Effect Of Percutaneous Transluminal Angioplasty Research Articles

Percutaneous management of occlusive arterial disease associated with vasculitis: a single center experience.

The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients (10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis (n = 8) and Takayasu arteritis (n = 3). Thirty-three occlusive lesions (including brachiocephalic and renal arteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound. Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses (n = 8) and re-restenoses (n = 1) occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low.

Percutaneous Intervention for Permanent Hemodialysis Access

Purpose: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulse-spray pharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodyalitic access, and to identify contributory patency-related factors following interventional procedures. Materials and Methods: Between August 1995 and July 2001, 105 cases of insufficient hemodyalitic access involving 38 artificial arteriovenous fistulae (AVF) and 67 graft arteriovenous fistulae (AVG) were treated interventionally. The patients underwent PTA alone in 53 cases and PSPMT combined with PTA in 47, and procedural success and long-term patency were evaluated in terms of a patient's age and sex, the presence of diabetes, the location of access, the type of AVG, the draining vein of AVG, the presence of central vein stenosis, the degree of residual stenosis, and the method of interventional procedure, and contributory factors were thus identified. Results: The overall technical success rate of interventional management was 83.8% (88/105), while the overall primary patency rate was 58.75.2% at 6 months, 43.06.0% at 1 year, and 18.16.0% at 2 years. In AVF/AVG groups, primary patency rates were 55.99.2%/57.86.5% at 6 months, 45.810.0%/42.78.4% at 1 year, and 21.8%9.8%/18.96.5% at 2 years. The overall secondary patency rate was 40.08.1% at 2 years. No contributory factors were found (95% confidence level), though patency of access decreased when residual stenosis was more than 30% (p=0.054). Conclusion: Interventional management of insufficient hemodyalitic access has high success and patency rates, and is an effective primary method. There appear to be no contributory factors, though residual stenosis of more than 30% tends to decrease the patency of hemodialytic access.

Management of renal vascular disease in neurofibromatosis type 1 and the role of percutaneous transluminal angioplasty.

The effectiveness of percutaneous transluminal angioplasty (PTA) in renal artery stenosis (RAS) associated with neurofibromatosis type 1 (NF1) has not been established. A review of the literature revealed 14 studies, mainly case reports, of which a total of 16 patients had been treated with PTA, all prior to any surgery being undertaken. A retrospective case review of 10 children with renal vascular disease secondary to NF was conducted to evaluate the outcome of different treatment modalities, including PTA. Four patients had unilateral disease, while six had bilateral disease, which was associated with middle aortic syndrome in three. Treatment was a combination of antihypertensive drug therapy, PTA and surgery. PTA was performed 15 times on six patients, nine procedures prior to surgery. The success rate for PTA on primary stenoses was 33% with improvement in blood pressure (BP) control in another 33%. Angioplasties performed on stenoses post-surgery had a success rate of 67%. There were no major complications and PTA had no adverse effect on subsequent surgery. The pre-surgery results obtained at a tertiary referral centre are consistent with those reported in the literature. PTA is a safe and moderately effective treatment modality for RAS secondary to NF1. Although there is only limited success in primary stenoses as there is no adverse effect on subsequent surgery we feel it should be considered as first line management when clinically indicated.

Short- and long-term functional effects of percutaneous transluminal angioplasty in hemodialysis vascular access.

The efficacy of percutaneous transluminal angioplasty (PTA) is usually expressed as the angiographic result. Access flow (Qa) measurements offer a means to quantify the functional effects. This study was performed to evaluate the short-term functional and angiographic effects of PTA and to determine the longevity of the functional effects during the follow-up period. Patients with an arteriovenous graft (AVG) or an arteriovenous fistula (AVF) who were eligible for PTA (Qa values of <600 ml/min) were included. Ultrasound-dilution Qa measurements were obtained shortly before PTA and periodically after PTA, beginning 1 wk after the procedure. The short-term effects were expressed as the increase in Qa and the reduction of stenosis. The long-term effects were expressed as patency and the decrease in Qa after PTA. Ninety-eight PTA procedures for 60 patients (65 AVG and 33 AVF) were analyzed. Qa improved from 371 +/- 17 to 674 +/- 30 ml/min for AVG and from 304 +/- 24 to 638 +/- 51 ml/min for AVF (both P < 0.0001). In 66% (AVG) and 50% (AVF) of cases, Qa increased to levels of >600 ml/min. The degree of stenosis decreased from 65 +/- 3 to 17 +/- 2% for AVG and from 72 +/- 5 to 23 +/- 7% for AVF (both P < 0.005). The reduction of stenosis was not correlated with DeltaQa (r(2) = 0.066). Six-month unassisted patency rates after PTA were 25% for AVG and 50% for AVF. The decreases in Qa were 3.7 +/- 0.8 ml/min per d for AVG and 1.8 +/- 0.9 ml/min per d for AVF. Qa values before PTA and DeltaQa were correlated with the subsequent decrease in Qa (P < 0.005). In conclusion, Qa increases after PTA but, in a substantial percentage of cases, not to levels of >600 ml/min. Qa values before PTA and the increase in Qa were correlated with long-term outcomes, whereas angiographic results were not. These data, combined with literature data, suggest that there is optimal timing for PTA.

Clinical evaluation of the effect of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage

The clinical efficacy of percutaneous transluminal angioplasty and intra-arterial papav~rine infusion for treatment of vasospasm following subarachnoid hemorrhage was investigated. Between 1990 and 1993, 84 patients were treated for cerebral vasospasm in National Defense Medical College Hospital. Angioplasty was performed for asymptomatic vasospasm in 78 patients and for symptomatic vasospasm in 72 patients. Intra-arterial papaverine infusion was performed for asymptomatic vasospasm in 70 patients and for symptomatic vasospasm in four patients. The other 40 patients were treated with standard conservative therapy including hypervolemic and hypertensive hemodilution. The outcomes of these patients were analyzed using the Glasgow Outcome Scale. The outcome tended to be better for patients treated with angioplasty, but not for those treated with papaverine infusion, than for those treated conservatively. Recurrence of vasospasm was more frequent after papaverine infusion than after angioplasty. Undesirable complications such as abrupt development of unconsciousness were experienced during papaverine infusion but not during angioplasty. We conclude that percutaneous transluminal angioplasty is superior to intra-arterial papaverine infusion for prevention and treatment of vasospasm following aneurysmal subarachnoid hemorrhage. [Neural Res 1999; 21: 195-203]

Effect of Percutaneous Transluminal Angioplasty in insufficiency of Arteriovenous Fistula for Hemodialysis

Purpose : To evaluate the effectiveness of percutaneous transluminal angioplasty(PTA) and to determine thefactors affecting the long-term patency rate in the management of insufficient hemodialytic arteriovenousfistula(AVF). Materials and Methods: Forty-nine cases of insufficient hemodialytic AVF were treated in 44patients(native AVF:20, graft AVF:29, M:17, F:27, Age:22-70 years). In 28 thrombus patients, thrombolysis wasperformed with urokinase, and was followed by PTA. The initial success rate and complications of PTA wereevaluated. According to the site and length of the stenosis, type and age of the AVF, the presence or abscence ofthrom-bus, a history of diabetic mellitus, the patient ’s age, and the duration of renal failure, patency rateswere com-pared within each subgroup using the Kaplan-Meier logrank test. Results : The initial success rate of PTAfor insufficient hemodialytic AVF was 88%(43/49), the patency rate of PTA was 67% at 6 months, and 50% at 12months. The initial success rate of thrombolysis was 89%(25/28). The complication rate of PTA was 12%(6/49), ofwhich five cases were vein rupture, and one was subcuta-neous hematoma. Statistically, the patency rates in theabove mentioned subgroups were not significantly different. Conclusion : PTA with or without thrombolysis offerssafe and effective management of insufficient hemodia-lytic AVF.

Limitations of Percutaneous Treatment for Peripheral Arterial Vein Graft Stenoses

Peripheral arterial bypass vein graft stenosis is the leading cause of graft failure within the first 2 years following implantation. These lesions are generally secondary to myointimal hyperplasia and have historically been treated with graft revision or operative patch angioplasty. Unfortunately, graft revision or angioplasty requires reoperation through a scarred incision and usage of additional portions of autologous conduit. The purpose of this study is to assess the effectiveness of percutaneous transluminal angioplasty (PTA) in the treatment of vein graft stenosis. PTA was performed in 17 patent vein grafts in 16 patients for the treatment of perianastomotic and/or midvein graft stenoses occurring 7 ± 1 months (range 0.5-18 months) after graft implantation. Criteria for follow-up and patency adhered to the standards of the Ad Hoc Committee on Reporting Standards of the SVS/NAISCVS. After a mean follow-up of 17 ±3 months (range 2-44 months), the procedure-specific 18-month primary patency, primary-assisted patency, secondary patency, and limb salvage rates were 48 + 17%, 63 + 12%, 67 ± 12%, and 78 ± 15%, respectively. Subgroup analysis revealed favorable lesions (one or two focal lesions, &lt; 1 cm length) in 11 grafts. Life-table analysis for this subgroup revealed primary patency, primary-assisted patency, secondary patency, and limb salvage rates of 68 ±20%, 90 ±9%, 90 ±9%, and 100%, respectively. The overall results of PTA for vein graft stenosis are poor and PTA should not be liberally applied to complex lesions. PTA may be a reasonable alternative to operative repair for focal vein graft stenoses in high-risk patients or in patients with limited remaining autologous conduit.

Ｂモード法を用いた経皮的血管形成術（ＰＴＡ）の内頚動脈壁プラークへの影響に関する検討

Ｂモード法を用いた経皮的血管形成術（ＰＴＡ）の内頚動脈壁プラークへの影響に関する検討

Hemodynamic evaluation of the effect of percutaneous transluminal angioplasty for atherosclerotic disease of the vertebrobasilar arterial system.

The relationship between clinical improvement after percutaneous transluminal angioplasty (PTA) and hemodynamic condition in vertebrobasilar insufficiency was evaluated in 43 patients between 45 and 86 years of age with clinically symptomatic atherosclerotic stenotic lesions in the posterior circulation. The 43 patients had a total of 51 stenotic lesions, including 17 in the first segment of the vertebral artery, 32 in the fourth segment of the vertebral artery, and two in the basilar artery. Angiography was performed and cerebral perfusion was measured with technetium-99m-hexamethyl-propyleneamine oxime single photon emission computed tomography before and after administration of 10 mg/kg acetazolamide prior to and more than 7 months after PTA. Mean stenosis was 81.3 +/- 7.4% before PTA, but only 41.5 +/- 17.4% at follow-up. Eighteen of the 24 patients with improved neurological condition after PTA had subnormal (< mean - 2 SDs) cerebral perfusion before PTA. Twenty of these 24 patients had subnormal vasodilatory response to administration of acetazolamide before PTA. Clinical improvement following PTA was noted in only one of the 12 patients with a single stenotic lesion of the first segment, but in 23 of the 31 patients with intracranial stenotic or multiple stenotic lesions. PTA in the posterior circulation is indicated for patients with atherosclerotic stenotic intracranial lesion or multiple stenotic lesions who have subnormal cerebral perfusion and low vasodilatory response to administration of acetazolamide.

Early Hemodynamic Effects of Percutaneous Transluminal Angioplasty in Superficial Femoral Artery Disease

This study was conducted to assess the early hemodynamic effects of percutaneous trans luminal angioplasty (PTA) in patients with superficial femoral artery (SFA) atheroscle rotic disease. Seventeen patients (forty-nine to eighty-five years, median sixty-seven years), underwent PTA in the SFA, except 1 who had PTA in both the SFA and popliteal artery. Fifteen patients were claudicant whereas the other one had rest pain and ulcera tion. Ten patients had localized SFA occlusion on the angiogram (3 of them had combined stenoses in the common femoral, profunda, and popliteal arteries) and 7 had localized stenoses more than 50%. Ankle-brachial index (ABI), limb blood flow (measured by air plethysmography), peak systolic velocity (PSV) ratio across the stenosis, and the spectral waveform analysis displayed by color flow duplex imaging (CFDI) were assessed before and one day after PTA. Before PTA, the median ABI and limb blood flow were 0.55 ±0.19 and 58.6 ±13.1 mL/min, respectively. The waveform in the poststenotic area of the SFA was monophasic in 5 patients and biphasic in the others, and the PSV was at least doubled in the stenotic area. PTA was technically successful in 16 patients and failed in 1 with an occluded SFA. After successful PTA the median ABI was 0.76 ±0.15 (P&lt;0.00001), and the median limb blood flow was 78.1 ±11.9 mL/min (P&lt;0.00001). The waveform in the dilated area of the SFA was biphasic in all patients with marked decrease in the PSV and forward diastolic velocity present. Postangioplasty pain-free walking distance was at least doubled in 12 patients. In the case of the failed PTA the ABI, limb blood flow, poststenotic waveform, PSV, and pain-free walking-distance were unchanged. In conclusion, early improvement in the hemodynamic parameters occurs over the first day after a successful PTA. These hemodynamic parameters correlate well with the findings of the postangioplasty angiogram and thus can be used in the follow-up of the patients after PTA.

Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis.

Surgery to the vertebrobasilar region is difficult and not considered in most centres. Furthermore, the basilar artery, with its penetrating branches supplying the brain stem, is likely to be extremely hazardous to dilate. The objective of this review was to assess the effect of vertebral artery percutaneous transluminal angioplasty combined with medical care, compared to medical care alone, in people with vertebrobasilar artery disease. We searched the Cochrane Stroke Groups trials register (to August 1997). We contacted researchers in the field and balloon catheter manufacturers. Randomised trials of vertebral percutaneous transluminal angioplasty (with or without stenting) combined with best medical therapy, compared with best medical therapy alone, in people with symptomatic vertebral artery stenosis. Two reviewers independently applied the inclusion criteria. No completed trials were found. One trial is underway, although few patients with vertebrobasilar disease have been recruited. There is no evidence as yet to assess the effects of percutaneous transluminal angioplasty for vertebral artery stenosis.

Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis?

The purpose of this study was to determine the effectiveness of percutaneous transluminal angioplasty (PTA) for treatment of patients with localized stenosis of the infrageniculate popliteal artery and tibio-peroneal trunk (IGPA). The records of 25 patients undergoing IGPA PTA from 1983 to 1993 were reviewed. Patients underwent follow-up with clinical examinations, ankle-brachial indexes, Duplex scanning, and arteriography. Demographic variables and cardiovascular risk factors were analyzed and correlated with outcome. Mean follow-up was 44 months. With life-table analysis, clinical and hemodynamic success was 59%, 32%, and 20% at 1, 2, and 3 years, respectively. Average time to recurrence was 17 months. Sixteen patients required a subsequent procedure; two had only repeat PTA, six had repeat PTA followed by arterial bypass, and eight had bypass alone. The mean additional benefit of repeat PTA was 8 months. Eleven of the 14 patients treated with bypass became symptom-free with patent grafts at a mean follow-up of 52 months. No risk factor was statistically significant in predicting success of IGPA PTA. IGPA PTA is an expensive temporizing measure with a high rate of recurrence requiring subsequent intervention. The procedure should be restricted to patients with limited life expectancy or contraindications to operation.

Changes in the Vasa Vasorum Following Percutaneous Transluminal Angioplasty in a Canine Model of Aortic Stenosis

To investigate the effects of percutaneous transluminal angioplasty on the vasa vasorum in dogs with experimentally created abdominal aortic stenoses. Two stenoses were created in the abdominal aorta in each of 21 dogs. After 6 weeks, the more cephalic stenosis was dilated; the other stenosis served as an untreated control. Groups of three dogs were killed at 24 hours, 3 and 6 weeks, and 4, 8, 12, and 18 months after angioplasty. The aortae were studied by means of histologic examination, microangiography, scanning electron microscopy, and the Spalteholz technique. At nondilated stenoses, the vasa vasorum was interrupted in the outer adventitia and unchanged in the outer media. At dilated stenoses, the number of precapillary arterioles in the outer media progressively increased up to 8 months; thereafter, the number of precapillary arterioles began to decrease. At 18 months, the number was normal. Angioplasty brings about changes in the number of precapillary arterioles in the outer media of the aorta in our canine model of focal abdominal aortic stenosis.

The acute effect of percutaneous transluminal angioplasty (PTA) on coagulation and fibrinolysis

The acute effect of percutaneous transluminal angioplasty (PTA) on coagulation and fibrinolysis

Classification of morphologic effects of percutaneous transluminal coronary angioplasty assessed by intravascular ultrasound

The aim of this study was the assessment and classification of the morphologic effects of percutaneous transluminal angioplasty (PTCA) by intravascular ultrasound (IU). Fifty-eight patients were examined immediately after PTCA with a 4.8Fr, 20 MHz rotational tip IU system. In 10 patients (17%), IU images could not be analyzed due to failure of the imaging system or poor image quality. In 48 patients (83%; 40 men and 8 women, aged 55 ± 9 years), IU images of 48 PTCA segments, as well as 41 distal and 44 proximal sites, were analyzed. The left anterior descending artery was studied in 30 patients, the right coronary artery in 17 and the left main coronary artery in 1. Calcium was present in 32 of 48 PTCA segments (67%). Plaque morphology was concentric in 18 patients (38%) and eccentric in 30 (62%). Seven distinct morphologic patterns were observed. In concentric plaques, plaque compression without significant wall alterations (type 1) was found in 2 patients (4%), superficial tears within the plaque (type 2) in 1 (2%) and deep tears (type 3) in 8 (17%). Deep tearing associated with submedial or subintimal dissection (type 4) was found in 2 patients (4%). Dissection between plaque and vessel wall without noticeable intimal tearing (type 5) was the most common morphology (n = 15; 31%) and occurred in concentric and eccentric plaques. In eccentric plaques, no significant tearing of the plaque (type 6) was found in 6 patients (13%), and tearing of the plaque close to its base with dissection (type 7) in 14 (29%). In the PTCA segment, minimal luminal diameter was 3.5 ± 0.7 mm, maximal luminal diameter 4.3 ± 0.8 mm, luminal area 11.8 ± 4.1 mm 2, plaque area 9.6 ± 5.5 mm 2 and vessel area 23.1 ± 6.9 mm 2. Mean residual stenosis was 40%, mean recoil was −13%, and the correlation between luminal diameter and balloon size was low (r = 0.18). IU is a new imaging modality that enables qualitative and quantitative assessment of coronary arteries after PTCA. A classification of IU findings after PTCA is proposed.

Captopril Renography and the Effect of Percutaneous Transluminal Angioplasty on Blood Pressure in 94 Patients With Renal Artery Stenosis

We treated 94 patients by percutaneous transluminal angioplasty (PTA) for renal artery stenosis (RAS). Prior to PTA, a renogram during angiotensin converting enzyme (ACE) inhibition with captopril was performed, but the result did not influence the decision to treat. The parenchymal time activity curves were judged by visual interpretation. Of the 94 patients, 51 had unilateral and 43 bilateral RAS. In 17 patients with bilateral RAS, PTA could be performed only in the least affected kidney; because of this the effect of PTA on their blood pressure could not be evaluated. Of the remaining 77 patients, a positive captopril renogram was seen in all 31 cured patients, in 22 of the 27 patients with improvement, and in six of the 19 patients with no change of their blood pressure. The sensitivity of the tests for cure and improvement of the blood pressure was 91% (53/58 patients) for all patients, 95% in patients with unilateral RAS (35/37), and 86% (18/21 patients) in patients with bilateral RAS, bilaterally treated. In 18 patients with a negative captopril renogram the blood pressure improved in five, and did not change in 13 patients. The success of PTA in patients with a negative captopril renogram was so poor that we feel it would have been better not to have performed angiography and PTA at all. In conclusion, captopril renography is a useful investigation in assessing the likelihood of blood pressure reduction after PTA of renal artery stenosis.

Successful percutaneous transluminal angioplasty of an obstructed abdominal aorta secondary to a chronic dissection

Previous reports have demonstrated the effectiveness of percutaneous transluminal angioplasty in treating patients with an obstructed abdominal aorta secondary to atherosclerosis, 1 coarctation 2 and other conditions. In the present report, we describe a successful dilatation of an obstructed distal aorta secondary to a “healed” aortic dissection.

Hemodynamic Effect of Percutaneous Transluminal Angioplasty for Lower Limb Atherosclerosis

Measurements of ankle pressure index (API) and arterial flow velocity including calculation of pulsatility index (PI) from the common femoral and pedal arteries were performed in 89 limbs of 75 patients before and after percutaneous transluminal angioplasty (PTA) (63 iliac and 26 femoropopliteal). A pulsed wave Doppler ultrasound flowmeter was used. An increase of API at rest of at least 0.15 or the absence of pressure drop after exercise following PTA was used as criteria for a hemodynamically successful angioplasty. In patients with hemodynamically successful PTA of an iliac obstruction PI increased from 4.2 to 8.6 (p less than 0.001); 91 per cent of these patients improved clinically. When iliac angioplasty was hemodynamically unsuccessful, PI remained unchanged; 11 per cent of these patients improved clinically. All limbs with hemodynamically successful PTA of a femoropopliteal obstruction improved clinically and PI increased from 3.1 to 8.7 (p less than 0.001). After hemodynamically unsuccessful femoropopliteal PTA, PI remained unchanged though 25 per cent of these patients improved clinically. These results illustrate that measurement of arterial flow velocity with calculation of PI may be a useful supplement for the functional evaluation of the effect of PTA, since symptomatic response alone may be unreliable.

Hemodynamic Effect of Percutaneous Transluminal Angioplasty for Lower Limb Atherosclerosis

Hemodynamic Effect of Percutaneous Transluminal Angioplasty for Lower Limb Atherosclerosis

The long term effects of percutaneous transluminal angioplasty for treating patients with renovascular hypertension: case studies.

Percutaneous transluminal angioplasty was performed on 10 patients with unilateral renovascular hypertension (7 with atheromatous and 3 with fibromuscular stenoses) who were then followed for an average of 42 months (range, 24 to 67 months). Dilation of the stenosis was initially successful in all patients except one who had severe atheromatous stenosis. Among patients with atheromatous disease, normotension was attained for 40, 25 and 24 months in 3 patients given no antihypertensive medication and for 67 and 55 months in 2 patients given only nicardipine. The remaining one patient had a recurrent stenosis 3 months after angioplasty. All patients with fibromuscular dysplasia have been normotensive without any hypotensive medication for more than 4 years. Plasma renin activity declined within one week after angioplasty and remained unchanged thereafter in all patients except the one case suffering from a recurrent stenosis. Renal blood flow and glomerular filtration rate remained increased after angioplasty. These results suggest that hypertension can be controlled and renal dysfunction in patients with renal artery stenosis caused by atheroma or fibromuscular dysplasia improved for long periods by percutaneous transluminal angioplasty. The antihypertensive effect obtained by this procedure was more valuable for the patients with fibromuscular dysplasia than in those with atheromatous disease.