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Huang Y, Xie X, Huang G, Lu W, Hong S, Chen Y, Lin Y, Fu W, Hong X, Wang L. Long-term outcomes of endovascular therapy for right subclavian artery occlusive lesions: A multi-center experience. Vascular 2024:17085381241247613. [PMID: 38631687 DOI: 10.1177/17085381241247613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To review our multi-institutional experience with endovascular therapy for right subclavian artery occlusive disease and to evaluate the long-term outcomes. METHODS We retrospectively evaluated all patients with right subclavian artery stenosis and occlusive disease who underwent endovascular therapy between March 2014 and September 2022 at two institutions. Patient baseline demographics, lesion characteristics, treatment strategies, and in-hospital and follow-up outcomes were prospectively collected and retrospectively analyzed. RESULTS Between March 2014 and September 2022, 73 patients underwent endovascular treatment at the two institutions. The dominant cause of lesions in this cohort was atherosclerosis. Three different types of lesions were summarized, and the corresponding endovascular strategies were performed. 66 patients (90.4%) underwent successful endovascular treatment, and 62 patients (84.9%) underwent balloon-expandable stent deployment. The mean perioperative in-hospital stay was 4.0 days (range, 3-6 days). Two patients died due to myocardial infarction, and one died of cerebral hemorrhage resulting from a traffic accident within 30 days of the intervention. The median follow-up time was 31.6 months (range, 12-96 months). No complications, including death, stroke, stent fractures, or migration, were noted in any patient during the follow-up period. The overall complication rate was 7/73 (9.6%), and 5/7 (6.9%) of the complications required reintervention. CONCLUSIONS Endovascular treatment of right subclavian artery lesions is safe, effective, and technically achievable. The reasonable use of balloon-expandable stents can achieve satisfactory outcomes with accurate orientation and promising patency.
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Affiliation(s)
- Yulong Huang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Xinsheng Xie
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Guoqiang Huang
- Department of Radiology, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Weifeng Lu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Shichai Hong
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Yihui Chen
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Yue Lin
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Weiguo Fu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Xiang Hong
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Lixin Wang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
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Hassan M, Mubarik A, Patel C, Haq F, Muddassir S. Atheroma of the Innominate Artery Presenting as a Transient Ischemic Attack. Cureus 2019; 11:e3961. [PMID: 30956913 PMCID: PMC6436674 DOI: 10.7759/cureus.3961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Supra-aortic atherosclerotic lesions, including innominate artery atheromas, are an uncommon but established cause of transient ischemic attacks, stroke, upper extremity ischemia, and vertebrobasilar insufficiency. We present a patient with a transient ischemic attack admitted with right hemispheric symptoms who was found to have a severe ulcerated innominate artery atheroma. The patient underwent an aortic arch angiogram with stenting of the innominate artery. The proper diagnosis, treatment, and management of innominate artery atheromas are imperative to prevent further cardiovascular morbidity and mortality in patients. Currently, both endovascular and surgical options are available for revascularization, and there have been no randomized controlled trials comparing endovascular versus open repair to standardize one as the standard of care over the other. No randomized controlled trials are examining the benefit of dual versus single antiplatelet therapy post-stenting in supra-aortic atherosclerotic lesions. We believe that this topic warrants further research and needs evidence-based guidelines to help direct physicians about treatment and management.
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Affiliation(s)
- Moin Hassan
- Internal Medicine, North Shore Medical Center, Salem, USA
| | - Ateeq Mubarik
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Chirag Patel
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Furqan Haq
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
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Mahler F. Trends in percutaneous transluminal angioplasty (PTA): application of laser and new mechanical devices. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1358836x9000100104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bergqvist D, Jonsson K, Weibull H. Complications after Percutaneous Transluminal Angioplasty of Peripheral and Renal Arteries. Acta Radiol 2016. [DOI: 10.1177/028418518702800102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This review deals with complications after percutaneous transluminal angioplasty (PTA). First some methodologic points are discussed. It seems important to standardize the way in which complications are reported. Our own complications in peripheral and renal PTA are summarized and taken as a basis for an analysis of various types of complications. Principally these may occur at different levels: at the puncture site, at the dilatation site as well as distant and general complications. To make comparisons with surgical series relevant it is suggested that all complications and mortality within 30 days are reported.
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Satti SR, Golwala SN, Vance AZ, Tuerff SN. Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach. Interv Neuroradiol 2016; 22:340-8. [PMID: 26861024 DOI: 10.1177/1591019916628321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/01/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION In symptomatic subclavian steal syndrome, endovascular treatment is the first line of therapy prior to extra-anatomic surgical bypass procedures. Subintimal recanalization has been well described in the literature for the coronary arteries, and more recently, in the lower extremities. By modifying this approach, we present a unique retrograde technique using a heavy tip microwire to perform controlled subintimal dissection. METHODS We present two cases of symptomatic subclavian steal related to chronic total occlusion of the left subclavian artery and right innominate artery, respectively. Standard crossing techniques were unsuccessful. Commonly at this point, the procedures would be aborted and open surgical intervention would have to be pursued. In our cases, retrograde access was easily achieved via an ipsilateral retrograde radial artery, using controlled subintimal dissection and a heavy-tipped wire. RESULTS We were able to easily achieve recanalization in both attempted cases of chronic total occlusion of the subclavian and innominate artery, using a retrograde radial subintimal approach. Subsequent stent-supported angioplasty resulted in complete revascularization. No major complications were encountered during the procedures; however, one patient did develop thromboembolic stroke secondary to platelet aggregation to the stent graft, 9 days post-procedure. CONCLUSIONS Endovascular treatment is considered the first-line intervention in medically refractory patients with symptomatic subclavian steal syndrome. In the setting of chronic total occlusions, a retrograde radial subintimal approach using a heavy tip wire for controlled subintimal dissection is a novel technique that may be considered when standard approaches and wires have failed.
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Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med 2010; 16:29-34. [PMID: 21078767 DOI: 10.1177/1358863x10384174] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral artery disease assessment typically focuses on the evaluation of lower extremity symptoms and physical findings. Few practitioners consider the importance of upper extremity arterial disease; which, besides causing hand and arm symptoms, can be associated with significant neurologic and cardiac sequelae. A review of the existing literature through PubMed using the search term 'subclavian stenosis' was performed. The latest original articles, including clinical studies, case reports and limited reviews of this topic were adapted. A comprehensive article review focusing on the diagnostic and treatment approach for subclavian stenosis was prepared. In conclusion, vascular medicine practitioners including cardiologists and vascular surgeons caring for patients with arterial disease should routinely assess for subclavian stenosis. There are excellent screening tools and effective medical therapies which can be instituted if diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness.
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Affiliation(s)
- Victor M Ochoa
- Division of Cardiology, University of California San Francisco, San Francisco, CA 94143-0103, USA
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Chikada M. An experimental study of surgical ultrasonic angioplasty: its effect on atherosclerosis and normal arteries. Ann Thorac Surg 2004; 77:243-6. [PMID: 14726069 DOI: 10.1016/s0003-4975(03)01191-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We have developed a new hand-held probe for surgically open ultrasonic angioplasty. Two experimental studies were conducted to determine the optimal power range for carrying out ultrasonic angioplasty. METHODS The probe measured 2.5 mm in diameter and 5 cm in length. The amplitude was 210 microm at 100% power. One of the studies was designed to determine the power range that is effective for removal of atherosclerotic lesions. Human cadaveric arteries were used in the study. The other study was designed to investigate the long-term adverse effect on normal arteries. Canine arteries were used in this study. RESULTS In the study using cadaveric arteries, the amplitude ranging from 90 to 110 microm was effective for soft atheroma, the range from 110 to 130 microm was effective for mild arteriosclerosis, and 150 microm was effective for calcified lesions. The other study of the long-term effect on canine normal arteries indicated that each incidence of stenosis and occlusion was 0% at amplitude ranging from 90 to 110 microm, 13% at 130 microm, and 25% at 150 microm. CONCLUSIONS The surgically open ultrasonic angioplasty with a new hand-held probe was effective for various kinds of atherosclerotic lesions, whereas the angioplasty at high amplitude had a problem with the long-term effect on normal arteries.
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Affiliation(s)
- Masahide Chikada
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan.
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Grimm J, Müller-Hülsbeck S, Jahnke T, Hilbert C, Brossmann J, Heller M. Randomized study to compare PTA alone versus PTA with Palmaz stent placement for femoropopliteal lesions. J Vasc Interv Radiol 2001; 12:935-42. [PMID: 11487673 DOI: 10.1016/s1051-0443(07)61572-3] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether percutaneous transluminal angioplasty (PTA) combined with Palmaz stent placement provides long-term advantages compared to PTA alone after 34 months of follow-up in the femoropopliteal region. MATERIALS AND METHODS Thirty patients randomized to undergo PTA in combination with stent placement and 23 patients randomized to undergo PTA alone were evaluated. RESULTS Mean follow-up (+/-SD) for the PTA group was 33.8 months (+/- 8.7) and for the Palmaz group 29.1 months (+/- 6.2), with a maximum follow-up period of 39 months for both groups. No significant differences in primary or secondary patency rates could be observed at 12 or 39 months. After 39 months, the primary patency rate for PTA alone was 68.4% and the secondary patency rate was 89.5%; the primary patency rate for PTA with stent placement was 62% and the secondary patency rate was 90%. CONCLUSIONS The results of this study show that even after a long-term follow up of more than 3 years, PTA with stent placement in the femoropopliteal artery does not produce better results than PTA alone, although it does provide better initial luminal gain after the procedure.
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Affiliation(s)
- J Grimm
- Klinik für Diagnostische Radiologie, Christian-Albrechts Universität zu Kiel, A.-Heller Str. 9, D-24105 Kiel, Germany.
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Chong PF, Golledge J, Greenhalgh RM, Davies AH. Exercise therapy or angioplasty? A summation analysis. Eur J Vasc Endovasc Surg 2000; 20:4-12. [PMID: 10906290 DOI: 10.1053/ejvs.2000.1112] [Citation(s) in RCA: 20] [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
OBJECTIVES To compare the outcome of exercise therapy or angioplasty for the treatment of patients with intermittent claudication. DESIGN A summation analysis. METHODS A search using MEDLINE and PUBMED between 1966 and April 1999 followed by a review of the manuscripts yielded 54 studies involving angioplasty and 27 studies involving exercise therapy for intermittent claudication. Studies were only included (12 angioplasty and nine exercise series) when results were available for patients with intermittent claudication alone, and when outcome was assessed in terms of symptoms at a minimum of 6 months. RESULTS The total number of claudicants undergoing exercise therapy was 294 patients, with a mean symptomatic success rate of 38. 4% and a mean improvement in maximum walking distance of 189.7% at 6 months. The total number of claudicants undergoing angioplasty was 2071, with a mean overall symptomatic success rate of 76.6%. The mean overall complication rate was 9% and mean major complication rate was 2.7% for the angioplasty studies. CONCLUSION Although the result demonstrates an advantage of angioplasty over exercise therapy at 6 months, there is a small risk of major complications. However, comparison of studies was impaired due to disparity in patient numbers, limited follow-up time and lack of uniformity in outcome assessment. In order to achieve a valid comparison of these therapies in a future randomised study, a validated disease-specific instrument for the assessment of symptomatic outcome for claudicants is required.
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Affiliation(s)
- P F Chong
- Department of Vascular Surgery, Charing Cross Hospital, London, U.K
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Chetter IC, Spark JI, Scott DJ, Kester RC. Does angioplasty improve the quality of life for claudicants?: A prospective study. Ann Vasc Surg 1999; 13:93-103. [PMID: 9878663 DOI: 10.1007/s100169900226] [Citation(s) in RCA: 23] [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
This study aims to analyze the impact of percutaneous transluminal angioplasty (PTA) for claudication on patients' quality of life (QOL). The patients in this study included 108 claudicants, 74 men and 34 women, with a median age of 67 years (range 40-87 years), who were assessed prior to and at 1, 3, and 6 months following PTA. This is the first report to demonstrate that the previously well-documented improvements in the clinical indicators of lower-limb ischemia are accompanied by improvements in individual QOL domains and in overall global QOL. These findings are detectable within a month following PTA and last at least 6 months. The results of this study may go some way to provide proof of efficacy for the procedure and thus help justify the recently questioned widespread use of PTA in clinical practice.
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Affiliation(s)
- I C Chetter
- Department of Vascular and Endovascular Surgery, St. James's and Seacroft University Hospitals, Leeds, UK
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11
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Golledge J, Ferguson K, Ellis M, Sabharwal T, Davies AH, Greenhalgh RM, Powell JT. Outcome of femoropopliteal angioplasty. Ann Surg 1999; 229:146-53. [PMID: 9923812 PMCID: PMC1191620 DOI: 10.1097/00000658-199901000-00019] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess prospectively the outcome of femoropopliteal angioplasty and investigate prognostic indicators of success. BACKGROUND Percutaneous transluminal angioplasty is commonly used to treat symptomatic femoropopliteal stenoses or occlusions, but the durability of the procedure is uncertain. METHODS Seventy-four consecutive patients treated by femoropopliteal angioplasty for intermittent claudication (43), rest pain (4), and tissue loss (27) were followed by assessment of symptoms, ankle-brachial pressure index (ABPI) to measure hemodynamic outcome, and duplex monitoring of velocity gradient at the angioplasty site to identify restenosis at 1 day and 3, 6, 9, and 12 months. Univariate comparisons, life table analysis, and backward stepwise regression were used to investigate factors predicting the symptomatic and hemodynamic outcome and restenosis. RESULTS Technical success was obtained in 67 patients (91%); failure occurred in 7 patients. At 1 year, a successful symptomatic outcome was achieved in 35 patients (51%), hemodynamic success was achieved in 41 patients (58%), and restenosis developed in 39%. ABPI at 24 hours after angioplasty was the most significant variable predicting a symptomatic outcome, hemodynamic outcome, and restenosis at 12 months. Life table analysis demonstrated that in 24% of patients with a 24-hour ABPI > or =0.9, restenosis developed by 12 months, compared with 64% of patients with a 24-hour ABPI <0.9. CONCLUSION Only half of the patients treated by femoropopliteal angioplasty had symptomatic improvement at 1 year, raising concern about the cost-benefit ratio of this procedure. Restoration of ABPI to >0.9 predicted a favorable outcome.
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Affiliation(s)
- J Golledge
- Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
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Abstract
Intermittent claudication is a relative indication for vascular reconstruction. Conservative management with a combination of risk factor control, exercise training and medical therapy will relieve or at least improve claudication in some patients. If claudication precludes gainful employment or imposes an unacceptable alteration in lifestyle, surgical revascularization should be considered. Surgical bypass for claudication will produce optimal results in younger patients, in whom near-normalization of the ankle/brachial index can be anticipated. Proximal axial (in-line) reconstructions maintain their patencies longer than more distal, and often technically more challenging, bypasses. These tenets also apply well to percutaneous transluminal angioplasty. Both surgical and catheter-based interventions carry potential risks of short- and long-term morbidity, although overall morbidity associated with surgery for claudication is acceptably low. Interventions are justified only if they are safe, effective and durable, and if they are performed after the long-term prognosis for both life and limb is considered.
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Affiliation(s)
- T A Whitehill
- Department of Surgery, University of Colorado Health Sciences Center, Denver 80262-0312, USA
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Miranda Júnior F, Perez MDC, Plavnik F, Francisco Júnior J, Burihan E. Percutaneous transluminal angioplasty in the treatment of renovascular hypertension: sequential prospective study. SAO PAULO MED J 1998; 116:1613-7. [PMID: 9699383 DOI: 10.1590/s1516-31801998000100004] [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: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the use of percutaneous transluminal renal angioplasty (PTRA) in the treatment of renal vascular hypertension. DESIGN Sequential prospective PTRA treatment of severe arterial hypertension, screening by the captopril test, confirmed by renal arteriography, and the result evaluated by post-PTRA arteriography, blood pressure measurement and renal function. SITE: Vascular Surgery, angioradiology sector, and Nephrology outpatients department of the Federal University of São Paulo-Paulista School of Medicine, São Paulo, Brazil, a tertiary health-care institution. PARTICIPANTS PTRA was employed on 32 patients screened by clinical examination, captopril test and renal arteriography. EVALUATION PTRA results were evaluated by the criteria of the Cooperative Study of Renovascular Hypertension. RESULTS After PTRA the completion arteriography showed no renal stenosis in 24 patients (75%), residual stenosis (20-50%) in 3 (9.4%) and no change in 5 (15.6%). The blood pressure results were: 3 patients (9.4%) were cured, 24 (75%) improved and 5 (15.6%) were unchanged. We observed normal renal function before and after PTRA in 25 patients (78%); altered pre- and improved post-PTRA in 2 (6.3%); post-PTRA remained unaltered in 2 (6.3%); and altered pre- and worsened post-PTRA in 3 (9.4%). Recurrence of stenosis occurred in one patient after 8 months. CONCLUSIONS PTRA is a convenient procedure, relatively safe and an effective complementary method of medical therapy for controlling renovascular hypertension.
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Affiliation(s)
- F Miranda Júnior
- Department of Surgery and Nephrology, Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
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Nyamekye I, Sommerville K, Raphael M, Adiseshiah M, Bishop C. Non-invasive assessment of arterial stenoses in angioplasty surveillance: a comparison with angiography. Eur J Vasc Endovasc Surg 1996; 12:471-81. [PMID: 8980440 DOI: 10.1016/s1078-5884(96)80017-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Comparison of non-invasive arterial measurements with angiography and their use for angioplasty surveillance. DESIGN Prospective assessments of arterial stenoses in patients undergoing angioplasty in a 9 month surveillance period. MATERIALS Fifty consecutive patients undergoing angioplasty. METHODS (i) One hundred and thirty-one sets of clinical assessments, ankle brachial Doppler pressure indices and colour Duplex velocities and diameters were compared to time-matched angiographic diameter stenosis. (ii) Fifty patients undergoing femoropopliteal angioplasty (32 stenoses and 18 occlusions) were studied with ankle branchial Doppler pressure indices and colour Duplex and angiography during a 9 month surveillance period. RESULTS (i) Symptoms, pulses, resting ABPI, and exercise ABPI showed no useful correlation with angiography. Duplex velocity ratio and Duplex diameters showed correlation and agreement with angiography respectively. (ii) On surveillance, restenosis was universal but not always clinically significant. Angioplasty caused a rapid improvement in ABPI and imaging studies which worsened at later times. ABPI did not predict clinical failure however, Duplex and angiography predicted all clinical failures. CONCLUSIONS Restenosis should be assessed with imaging of the angioplasty site during angioplasty surveillance.
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Affiliation(s)
- I Nyamekye
- U.C.L. Hospitals Vascular Unit, Middlesex Hospital, London, U.K
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Varty K, Nydahl S, Butterworth P, Errington M, Bolia A, Bell PR, London NJ. Changes in the management of critical limb ischaemia. Br J Surg 1996; 83:953-6. [PMID: 8813785 DOI: 10.1002/bjs.1800830722] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A prospective study of all patients with critical limb ischaemia (CLI) who presented to a single vascular unit was undertaken for a 12-month period. There were 222 referrals in 188 patients, 80.2 per cent of which were emergency or urgent admissions. The majority (72.5 per cent) were initially investigated with colour duplex scanning to characterize the arterial lesion. Diagnostic angiography was performed in 35.1 per cent. An attempt at revascularization was made in 73.0 per cent of cases using percutaneous transluminal angioplasty (PTA) in 42.3 per cent, surgery in 24.3 per cent, and a combination of surgery and PTA in 6.3 per cent. Primary major amputation was required in 22 cases (9.9 per cent) and conservative treatments were used in 38 (17.1 per cent). The in-hospital mortality rate was 10 per cent with a limb salvage rate of 79 per cent. Diabetes was an independent risk factor for amputation (odds ratio 2.4, 95 per cent confidence interval 1.22-4.79, P = 0.012). Median hospital stay was much shorter for patients treated by PTA (4.5 days) than surgery (16 days) or primary amputation (18 days). The complication rate of PTA requiring surgery was 5.5 per cent. CLI represents a large non-elective workload for a vascular unit. The increasing use of non-invasive duplex assessment and angioplasty plays a major part in the successful management of these patients.
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Affiliation(s)
- K Varty
- Department of Surgery, University of Leicester, Leicester Royal Infirmary, UK
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Isner JM, Walsh K, Rosenfield K, Schainfeld R, Asahara T, Hogan K, Pieczek A. Arterial gene therapy for restenosis. Hum Gene Ther 1996; 7:989-1011. [PMID: 8727510 DOI: 10.1089/hum.1996.7.8-989] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Cikrit DF, Gustafson PA, Dalsing MC, Harris VJ, Lalka SG, Sawchuk AP, Trerotola SO, Snidow JJ, Johnson MS, Solooki B. Long-term follow-up of the Palmaz stent for iliac occlusive disease. Surgery 1995; 118:608-13; discussion 613-4. [PMID: 7570312 DOI: 10.1016/s0039-6060(05)80025-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Thirty-eight limbs with iliac occlusive disease were treated with Palmaz stents from 1987 through 1991. METHODS Indications for stent utilization included dissection induced by percutaneous transluminal balloon angioplasty (PTA) (10), restenosis after PTA (nine), post-PTA residual stenosis (nine), multiple stenoses or occlusion (five), and unfavorable location (five). RESULTS The ankle/brachial pressure index increased from 0.53 +/- 0.27 to 0.8 +/- 0.26 after stent deployment. The intraluminal pressure gradient decreased from 31.9 +/- 16.3 to 0.9 +/- 2.2 mm Hg after stent deployment. Complications included pseudoaneurysm (one), arteriovenous fistula (one), iliac perforation (one), groin hematoma (two), and occlusion (two). Follow-up arteriogram showed stenosis proximal or distal (n = 4) or within the stents (n = 4). These were treated with PTA or stents. Two patients required an aortobifemoral graft. Nine patients have died. Life table analysis showed a 1-, 3-, and 5-year primary and secondary cumulative patency of 87% +/- 5.9%, 74% +/- 8.2%, and 63% +/- 10% and 91% +/- 5.1%, 91% +/- 5.6%, and 86% +/- 7.6%, respectively. CONCLUSIONS Palmaz stents, often required to salvage a PTA failure, appear to maintain overall patency at a high level. However, intimal hyperplasia and the progression of atherosclerotic disease may result in a need for additional procedures to obtain this favorable outcome.
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Affiliation(s)
- D F Cikrit
- Department of Surgery, Indiana University Medical Center, Richard L. Roudebush Veterans Administration Hospital, Indianapolis 46202, USA
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Gussenhoven EJ, van der Lugt A, Pasterkamp G, van den Berg FG, Sie LH, Vischjager M, The SH, Li W, Pieterman H, van Urk H. Intravascular ultrasound predictors of outcome after peripheral balloon angioplasty. Eur J Vasc Endovasc Surg 1995; 10:279-88. [PMID: 7552525 DOI: 10.1016/s1078-5884(05)80043-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study investigates the potential role of intravascular ultrasound (IVUS) in the outcome in patients undergoing percutaneous transluminal angioplasty (PTA) of the superficial femoral artery. MATERIALS Angiographic and the qualitative and quantitative IVUS data obtained at the narrowest site derived from 39 patients before and after PTA were analysed. RESULTS Angiographically the diameter of the remaining stenosis seen after PTA was classified as < 50% in 31 patients (success); in eight patients a failure was encountered. Evaluating at 6 months the functional and anatomic results of the PTA in 31 patients, the intervention was a success in 14 patients (Group I) and a failure in 17 patients (Group II). The remaining eight patients defined as angiographic failure following PTA comprised Group III. Neither qualitative nor quantitative IVUS data obtained before PTA could predict outcome. Conversely, after PTA, the extent of dissection was significantly more severe in Groups II and III than in Group I. Similarly, significant differences were found between Groups I and II for mean free lumen area (13.2 vs. 9.7 mm2, respectively) and mean free lumen diameter (4.1 vs. 3.5 mm, respectively). Quantitative data obtained in Group II were similar to those in Group III. CONCLUSION This preliminary study demonstrates that following PTA the extent of dissection, free lumen area and diameter seen with IVUS are predictive factors of patency. Future studies with more patients are mandatory to further highlight the sensitivity of these observations.
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Golledge J, Torrie EP, Galland RB. Lysis-assisted angioplasty in the treatment of lower-limb arterial thrombosis. Br J Surg 1995; 82:762-4. [PMID: 7627506 DOI: 10.1002/bjs.1800820616] [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: 01/26/2023]
Abstract
This study examined the results in 30 patients treated with lysis-assisted angioplasty and compared them with the results of 30 patients with simple stenotic disease treated by angioplasty alone. One patient died on the day of treatment with lysis-assisted angioplasty from arterial perforation and haemorrhage. Of the remaining 29 patients 16 (55 per cent) were symptomatically improved and 13 had early reocclusion. Six patients developed major complications (two deaths, two major haemorrhage, two cerebrovascular accident). The late results were comparable to those for patients undergoing angioplasty alone. The best outcome was obtained in patients with proximal disease (P < 0.01); poor run-off or critical ischaemia did not preclude a good outcome.
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Affiliation(s)
- J Golledge
- Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK
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21
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Isner JM, Rosenfield K. Redefining the treatment of peripheral artery disease. Role of percutaneous revascularization. Circulation 1993; 88:1534-57. [PMID: 8403302 DOI: 10.1161/01.cir.88.4.1534] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- J M Isner
- Department of Medicine, St Elizabeth's Hospital, Tufts University School of Medicine, Boston, Mass. 02135
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Abstract
OBJECTIVES The purpose of this study was to present follow-up data as well as short-term results on a larger clinical series of patients undergoing ultrasound angioplasty. BACKGROUND Previous pilot studies have demonstrated the feasibility of peripheral arterial ultrasound angioplasty. METHODS We performed percutaneous ultrasound angioplasty on 50 arterial lesions in 45 patients. Our ultrasound ablation system had a frequency of 19.5 kHz. A fixed-wire probe with 2- or 3-mm ball tips and a 3-mm over-the-wire probe were used to treat 40 femoral, 7 popliteal and 3 tibioperoneal lesions. Seventeen (34%) of the lesions were calcific. Thirty (86%) of 35 occluded segments, 0.5 to 28 cm long (mean 6.2 +/- 5.7), were recanalized. RESULTS In the 45 patent arteries, the stenosis decreased from 94 +/- 10% to 55 +/- 23% after ultrasound angioplasty and to 12 +/- 8% after balloon angioplasty. Mechanical arterial dissections (n = 4) and perforations (n = 4) without clinical consequence occurred only with the fixed non-over-the-wire probes. No evidence of embolism or vasospasm was detected; in fact, vasodilation occurred. There were no clinical manifestations of acute reocclusion. At 24 h, ankle-brachial indexes increased by 0.23 +/- 0.21 (range -0.27 to 0.72). Six- to 12-month clinical and ankle-brachial index follow-up data for 35 patients treated with ultrasound and adjunctive balloon angioplasty were indicative of restenosis in 7 patients (20%). CONCLUSIONS Our findings indicate that percutaneous peripheral ultrasound angioplasty 1) is useful for recanalization of fibrous, calcific and thrombotic arterial occlusions; 2) reduces arterial stenoses; and 3) has clinical and ankle-brachial index data indicative of a restenosis rate of 20% at 6 to 12 months in a small cohort of patients. A larger randomized series of patients will need to be studied to assess the impact of ultrasound ablation on restenosis.
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Affiliation(s)
- R J Siegel
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048
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Kidney D, Murphy J, Malloy M. Balloon-expandable intravascular stents in atherosclerotic iliac artery stenosis: preliminary experience. Clin Radiol 1993; 47:189-92. [PMID: 8472482 DOI: 10.1016/s0009-9260(05)81160-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ten patients with symptomatic iliac artery stenosis underwent percutaneous insertion of balloon-expandable intravascular stents. A total of 12 stents were inserted in the common iliac (7 patients) and external iliac (3 patients) arteries. The indications for placement were unsuccessful angioplasty (5 cases), to improve inflow prior to a subsequent distal bypass graft (3 cases) and localized iliac disease in patients deemed unfit for aorto-femoral by-pass surgery (2 cases). Of the 10 patients, five had rest pain and five had severe intermittent claudication at distances varying from 25 to 75 yards, prior to the procedure. Ankle-Arm Doppler systolic pressure indices increased from a mean of 0.61 to 0.91 post procedure. Eight of the 10 patients are asymptomatic at follow-up, average 12 months (range 8-18 months). One patient died from an unrelated cause and the other patient remains symptomatic due to distal disease (Table 1). Our experience suggests that percutaneous insertion of balloon-expandable intravascular stents is a valuable technique for treatment of external and common iliac stenosis.
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Affiliation(s)
- D Kidney
- Diagnostic Imaging Department, St James's Hospital, Dublin, Ireland
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25
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Do-dai-Do, Triller J, Walpoth BH, Stirnemann P, Mahler F. A comparison study of self-expandable stents vs balloon angioplasty alone in femoropopliteal artery occlusions. Cardiovasc Intervent Radiol 1992; 15:306-12. [PMID: 1423391 DOI: 10.1007/bf02733955] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a group of 26 patients percutaneous transluminal (balloon) angioplasty (PTA) and stents (Wallstents) were applied and in another 26 matched patients PTA alone was used as primary treatment for femoropopliteal occlusions of 3 cm or longer. Five patients with stents showed early thrombosis necessitating catheter thrombolysis and/or thrombus aspiration. Ten patients had recurrent stenoses within 12 months, mostly due to neointimal hyperplasia. Following three late catheter reinterventions, a cumulative secondary patency rate of 69% was achieved after 12 months. The group of patients treated by PTA alone showed a 12 months patency rate of 65% without reinterventions. In 8 other patients, stents were inserted for recurrent obstructive or PTA-resistant lesions, and similar results as with the stents above were obtained. Thus, these stents do not improve primary results of PTA in femoropopliteal occlusions but may be useful secondarily after unsuccessful PTA.
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Affiliation(s)
- Do-dai-Do
- Department of Medicine, University of Bern, Switzerland
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26
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Abstract
Endovascular surgery is a new multidisciplinary field that applies the recently innovated techniques of angioscopy, intraluminal ultrasound, balloon angioplasty, laser, mechanical atherectomy, and stents. This field can be defined as a diagnostic and therapeutic discipline that uses catheter-based systems to treat vascular disease. As such, it integrates the subspecialties of vascular surgery, interventional radiology, interventional cardiology, and biomedical engineering for the common purpose of improving arterial hemodynamics. Endovascular surgery offers many potential benefits: long incisions are replaced with a puncture wound, the need for postoperative intensive care is significantly reduced, major cardiac and pulmonary complications from general anesthesia are side stepped, and the dollar savings could be dramatic as the need for intensive care unit and in-hospital stay diminishes. Despite these technological advancements, endovascular surgery is still in its infancy and currently has limited applications. This review provides an updated summary of endovascular surgery today and addresses some of the obstacles still preventing its widespread use.
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Affiliation(s)
- S S Ahn
- Section of Vascular Surgery, UCLA Center for the Health Sciences 90024
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27
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Ahn SS, Eton D, Yeatman LR, Deutsch LS, Moore WS. Intraoperative peripheral rotary atherectomy: early and late clinical results. Ann Vasc Surg 1992; 6:272-80. [PMID: 1610659 DOI: 10.1007/bf02000274] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early and late clinical results of intraoperative peripheral atherectomy using the Auth Rotablator are analyzed. Twenty patients (15 males and 5 females age 39-89 years, mean 70 years) underwent 25 atherectomy procedures for peripheral arterial occlusive disease from August 1987 to October 1989. All patients underwent serial history, physical exam, and Doppler pressure measurements preoperatively and then postoperatively at 24 hours, one week, one month, and six months during a follow-up period of 15 to 41 months, mean 27 months. Preoperative and intraoperative completion follow-up arteriography was done in all cases and follow-up arteriography in 19 of 25 cases. Initial arteriographic success was achieved in 23/25 (92%) cases and in 39/41 (93%) arterial segments (superficial femoral artery 12/13, popliteal 14/15, tibial 12/13, profunda-femoral 1/1). Complications included intimal dissection (1), equipment breakage (2), minor emboli (3), major emboli with thigh skin loss (1), transient hemoglobinuria (4), wound hematoma (1), wound infection (1), and limb loss (1). Early thrombosis occurred in five cases to give an in-hospital success rate of 18/25 (72%). Primary patency was 66% at six months but only 12% at two years. Rotary atherectomy effectively recanalizes femoral, popliteal and tibial arteries. However, early thromboembolic complications occurred frequently, and the two year patency was dismal. Rotary atherectomy is not recommended for general use until problems of thromboemboli and intimal hyperplasia are solved.
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Affiliation(s)
- S S Ahn
- Department of Surgery/Vascular, UCLA School of Medicine 90024-6904
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28
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Ahn S, Rutherford RB. A multicenter prospective randomized trial to determine the optimal treatment of patients with claudication and isolated superficial femoral artery occlusive disease: conservative versus endovascular versus surgical therapy. J Vasc Surg 1992; 15:889-91. [PMID: 1533686 DOI: 10.1016/0741-5214(92)90736-r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Mitchell DC, Murray A, Wood RF, Grasty M, Smith RE, Dacie JE, Walters TK, Cotton G. Laser-assisted angioplasty for arterial occlusion of the lower limb: initial results and follow-up. Br J Surg 1992; 79:81-5. [PMID: 1737287 DOI: 10.1002/bjs.1800790129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A flashlamp-pumped pulsed dye laser operating at either 480 or 504 nm, coupled to an integral ball-tipped optical fibre, was used to recanalize occluded lower limb arteries. All channels created by the laser were augmented with balloon dilatation. We have treated 78 limbs in 71 patients; 46 limbs (59 per cent) had rest pain and 22 (48 per cent) of these had tissue loss. The median occlusion length was 18 (range 0.5-58) cm. Technical success was achieved in 58 limbs (74 per cent) with clinical success in 46 (59 per cent). Success rates fell with increasing length of occlusion. Two patients died in the perioperative period. A subgroup of 22 patients with marked discrete arterial calcification had a lower technical success rate than the subgroup without calcification (50 per cent versus 84 per cent, P less than 0.01). Both subgroups displayed a similar pattern of reclosure during follow-up. The cumulative patency rate after technical success was 67 per cent at 6 months and 45 per cent at 12 months. Forty-six (59 per cent) limbs avoided bypass surgery or amputation. Laser-assisted angioplasty may offer an alternative to femoropopliteal bypass, although the former procedure is not as durable.
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Affiliation(s)
- D C Mitchell
- Professorial Surgery Unit, St. Bartholomew's Hospital, London, UK
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32
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Smits PC, Borst C. Laser angioplasty versus balloon angioplasty: The need for imaging. Lasers Med Sci 1991. [DOI: 10.1007/bf02030875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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Arlart IP, Gerlach A, Grass HG. Laser-assisted balloon angioplasty in complete femoropopliteal occlusions: preliminary results. Cardiovasc Intervent Radiol 1991; 14:233-7. [PMID: 1833059 DOI: 10.1007/bf02578468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Laser-assisted balloon angioplasty (LA) using a Nd-YAG laser with a sapphire tip probe was performed in 40 selected patients with complete chronic femoropopliteal occlusions (SFA n = 30, PA n = 10), in whom the lesion was resistant to conventional guidewire/catheter traversal. Overall technical success rate was 77.5% (31/40). Technical failure occurred in nine cases due to calcifications (n = 2), imminent perforation (n = 5), or complete perforation (n = 4). In 1 case a Simpson atherectomy was done following LA. In addition, 3 cases of peripheral embolizations were managed successfully by selective fibrinolysis and thrombus aspiration. Follow-up studies up to 14 months demonstrated a clinical improvement in 87% (27/31). Early reocclusion rate was 4/31; after 2-14 months, reocclusion rate was 7/31. Our results demonstrate that LA may be recommended for chronic occlusions resistant to conventional guidewire or catheter traversal in spite of a relatively high rate of technical failure and complications, and recurrence.
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Affiliation(s)
- I P Arlart
- Radiologisches Institut, Katharinenhospital Stuttgart, FRG
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34
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35
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Jørgensen B, Meisner S, Holstein P, Tønnesen KH. Early rethrombosis in femoropopliteal occlusions treated with percutaneous transluminal angioplasty. EUROPEAN JOURNAL OF VASCULAR SURGERY 1990; 4:149-52. [PMID: 2140988 DOI: 10.1016/s0950-821x(05)80429-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
One hundred and thirty-seven consecutive percutaneous transluminal angioplasties (PTA) were performed for femoropopliteal vascular disease including 58 stenoses and 79 total occlusions. Nine occlusions could not be crossed with the guidewire, but in the remaining 128 the haemodynamic and clinical success as well as vascular patency were evaluated. The results were grouped into the following subsets: the indication for PTA, the severity of the vascular lesion, the crural run-off and the length of lesion. The results were in every respect poor with total occlusions when compared with stenoses. This was explained by a high incidence (41%) of rethrombosis within hours of dilatation. Early rethrombosis was seen with all lengths of occlusion (1-27 cm) with no statistically significant difference from other subsets. This study concludes that conventional PTA in femoropopliteal occlusions should be reserved for cases of limb salvage, preferably in patients who are technically inoperable. We suggest a new technique of segmentally enclosed thrombolysis to prevent early rethrombosis after PTA in femoropopliteal occlusions.
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Affiliation(s)
- B Jørgensen
- Department of Clinical Physiology, Bispebjerg Hospital, University of Copenhagen, Denmark
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36
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von Pölnitz A, Nerlich A, Berger H, Höfling B. Percutaneous peripheral atherectomy: angiographic and clinical follow-up of 60 patients. J Am Coll Cardiol 1990; 15:682-8. [PMID: 2303639 DOI: 10.1016/0735-1097(90)90646-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Simpson atherectomy catheter was used to treat 60 patients with a total of 94 lesions comprising 63 stenoses (mean length 1.1 +/- 0.5 cm) and 31 occlusions (4.2 +/- 2.9 cm) of the superficial femoral (n = 77), popliteal (n = 8), iliac (n = 8) and anterior tibial (n = 1) arteries. The immediate angiographic success rate was 90% for both occlusions and stenoses, and clinical success was obtained in 82% of patients. The stenoses were reduced from 83 +/- 13% to 17 +/- 18% acutely and to 31 +/- 26% at 6 months; the occlusions were reduced from 100% to 9 +/- 9% initially and to 60 +/- 34% at 6 months. Angiographic restenosis was found in 24% of lesions: 23% in concentric and 11% in eccentric lesions and 47% in total occlusions. At 1 year, 72% of patients had clinically patent arteries with maintained Doppler index and walking distance. Three of four patients undergoing repeat atherectomy had a second restenosis. In summary, the procedure was found to be safe and effective in the treatment of peripheral vascular disease. It appears to be particularly beneficial in the treatment of eccentric stenoses and is not limited by the presence of calcification.
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Affiliation(s)
- A von Pölnitz
- Department of Medicine, Klinikum Grosshadern, Munich, Federal Republic of Germany
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37
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Baert AL, Wilms G, Amery A, Vermylen J, Suy R. Percutaneous transluminal renal angioplasty: initial results and long-term follow-up in 202 patients. Cardiovasc Intervent Radiol 1990; 13:22-8. [PMID: 2140294 DOI: 10.1007/bf02576933] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Percutaneous transluminal renal angioplasty was performed in 202 patients with 250 stenoses. The procedure was successful in 201 of 250 (83%). Results were better for postostial atherosclerotic lesions (94%), fibromuscular lesions (83%), and transplant kidneys (71%) than for ostial atherosclerotic lesions (29%). Of all the patients, 61% had reduced blood pressures following the procedure, with cure (diastolic blood pressure less than or equal to 90 mm Hg) in 31% of the patients. Cure rate with a mean follow-up of 25.8 +/- 19.4 months was 21% in bilateral atheromatous lesions, 30% in unilateral atheromatosis, 65% in unilateral fibromuscular disease, and 40% in bilateral fibromuscular dysplasia. Of the transplanted patients, 60% were cured. Complications occurred in 23 (11%) of the patients. Recurrence of stenoses occurred in 16 lesions (8%), 80% within the first year after the procedure.
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Affiliation(s)
- A L Baert
- Department of Radiology, University Hospitals K.U. Leuven, Belgium
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38
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Wilkins RA, Nunnerley HB, Allison DJ, Mason R, Kellett MJ, Cumberland DC, Sandin B. The expansion of interventional radiology. Report of a survey conducted by the Royal College of Radiologists. Clin Radiol 1989; 40:457-62. [PMID: 2529073 DOI: 10.1016/s0009-9260(89)80242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The Interventional Radiology Group of the Royal College of Radiologists sent a questionnaire to major hospitals in the United Kingdom in 1982 and 1987 in order to assess the impact of the introduction and growth of interventional procedures on patient management over the 5-year period and to consider the implications of these data for the future staffing and equipment requirements of radiology departments. In the 194 hospitals correctly completing the most recent survey, a total of 30,794 interventional procedures were performed in a 12 month period, representing an overall increase of 116% since the previous survey of 1982.
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Affiliation(s)
- R A Wilkins
- Interventional Radiology Group, Royal College of Radiologists, Northwick Park Hospital, Harrow, Middlesex
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39
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Miller A, Lipson WE, Isaacsohn JL, Schoen FJ, Lees RS. Intraoperative angioscopy: principles of irrigation and description of a new dedicated irrigation pump. Am Heart J 1989; 118:391-9. [PMID: 2750658 DOI: 10.1016/0002-8703(89)90200-7] [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: 01/02/2023]
Abstract
The value of intraoperative angioscopy in the detection and immediate correction of technical errors and deficiencies during vascular surgery has been previously documented. The inability to see through blood remains the most significant limitation to the general application of angioscopy. Local irrigation with a balanced salt solution is the most commonly used method to clear the blood from a restricted field in a particular vessel. We have developed a new catheter irrigation pump system (maximum flow rate 340 ml/min) to establish and maintain visibility of the field during intraoperative angioscopy. Furthermore, we have demonstrated the safety of irrigating with high volume flows in the peripheral arteries and defined the basic principles of irrigation for angioscopy. The prototype pump tested in this study provides a wide range of flow rates and permits precise measurements of the fluid delivered. The instrument's display and its control with a single foot pedal makes its use relatively simple, obviating the need for additional support personnel while increasing the efficacy and safety of the angioscopic examination and increasing the number of situations where angioscopy may be very useful.
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Affiliation(s)
- A Miller
- Department of Surgery, New England Deaconess Hospital, Boston, MA 02215
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40
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Beck AH, Muhe A, Ostheim W, Heiss W, Hasler K. Long-term results of percutaneous transluminal angioplasty: a study of 4750 dilatations and local lyses. EUROPEAN JOURNAL OF VASCULAR SURGERY 1989; 3:245-52. [PMID: 2526025 DOI: 10.1016/s0950-821x(89)80090-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During a period of 8 years 4750 percutaneous transluminal angioplasties and local lyses have been performed in the Department of Radiology of the University of Freiburg and the Hochrheinklinik Bad Sackingen. From 1984 to 1987 all patients have been assessed clinically and in 320 cases angiographically. Lesions were localised mainly to the pelvic and the femoro-popliteal regions. The short and long term results have been compared, i.e. 2-8 years after PTA. Patients with occlusive disease from stage IIa to stage IV were treated. Long-term success of PTA (2-8 years after the intervention) reached 85% in stage IIa, 73% in stage IIb, 68% in stage III and 36% in stage IV, when all treated lesions were included.
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Affiliation(s)
- A H Beck
- Freiburg University Hospital, Department of Radiology, FRG
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41
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Bennett IC, Downes MO, Collins RE. Distal bowel infarction following angioplasty of the internal iliac artery. Br J Radiol 1989; 62:489-90. [PMID: 2523748 DOI: 10.1259/0007-1285-62-737-489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- I C Bennett
- Department of Surgery, Kent and Canterbury Hospital
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Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery. Cardiovasc Intervent Radiol 1988; 11:127-31. [PMID: 2971443 DOI: 10.1007/bf02577101] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report the results of 50 angioplasty procedures via the popliteal artery. A 3-year follow-up including control of blood pressures at ankle and toe levels show results comparable to reports in the literature. This new approach for angioplasty of the superficial femoral artery and eventually of coexisting iliac lesions enables treatment of previously inaccessible lesions. The technique is especially suited for lesions close to the takeoff of the superficial femoral artery.
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43
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Ahn SS, Auth D, Marcus DR, Moore WS. Removal of focal atheromatous lesions by angioscopically guided high-speed rotary atherectomy. J Vasc Surg 1988. [DOI: 10.1016/0741-5214(88)90148-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Moran CG, Ruttley MS. Development of a false aneurysm following percutaneous transluminal angioplasty. Br J Surg 1987; 74:652. [PMID: 2957018 DOI: 10.1002/bjs.1800740746] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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45
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Burnett JR, Walsh JA, Howard PR, Phillips PJ, Fon GT, Dupont PA, Foreman RK, James MJ, Kneller PN. Transluminal balloon angioplasty in diabetic peripheral vascular disease. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1987; 57:307-9. [PMID: 2956941 DOI: 10.1111/j.1445-2197.1987.tb01363.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transluminal (balloon) angioplasty of iliac or superficial femoral stenoses in 18 diabetic patients resulted in a significant improvement in ankle/brachial systolic pressure index with marked symptomatic improvement in 16, little change in one and deterioration requiring arterial bypass surgery in one patient. Follow-up for 12 months or more showed that the initial good results were sustained despite a downward drift in ankle pressures. These findings indicate that transluminal angioplasty has a useful place in the management of proximal atherosclerotic stenotic lesions in diabetic patients with symptomatic peripheral vascular disease.
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Wilms G, Baert A, Dewaele D, Vermylen J, Nevelsteen A, Suy R. Percutaneous transluminal angioplasty of the subclavian artery: early and late results. Cardiovasc Intervent Radiol 1987; 10:123-8. [PMID: 2955895 DOI: 10.1007/bf02577985] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Percutaneous transluminal angioplasty of 23 subclavian arteries was attempted in 22 patients. Dilatation was successful in 3 of 4 right subclavian artery stenoses and 18 of 19 left subclavian artery stenoses. The primary clinical indication was posterior fossa ischemia in 11 patients, upper limb ischemia in 14 and both symptoms in 6. In 2 patients, dilatation of an asymptomatic high-degree left subclavian artery stenosis was performed before coronary artery bypass surgery using the internal mammary artery. Eighteen patients on follow-up over 6-60 months (mean 25 months) are free of symptoms with equivalent systolic blood pressures in both arms. Three patients showed relapse of the stenosis after 8, 12, and 15 months; one was successfully treated with a second dilatation. Complications consisted of an occlusion at the left axillary artery puncture site and a distal embolus to a finger artery. Percutaneous transluminal angioplasty appears safe and efficient therapy for subclavian artery stenoses with excellent short- and long-term results.
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McLean L, Jeans WD, Horrocks M, Baird RN. The place of percutaneous transluminal angioplasty in the treatment of patients having angiography for ischaemic disease of the lower limb. Clin Radiol 1987; 38:157-60. [PMID: 2952388 DOI: 10.1016/s0009-9260(87)80019-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A prospective survey was made during 1 year of all 226 patients having angiography for lower limb ischaemia, to assess the accuracy of selection for angiography and the current treatment of the disease. Sixty-two percent of the patients presented with intermittent claudication and were found to have a fall in ankle systolic blood pressure on exercise. Thirty-one percent had rest pain or ischaemic skin changes. All patients had abnormal angiograms, with aorto-iliac disease present in 42%, combined with distal disease in 22%. There was a normal aorto-iliac segment in 58% of patients who had more distal disease. Calf-vessels only were affected in 15%. Treatment was by surgery only in 49%, and balloon dilatation only in 19%. A further 2% had dilatation as a complement to surgery, and 6% had surgery when dilatation failed or had complications. Dilatation was attempted unsuccessfully in 6%. No treatment was offered to 20% of patients. It is concluded that selection of patients for angiography using clinical and vascular laboratory assessment avoids unnecessary examinations and that approximately one-third of these selected patients are candidates for angioplasty, which is the preferred first option for treatment in all suitable patients.
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Abstract
Of 768 angioplasties performed in our institute, 42 procedures (5%) in 39 patients were performed by a radiologist in the operating room in combination with vascular surgery; 15 ilial, 20 femoral, 5 tibial, 1 renal, and 1 brachiocephalic artery stenoses were treated. Immediate and late successes, as well as the complication rates, were comparable to those of the percutaneous approach. The main reasons for the intraoperative approach were absence of arterial pulsations, ulcerative lesions at the puncture site with risk of peripheral embolisation, and the opportunity of a surgical arteriotomy offering access to an otherwise unreachable stenotic artery. The advantages of intraoperative dilatation in combination with surgery over simple operation are the reduction of operative morbidity and mortality, shortening of the operative time, and improved results by reassuring the in- or outflow of the operated territory. The main disadvantages are the limited fluoroscopic field and the limited mobility of the fluoroscopy device.
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Korogi Y, Takahashi M. Percutaneous transluminal angioplasty of totally occluded iliac arteries in high-risk patients. Br J Radiol 1986; 59:1167-70. [PMID: 2948603 DOI: 10.1259/0007-1285-59-708-1167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Percutaneous transluminal angioplasty was performed successfully in five of six patients with complete iliac artery occlusion. All of the patients were at high risk because of various co-existing diseases. The length of occlusion ranged from 3.0 cm to 12.0 cm. No significant complications requiring surgery occurred during or after the procedures. Follow-up of patients revealed that the vessels were still patent after 3-22 months. Percutaneous transluminal angioplasty of totally occluded iliac arteries may represent the therapy of first choice even in the high-risk group.
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Fletcher JP, Little JM, Fermanis GG, Simmons K. Percutaneous transluminal angioplasty for severe lower extremity ischaemia. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1986; 56:121-5. [PMID: 2942139 DOI: 10.1111/j.1445-2197.1986.tb01867.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Percutaneous transluminal angioplasty (PTA) was attempted on 70 occasions in 63 consecutive patients presenting with advanced ischaemia. The procedure was technically successful in 64 (91%) with haemodynamic improvement in 39 (56%) and clinical improvement maintained at 6 months in 51 (73%). Follow-up ranged from 6 months to 4 years and life-table analysis showed 60% success at 1 year and 58% success at 2 years. Overall limb salvage was 76%. Complications occurred in 6 (9%) and in one case this lead to amputation. The relationship of a number of associated factors to outcome was assessed. The presence of cardiac disease requiring treatment for failure or angina was a highly significant adverse factor (P less than 0.001). Decreasing age and greater extent of disease were also significant adverse factors (P less than 0.05). Therefore, because of its low morbidity and cost, PTA can be seen as a useful procedure in patients presenting with advanced peripheral vascular disease.
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