Percutaneous transluminal abdominal aortic angioplasty

Endovascular treatment of infrarenal abdominal aortic lesions with or without common iliac artery involvement

PURPOSE

To evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery.

MATERIALS AND METHODS

Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography.

RESULTS

Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy.

CONCLUSION

Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.

[Focal atherosclerotic abdominal aortic stenosis]

We report a case of a 54-year-old woman presenting a symptomatic focal atherosclerotic abdominal aortic stenosis. Computed tomographic angiography allowed to study the lesion, the abdominal aorta and its main branches. The patient was treated via an endovascular approach using a covered stent. The postoperative course was uneventful and the patient was asymptomatic with a patent reconstruction after 18 months. Improvement in endovascular technology has totally modified the treatment of focal atherosclerotic abdominal aortic stenosis. However, many technical points remain to be determined including the necessity of systematic stenting, the type of stent to use, and the steps of the procedure.

Standards for the Endovascular Management of Aortic Occlusive Disease

Occlusive disease of the infrarenal aorta and aorto-iliac arteries can be safely treated by minimally invasive therapy and is now widely available. The aim of this article is to produce standards for the management of these patients using current endovascular techniques.

Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is technically feasible with acceptable long-term results

OBJECTIVES

To investigate the results of endovascular treatment of symptomatic, atherosclerotic lesions of the infrarenal aorta.

PATIENTS AND METHOD

This is a retrospective study including 30 procedures performed on 25 patients in the period from 1990 through 2003. There were 16 women (64%) and 9 men, with a mean age of 55 years (range 35-81 years). The indication was disabling intermittent claudication in all cases. Preoperative assessment was done with ankle-arm pressure measurement and angiography. The mean length of the lesions was 2.5cm (range 1-6cm). One lesion was a short occlusion and nine were >90% stenoses. The remaining 20 lesions were significant (>70%) stenoses. The procedure was done with PTA alone in 13 cases, and with additional stenting in 17.

RESULTS

The procedures were technically successful in 28 cases and clinically successful in all 30. In two cases, a >50% residual stenosis was not dilated further because of stretch pain. The mean observation time was 40 months (range 0-135 months). The primary 2 and 5 year patency rates calculated on basis of intention to treat were 90 and 77%. The primary assisted patency rate was 90% at 2 years and 83% at 5 years. Eight patients developed significant restenosis, of which five were treated with a new endovascular procedure. Two failures were treated conservatively and one with surgical thrombendarterectomy.

CONCLUSION

Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is feasible in patients with suitable anatomy. Clinical success rates are high and long-term patency is good. Complications are few and minor. The majority of failures are amenable to new endovascular treatment.

Primary stenting in the treatment of focal atherosclerotic abdominal aortic stenoses

AIM

To evaluate the results of primary stent placement in focal atherosclerotic aortic stenoses using balloon expandable stents.

MATERIALS AND METHODS

Twenty-six primary balloon expandable stent placements in the abdominal aorta were performed and reviewed. All the aortic stenoses were atherosclerotic. Patients were followed up by ankle/brachial pressure indices (ABPI) and Doppler ultrasound (US) at 24h after procedure and at 12 and 24 months. Follow-up angiograms were performed at 12 months.

RESULTS

Twenty-six stents in 26 patients were placed in the infrarenal aorta. All procedures were technically successful and immediate clinical success was obtained. The mean ABPI significantly improved from 0.52+/-0.10 to 0.94+/-0.09 within 24h after procedure, and remained at 0.90+/-0.12 between 12 and 24 months follow-up (mean 18 months). There was full haemodynamic success at hospital discharge and at 12 and 24 months after the procedure. Clinical success at 12 and 24 months (mean 18 months) was defined as an improvement in the Fontaine classification by at least one class compared with the pre-procedure class and was shown to be 100%.

CONCLUSION

In summary, we report that primary stenting is a safe and effective alternative to surgery in cases of symptomatic stenosis of the infrarenal abdominal aorta. The excellent intermediate term results suggested that we would recommend primary stenting as the treatment of choice for focal atherosclerotic stenoses of the infrarenal aorta in selected patients.

Stent placement for chronic iliac arterial occlusive disease: the results of 10 years experience in a single institution

Objective

We wanted to retrospectively evaluate the long-term therapeutic results of iliac arterial stent placement that was done in a single institution for 10 years.

Materials and Methods

From May 1994 to April 2004, 206 patients who underwent iliac arterial stent placement (mean age; 64±8.8) were followed up for evaluating the long term stent patency. Combined or subsequent bypass surgery was performed in 72 patients. The follow up period ranged from one month to 120 months (mean; 31±25.2 months). The factors that were analyzed for their effect on the patency of stents were age, the stent type and diameter, the lesion site, lesion shape, lesion length, the Society of Cardiovascular and Interventinal Radiology criteria, the total run off scores, the Fontaine stage and the cardiovascular risk factors (diabetes mellitus, hypertension and smoking). Follow-up included angiography and/or CT angiography, color Doppler sonography and clinical evaluation with the ankle-brachial index.

Results

Two hundred and eighty-four stents were placed in 249 limbs of 203 patients. The technical success rate was 98% (203/206). The primary patency rates of the stents at 3, 5, 7 and 10 year were 87%, 83%, 61% and 49%, respectively. One hundred seventy-seven patients maintained the primary stent patency until the final follow up and 26 patients showed stenosis or obstruction during the follow up. Secondary intervention was performed in thirteen patients. Lesions in the external iliac artery (EIA) or lesions in both the common iliac artery (CIA) and EIA were a poor prognostic factor for stent patency. The run off score and stent diameter also showed statistically significant influence on stent patency. The overall complication rate was 6%.

Conclusion

Iliac arterial stent placement is a safe treatment with favorable long term patency. Lesions in the EIA or lesions in both the EIA and CIA, poor run off vessels and a stent having the same or a larger diameter than 10 mm were the poor prognostic factors for long term stent patency.

Primary Stenting of Focal Atherosclerotic Infrarenal Aortic Stenoses: Long-Term Results in 13 Patients and a Literature Review

We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 +/- 9.1 years (mean +/- SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 +/- 23 months (mean +/- SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta.

Clinical efficacy of metal stents for the treatment of focal abdominal aortic stenosis

Seven patients (four women and three men) who underwent primary stenting of infrarenal abdominal aortic stenosis over a 4-year period are reported. The patients ranged between 44 and 77 years of age. All were referred for treatment of disabling claudication. Self-expanding stents with balloon assistance were used. A single complication, a retroperitoneal haematoma, requiring surgical intervention occurred in one patient. Patients had either complete resolution of symptoms (five of seven) or a substantial decrease in their claudication symptoms. Primary stenting is a safe and effective treatment for severe abdominal aortic stenosis.

Freedom from secondary interventions to treat stenotic disease after percutaneous transluminal angioplasty of infrarenal aorta: long-term results

PURPOSE

The purpose of this study was to determine the long-term results (1-15 years) of percutaneous transluminal angioplasty (PTA) of localized atherosclerotic lesions of the infrarenal aorta.

METHODS

This was a retrospective study. From January 1987 to January 2002, 69 patients underwent PTA of an isolated stenosis of the lower abdominal aorta under local anesthesia in the department of interventional radiology. All atherosclerotic lesions were hemodynamically significant, defined as a subjective report of walking distance less than one block, resting pain, or trophic changes in combination with diameter reduction of 50% or greater at duplex ultrasound scanning and angiography.

RESULTS

The female-male ratio of study patients was 3.6:1; mean age was 58 years. Endovascular treatment was initially technically and clinically successful in all but one patient (98%), who had a near total occlusion. No major complications were noted. Mean follow-up was 57 months (range, 6 months-15 years). At life table analysis, 5-year primary patency was 75%, and secondary patency was 97%. Twelve patients (17%) required repeat interventions because of hemodynamically significant recurrent stenosis in combination with severe clinical symptoms. Most recurrent stenoses (67%) were successfully treated with repeat endovascular procedures.

CONCLUSIONS

Early and long-term results of PTA (with additional stent placement) of isolated stenosis of the infrarenal aorta are good. This minimally invasive procedure is a true alternative to traditional surgical methods.

Endovascular Treatment of Isolated Atherosclerotic Stenosis of the Infrarenal Abdominal Aorta: Long-term Outcome

The purpose of this multicenter study was to assess the long-term outcome of endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta on the basis of clinical and ultrasound examination. Clinical, ultrasound, and angiographic findings from 36 women and 50 men (mean age, 53.2 years) treated for atherosclerotic stenosis of the infrarenal abdominal aorta were reviewed. Patients had claudication in 74 cases and rest pain in 4. Seven patients presented trophic manifestations and one had blue toe syndrome. Mean preoperative systolic index was 0.71. Mean diameter reduction was 77%. Circumferential calcification was partial in 36 cases (41%) and complete in 30 cases (35%). Percutaneous transluminal angioplasty was performed using the single-balloon technique in 60 cases and double-balloon technique in 26 cases. A stent was placed in 76 cases (88%) by necessity in 34% of cases (22 residual stenoses, 4 dissections). Completion angiographic findings were considered good in 82 cases (95%). The remaining four patients had residual stenosis with a diameter reduction >30%. One patient died during the immediate postoperative period from septicemia unrelated to treatment (early mortality, 1.2%). Aortic angioplasty was complicated by stent detachment from the angioplasty balloon in two patients, retroperitoneal hematoma in one, peripheral embolism in two, puncture-site hematoma in three, myocardial infarction in one, and thrombophlebitis of deep femoral artery in one patient (early morbidity, 9.3%). All patients underwent follow-up with clinical and hemodynamic evaluation (mean follow-up, 31 months). Actuarial survival at 3 years was 91%. Primary actuarial patency was 94% at 1 year, 89% at 3 years, and 77% at 5 years. Aortic restenosis occurred in seven patients and was treated by angioplasty in two, aortobifemoral bypass in four, and surveillance in one. Mean systolic index was 0.89. Statistical analysis of patency demonstrated no factor predictive of long-term complication. From the long-term follow-up findings in this study, we conclude that aortic angioplasty is a reliable minimally invasive technique for treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta.

Percutaneous endovascular treatment for stenoses and occlusions of infrarenal aorta and aortoiliac bifurcation: midterm results

OBJECTIVE

evaluation and comparison of the endovascular treatment of isolated aortic and aortoiliac atherosclerotic lesions (stenoses and occlusions).

METHODS

a percutaneous endovascular procedure was performed in 52 patients (38 men and 14 women) with a mean age of 52 years (range, 25-85 years). The baseline angiogram showed 35 aortic lesions (31 stenoses, 4 occlusions) and 17 aortoiliac lesions (14 stenoses, 3 occlusions). Percutaneous techniques used in this series included variable combinations of transluminal angioplasty and stenting. All stents placements were performed over-the-wire using the transfemoral route (most often bilateral approach). Clinical examination and Duplex-scan were performed at discharge, 1 month, 6 months, 12 months, and then yearly.

RESULTS

technical success was 100% for aortic and aortoiliac lesions. Angiographic success rates were comparable for aortic (91%) and aortoiliac (94%) lesions. No death occurred during or early after the endovascular intervention. Duplex-scan confirmed 100% patency rate at discharge. There was no significant difference between the aortic (94%) and aortoiliac (96%) groups regarding immediate clinical improvement. Mean follow-up was 34+/-31 months (range, 0-130 months). The cumulative primary patency rate at 36 months was 85% in the aortic group and 86% in the aortoiliac group. Clinical success, defined as a symptom-free status at the end of follow-up, was also similar in both groups.

CONCLUSION

endovascular treatment of isolated aortic lesions of the infra-renal aorta has favorable outcomes comparable to those of aortoiliac lesions.

Primary stenting for chronic total occlusion of the infrarenal aorta

PURPOSE

To present a rare case of chronic total occlusion of the infrarenal aorta treated with a self-expanding endoluminal stent implanted without preliminary dilation.

METHODS AND RESULTS

A 68-year-old woman presented with severe bilateral buttock and thigh claudication. Angiography revealed total occlusion of the infrarenal abdominal aorta and relatively normal iliac vessels. Via a right groin puncture and a 9-F sheath, a 14-mm x 5-cm self-expanding Wallstent was deployed in the abdominal aorta and expanded with an angioplasty balloon. Completion angiography showed successful recanalization of the aorta with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. She remained asymptomatic until her death from a major stroke 11 months after aortic stent implantation.

CONCLUSIONS

Primary stenting may be considered a viable alternative to conventional surgery in selected patients with total infrarenal aortic occlusion.

Primary stenting in infrarenal aortic occlusive disease

PURPOSE

To evaluate the results of primary stenting in aortic occlusive disease.

METHODS

Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months).

RESULTS

Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented.

CONCLUSIONS

Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.

Early and long-term results of percutaneous transluminal angioplasty of the lower abdominal aorta

PURPOSE

The purpose of this study was to determine the early and long-term results of percutaneous transluminal angioplasty (PTA) of atherosclerotic lower abdominal aorta stenosis.

METHODS

This study was performed as a retrospective study. From 1980 to 1997, 46 patients with chronic lower limb ischemia with moderate to severe claudication as the result of isolated infrarenal disease or aortoiliac disease underwent PTA. All patients underwent angiography before and after angioplasty and Doppler ultrasound scan examination with ankle-brachial index determination. No stents were used.

RESULTS

The technical success rate was 96% (44 of 46 cases). Thirty-eight patients (83%) immediately showed clinical, hemodynamic, and angiographic improvement. The initial success rate for patients with isolated infrarenal or bifurcation disease was 92%, whereas it was 71% for aortoiliac disease. Among the eight patients with no initial improvement, four had clinical deterioration and two required emergency surgical revascularization. There were no other complications. Fifty-six percent of the patient conditions (95% confidence interval [CI], 38% to 74%) remained clinically improved at the 5-year follow-up examination. Recurrence of symptoms was caused by femoropopliteal disease in most patients. The primary patency rate assumed with maintenance of hemodynamic improvements was 70% (95% CI, 52% to 88%) and 64% (95% CI, 44% to 84%) at 4 and 5 years of follow-up, respectively. The primary patency rate at 4 years for patients with isolated infrarenal or bifurcation disease was 83% (95% CI, 64% to 100%), whereas it was 55% for aortoiliac disease (95% CI, 30% to 80%; P =.06) The variables that were statistically predictive of patency failure were poor runoff (P =. 01) and presence of aortoiliac atherosclerotic disease (P =.04).

CONCLUSION

Our results suggest that PTA is an excellent treatment for chronic arterial insufficiency of the lower extremities as the result of isolated atherosclerotic lower abdominal aortic occlusive lesions because of good long-term patency. Aortic PTA for those patients with iliac involvement or with poor runoff gives acceptable results but carries lower patency and clinical success rates.

Percutaneous transluminal stent placement in the abdominal aorta

PURPOSE

To retrospectively review and to report the results of stent placement for focal mid-abdominal aortic stenoses.

MATERIALS AND METHODS

During a 4-year period, 10 focal mid-abdominal aortic stenoses were treated with stent placement in nine patients (six women and three men; mean age, 61 years; range, 49-73 years). All of the stenoses were atherosclerotic in nature except for one at the proximal anastomosis of an aortobi-femoral graft, which may have been from fibrointimal hyperplasia. Seven of the 10 stenoses were treated with primary stent placement, whereas three were treated with stent placement after suboptimal angioplasty.

RESULTS

The technical success rate was 100%. Clinical success, defined as complete elimination or improvement of symptoms present before stent placement, was achieved in eight of the nine patients with a mean duration of follow-up of 1.6 years (range, 0.2-3.0 years).

CONCLUSION

In view of the excellent technical and clinical success, the authors believe that stent placement should be considered as an adjective therapy to angioplasty or as a primary method of treatment in properly selected patients with focal mid-abdominal aortic stenoses.

Percutaneous transluminal angioplasty of the infrarenal aorta: initial outcome and long-term clinical and angiographic results

OBJECTIVE

Report of 1-8 year follow-up of patients treated by percutaneous transluminal angioplasty (PTA) for obstructive atherosclerosis of the infrarenal aorta.

DESIGN

Cohort study.

MATERIALS

Thirty-eight patients aged 26-81 years (mean 50 years) were submitted to undergo percutaneous transluminal angioplasty of the infrarenal aorta. All patients had symptomatic isolated stenotic lesions of the aorta located below the renal arteries and above the bifurcation. Stenoses at bifurcation-level and the iliac arteries were excluded.

METHODS

PTA of the aorta was performed under local anaethesia in the radiological department. Clinical symptoms and ankle/brachial indices were registered before, directly after the procedure and at follow-up. Angiography was performed in all patients pre- and post-procedure, and at follow-up. All patients received angiography in March 1995. Clinical data were analysed based on intention-to-treat.

RESULTS

Initial clinical and angiographic success was achieved in 36 patients (94%). Mean follow-up was 34 months (range 1-92). Recurrent stenosis was seen in seven patients (19%) at follow-up. Only five (13%) of these had recurrent symptoms and were treated successfully with a second PTA. No major complications were seen.

CONCLUSION

These results show PTA to be a safe, minimally-invasive and effective alternative to surgery in case of symptomatic stenosis of the infrarenal abdominal aorta.

Percutaneous transluminal angioplasty of the abdominal aorta

PURPOSE

To determine the long-term results of percutaneous transluminal angioplasty (PTA) of focal infrarenal abdominal aortic stenoses.

PATIENTS AND METHODS

Over a 10-year period, 15 focal infrarenal abdominal aortic stenoses were treated with PTA in 14 patients (13 women and one man; mean age, 53.2 years; range, 43-78 years).

RESULTS

The initial technical success rate was 100%. Clinical patency, as defined by continued absence or improvement in symptoms after PTA, was achieved in 14 of the 15 angioplasty procedures (93%) with a mean duration of clinical follow-up of 4.3 years (range, 0.6-9.8 years) in the 14 patients. Long-term noninvasive follow-up demonstrated continued patency of the angioplasty site in 11 of 11 patients available for study. The mean ankle-arm index in these 11 patients was 0.95 (range, 0.9-1.0) at a mean follow-up of 4.8 years (range, 0.6-9.8 years). There was no significant morbidity or mortality associated with the angioplasty procedures.

CONCLUSION

In view of the high degree of technical success and the excellent long-term patency, we believe that PTA should be considered a primary method of treatment in properly selected patients with focal abdominal aortic stenoses.

Infrarenal aortic stents: initial clinical experience and angiographic follow-up

From March 1990 to May 1991, arterial stents were placed in seven patients because of a tight stenosis (five patients) or a total chronic occlusion (two patients) located in the infrarenal aorta. In one case, the aortic occlusion extended to both common iliac arteries. After balloon dilatation, aortic stents were successfully positioned in all cases. Bilateral common iliac recanalization and stent placement were performed in one case. No complications occurred in any of the patients. No complications occurred in any of the patients. Follow-up data were derived from clinical assessments and angiographic results. After a 15.1-month mean follow-up period (range 12-24 months), the seven aortic stents remained patent. Three iliac artery procedures were performed in two of the patients as well. Claudication recurred in three of the seven patients which was related to a common iliac occlusion (one case) or distal progression of atherosclerosis (two cases). Aortic stents seem to be suitable for treating failed angioplasty of aortic lesions but the procedure remains technically difficult when there is associated severe atherosclerosis of the proximal common iliac arteries. Nevertheless, considering the morbidity rate (0%) and the patency rate in this series, this technique could become an alternative to surgical treatment for infrarenal aortic occlusive lesions.

Endovascular treatment of abdominal aortic occlusive disease: the impact of stents and intravascular ultrasound imaging

Distal abdominal aortic occlusive disease has been conventionally treated with endarterectomy or bypass grafting. However, today's expanding spectrum of intraluminal devices and techniques may well replace classical surgery in this arterial region in all but a few instances. Since January 1990, we have investigated the potential for such endovascular therapies as thrombolysis, balloon dilation and intravascular stenting in 29 symptomatic patients with a variety of distal abdominal aortic pathologies. The prudent application of these intraluminal therapies hinges on accurate intra-arterial assessment. Arteriographic data are notably inadequate for most endovascular procedures; however, intravascular ultrasound imaging (IVUS) is a newer diagnostic tool that works particularly well in the aortoiliac region where angioscopy is more difficult to utilize for assessment. Using IVUS as a complement to arteriography, we were able to assess the need for 43 Palmaz stents in these cases of distal abdominal aortic pathologies; 23 additional iliac stents were deemed necessary. Moreover, IVUS was the only tool available to confirm adequate stent deployment. Given the apparent long-term success of stents in large-bore arteries, abdominal aortic stenting may ensure proximal inflow to distal vessels, saving many patients from an intra-abdominal operation. The specific intraluminal and transmural data offered by IVUS facilitates stent application and documents adequate deployment, two vitally important elements in the percutaneous treatment of abdominal aortic occlusive disease.

Preliminary observations on the use of the Palmaz stent in the distal portion of the abdominal aorta

The opportunities to avoid surgical treatment of distal abdominal aortic occlusive disease are expanding because of the proliferation in catheter-based techniques. Since January 1990, 24 symptomatic patients with distal abdominal disorders have been treated percutaneously with balloon angioplasty and intraluminal stenting. A total of 38 Palmaz stents were deployed at distal abdominal aortic sites; 21 additional iliac stents were implanted. After the procedure all patients improved clinically, and 83% (21/24) improved by objective measurement (average ABI 0.93 +/- 0.21). Three access-related complications occurred (two hematomas, one thrombus), but no complications were related to the stents. At up to 29 months of follow-up (average 10.3 +/- 6.7 months), clinical improvement persists in all patients (average ABI 0.93 +/- 0.22). In 11 patients eligible for follow-up aortography, all aortic stents are patent without evidence of restenosis. With the low likelihood for restenosis in the abdominal aorta, the long-term outcome of aortic stenting looks promising and may equal or surpass that found in the iliac region.

Percutaneous transluminal aortic angioplasty: early and late results

Percutaneous transluminal angioplasty of the infrarenal abdominal aorta (13 patients) and its bifurcation (15 patients) was performed in 28 patients with a total of 32 dilatation procedures. The group consisted of 16 female and 12 male patients and initial successful dilatation was achieved in all. Recurrence within 1 month requiring bypass surgery occurred in 1 patient. Three patients were lost to follow-up. Long-term follow-up in the remaining 24 patients ranged from 1 to 9 years with a mean of 4.5 years. During the follow-up period, repeat angioplasty of the original stenosis was performed in 3 patients and another patient underwent dilatation of a new lesion which developed in the aorta. According to clinical and noninvasive studies, these 4 patients, as well as the other 20, have maintained patency of the treated lesions and are symptom free. No immediate complications requiring surgery occurred. We conclude that angioplasty is the initial treatment of choice in focal lesions of the distal abdominal aorta and its bifurcation.

Stent placement for failed angioplasty of aortic stenoses: report of two cases

In 2 patients, an aortic stenosis failed to respond adequately to balloon dilatation but was successfully treated by implantation of a self-expandable large caliber endoprosthesis and subsequent balloon angioplasty. Intravascular ultrasound helped to classify the characteristics of the lesion in preparation for intervention.

Angioplasty of the terminal aorta: follow-up of 20 patients treated by PTA or PTA with stents

Twenty patients with distal aortic stenosis were treated by PTA for intermittent claudication and, in 3, 'blue toe' syndrome. Additionally, a self-expandable endoprosthesis (stent) was inserted into the aorta in three of the patients. The overall primary success rate (including those with a stent) was 100% with all patients becoming free of symptoms. Mean arm-ankle pressure difference decreased from 48 mmHg to 9 mmHg (P less than 0.01). During a median follow-up period of 15 months no patient had recurrence of claudication, embolism, or deterioration of the non-invasive parameters. Thus, PTA seems suitable for treating stenoses of the abdominal aorta, even in the presence of distal microembolization. Balloon dilatation, with the addition of stents in resistant cases, offers a valuable alternative to surgery in distal aortic stenosis.

Percutaneous transluminal angioplasty of the distal abdominal aorta

Percutaneous Transluminal Angioplasty (PTA) has become widely practised and is a significant advance in the treatment of arterial disease. Its use in the treatment of atheromatous abdominal aortic stenoses in thirteen patients is described. Technical success was achieved in all with no complications. In a follow-up period from 7 to 70 months all patients have benefitted and 85% remain symptom free.

Percutaneous transluminal angioplasty of abdominal aortic stenoses

Percutaneous transluminal angioplasty (PTA) was performed on 25 patients with localized distal abdominal aortic stenoses. All patients were smokers and all complained of bilateral lower limb claudication. Eleven patients had small distal aortas and iliac vessels. Technically successful dilatation was achieved in all patients. Long-term follow-up was available on 17 of the patients. The mean follow-up period was 38 months. Cumulative patency at 5 years was 70%. Thirteen patients remain asymptomatic 15-83 months following PTA. Late failure occurred in 4 patients, 1-38 months following PTA. No complications related to PTA were experienced. PTA of localized aortic stenoses is a safe alternative to surgery and should be the treatment of choice in this condition.

Advances in balloon technology and reperfusion devices for peripheral circulation

Major improvements in balloon and wire technology have been occurring for several years and, consequently, the approach to conventional angioplasty has been simplified. Results in isolated stenotic segments in renal circulation and within the iliac and superficial femoral vessels have generally been 95% technically successful, with 1-year patency rates of 80% in the superficial and renal sites and 90% in the iliac vessels. The procedure has been extended to include more distal vessels including the popliteal and tibial circulation as well as more complex lesions involving the mesenteric circulation and pre-Leriche syndromes with stenotic disease involving the infrarenal segment of the abdominal aorta. Successful results have also been achieved in stenotic atherosclerotic disease involving the subclavian artery and the associated subclavian steal syndromes. Preliminary results are also being reported in a few selected series of vertebral and carotid artery angioplasty. Totally occluded segments in the iliac and peripheral circulation had previously been ammenable only to surgical bypass procedures. A series of new recanalization devices are under investigational evaluation for reperfusing these totally obstructed segments. Although technical recanalization in segments as long as 20 cm can be accomplished in approximately 75% of these patients, long-term patency is totally dependent on popliteal-tibial outflow. For these reasons, diffuse disease and totally obstructive disease in the superficial femoral vessels can have recurrence rates as high as 45%, and reestablishing tibial outflow is equally as important as successfully recanalizing the totally obstructed superficial femoral vessels.

Percutaneous transluminal angioplasty of the distal abdominal aorta and its bifurcation

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

Gruentzig balloon catheter dilation for acquired bronchial stenosis in an infant

A long stricture of the left main bronchus, which was resistant to the traditional methods of treatment, developed in a 992-gm twin who was ventilated for 114 days. The patient had two bronchial dilations with the Gruentzig balloon catheter placed under fluoroscopic control and inflated to 6 atm of pressure. The treatment was well tolerated by the patient, and one year after the Gruentzig balloon dilation she had a normal chest roentgenogram. Gruentzig balloon catheter dilation is a new technique for repairing bronchial stenosis in infancy without major intrathoracic surgical intervention.