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

Introduction. Minimally invasive therapy in five European countries: diffusion, effectiveness and cost-effectiveness

Minimally invasive therapy (MIT) is a field that has gained a great deal of attention since the mid-1980s. MIT is a new and rapidly growing area of medical treatment based on developments in endoscopy, vascular catheters, imaging devices, and related technologies. Although endoscopes have been in use for more than 100 years, it is relatively new to use them for therapeutic purposes. Now practically every organ system in the body can be approached by these technologies. The resulting revolution in health care is the subject of this issue of the journal.

Percutaneous transluminal angioplasty of the distal abdominal aorta and its bifurcation

Percutaneous transluminal angioplasty (PTA) of stenotic lesions in the distal abdominal aorta and its bifurcation was performed in 14 patients, 6 of whom were women. The stenotic segment in the aorta or aortic bifurcation was usually the only significant lesion. The double-balloon technique was used in 12 patients via bilateral femoral artery catheterizations. In 2 other patients with aortic lesions, a single large balloon sufficed. Good results were achieved in all but 1 patient, with minor complications occurring in 3 instances. The follow-up period varied from 6 months to 5 years. We believe that PTA is the procedure of choice in treating localized lesions of the distal abdominal aorta and its bifurcation, especially when distal vessels are relatively uninvolved.

Percutaneous transluminal recanalization of common iliac artery occlusions

Percutaneous transluminal recanalization of occluded iliac arteries was attempted in 25 patients (26 limbs). In 22, successful recanalization was achieved, although 4 patients required additional surgical thrombectomy. The remaining 4 patients had surgical bypass procedures. The early and late results of percutaneous recanalization are presented as well as the technique used. We conclude that percutaneous recanalization of iliac occlusion is an effective procedure in the majority of cases. The option of surgical treatment remains viable when the percutaneous approach is unsuccessful.

Trends in revascularization of the lower extremity

Several trends are evident in revascularization of the lower extremity. Currently, few patients with severe leg ischemia undergo amputation without prior surgical or angioplasty attempts at revascularization. Percutaneous balloon angioplasty and thrombolytic therapy have had a definite but limited influence on the treatment of all patients with lower-limb arterial disease. Although pentoxifylline, a hemorrheologic agent, is being widely used, it has not changed the need for surgical intervention in patients with severe arterial disease. In the aggressive approach to save legs with severe popliteal-tibial disease, the use of femorotibial grafts is increasing. In situ saphenous vein grafting is becoming the operation of choice for infrapopliteal occlusive disease. For most patients with severe lower-extremity arterial occlusive disease, a properly selected and conducted operation remains the safest and most durable treatment.

Chronic upper extremity ischemia: current concepts in management

As a rule, the few innominate or subclavian obstructions that are symptomatic produce neurologic and extremity symptoms that are easily reversed by an extrathoracic surgical approach. Balloon angioplasty is seeing some utility for this problem also. Concomitant carotid disease may be more significant in that its correction may not only prevent stroke but also mitigate symptoms of subclavian steal. The reconstruction of lesions distal to the vertebral artery frequently results in dramatic and durable improvement. Sympathectomy has a valuable role to play in those cases in which restoration of perfusion cannot be complete.