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Vedula RR, Kolathu RM. Birth and Growth of Neuroimaging and Vascular Intervention at Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram—Part I. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1726147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractThis article is a historical narrative that traces the growth of neuroradiology and interventional radiology at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram. From its humble origins in the pre-CT scan era of the mid and late 1970s, when invasive diagnostic procedures such as percutaneous carotid angiography, myelography, pneumoencephalography (PEG) and ventriculography were the mainstay of neuroimaging, the authors take the reader through their gradual foray into catheter four-vessel angiography and later free-flow embolization of arteriovenous malformations (AVMs), and finally to the use of microcatheters for selective embolization procedures. The equipment used in those early years—fluoroscopic tilting table, roll-film cameras, serial changers, PEG tables—provide an insight to an era with all its challenges before the advent of digital imaging. The authors’ efforts to indigenize some of the hardware such as metallic stents and embolization material such as hydrogel spheres and lyophilized dura are also highlighted. The development of peripheral vascular intervention alongside neuroradiology is also highlighted. The authors pay tribute to an early pioneer of neuroradiology in India, Prof. Mahadevan Pillai, who was a guiding light to them during those nascent years.
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Affiliation(s)
- Rajanikanth Rao Vedula
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ravi Mandalam Kolathu
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
- KPJ Sabah Specialist Hospital, Jalan Bersatu, Luyang, Kota Kinabalu, Malaysia
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Ziadi J, Ben Hammamia M, Sobhi M, Ben Mrad M, Denguir R. [Revascularization of supra-aortic trunks in Takayasu's arteritis]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:260-265. [PMID: 31213298 DOI: 10.1016/j.jdmv.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/08/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Takayasu's disease is an inflammatory arteritis mainly affecting the aorta, its main divisional branches and pulmonary arteries. The arterial damage during Takayasu's disease is essentially occlusive and preferentially affects supra-aortic trunks. Indications for revascularization of supra-aortic trunks are clear but results are rarely reported. The purpose of this study was to evaluate the results of supra-aortic trunk revascularization in Takayasu's arteritis. PATIENTS AND METHODS We report a retrospective study conducted between 2012 and 2018 about patients with Takayasu's arteritis who underwent revascularization of supra-aortic trunks. RESULTS Our series consisted of six patients. All patients were female. The average age was 29 (range 18-48) years. The operative indication was cerebrovascular ischemic symptoms in five patients and intermittent claudication of the upper limb in one. We performed aorto-bi-carotid bypass in four patients, a subclavian artery angioplasty in one and a vertebral artery angioplasty in one. At 1 month, operative mortality was zero and morbidity was marked by hemorrhagic stroke in one patient operated by conventional surgery. The average follow-up was 4 years (1.8). During the follow-up, one patient was reoperated after 18 months for an anastomotic false aneurysm in the ascending aorta. We noted a favorable outcome with total resolution of the symptomatology for the other patients and Doppler ultrasound confirmed patency during follow-up. CONCLUSION Surgical revascularization of supra-aortic trunks in Takayasu's arteritis can be associated with a risk of stroke and a risk of anastomotic pseudoaneurysms. Endovascular revascularization appears to be less invasive but its long-term results are rarely reported.
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Affiliation(s)
- Jalel Ziadi
- Service de chirurgie cardiovasculaire, La Rabta, Tunis, Tunisie
| | | | - Mleyhi Sobhi
- Service de chirurgie cardiovasculaire, La Rabta, Tunis, Tunisie
| | - Malek Ben Mrad
- Service de chirurgie cardiovasculaire, La Rabta, Tunis, Tunisie
| | - Raouf Denguir
- Service de chirurgie cardiovasculaire, La Rabta, Tunis, Tunisie
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Lim RW, Keh YS, Yeo KK, Khanna NN. Takayasu’s arteritis: a review of the literature and the role of endovascular treatment. ASIAINTERVENTION 2018; 4:117-125. [PMID: 36484003 PMCID: PMC9706770 DOI: 10.4244/aij-d-16-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/23/2018] [Indexed: 06/17/2023]
Abstract
Takayasu's arteritis (TA) is a chronic non-specific vasculitis with variable presentation in different ethnicities and countries. Treatment options vary and are dependent on the stage and presentation of the disease. We aimed to review current literature related to TA, focusing on the role of endovascular treatment in revascularisation. The temporal course of the disease and stage at presentation influence the management of TA. Treatment options include medical therapy, endovascular intervention or surgical vascular reconstruction. The decision to intervene is individualised according to vascular anatomy and the presence of haemodynamically significant lesions. There are currently no clear guidelines regarding the choice between the endovascular and open surgical approaches, but studies have shown that endovascular procedures are associated with slightly higher rates of restenosis while surgical procedures have higher rates of thrombosis. Periprocedural immunosuppression is suggested if the disease is active at the point of intervention. This improves outcomes but at the cost of immunosuppression-related side effects. Careful long-term follow-up is essential due to the risk of disease activation or flare-up, requiring appropriate evaluation of the diseased vessels.
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Affiliation(s)
| | | | - Khung Keong Yeo
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Abstract
The supra-aortic arteries are no stranger to endovascular interventions. Since the 1980s, interventionists have been evaluating and refining the use of transluminal techniques for recanalizing stenotic and occlusive lesions in these large-bore, high-flow vessels. The authors present their methodologies for evaluating, selecting, and treating supra-aortic lesions with balloon angioplasty and stenting. Helpful suggestions are offered for optimizing the outcome of these endovascular approaches to atherosclerotic occlusive disease in the supra-aortic trunks.
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Affiliation(s)
- Frank J. Criado
- Division of Vascular Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA
| | - Mordechai Twena
- Division of Vascular Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA
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Bali HK, Jain AK. Takayasu's Arteritis: Current Status of Angioplasty and Stenting. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239900700423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Takayasu's arteritis is a chronic inflammatory disease characterized by stenotic occlusive lesions of the aorta and its major branches. The medical management of such lesions is far from satisfactory and surgical treatment is associated with high morbidity and mortality. Angioplasty with or without stenting has emerged as the treatment of choice for such lesions. Angioplasty and stenting of various vessels in Takayasu's arteritis are reviewed, highlighting the advantage of stents in reducing the rate of restenosis in chronically occluded or diffusely diseased vessels.
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Affiliation(s)
- Harinder K Bali
- Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh, India
| | - Anshul K Jain
- Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh, India
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Ahmed AT, Mohammed K, Chehab M, Brinjikji W, Hassan Murad M, Cloft H, Bjarnason H. Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2015; 39:652-667. [DOI: 10.1007/s00270-015-1250-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
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Mousa AY, AbuRahma AF, Bozzay J, Broce M, Barsoum E, Bates M. Anatomic and clinical predictors of reintervention after subclavian artery stenting. J Vasc Surg 2015; 62:106-14. [DOI: 10.1016/j.jvs.2015.01.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. Rheumatology (Oxford) 2013; 53:793-801. [DOI: 10.1093/rheumatology/ket320] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Affiliation(s)
- Enrico Tombetti
- San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Unit of Internal Medicine, Clinical Immunology and Rheumatology, Via Olgettina 60, Milan, Italy
| | - Angelo Manfredi
- San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Unit of Internal Medicine, Clinical Immunology and Rheumatology, Via Olgettina 60, Milan, Italy
| | - Maria Grazia Sabbadini
- San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Unit of Internal Medicine, Clinical Immunology and Rheumatology, Via Olgettina 60, Milan, Italy
| | - Elena Baldissera
- San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Unit of Internal Medicine, Clinical Immunology and Rheumatology, Via Olgettina 60, Milan, Italy
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Gupta PN, Salam Basheer A, Sukumaran GG, Padmajan S, Praveen S, Velappan P, Nair BU, Nair SG, Kunjuraman UK, Madthipat U, R J. Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented? HEART ASIA 2013; 5:144-7. [PMID: 27326111 DOI: 10.1136/heartasia-2013-010297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/17/2013] [Accepted: 06/26/2013] [Indexed: 11/04/2022]
Abstract
Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in response to conservative treatment, and review the literature on the prevention and treatment of femoral pseudoaneurysm.
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Affiliation(s)
- Prabha Nini Gupta
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | - Abdul Salam Basheer
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | | | - Sabin Padmajan
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | - Satheesan Praveen
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | - Praveen Velappan
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | | | | | | | - Unnikrishnan Madthipat
- Department of Cardiothoracic surgery , Sri Chitra Tirunal Institute of Medical Sciences , Trivandrum, Kerala , India
| | - Jayadevan R
- Department of Interventional Radiology , Sri Chitra Tirunal Institute of Medical Sciences, Trivandrum , Trivandrum, Kerala , India
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Loewenhardt B, Bernhard M, Pierskalla A, Neumann-Haefelin T, Hofmann E. Neurointerventional treatment of amphetamine-induced acute occlusion of the middle cerebral artery by intracranial balloon angioplasty. Clin Neuroradiol 2013; 23:137-43. [PMID: 22173373 DOI: 10.1007/s00062-011-0122-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 12/01/2011] [Indexed: 10/14/2022]
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Tann SM, Pershad A. A novel approach to the treatment of recurrent non-atherosclerotic carotid stenosis in a patient with takayasu arteritis. Catheter Cardiovasc Interv 2012; 80:337-41. [DOI: 10.1002/ccd.23401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 09/24/2011] [Indexed: 11/10/2022]
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Kim YW, Kim DI, Park YJ, Yang SS, Lee GY, Kim DK, Kim K, Sung K. Surgical bypass vs endovascular treatment for patients with supra-aortic arterial occlusive disease due to Takayasu arteritis. J Vasc Surg 2012; 55:693-700. [DOI: 10.1016/j.jvs.2011.09.051] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 10/15/2022]
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Endovascular and Open Surgical Treatment of Brachiocephalic Arteries. Ann Vasc Surg 2011; 25:569-81. [DOI: 10.1016/j.avsg.2010.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 11/19/2022]
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Stent-supported recanalization of supra-aortic vessels in takayasu arteritis—A case report. Int J Angiol 2011. [DOI: 10.1007/s00547-005-1097-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Qureshi MA, Martin Z, Greenberg RK. Endovascular Management of Patients with Takayasu Arteritis: Stents versus Stent Grafts. Semin Vasc Surg 2011; 24:44-52. [DOI: 10.1053/j.semvascsurg.2011.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Chalumeau NC, Boutin DLTH, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 2010; 89:1-17. [PMID: 20075700 DOI: 10.1097/md.0b013e3181cba0a3] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We conducted a single-center retrospective study to compare the characteristics of Takayasu arteritis (TA) among white, North African, and black patients in a French tertiary care center (Hospital Pitié-Salpêtrière, Paris). Eighty-two patients were studied (82.9% female) during a median follow-up of 5.1 years (range, 1 mo to 30 yr). Among these 82 patients, 39 (47.6%) were white, 20 (24.4%) were North African, and 20 (24.4%) were black patients. Median age at diagnosis was 39.3 years (range, 14-70 yr) in white patients vs. 28.4 years (range, 12-54 yr) in North African (p = 0.02), and 28.0 years (range, 13-60 yr) in black patients (p = 0.08). Patients aged >40 years at TA onset were more frequently white than non-white (40.0% vs. 18.6%, p = 0.03). North African patients had more frequent occurrence of ischemic stroke (p = 0.03) and poorer survival (p = 0.01) than white patients. Type V of the Hata classification was the most frequent type among white (38.5%), North African (65.0%), and black patients (40.0%). Corticosteroids were used in 96.1% of patients. Fifty-three percent of white and North African patients, and 44% of black patients required a second line of immunosuppressive treatment (p = 0.60). Vascular surgical procedures were respectively performed in 46.1%, 50.0%, and 55.0% of white, North African, and black patients, p = 0.81. The 5-year and 10-year survival rates were 100% and 95.0%, respectively, in white patients; 67.4% at both 5 years and 10 years in North African patients; and 100% at both 5 years and 10 years in black patients. This study is one of the first direct comparisons of TA profiles among patients of distinct ethnic backgrounds. Our data support the idea that late-onset TA or an overlap between TA and large-vessel giant cell arteritis may be observed in white patients. North African patients have a higher occurrence of ischemic stroke and poorer survival than white patients.
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Affiliation(s)
- Laurent Arnaud
- From Service de Médecine Interne (LA, JH, NL, NCC, DB, P Cacoub, JCP, ZA), Service de Radiologie (DT, P Cluzel), Service de Santé Publique (LG), and Service de Chirurgie Vasculaire (FK, EK); and Hôpital Pitié-Salpêtrière, AP-HP, Université Paris 6, Paris, France
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Both M, Moosig F, Gross WL, Heller M. [Large-vessel vasculitis. Imaging and interventional therapy]. Radiologe 2009; 49:947-63; quiz 964-5. [PMID: 19330311 DOI: 10.1007/s00117-008-1817-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Giant cell arteritis and Takayasu's arteritis are classified as primary large-vessel vasculitides. Inflammatory cell infiltrates and cytokines induce destruction and hyperplasia of the vessel wall, leading to stenoses or aneurysms. When extracranial large arteries are involved, there is often a similar clinical and radiologic disease pattern of an inflammatory aortic arch syndrome. Rare causes of large-vessel vasculitis include Behçet's disease, association with other autoimmune diseases, and infection. Depending on the localization, imaging is usually performed by means of duplex ultrasound, magnetic resonance imaging, computed tomography, or positron emission tomography. These imaging modalities are used not only to establish the diagnosis but also to determine the disease extent and activity and to perform follow-up in the course of medical therapy. Angiography offers the option to perform interventional therapy for vascular stenoses and occlusions.
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Affiliation(s)
- M Both
- Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
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Sixt S, Rastan A, Schwarzwälder U, Bürgelin K, Noory E, Schwarz T, Beschorner U, Frank U, Müller C, Hauk M, Leppanen O, Hauswald K, Brantner R, Nazary T, Neumann FJ, Zeller T. Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheter Cardiovasc Interv 2009; 73:395-403. [DOI: 10.1002/ccd.21836] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Diseases of the aorta are imaged using different modalities according to the cause and clinical situation. Current imaging strategies for the clinically most pertinent aortic diseases are analysed. These disease entities may be differentiated into congenital, acquired and inflammatory diseases. Traumatic and non-traumatic aortic aneurysms and dissections are emphasised in context with endovascular treatment options and subsequent follow-up.
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Affiliation(s)
- P Reimer
- Radiologie Gefässzentrum Karlsruhe, Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany.
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Both M, Aries PM, Müller-Hülsbeck S, Jahnke T, Schäfer PJ, Gross WL, Heller M, Reuter M. Balloon angioplasty of arteries of the upper extremities in patients with extracranial giant-cell arteritis. Ann Rheum Dis 2006; 65:1124-30. [PMID: 16464985 PMCID: PMC1798271 DOI: 10.1136/ard.2005.048470] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the outcome of balloon angioplasty in the arteries of the upper extremities in patients with giant-cell arteritis (GCA) and stenosing extracranial involvement. METHODS Percutaneous transluminal angioplasty (PTA) for symptomatic upper limb artery stenoses (n = 29) and occlusions (n = 1) resistant to medical treatment was carried out in 10 patients (all women, mean age 65 years) with GCA. Vascular lesions were located in the subclavian (n = 4), axillary (n = 10) and brachial (n = 16) arteries. Interventional treatment was accompanied by immunosuppressive drugs in all patients. Follow-up included clinical and serological examination, magnetic resonance angiography and colour duplex ultrasound. RESULTS Initial technical success of angioplasty was achieved in the case of all vascular lesions. In five patients, marked recurrent stenoses (vascular territories; n = 10/30) were found during follow-up (mean 24 months). The cumulative primary patency rate was 65.2%. All recurrent lesions developed in the territories of the initial long-segment stenoses. Repeated PTA (vascular territories, n = 8; patients, n = 5) provided a cumulative secondary patency rate of 82.6% and a cumulative tertiary patency rate of 89.7%. CONCLUSIONS Despite a tendency to restenoses, balloon angioplasty of the upper-extremity artery, in combination with immunosuppressive treatment, is an efficient method for the treatment of extracranial GCA.
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Affiliation(s)
- M Both
- Department of Diagnostic Radiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
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Min PK, Park S, Jung JH, Ko YG, Choi D, Jang Y, Shim WH. Endovascular Therapy Combined With Immunosuppressive Treatment for Occlusive Arterial Disease in Patients With Takayasu's Arteritis. J Endovasc Ther 2005; 12:28-34. [PMID: 15683269 DOI: 10.1583/12-01-04-1329.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the feasibility and efficacy of endovascular therapy combined with immunosuppression for the treatment of arterial occlusive disease in patients with Takayasu's arteritis (TA). METHODS From January 1998 to June 2003, 25 patients (22 women; age 37.8+/-15.5 years) with TA were treated with angioplasty for symptomatic lesions or with a hemodynamically significant aortic narrowing. The patients with active disease, defined as an increase in inflammatory markers (e.g., erythrocyte sedimentation rate [ESR]), were treated with immunosuppressive agents before intervention. Angioplasty was performed after the ESR had been normalized. RESULTS In the 25 patients, 58 vascular territories (7 aortic, 9 carotid, 3 vertebral, 11 subclavian, 2 superior mesenteric, 18 renal, 4 iliac, and 4 coronary arteries) were treated with angioplasty only (19 lesions) or with stents (39 lesions). The mean ESR when the vascular lesions were initially diagnosed was 35.6+/-26.2 mm/h, which fell to 18.5+/-7.8 mm/h after immunosuppressive therapy. The endovascular procedure was performed successfully in 52 (90%) of 58 lesions. During the mean 23.7+/-18.4-month follow-up, 9 (17%) treated segments restenosed; 4 were treated with repeat angioplasty. The overall cumulative primary clinical success rate was 82%; secondary clinical success was 90%. CONCLUSIONS Endovascular therapy for stenotic lesions in patients with TA is safe and effective when disease activity is strictly controlled with immunosuppressive treatment.
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Affiliation(s)
- Pil-Ki Min
- Division of Cardiology, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea
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Khaw AV, Schumacher HC, Meyers PM, Gupta R, Higashida RT. Extracranial revascularization therapy: Angioplasty and stenting. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:179-192. [PMID: 15096309 DOI: 10.1007/s11936-996-0012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Beginning with simple balloon angioplasty, minimally invasive revascularization techniques have progressed to the use of metallic stents for improved immediate and long-term results. Stent-supported angioplasty now offers a therapeutic option for those individuals ineligible for surgical revascularization of stenotic atherosclerotic lesions and who have failed maximal medical therapy. However, the clinical equivalence, or possibly even superiority, of angioplasty of the extracranial carotid and vertebral arteries in atheromatous occlusive disease over surgical revascularization has yet to be determined in ongoing randomized controlled trials. Additionally, endovascular techniques offer treatment for a variety of nonatherosclerotic disease affecting the extracranial arteries, such as inflammatory, radiation-induced, and postsurgical strictures; acute intimal dissection; traumatic and spontaneous arteriovenous fistulas; and aneurysms or pseudoaneurysms. For certain disease entities at high risk for surgical complications, endovascular procedures have gained preference as the therapeutic modality of choice, yet lacking controlled trials providing evidence for noninferiority against surgical approach. Continued innovation and refinement of endovascular technology and techniques will further improve technical success, reduce procedure-related morbidity, and broaden the endovascular therapeutic spectrum for extracranial and intracranial cerebrovascular disease.
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Affiliation(s)
- Alexander V. Khaw
- Neuroendovascular Service, Departments of Radiology and Neurological Surgery, Columbia and Cornell University Medical Centers, Neurological Institute
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Mieno S, Horimoto H, Arishiro K, Negoro N, Hoshiga M, Ishihara T, Hanafusa T, Sasaki S. Axillo-axillary bypass for in-stent restenosis in Takayasu arteritis. Int J Cardiol 2004; 94:131-2. [PMID: 14996490 DOI: 10.1016/j.ijcard.2003.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2003] [Accepted: 04/06/2003] [Indexed: 11/24/2022]
Abstract
We report a patient with Takayasu arteritis (TA) who initially received stent placement (SP) following percutaneous transluminal balloon angioplasty for stenotic lesion of the left subclavian artery and subsequently had recurrent in-stent restenosis three times. Every time restenosis occurred, percutaneous transluminal rotational arterectomy (RA) was performed. After all, the patient underwent axillo-axillary bypass and has remained asymptomatic for 10 months after the surgery. We suggest that surgical treatment is beneficial for in-stent restenosis in patient with Takayasu arteritis.
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Walter J, Hofmann WJ, Ugurluoglu A, Magometschnigg H. False aneurysm after balloon dilation of a calcified innominate artery stenosis. J Endovasc Ther 2003; 10:825-8. [PMID: 14533958 DOI: 10.1177/152660280301000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the occurrence of a false aneurysm after percutaneous transluminal angioplasty of a severely calcified, high-grade stenosis of the brachiocephalic trunk. CASE REPORT A 68-year-old patient was admitted with cerebrovascular insufficiency, right upper extremity ischemia, and recurrent amaurosis fugax. Magnetic resonance arteriography (MRA) and duplex ultrasound revealed a severely calcified, high-grade stenosis of the innominate artery. Balloon dilation of this lesion was performed with minimal morphological success. After dilation, the patient suffered a reversible ischemic neurological deficit, from which he recovered completely. The patient's symptoms improved, but after 3 weeks he was re-admitted with palsy of the recurrent laryngeal nerve. An MRA showed a false aneurysm at the dilation site. Open surgery was performed, and the patient received a bifurcated aorto-subclavian-carotid bypass graft. He was discharged free of his preoperative symptoms. CONCLUSIONS This case illustrates the potential hazards of angioplasty of severely calcified stenoses of the supra-aortic vessels.
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Affiliation(s)
- Johannes Walter
- Department of Vascular Surgery, St John's Hospital, Salzburg, Austria.
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Walter J, Hofmann WJ, Ugurluoglu A, Magometschnigg H. False Aneurysm After Balloon Dilation of a Calcified Innominate Artery Stenosis. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0825:faabdo>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Recent advances in the management of non-specific aorto-arteritis. Indian J Pediatr 2002; 69:523-6. [PMID: 12139140 DOI: 10.1007/bf02722657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Non-Specific Aorto-arteritis or Takayasu's arteritis (TA) is a chronic inflammatory disease of the aorta and its major branches which either presents with constitutional symptoms in its active phase or with steno-occlusive symptoms in the healing phase. In children, it is an aggressive disease and often lethal. Congestive heart failure is more common in children than adults. TA often goes undiagnosed till it is too late and death rate of 35% or more is observed in 5 years. Therapeutic Interventional Cardiology offers new hope and saves the children with TA from certain death. Today, percutaneous transluminar balloon angioplasty (PTBA) has emerged as a non-surgical, safe, effective alternative therapeutic option and endovascular stents have revolutionised the management. The disease must be suspected and diagnosed precisely with echocardiography and angiography before it is too late to manage.
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el Asri A, Tazi-Mezalek Z, Aouni M, Adnaoui M, Mohattane A, Bensaid Y, Maaouni A. [Takayasu's disease in Morocco. Report of 47 cases]. Rev Med Interne 2002; 23:9-20. [PMID: 11859700 DOI: 10.1016/s0248-8663(01)00510-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Moroccan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country. METHODS Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999. RESULTS In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteries were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients. CONCLUSION The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis.
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Affiliation(s)
- A el Asri
- Service de médecine interne, hôpital Ibn-Sina, 10000 Rabat, Maroc
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Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E. Risk Stratification for Subclavian Artery Angioplasty:Is There an Increased Rate of Restenosis After Stent Implantation? J Endovasc Ther 2001. [DOI: 10.1583/1545-1550(2001)008<0550:rsfsaa>2.0.co;2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E. Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation? J Endovasc Ther 2001; 8:550-7. [PMID: 11797967 DOI: 10.1177/152660280100800603] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare long-term patency after balloon angioplasty of stenotic or occluded subclavian arteries with and without adjunctive stenting and to identify independent risk factors for restenosis after balloon angioplasty. METHODS In a retrospective cohort study, 115 consecutive patients (65 women; mean age 60 years, interquartile range 53-68) who underwent PTA for atherosclerotic subclavian artery obstruction within a 15-year period were included. Among these, 26 (23%) consecutive patients had Palmaz stents routinely implanted since 1996. Follow-up investigation was performed in the year 2000. Patency during the median 44-month follow-up period (interquartile range 18-69 months, minimum 12) was evaluated by oscillography, blood pressure measurement, and color-coded duplex sonography. The predictive value of possible risk factors for restenosis was assessed in a multivariate model controlling for cardiovascular comorbidities and angiographic data. RESULTS PTA success was achieved in 98 (85%) patients, 72 (81%) of 89 undergoing angioplasty alone and all 26 with stents. Complete occlusion of the vessel and long lesions (> or = 2 cm) correlated with a lower success rate. One-year patency was 76% in unstented arteries and 95% in stented lesions due to better primary technical success, but at 4 years, the patency rates were 59% in arteries with stents and 68% in arteries without. Long lesions, residual stenosis after PTA, and stent implantation were independent predictors for restenosis after successful intervention. CONCLUSIONS Subclavian arterial stent implantation is associated with better 1-year patency than PTA due to improved technical success, but intermediate and long-term outcomes are less favorable, as instent restenosis frequently occurs.
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Affiliation(s)
- M Schillinger
- Department of Internal Medicine II, University of Vienna Medical School, Austria.
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Sharma BK, Jain S, Bali HK, Jain A, Kumari S. A follow-up study of balloon angioplasty and de-novo stenting in Takayasu arteritis. Int J Cardiol 2000; 75 Suppl 1:S147-52. [PMID: 10980354 DOI: 10.1016/s0167-5273(00)00192-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Percutaneous balloon angioplasty (PTBA) is a universally accepted mode of therapy for stenotic coronary and peripheral arterial lesions. To establish the role of PTBA and stent placement in patients with Takayasu's arteritis (TA), these procedures were performed in 20 patients with TA. All patients received steroids, aspirin and ticlodipine (for stent placement) prior to procedure. Angioplasty was carried in patients with symptomatic stenotic vessel of more than 70% of normal diameter or a peak systolic gradient of more than 50 mm across stenotic aortic lesion. Stenting was performed for ostial lesion, long segment lesion or incomplete relief of stenosis and dissection following angioplasty. Carotid angioplasty and stenting was performed in five patients, aortic angioplasty in nine patients, aortic angioplasty and stenting in four patients, renal angioplasty in three patients, renal angioplasty and stenting in two patients and subclavian angioplasty in two patients, subclavian, angioplasty and stenting in three patients and coronary angioplasty and stent placement in one patient. The procedure was successful in all but one patient. On following up, two patients with carotid stent placement had restenosis. A saccular aneurysm developed at the lower end of stent in one patient with aortic stent placement. The PTBA with or without stent placement is a safe and effective method for relief of stenotic lesion in patients with TA.
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Affiliation(s)
- B K Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 160012, Chandigarh, India.
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Phatouros CC, Higashida RT, Malek AM, Meyers PM, Lefler JE, Dowd CF, Halbach VV. Endovascular Treatment of Noncarotid Extracranial Cerebrovascular Disease. Neurosurg Clin N Am 2000. [DOI: 10.1016/s1042-3680(18)30136-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Masković J, Janković S, Lusić I, Cambj-Sapunar L, Mimica Z, Bacić A. Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent. Eur J Radiol 1999; 31:193-6. [PMID: 10566520 DOI: 10.1016/s0720-048x(98)00160-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.
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Affiliation(s)
- J Masković
- Department of Radiology, Clinical Hospital Split, Croatia
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Lambert M, Hachulla E, Hatron PY, Perez-Cousin M, Beregi JP, Warembourg H, Devulder B. [Takayasu's arteritis: vascular investigations and therapeutic management. Experience with 16 patients]. Rev Med Interne 1998; 19:878-84. [PMID: 9887455 DOI: 10.1016/s0248-8663(99)80060-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There is no consensus in regard to vascular explorations and therapeutical management of Takayasu's arteritis. The objective of this study was therefore to establish the most appropriate vascular explorations and to analyze current treatments. METHODS Clinical, biological and morphological findings related to either diagnosis or treatment were retrospectively evaluated in sixteen patients diagnosed with Takayasu's arteritis according to the American College of Rheumatology criteria. RESULTS Median delay between the occurrence of the first symptoms and the diagnosis was 9 months. Aortic lesions and aortic valvular incompetence were more frequent. Statistical analysis showed the existence of a correlation between the lack of relapse and corticosteroid therapy (Fisher exact test, P = 0.021). Percutaneous transluminal angioplasty led to stabilization of vascular lesions. Surgical management led to satisfactory results, except for patients with aortic lesions, as survival was then less than 1 year. CONCLUSION Early diagnosis is mandatory in patients with Takayasu's arteritis in order to propose appropriate therapy, particularly corticosteroid therapy. Surgery and angioplasty prove to be useful in occlusive forms. Late diagnosis is accompanied by severe aortic lesions and fatal outcome.
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Affiliation(s)
- M Lambert
- Service de médecine interne A, hôpital Claude-Huriez, CHRU de Lille, France
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Abstract
Eleven patients with Takayasu Arteritis (TA) underwent angioplasty and stent placement in aorta, renal, carotid, subclavian and coronary arteries. Five wall stents were deployed in aorta in four patients. Indications for angioplasty and stent placement in aorta included hypertension in four patients and claudication and erectile impotence in one patient each. Post-procedure the peak systolic pressure gradient across the stenotic segment in the aorta disappeared. Six patients underwent angioplasty and stent placement in carotid arteries. Indications were syncope in 6 patients, loss of vision, stroke, transient ischaemic attack and seizures in one patients each. There was a marked improvement in symptoms in the patients following the procedure. For chronic total occlusion of subclavian arteries, two stents were deployed in two patients. Following the stent placement pulses in upper limb reappeared. Stents were also deployed to treat near total occlusion of right coronary artery and flow limited dissection of renal artery in one patient each. Complications of the procedure included pain in the back, mild hypertension, transient bradycardia and conduction block in one patient each. In conclusion, the stenotic and obliterative vascular lesions in TA can be managed successfully with angioplasty and stent placement. A long term follow up is required to determine the re-stenosis rate.
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Affiliation(s)
- H K Bali
- Department of Internal Medicine, and Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chapdelaine JP, Najarian KE, D'Agostino R, Morris CS. Stent placement in a carotid artery bypass graft in a patient with Takayasu arteritis. J Vasc Interv Radiol 1998; 9:846-8. [PMID: 9756078 DOI: 10.1016/s1051-0443(98)70403-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J P Chapdelaine
- Department of Radiology, University of Vermont College of Medicine, Burlington 05405, USA
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Affiliation(s)
- L A Queral
- Division of Vascular Surgery, Mercy Medical Center, Baltimore, Maryland 21202, USA
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Tyagi S, Verma PK, Gambhir DS, Kaul UA, Saha R, Arora R. Early and long-term results of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis. Cardiovasc Intervent Radiol 1998; 21:219-24. [PMID: 9626438 DOI: 10.1007/s002709900248] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the early and long-term outcomes of subclavian artery angioplasty in patients with aortoarteritis and atherosclerosis. METHODS Sixty-one subclavian artery angioplasties were performed in 55 consecutive patients with aortoarteritis (n = 32) and atherosclerosis (n = 23) between 1986 and 1995. An arch aortogram followed by a selective subclavian artery angiogram was done to profile the site and extent of the lesion, its relation to the vertebral artery, and the distal circulation. Percutaneous transluminal angioplasty (PTA) was performed via the femoral route for 56 stenotic lesions and 5 total occlusions. RESULTS PTA was successful in 52 (92.8%) stenotic lesions and 3 (60%) total occlusions. Three patients (5.4%) had complications, that could be effectively managed nonsurgically. Compared with atherosclerosis, patients with aortoarteritis were younger (27.4 +/- 9.3 years vs 54.5 +/- 10.5 years; p < 0.001), more often female (75% vs 17.4%; p < 0.001), gangrene was uncommon (0% vs 17.4%; p < 0.05), and diffuse involvement was seen more often (43.8% vs 4.4%; p < 0.001). The luminal diameter stenoses were similar before PTA (88.6 +/- 9.7% vs 89.0 +/- 9.1%; p = NS). Higher balloon inflation pressure was required to dilate the lesions of aortoarteritis (9.9 +/- 4.6 ATM vs 5.5 +/- 1.0 ATM; p < 0.001). This group had more residual stenosis (15.5 +/- 12.4% vs 8.3 +/- 9.4%; p < 0.05) after PTA. There were no neurological sequelae, even in PTA of prevertebral lesions. On 3-120 months (mean 43.3 +/- 28.9 months) follow-up of 40 patients, restenosis was more often observed in patients with aortoarteritis, particularly in those with diffuse arterial narrowing. These lesions could be effectively redilated. Clinical symptoms showed marked improvement after successful angioplasty. CONCLUSION Subclavian PTA is safe and can be performed as effectively in aortoarteritis as in atherosclerosis, with good long-term results. Long-term follow-up shows that it provides good symptomatic relief.
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Affiliation(s)
- S Tyagi
- Department of Cardiology, G.B. Pant Hospital, Maulana Azad Medical College, New Delhi, India
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Joseph G, Krishnaswami S, Baruah DK, Kuruttukulam SV, Abraham OC. Transseptal approach to aortography and carotid artery stenting in pulseless disease. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 40:416-20; discussion 421. [PMID: 9096949 DOI: 10.1002/(sici)1097-0304(199704)40:4<416::aid-ccd23>3.0.co;2-j] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report on a patient with pulseless disease (Takayasu's arteritis) in whom access to the central circulation by extremity arterial cannulation was not possible due to absent pulses in all four limbs. The transseptal approach was used for aortography, bilateral selective carotid angiography, and successful elective stent deployment in the right common carotid artery.
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Affiliation(s)
- G Joseph
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
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Criado FJ, Twena M. Techniques for endovascular recanalization of supra-aortic trunks. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1996; 3:405-13. [PMID: 8959498 DOI: 10.1583/1074-6218(1996)003<0405:tferos>2.0.co;2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The supra-aortic are no stranger to endovascular interventions. Since the 1980s, interventionists have been evaluating and refining the use of transluminal techniques for recanalizing stenotic and occlusive lesions in these large-bore, high-flow vessels. The authors present their methodologies for evaluating, selecting, and treating supra-aortic lesions with balloon angioplasty and stenting. Helpful suggestions are offered for optimizing the outcome of these endovascular approaches to atherosclerotic occlusive disease in the supra-aortic trunks.
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Affiliation(s)
- F J Criado
- Division of Vascular Surgery, Union Memorial Hospital, Baltimore, Maryland, USA
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