôpital Gabriel Montpied, Rue Montalembert, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
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Nyman U, Uher P, Lindh M, Lindblad B, Ivancev K. Primary stenting in infrarenal aortic occlusive disease. Cardiovasc Intervent Radiol 2000; 23:97-108. [PMID: 10795833 DOI: 10.1007/s002709910021] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the results of primary stenting in aortic occlusive disease. METHODS Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months). RESULTS Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented. CONCLUSIONS Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.
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Affiliation(s)
- U Nyman
- Department of Radiology, Malmö University Hospital, University of Lund, Sweden
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Elkouri S, Hudon G, Demers P, Lemarbre L, Cartier R. Early and long-term results of percutaneous transluminal angioplasty of the lower abdominal aorta. J Vasc Surg 1999; 30:679-92. [PMID: 10514207 DOI: 10.1016/s0741-5214(99)70107-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the early and long-term results of percutaneous transluminal angioplasty (PTA) of atherosclerotic lower abdominal aorta stenosis. METHODS This study was performed as a retrospective study. From 1980 to 1997, 46 patients with chronic lower limb ischemia with moderate to severe claudication as the result of isolated infrarenal disease or aortoiliac disease underwent PTA. All patients underwent angiography before and after angioplasty and Doppler ultrasound scan examination with ankle-brachial index determination. No stents were used. RESULTS The technical success rate was 96% (44 of 46 cases). Thirty-eight patients (83%) immediately showed clinical, hemodynamic, and angiographic improvement. The initial success rate for patients with isolated infrarenal or bifurcation disease was 92%, whereas it was 71% for aortoiliac disease. Among the eight patients with no initial improvement, four had clinical deterioration and two required emergency surgical revascularization. There were no other complications. Fifty-six percent of the patient conditions (95% confidence interval [CI], 38% to 74%) remained clinically improved at the 5-year follow-up examination. Recurrence of symptoms was caused by femoropopliteal disease in most patients. The primary patency rate assumed with maintenance of hemodynamic improvements was 70% (95% CI, 52% to 88%) and 64% (95% CI, 44% to 84%) at 4 and 5 years of follow-up, respectively. The primary patency rate at 4 years for patients with isolated infrarenal or bifurcation disease was 83% (95% CI, 64% to 100%), whereas it was 55% for aortoiliac disease (95% CI, 30% to 80%; P =.06) The variables that were statistically predictive of patency failure were poor runoff (P =. 01) and presence of aortoiliac atherosclerotic disease (P =.04). CONCLUSION Our results suggest that PTA is an excellent treatment for chronic arterial insufficiency of the lower extremities as the result of isolated atherosclerotic lower abdominal aortic occlusive lesions because of good long-term patency. Aortic PTA for those patients with iliac involvement or with poor runoff gives acceptable results but carries lower patency and clinical success rates.
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Affiliation(s)
- S Elkouri
- Department of Cardiovascular Surgery, Montreal Heart Institute, Québec, Canada
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11
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Westcott MA, Bonn J. Comparison of conventional angioplasty with the Palmaz stent in the treatment of abdominal aortic stenoses from the STAR registry. SCVIR Transluminal Angioplasty and Revascularization. J Vasc Interv Radiol 1998; 9:225-31. [PMID: 9540904 DOI: 10.1016/s1051-0443(98)70261-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To retrospectively compare the safety and short-term efficacy of conventional percutaneous transluminal angioplasty (PTA) and PTA with the Palmaz balloon-expandable intravascular stent for the treatment of infrarenal abdominal aortic atherosclerotic stenoses. PATIENTS AND METHODS The records of 25 patients with infrarenal aortic stenoses treated by means of percutaneous techniques were retrieved from the SCVIR Transluminal Angioplasty and Revascularization (STAR) Registry and analyzed. Thirteen patients were treated with PTA alone and 12 were treated with the Palmaz intravascular stent. RESULTS Technical success was achieved in 92% of patients treated with PTA alone and in 100% of those treated with the Palmaz stent. Significant improvements in lesion morphology, hemodynamics, clinical status, and ankle arm indexes were shown in both groups. There was no statistically significant difference in percent stenosis reduction, decrease in trans-stenotic gradient, or initial clinical outcome between the group treated by means of PTA and the group treated by means of PTA with the Palmaz stent. CONCLUSIONS PTA and intravascular stent placement of atherosclerotic stenoses involving the infrarenal aorta are both safe and efficacious therapeutic modalities. At present, it does not appear that primary stent placement confers any short-term benefits over technically successful PTA in aortic stenoses.
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Affiliation(s)
- M A Westcott
- Thomas Jefferson University Hospital, Division of Cardiovascular and Interventional Radiology, Philadelphia, Pennsylvania, USA
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12
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Sheeran SR, Hallisey MJ, Ferguson D. Percutaneous transluminal stent placement in the abdominal aorta. J Vasc Interv Radiol 1997; 8:55-60. [PMID: 9025039 DOI: 10.1016/s1051-0443(97)70515-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To retrospectively review and to report the results of stent placement for focal mid-abdominal aortic stenoses. MATERIALS AND METHODS During a 4-year period, 10 focal mid-abdominal aortic stenoses were treated with stent placement in nine patients (six women and three men; mean age, 61 years; range, 49-73 years). All of the stenoses were atherosclerotic in nature except for one at the proximal anastomosis of an aortobi-femoral graft, which may have been from fibrointimal hyperplasia. Seven of the 10 stenoses were treated with primary stent placement, whereas three were treated with stent placement after suboptimal angioplasty. RESULTS The technical success rate was 100%. Clinical success, defined as complete elimination or improvement of symptoms present before stent placement, was achieved in eight of the nine patients with a mean duration of follow-up of 1.6 years (range, 0.2-3.0 years). CONCLUSION In view of the excellent technical and clinical success, the authors believe that stent placement should be considered as an adjective therapy to angioplasty or as a primary method of treatment in properly selected patients with focal mid-abdominal aortic stenoses.
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Affiliation(s)
- S R Sheeran
- Department of Vascular and Interventional Radiology, Hartford Hospital, CT 06106, USA
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Long AL, Gaux JC, Raynaud AC, Faintuch JM, Pagny JY, Lacombe P, Fiessinger JN, Relland JY, Beyssen BM. Infrarenal aortic stents: initial clinical experience and angiographic follow-up. Cardiovasc Intervent Radiol 1993; 16:203-8. [PMID: 8402780 DOI: 10.1007/bf02602961] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
From March 1990 to May 1991, arterial stents were placed in seven patients because of a tight stenosis (five patients) or a total chronic occlusion (two patients) located in the infrarenal aorta. In one case, the aortic occlusion extended to both common iliac arteries. After balloon dilatation, aortic stents were successfully positioned in all cases. Bilateral common iliac recanalization and stent placement were performed in one case. No complications occurred in any of the patients. No complications occurred in any of the patients. Follow-up data were derived from clinical assessments and angiographic results. After a 15.1-month mean follow-up period (range 12-24 months), the seven aortic stents remained patent. Three iliac artery procedures were performed in two of the patients as well. Claudication recurred in three of the seven patients which was related to a common iliac occlusion (one case) or distal progression of atherosclerosis (two cases). Aortic stents seem to be suitable for treating failed angioplasty of aortic lesions but the procedure remains technically difficult when there is associated severe atherosclerosis of the proximal common iliac arteries. Nevertheless, considering the morbidity rate (0%) and the patency rate in this series, this technique could become an alternative to surgical treatment for infrarenal aortic occlusive lesions.
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Affiliation(s)
- A L Long
- Service de Radiologie Cardiovasculaire, Hôpital Broussais, Paris, France
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Diethrich EB. Endovascular treatment of abdominal aortic occlusive disease: the impact of stents and intravascular ultrasound imaging. EUROPEAN JOURNAL OF VASCULAR SURGERY 1993; 7:228-36. [PMID: 8513900 DOI: 10.1016/s0950-821x(05)80002-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Distal abdominal aortic occlusive disease has been conventionally treated with endarterectomy or bypass grafting. However, today's expanding spectrum of intraluminal devices and techniques may well replace classical surgery in this arterial region in all but a few instances. Since January 1990, we have investigated the potential for such endovascular therapies as thrombolysis, balloon dilation and intravascular stenting in 29 symptomatic patients with a variety of distal abdominal aortic pathologies. The prudent application of these intraluminal therapies hinges on accurate intra-arterial assessment. Arteriographic data are notably inadequate for most endovascular procedures; however, intravascular ultrasound imaging (IVUS) is a newer diagnostic tool that works particularly well in the aortoiliac region where angioscopy is more difficult to utilize for assessment. Using IVUS as a complement to arteriography, we were able to assess the need for 43 Palmaz stents in these cases of distal abdominal aortic pathologies; 23 additional iliac stents were deemed necessary. Moreover, IVUS was the only tool available to confirm adequate stent deployment. Given the apparent long-term success of stents in large-bore arteries, abdominal aortic stenting may ensure proximal inflow to distal vessels, saving many patients from an intra-abdominal operation. The specific intraluminal and transmural data offered by IVUS facilitates stent application and documents adequate deployment, two vitally important elements in the percutaneous treatment of abdominal aortic occlusive disease.
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Affiliation(s)
- E B Diethrich
- Department of Cardiovascular Surgery, Arizona Heart Institute & Foundation, Phoenix 85006
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15
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Diethrich EB, Santiago O, Gustafson G, Heuser RR. Preliminary observations on the use of the Palmaz stent in the distal portion of the abdominal aorta. Am Heart J 1993; 125:490-501. [PMID: 8427146 DOI: 10.1016/0002-8703(93)90031-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The opportunities to avoid surgical treatment of distal abdominal aortic occlusive disease are expanding because of the proliferation in catheter-based techniques. Since January 1990, 24 symptomatic patients with distal abdominal disorders have been treated percutaneously with balloon angioplasty and intraluminal stenting. A total of 38 Palmaz stents were deployed at distal abdominal aortic sites; 21 additional iliac stents were implanted. After the procedure all patients improved clinically, and 83% (21/24) improved by objective measurement (average ABI 0.93 +/- 0.21). Three access-related complications occurred (two hematomas, one thrombus), but no complications were related to the stents. At up to 29 months of follow-up (average 10.3 +/- 6.7 months), clinical improvement persists in all patients (average ABI 0.93 +/- 0.22). In 11 patients eligible for follow-up aortography, all aortic stents are patent without evidence of restenosis. With the low likelihood for restenosis in the abdominal aorta, the long-term outcome of aortic stenting looks promising and may equal or surpass that found in the iliac region.
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Affiliation(s)
- E B Diethrich
- Department of Cardiovascular Surgery, Arizona Heart Institute & Foundation, Phoenix 85064
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16
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Morag B, Garniek A, Bass A, Schneiderman J, Walden R, Rubinstein ZJ. Percutaneous transluminal aortic angioplasty: early and late results. Cardiovasc Intervent Radiol 1993; 16:37-42. [PMID: 8435834 DOI: 10.1007/bf02603035] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- B Morag
- Department of Radiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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17
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Insall RL, Loose HW, Chamberlain J. Long-term results of double-balloon percutaneous transluminal angioplasty of the aorta and iliac arteries. EUROPEAN JOURNAL OF VASCULAR SURGERY 1993; 7:31-6. [PMID: 8454075 DOI: 10.1016/s0950-821x(05)80540-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Seventy-nine patients have been treated by double-balloon percutaneous transluminal angioplasty for aortoiliac atherosclerotic lesions within 0.5 cm of the aortic bifurcation. Seven patients had repeated angioplasties, a total of 86 procedures over an 8 year period up to December 1990. The technique is described and its merits discussed. Technically successful dilatation was achieved in 81 cases (94%) and symptomatic relief was obtained in 75 (87%), including 12 of 14 patients with critical ischaemia. Fourteen of 17 occlusions up to 6 cm long and 67 of 69 stenoses were successfully dilated. After an average follow-up of 49 months (median 51 months, range 7-93), only six patients (7%) developed late recurrence of symptoms requiring further treatment. Six patients have died and 12 have been discharged from follow-up. The cumulative success rate beyond 5 years' follow-up was 80%. Complications requiring surgical intervention occurred in four patients (5%). Double-balloon percutaneous transluminal angioplasty was seen to be an effective procedure which produced lasting improvement and is recommended as the first choice treatment for localised stenotic and occlusive disease at the aortic bifurcation.
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Affiliation(s)
- R L Insall
- Department of Vascular Surgery, Freeman Hospital, High Heaton, Newcastle-upon-Tyne, U.K
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18
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Vorwerk D, Günther RW, Bohndorf K, Keulers P. Stent placement for failed angioplasty of aortic stenoses: report of two cases. Cardiovasc Intervent Radiol 1991; 14:316-9. [PMID: 1834339 DOI: 10.1007/bf02578459] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In 2 patients, an aortic stenosis failed to respond adequately to balloon dilatation but was successfully treated by implantation of a self-expandable large caliber endoprosthesis and subsequent balloon angioplasty. Intravascular ultrasound helped to classify the characteristics of the lesion in preparation for intervention.
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Affiliation(s)
- D Vorwerk
- Department of Diagnostic Radiology, Technical University of Aachen, FRG
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