Transluminal Catheter angioplasty of abdominal aorta in Takayasu's arteritis

Percutaneous treatment of abdominal coarctation in children using a covered stent

Coarctation of the abdominal aorta is extremely rare. It generally involves a long segment of the descending aorta and causes uncontrolled and unexplainable hypertension in children. The therapeutic choice is very challenging because acute and chronic complications are reported for both the surgical and the percutaneous approaches. The two reported cases of abdominal coarctation were treated primarily and successfully through the use of covered stents. Three covered stents were implanted in two children. No complication occurred with either procedure. At this writing, an 18-month follow-up assessment has found the patients in good health with no restenosis at the coarctation site. Covered stent implantation in children with abdominal coarctation is a feasible, safe, and effective procedure. It provides adequate relief of symptoms and reduces the risk of aneurysm formation. To avoid covering important side branches with polytetrafluoroethylene, this type of procedure must be preceded by precise study of the aorta and its branches.

Stenosis in the aorta caused by non-specific aortitis: results of treatment by percutaneous stent placement

AIM

To evaluate the short-term results of percutaneous stent placement in treating stenosis in the aorta caused by non-specific aortitis (Takayasu's disease).

METHOD

Five patients were treated by this method, all of whom had uncontrolled hypertension, haemodynamically significant stenosis in the aorta and a clinically inactive disease. Stents were placed to treat an obstructing dissection in four and recurrent stenosis in one patient. All procedures were carried out via the percutaneous transfemoral route, utilizing self-expanding stents.

RESULTS

The lesion was located in the thoracic aorta in three patients and in the abdominal aorta in two patients. The stenosis decreased from 81+/-2 to 7+/-3%, the pressure gradient fell from 97+/-5 to 9+/-2 mmHg, the blood pressure improved from 200+/-3/124+/-2 to 131+/-2/81+/-2 mmHg, and the drug requirement fell from 4+/-.2 to 1.3+/-.3 (P value for all <0.001). No complication was encountered. At follow-up at 13+/-4 months, all of the patients had improved clinically. Intimal hyperplasia within the stent was seen in two patients who underwent follow-up angiograms.

CONCLUSION

Percutaneous aortic stenting is useful in treating selected patients with non-specific aortitis. Further information about the long-term behaviour of intimal hyperplasia and the response of stented segments to the aging process needs to be understood before elective stenting in this young patient population can be advocated.

Percutaneous transluminal angioplasty in patients with Takayasu arteritis: five-year experience

PURPOSE

The authors report their 5-year experience with percutaneous transluminal angioplasty (PTA) for treatment of stenoses related to Takayasu arteritis.

PATIENTS AND METHODS

Twenty patients were treated; 12 patients had renovascular hypertension at presentation, three patients had abdominal aortic coarctation syndrome, and five patients had aortoiliac occlusive disease.

RESULTS

The initial success rate for patients with renovascular hypertension was 83%, with a 5-year patency of 33.3%. In patients with abdominal aortic coarctation, initial success rate was 100% but 5-year patency was 33.3%. In patients with aortoiliac occlusive disease, the initial success rate was 100%, with a 5-year patency of 60%.

CONCLUSION

Despite the high initial success rate for PTA in these patients, the disease recurs in a substantial number of the, due to the fact that this technique does not treat the disease itself but only its consequences.

Balloon angioplasty for renovascular hypertension in Takayasu's arteritis

Percutaneous transluminal renal angioplasty was performed in 54 consecutive patients with hypertension and renal artery stenosis caused by Takayasu's arteritis. Angioplasty was technically successful in 67 (89.3%) of 75 lesions attempted. In these 67 lesions, the degree of stenosis decreased from 88.3 +/- 4.8% to 23.5% +/- 13.6% (p < 0.001) after angioplasty. Following successful angioplasty there was significant improvement in hypertension (p < 0.001) within 48 hours. Patients with bilateral renal artery stenosis had higher systolic blood pressure both before balloon dilatation (p < 0.05) and after balloon dilatation before discharge (p < 0.001), compared with patients with unilateral renal artery stenosis. Three to 70 months (mean 26.4 +/- 10.3 months) after successful angioplasty, blood pressure was reduced to normal or was improved in 93% of patients. Angiographic restudy an average of 14.2 +/- 7.8 months after angioplasty showed restenosis at the same site in 7 of 52 (13.5%) lesions and fresh stenosis in one artery. All these eight lesions were successfully dilated. Further improvement in the luminal diameter was observed in 11 (21.2%) lesions. Late angiographic restudy in seven patients an average of 56.1 +/- 6.3 months after angioplasty showed no restenosis. Our results suggest that balloon angioplasty is safe and highly effective in relieving renal artery stenosis caused by Takayasu's arteritis and should be the treatment of choice for renovascular hypertension in this disease.

Balloon angioplasty of the aorta in Takayasu's arteritis: Initial and long-term results

Percutaneous transluminal balloon angioplasty for stenosis of the aorta was performed in 36 patients with Takayasu's arteritis (age range, 8 to 36 years; mean, 19.1 +/- 7.7 years). Balloon dilatation was successful in 34 patients and resulted in a decrease in the mean peak systolic pressure gradient (PSG) from 75.2 +/- 29.1 mm Hg to 24.8 +/- 19 mm Hg (p less than 0.001) and a mean increase in the diameter of the stenosed segments from 4.5 +/- 2.2 mm to 9.6 +/- 3.8 mm (p less than 0.001). Hemodynamic and angiographic restudy, which was performed in 20 patients at a mean follow-up period of 7.7 +/- 4.1 months (range, 3 to 24 months), showed a further decrease in PSG (greater than or equal to 15 mm Hg) in seven patients (from 40.0 +/- 11.2 mm Hg to 15.7 +/- 10.2 mm Hg; p less than 0.01), no significant change in PSG in 12 patients (17.1 +/- 13.6 mm Hg vs 16.6 +/- 12.7 mm Hg; p = NS), and an increase in PSG from 15 mm Hg to 85 mm Hg in one patient. The patient who showed restenosis underwent successful redilatation. Six patients who underwent late recatheterization and angiography at 36 to 60 months (mean, 43 +/- 9.4 months) show continued relief of stenosis (mean PSG, 8.8 +/- 7.8 mm Hg). Patients with short-segment (less than 4 cm) stenosis experience more relief than patients with long-segment (greater than or equal to 4 cm) stenosis (residual PSG, 18.6 +/- 8.2 mm Hg vs 40 +/- 16 mm Hg; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Transluminal angioplasty of the aorta, renal and mesenteric arteries in Takayasu arteritis: Report of two cases

Two patients with Takayasu arteritis presented with either severe renovascular hypertension or profound weight loss due to intestinal angina. The leading clinical signs were cured by successful percutaneous transluminal angioplasty (PTA) of the abdominal aorta and renal arteries in one patient and of the superior mesenteric artery and coeliac trunk in the second. These results and a literature review of the topic suggest that PTA should be the first therapeutic approach in symptomatic arterial stenoses due to TA in the inactive stage of the disease.

Aortic dissection following transluminal angioplasty of the thoracic aorta in nonspecific aortoarteritis

We performed transluminal angioplasty for an eccentric, calcific stenosis of the thoracic aorta in a patient with nonspecific aortoarteritis and encountered an iatrogenic aortic dissection. Follow-up by intravenous digital subtraction angiography at 12 hours and at one week showed no change in the picture. He is asymptomatic at 6 months except for residual hypertension. Eccentric, localized thoracic stenosis may constitute an unfavourable angiographic morphology for angioplasty.

Reconstructive surgery of the renal arteries in Takayasu's disease

Between 1977 and 1989, 24 patients (19 women and 5 men) with Takayasu's disease underwent renal artery restoration. Mean age was 32.9 years (range 15 to 60 years). All patients were hypertensive and three had moderate, chronic renal failure. Renal artery lesions were unilateral in two patients (8%), bilateral in 17 patients (71%), and unilateral in a solitary kidney in five (21%). Associated lesions of the thoracic or abdominal aorta or both were found in 22 patients (92%). Lesions of the visceral arteries found located in 21 patients (87%) and of the supraaortic trunks in 16 (67%). Initial revascularization of the supraaortic trunks was performed in four patients (17%). Renal artery revascularization was unilateral in 11 patients (46%) and bilateral in 13 (54%). Concomitant aortic reconstruction was performed in 21 patients (87%), visceral artery reconstruction in 17 patients (71%), and supraaortic surgery in seven (29%). One patient who underwent combined aortic and renal artery restoration, and in whom visceral artery involvement had been neglected, died postoperatively of heart failure and intestinal infarction. Three patients were lost to follow-up. Twenty patients have been followed for a mean of 61.3 months (range 4 to 124 months). One patient died at 89 months of intestinal infarction secondary to embolization originating from a false aortic aneurysm. Five repeat renal revascularizations were required in four patients. Hypertension is presently cured in 12 patients (63%), improved in six (31%), and unchanged in one (6%). Even though surgical treatment of arterial lesions in Takayasu's disease often includes complex and repeat revascularization procedures, satisfactory long-term results suggest the use of renal artery reconstruction in this affliction.