Percutaneous transluminal angioplasty of the lower abdominal aorta

Transluminal Catheter Angioplasty of Abdominal Aorta in Takayasu's Arteritis

Nine patients with Takayasu's arteritis and a long stenotic segment of the abdominal aorta were treated by percutaneous transluminal angioplasty (PTA). Intermittent claudication dissappeared in six of seven cases, the femoral pulse reappeared in all five; ankle/arm indices increased in seven cases; elevated blood pressure normalized in seven of eight cases. Seven patients were followed for 3 to 28 months. They were all free of symptoms from the lower extremities. In three patients with or without renal artery stenosis and with hypertension, the blood pressure decreased after PTA of the abdominal aorta only. PTA may be a valuable treatment in Takayasu's arteritis and stenosis of the abdominal aorta.

Endovascular management of aortoiliac occlusive disease

Patients with aortoiliac occlusive disease (AIOD) may be asymptomatic or may have intermittent claudication or critical limb ischemia. Treatment options for AIOD include management of risk factors, endovascular intervention, and/or surgical revascularization.

[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.

Bifurcated Abdominal Aorta, with a Coarctation over the Right Branch of the Bifurcated Abdominal Aorta and Aberrant Renal Arteries Originating from the Left Branch of the Bifurcated Abdominal Aorta

This study describes an unusual case of secondary hypertension in a young female patient presenting with severe hypertension and abdominal bruits. Gadolinium-enhanced MRA revealed a clearly bifurcated abdominal aorta, with a coarctation over the right branch of the bifurcated abdominal aorta and aberrant renal arteries originated from the left branch of the bifurcated abdominal aorta. Of interest is conventional angiography had failed to reveal these vascular abnormalities. This study mentions both embryologic and clinical aspects of this developmentally abnormal bifurcated abdominal aorta, coarctation of abdominal aorta and aberrant renal arteries.

Endovascular management of chronic infrarenal aortic occlusion

PURPOSE

To review our experience with the endovascular treatment of chronic infrarenal aortic occlusion with regard to technical success and midterm patency, as well as perioperative mortality and morbidity.

METHODS

A retrospective review was performed of patients who presented from January 1, 2000, to December 31, 2005, with a diagnosis of chronic infrarenal aortic occlusion (TASC D) treated with endovascular techniques. In this time period, 31 patients (22 women; mean age 63 years) underwent attempted recanalization of the occluded aorta and iliac arteries. Claudication was the most common presenting symptom (14, 45%). Patients were treated solely with angioplasty and stenting or thrombolysis followed by angioplasty/stenting based on surgeon preference.

RESULTS

Technical success was 93%. The 2 failures were individual cases of wire-induced iliac artery perforation and failed access; both patients were treated with bypass grafting. Nine (29%) patients had thrombolysis prior to angioplasty. There were no perioperative deaths. Postoperative ankle-brachial indexes increased significantly from preoperative values (p<0.0001). There were 3 technical complications: 1 (3%) iatrogenic iliac artery injury and 2 (6%) perioperative limb thromboses requiring intervention. Other complications included 6 (19%) access site events and 5 (16%) episodes of acute renal dysfunction, 2 requiring permanent dialysis. Over a mean follow-up of 12 months, there was no limb loss. At 1 and 3 years, the primary/secondary patency rates were 85%/100% and 66%/90%, respectively.

CONCLUSION

Endovascular therapy for chronic infrarenal aortic occlusion has a high technical success rate, with good midterm primary and secondary patency rates. However, renal dysfunction can occur; the etiology is likely multifactorial from contrast volumes, embolization, and/or renal arterial disease.

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.

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.

Long-term results of primary stent placement to treat infrarenal aortic stenosis

OBJECTIVE

To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease.

DESIGN

Retrospective observational study.

PATIENTS AND METHODS

From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39-80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions.

RESULTS

Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1-86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years.

CONCLUSION

Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates.

Primary Stent Placement for Infrarenal Aortic Stenosis: Immediate and Midterm Results

PURPOSE

To evaluate the safety and the long-term clinical and hemodynamic results of primary stent placement of atherosclerotic calcified stenosis of the infrarenal aorta.

MATERIAL AND METHODS

Between July 1996 and July 1999, 15 patients (nine male, si- female; mean age, 53.9 years) with symptomatic, calcified aortic stenosis were treated with primary stent placement. Patients underwent abdominal aortography and bilateral lower extremity arteriography. Follow-up was performed in all 15 patients. Technical success was defined as residual stenosis of less than 30% or a resting trans-systolic pressure gradient of less than 10 mm Hg after stent placement. Clinical patency was defined as the absence or improvement of symptoms after stent placement. Hemodynamic patency was defined as a normal triphasic Doppler waveform in the common femoral artery, an ankle-brachial index greater than 0.90, or the absence of a thigh-brachial pressure gradient at rest in either limb.

RESULTS

Technical success was achieved in 13 of 15 patients. The two patients considered to be technical failures had resting trans-systolic pressure gradients of 12 and 13 mm Hg, respectively, after stent placement. After the mean follow-up of 36 months, primary clinical and hemodynamic patency rates were 85% and the secondary hemodynamic patency rate was 100%. Two of five symptomatic recurrences during the 36-month follow-up period (range, 12-46 months) were a result of aortic restenosis and were treated with repeated percutaneous transluminal angioplasty. None of the patients required aortic surgery. Complications of the primary procedure included one puncture site infection, one pseudoaneurysm, and one distal embolization, which delayed discharge of three patients. There was no morbidity during the secondary interventions.

CONCLUSION

Primary stent placement as treatment of calcified infrarenal aortic stenosis proved to be safe and also provided durable long-term clinical improvement.

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.

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.

Infrarenal Aortic Stenosis: Value of Stent Placement after Percutaneous Transluminal Angioplasty Failure

PURPOSE

To evaluate the long-term clinical and hemodynamic effectiveness of aortic stent placement in cases of failure of intended infrarenal percutaneous transluminal aortic angioplasty (PTAA).

MATERIALS AND METHODS

Fifty-three patients who underwent technically successful PTAA were compared with 24 patients who underwent aortic stent placement because of PTAA failure (19 patients) or ulcerated lesions (five patients) that otherwise would have been treated surgically because of the embolization hazard associated with PTAA alone. Clinical patency was defined as the absence or improvement of symptoms after the intervention. Hemodynamic patency was defined as a normal Doppler waveform in the common femoral arteries, an ankle-brachial index greater than 0.95, or the absence of a thigh-brachial pressure gradient.

RESULTS

Three-year clinical and hemodynamic patency rates, respectively, were 85% and 79% for PTAA and 69% and 43% for aortic stent placement. No morbidity was encountered. With use of the Cox proportional hazards model, two significant risk factors were retained for restenosis: unchanged smoking habit (P =.04) and small dilatation diameter (P =.001). Aortic stent placement, performed in patients with a smaller aortic diameter (10.3 vs. 12.7 mm for PTAA), appeared to be a predictive factor for restenosis by using univariate analysis. By using the Cox proportional hazards model, however, the restenosis rates after PTAA and aortic stent placement were not significantly different.

CONCLUSION

When aortic diameter is taken into consideration, there is no evidence that clinical outcome after secondary aortic stent placement would be poorer than technically successful PTAA.

Non-surgical treatment of patients with peripheral vascular disease

Dotter first described percutaneous revascularization of peripheral vascular disease (PVD) in 1964. In 1974, Gruentzig developed a balloon catheter for dilation of vascular lesions. Currently, percutaneous transluminal angioplasty (PTA) employs a variety of devices ranging from implantable stents to endovascular radiation devices for re-stenosis and is recognized as a safe and effective alternative to surgery for selected patients. In addition to the general efficacy of peripheral angioplasty, which is comparable to that of bypass surgery for selected lesions, angioplasty offers several distinct advantages over surgery. It is performed under local anaesthesia, making it feasible to treat patients who are at high risk for general anaesthesia. When compared to surgical revascularization, the morbidity from angioplasty is low, generally related to problems at the vascular access site, and mortality is extremely rare. Unlike vascular surgery, there is no recovery period after angioplasty, and most patients can return to normal activity within 24-48 h of an uncomplicated procedure. Finally, angioplasty can be repeated if necessary usually without increased difficulty or increased patient risk compared to the first procedure, and does not preclude surgery as adjunctive or definitive therapy.

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.

Comparison of conventional angioplasty with the Palmaz stent in the treatment of abdominal aortic stenoses from the STAR registry. SCVIR Transluminal Angioplasty and Revascularization

PURPOSE

To retrospectively compare the safety and short-term efficacy of conventional percutaneous transluminal angioplasty (PTA) and PTA with the Palmaz balloon-expandable intravascular stent for the treatment of infrarenal abdominal aortic atherosclerotic stenoses.

PATIENTS AND METHODS

The records of 25 patients with infrarenal aortic stenoses treated by means of percutaneous techniques were retrieved from the SCVIR Transluminal Angioplasty and Revascularization (STAR) Registry and analyzed. Thirteen patients were treated with PTA alone and 12 were treated with the Palmaz intravascular stent.

RESULTS

Technical success was achieved in 92% of patients treated with PTA alone and in 100% of those treated with the Palmaz stent. Significant improvements in lesion morphology, hemodynamics, clinical status, and ankle arm indexes were shown in both groups. There was no statistically significant difference in percent stenosis reduction, decrease in trans-stenotic gradient, or initial clinical outcome between the group treated by means of PTA and the group treated by means of PTA with the Palmaz stent.

CONCLUSIONS

PTA and intravascular stent placement of atherosclerotic stenoses involving the infrarenal aorta are both safe and efficacious therapeutic modalities. At present, it does not appear that primary stent placement confers any short-term benefits over technically successful PTA in aortic stenoses.

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 in adults less than 45 years of age with premature lower extremity atherosclerosis

Despite poor results reported with conventional vascular bypasses in young adults with ischemia from premature lower extremity atherosclerosis (PLEA), little attention has been given to alternative revascularization techniques. This study evaluated 32 patients (21 males and 11 females) < 45 years of age with PLEA who underwent 53 primary percutaneous transluminal angioplasty (PTA) procedures for treatment of 46 ischemic limbs. A residual arterial stenosis < 30% was achieved in 83% of PTA sites. Mean degree of stenosis decreased from 79.9% to 24.1% (p < 0.0001). Clinical improvement in ischemic symptoms was obtained in 39 (85%) limbs. Hemodynamic improvement was achieved in 31 (70%) of 40 limbs as documented by ankle/brachial indices. All criteria for early clinical success were met in 70%. Another 13% met all criteria except that the residual stenosis was < 50%. Hematoma and early restenosis were reported in two patients each. Mean follow-up was 27.3 months (range 1 to 84 months). Cumulative patency by life-table analysis was 81% at 1 year, 77% at 2 years, and 71% at 3 years. Thirteen (41%) patients required secondary PTA or bypass; 85% were performed within 1 year. Two patients had adjunctive bypasses; six (19%) were performed after PTA failure. Only one (3%) patient required major amputation. Neither cardiovascular risk factors, treatment indication, location of the diseased arterial segment, nor quality of distal runoff vessels predicted the need for secondary PTA or surgical procedures. PTA of the proximal arteries in young patients with PLEA is an effective primary revascularization technique with results comparable to those of conventional operative revascularization procedures.

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.

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.

Aortic bifurcation stenosis: treatment with intravascular stents

Balloon-expandable intravascular stents were employed to correct atherosclerotic stenosis of the aortic bifurcation. The devices were placed in the proximal iliac arteries with the cephalic end of the stents contacting in the midline. This arrangement provided an adequate lumen for the distal portion of the aortic wall and the proximal iliac arteries. Six of seven patients who received this form of treatment had hemodynamic and clinical improvement of their vascular insufficiency at an average follow-up of 1 year.

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.

Percutaneous transluminal balloon angioplasty of the aorta in patients with aortitis

Four patients with aortitis and stenotic lesions of the aorta were successfully treated by percutaneous transluminal balloon angioplasty. The peak systolic gradient across the constrictions decreased from 82.5 +/- 35.7 to 37.5 +/- 18.5 mm Hg immediately after dilatation. Repeat angiography in the first three patients performed 2 months later showed a further decrease in the gradient to 13.8 +/- 9.5 mm Hg. There were no complications during or after the procedure, and all the patients have shown remarkable symptomatic relief during the follow-up.