Percutaneous Transluminal Angioplasty For Treatment Research Articles

Imaging diagnosis and treatment results of arteriovenous fistulas stenosis complication among hemodialysis patients

ABSTRACT Introduction: Percutaneous transluminal angioplasty (PTA) presents several advantages in addressing arteriovenous fistula (AVF) stenosis compared to surgical approaches. In addition, Doppler ultrasonography (DUS) serves as a noninvasive technique for stenosis measurement and access flow volume calculation. This study aimed to evaluate the agreement in stenosis diagnosis using PTA and DUS before intervention and to assess the effectiveness of the PTA method after intervention. Method: A non - controlled intervention study involved 15 chronic HD patients with a mature AVF in place for over three months, presenting AVF stenosis ≥ 50%, who underwent PTA intervention. Correlation analysis was employed to assess the similarity of AVF stenosis evaluations using DUS and PTA. The study also compared pre - and post - intervention indicators to evaluate the effectiveness of PTA intervention. Results: The results indicated a strong positive correlation between the two techniques (r = 0.997, r2 = 0.994, p < 0.001). Following intervention, all patients were considered successful, with significant reductions observed in various indicators, including alterations in murmurs along AVF, VAPR, the number of patients with AVF stenosis ≥ 50% on DUS, and none with Qmin < 500 mL/min. Conclusion: This study recommends utilizing DUS to evaluate stenosis before contemplating PTA intervention, owing to the correlation and similarity observed in the results of AVF stenosis examination between these two techniques. Ultimately, our research endorses PTA intervention as the preferred method for HD patients with AVF stenosis, considering the observed enhancements in clinical, hemodialysis, and DUS parameters

Impact of Tissue Damage and Hemodynamics on Restenosis Following Percutaneous Transluminal Angioplasty: A Patient-Specific Multiscale Model.

Multiscale agent-based modeling frameworks have recently emerged as promising mechanobiological models to capture the interplay between biomechanical forces, cellular behavior, and molecular pathways underlying restenosis following percutaneous transluminal angioplasty (PTA). However, their applications are mainly limited to idealized scenarios. Herein, a multiscale agent-based modeling framework for investigating restenosis following PTA in a patient-specific superficial femoral artery (SFA) is proposed. The framework replicates the 2-month arterial wall remodeling in response to the PTA-induced injury and altered hemodynamics, by combining three modules: (i) the PTA module, consisting in a finite element structural mechanics simulation of PTA, featuring anisotropic hyperelastic material models coupled with a damage formulation for fibrous soft tissue and the element deletion strategy, providing the arterial wall damage and post-intervention configuration, (ii) the hemodynamics module, quantifying the post-intervention hemodynamics through computational fluid dynamics simulations, and (iii) the tissue remodeling module, based on an agent-based model of cellular dynamics. Two scenarios were explored, considering balloon expansion diameters of 5.2 and 6.2mm. The framework captured PTA-induced arterial tissue lacerations and the post-PTA arterial wall remodeling. This remodeling process involved rapid cellular migration to the PTA-damaged regions, exacerbated cell proliferation and extracellular matrix production, resulting in lumen area reduction up to 1-month follow-up. After this initial reduction, the growth stabilized, due to the resolution of the inflammatory state and changes in hemodynamics. The similarity of the obtained results to clinical observations in treated SFAs suggests the potential of the framework for capturing patient-specific mechanobiological events occurring after PTA intervention.

Application of Freehand 3D Ultrasound Guidance in Percutaneous Transluminal Angioplasty for Autogenous Arteriovenous Fistula Stenosis

Objective: Using freehand three dimensional (3D) ultrasound imaging to evaluate arteriovenous fistula stenosis. Comparing the value of freehand 3D ultrasound and Doppler ultrasound in the application of percutaneous transluminal angioplasty (PTA) treatment for stenosis of an arteriovenous fistula. Methods: A retrospective analysis was conducted on 34 patients with arteriovenous fistula (AVF) stenosis who were treated at the 903RD Hospital of PLA and the Kidney Center of Zhejiang Provincial People's Hospital from August 2021 to August 2022. Based on the different types of surgical assistance, the patients were divided into two groups: the Doppler ultrasound group (Group A, n = 17) and the freehand 3D ultrasound imaging group (Group B, n = 17). Freehand 3D ultrasound and Doppler ultrasound were used to assess the narrowing of arteriovenous fistulas, and images and relevant data were collected before and after the PTA procedure. The differences in the time of puncture and sheath placement, guidewire insertion time, the duration of the procedure, complications, and methods to measure stenosis were compared between the two groups of patients, as well as the technical success rate, the initial patency rate, and the primary patency rates at 1, 3, 6 and 9 months post-surgery. This study discusses the clinical efficacy of using these two types of ultrasound to assist in the PTA treatment of arteriovenous fistula stenosis. Results: The differences in baseline demographics between the conventional ultrasound group (Group A) and the 3D ultrasound group (Group B) were not statistically significant (p > 0.05). The intraoperative guidewire insertion time (4.647 ± 1.347 min vs. 2.824 ± 0.326 min) and the operating times (75.941 ± 7.557 min vs. 59.824 ± 8.175 min) between the two groups were statistically significant (t = 2.788, 3.069, p < 0.01). The technical success rates for the two groups were 94.1% vs. 100%, not statistically significant (t = 1.03, p = 0.31). The first-time patency rates were 88.2% vs. 94.1%, with no statistically significant difference (t = 0.366, p = 0.545). No complications occurred in Group A, while one case of hematoma occurred postoperatively in Group B, with an incidence of 5.9% (1/17), which was not statistically significant (t = 1.03, p > 0.05). Comparing the primary patency rates at 1, 3, 6 and 9 months post-surgery between Groups A and B, there were no statistically significant differences (p > 0.05). However, the patency rates at different time points for Group B were consistently higher than Group A (94.1%, 82.4%, 82.4%, 82.4% vs. 88.2%, 82.4%, 76.5%, 76.5%). Conclusion: Freehand 3D ultrasound imaging can provide more intuitive, high-resolution, and high-definition three-dimensional images, clearly defining the lesion site and vascular structures. Its accuracy in assessing complications of arteriovenous fistulas is similar to that with conventional ultrasound. When used as an adjunct to PTA treatment, its efficacy is equivalent. It can significantly reduce guidewire insertion time and operation time, decrease postoperative recovery time, and alleviate the patients' concerns regarding surgical risks. It can be considered a new method for diagnosing, treating, and patients with AVF stenosis.

Stable Arterial Perforators Mapping in Lower Leg Using Color-Coded Doppler Sonography, Acoustic Doppler, and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Angiography

Abstract Background Chronic defects in the lower leg present significant challenges in plastic surgery due to their diverse etiologies and association with impaired peripheral circulation. This study describes the localization of stable perforators and assesses their changing velocities after digital subtraction angiography (DSA) and alterations of flow characteristics. Methods Ten patients with lower extremity defects requiring DSA had undergone examinations by using standard methods. The localization of 40 stable perforators originating from the anterior tibial artery, posterior tibial artery, fibular artery, and medial sural artery was performed before and after angiography. Where stenoses or occlusions were observed, percutaneous transluminal angioplasty (PTA) was conducted, and velocity changes following reperfusion were measured. Results Angiographic abnormalities were observed in all of patients, thus necessitating PTA interventions. Prior to PTA, handheld acoustic Dopplers detected 37 out of 40 perforators (90%), whereas color-coded sonography detected 35 out of 40 perforators (87.5%). After PTA, these numbers increased to 38 out of 40 (95%) and 37 out of 40 (92.5%), respectively. The diameter of the perforators ranged between 1.14 and 1.16 mm. The mean flow characteristics included the peak systolic velocities (PSV) of 21.9 and 27.2, end-diastolic velocities (EDV) of 9.4 and 11.4, and resistance indexes (RI) of 0.63 and 0.71, respectively. In the postintervention period, 16 microvessels exhibited enlarged lumen diameters ranging from 1 to 3 mm, resulting in increased perfusion values for PSV in 85.2% (21.9/27.2) and EDV in 88.2% (9.4/11.4) of the patients. The RI increased from 0.63 to 0.71. However, two perforators showed decreases in flow velocity after PTA. Conclusion In most patients with chronic lower leg wounds and other comorbidities, adequate perforators for reconstruction can be identified by using conventional methods. PTA interventions positively impact blood flow in perforators, although they are not necessarily required prior to reconstruction.

Management of Refractory Central Vein Stenosis in Hemodialysis Patient

BACKGROUND: Patient with hemodialysis (HD) is prone to central venous stenosis (CVS). The presence of CVS contributed to poor dialysis adequacy. Symptomatic CVS is treated with percutaneous transluminal angioplasty (PTA) with or without a stent. This report aimed to understand the characteristics of PTA with or without a stent. CASE PRESENTATION: A 43-year-old woman was admitted to the hospital with a chief complaint of a deteriorating swollen right arm with pain 1 week prior. Patient had been on HD since 2019, had AV shunt access, continuous ambulatory peritoneal dialysis (CAPD), and 4 times balloon angioplasty due to similar complaints. Diagnoses of the patient were AV shunt stenosis, chronic kidney disease Stage 5 on CAPD, heart failure Stage C FC II, hypertension on treatment, anemia related to renal disease, and severe hypoalbuminemia based on anamnesis and extensive examination. PTA with stent was conducted in this patient and showed TIMI Flow III. CONCLUSION: PTA is the primary treatment for symptomatic CVS. A stent implantation is used in cases that failed PTA treatment. PTA with a stent provides immediate symptom alleviation and benefits an angioplasty-resistant lesion by secondary patency.

Prospective, randomized, multicenter clinical study comparing a self-expanding covered stent to percutaneous transluminal angioplasty for treatment of upper extremity hemodialysis arteriovenous fistula stenosis

Use of a covered stent after percutaneous transluminal angioplasty (PTA) was compared to PTA alone for treatment of upper extremity hemodialysis patients with arteriovenous fistula (AVF) stenoses. Patients with AVF stenosis of 50% or more and evidence of AVF dysfunction underwent treatment with PTA followed by randomization of 142 patients to include a covered stent or 138 patients with PTA alone. Primary outcomes were 30-day safety, powered for noninferiority, and six-month target lesion primary patency (TLPP), powered to test whether TLPP after covered-stent placement was superior to PTA alone. Twelve-month TLPP and six-month access circuit primary patency (ACPP) were also hypothesis tested while additional clinical outcomes were observed through two years. Safety was significantly non-inferior while six- and 12-month TLPP were each superior for the covered stent group compared to PTA alone (six months: 78.7% versus 55.8%; 12 months: 47.9% versus 21.2%, respectively). ACPP was not statistically different between groups at six-months. Observed differences at 24 months favored the covered-stent group: 28.4% better TLPP, fewer target-lesion reinterventions (1.6 ± 1.6 versus 2.8 ± 2.0), and a longer mean time between target-lesion reinterventions (380.4 ± 249.5 versus 217.6 ± 158.4 days). Thus, our multicenter, prospective, randomized study of a covered stent used to treat AVF stenosis demonstrated noninferior safety with better TLPP and fewer target-lesion reinterventions than PTA alone through 24 months.

Using T1 mapping indices to evaluate muscle function and predict conservative treatment outcomes in diabetic patients with peripheral arterial disease.

To investigate interstitial muscle fibrosis via T1 mapping indices and its relationships with muscle function and conservative treatment outcomes. A total of 49 DM patients with PAD were prospectively recruited from 2016 to 2017. All PAD patients underwent pre-treatment MRI with conservative treatment via a rehabilitation program and antiplatelet therapy. The need to require percutaneous transluminal angioplasty intervention was recorded as intolerance to conservative treatment outcomes. We quantified calf interstitial muscle fibrosis using T1 mapping indices (native T1, post-contrast T1, and the extracellular volume fraction [ECV]). Muscle function was evaluated using a 6-min walking test (6MWT) and a 3-min stepping test (3MST). PAD patients were divided into two groups according to their tolerance or intolerance of the conservative treatment. Pearson's correlation, reproducibility, and multivariable Cox hazard analyses were performed with p < 0.05 indicating statistical significance. Among the T1 mapping indices in the posterior compartment of the calf in PAD patients, the native T1 value was significantly correlated with 6MWT (r = -0.422, p = 0.010) and 3MST (r = -0.427, p = 0.009). All T1 mapping indices showed excellent intra-observer and inter-observer correlations. ECV was an independent predictor of conservative treatment intolerance (average ECV, hazard ratio: 1.045, 95% confidence interval: 1.011-1.079, p = 0.009). T1 mapping measurements are reproducible with excellent intra-observer and inter-observer correlations. T1 mapping indices may be predictive of treatment and functional outcomes and carry promise in patient evaluation. Clinical Trials Identifier: NCT02850432 . • T1 mapping measurements of the calf muscles are reproducible with excellent intra-observer and inter-observer correlations (0.98 and 0.95 for anterior and posterior compartment muscle extracellular volume matrix [ECV] measurements, respectively). • ECV is shown to independently predict conservative treatment intolerance. • T1 mapping indices may be predictive of treatment and functional outcomes and carry promise in patient evaluation.

Percutaneous balloon and stent angioplasty in children with renal artery stenosis

Renal artery stenosis(RAS) is responsible for about 10% of secondary childhood hypertension that lead to end organ dysfunction and mortality. Angioplasty is gold intervention approach for stenosis treatment. However, there are rare studies in term of the pediatric RAS and angioplasty outcome in the children. In this Single-center, retrospective study, the medical records of pediatric RAS patients were analyzed who referred for Rajaei cardiovascular medical and research center of Tehran from 2005 to 2018. Of these, 13 patients underwent PTA (Percutaneous transluminal angioplasty) treatment. Demographic data, etiology, symptoms, presenting feature, stenosis, blood pressure, number of drugs, hematological and biochemical parameters, intervention type, treatment complication and echocardiography reports were reviewed. Statistical analysis was performed with SPSS Version 23 software package. Descriptive statistics, Chi square and Pearson correlation, parametric and non-parametric tests used for statistical analysis. Our results showed headache and cardiovascular damage was most common presenting feature. PTA intervention is effective in order of 50% of patients that reduced the blood pressure and improved medical therapy. The numbers of administrated antihypertensive drugs were reduced after PTA therapy. Restenosis and contrast induced-nephropathy emerge as major complications. Higher stenosis present but not lesion length had a negative relationship with treatment success and outcome. Age, ESR and serum potassium levels predicted the treatment outcome significantly. In conclusion, this study confirm the effectiveness of PTA in the treatment of pediatric RAS but need more technical and biomedical improvement to yield higher success and outcome.

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

ObjectivesMaintenance of vascular access (VA) patency after percutaneous transluminal angioplasty (PTA) is important and remains a challenge despite VA monitoring and surveillance. The aim of this study was to examine...

Virtual Reality-Assisted Percutaneous Transluminal Angioplasty for Interventional Treatment of Lower-Extremity Arteriosclerosis Obliterans.

This study was to evaluate the biomechanical characteristics of the vascular wall during virtual reality- (VR-) assisted percutaneous transluminal angioplasty (PTA) and its effect on the treatment of lower-extremity arteriosclerosis obliterans (LEAO). In this study, a three-dimensional (3D) model and a finite-element model of arteries were constructed first, and various fluid mechanics were analyzed. Then, the virtual expansion simulation (VES) of individualized PTA was performed based on the ABAQUS/Explicit module to analyze the interaction between the balloon and the blood vessel at different times and the changes in the vascular shape and structural stress distribution. Finally, an LEAO animal model was constructed. Based on conventional PTA (PTA group) and VR-assisted PTA (VR-PTA) treatment, the morphological changes of vascular lumen of the two animal models were evaluated. The results showed that the normal, stenotic blood vessels and blood models were successfully constructed; the pressure of the stenotic blood vessel at the stenosis decreased obviously and the shear stress of blood vessel wall increased compared with that of the normal blood vessels, and there may be a blood reflux area in the poststenosis stage. The simulation results of the VES showed that the maximum principal stress value at 3 mm of the marginal vessel was much lower than that at 5 mm (about 10% lower), so the maximum principal stress change within 2 mm of the balloon-expanded vessel was the most obvious. The treatment results of the animal model showed that the VR-PTA group showed an obvious increase in the diameter of the vascular lumen, a decrease in the intima and media area, and a decrease in the thickness of the vessel wall in contrast to the PTA group (P < 0.05), which had an important effect on the reconstruction and expansion of the vascular lumen. The VR-PTA treatment on LEAO was realized in this study, which provided critical reference for the follow-up application of VR technology in the evaluation of surgical plan and research on biomechanical mechanisms of restenosis after PTA.

Percutaneous Transluminal Angioplasty in the Treatment of Diabetic Foot

Background: Diabetic foot is the foot tissue damage, ulceration, secondary segmental necrosis in diabetic patients. The prevalence of diabetes is predominantly due to long-term high blood sugar, high blood lipids in the state, the systemic arterial prone to atherosclerosis, lower limb arteries are more prone to endometrial damage, and then there is stenosis or occlusion, distal extremity ischemia, Leading to diabetic foot ulcers. Objective: To assess the value of percutaneous transluminal angioplasty (PTA) in the surgical treatment of diabetic foot

Percutaneous Transluminal Angioplasty In The Treatment Of Diabetic Foot

Background: Diabetic foot is the foot tissue damage, ulceration, secondary segmental necrosis in diabetic patients. The prevalence of diabetes is predominantly due to long-term high blood sugar, high blood lipids in the state, the systemic arterial prone to atherosclerosis, lower limb arteries are more prone to endometrial damage, and then there is stenosis or occlusion, distal extremity ischemia, Leading to diabetic foot ulcers. Objective: To assess the value of percutaneous transluminal angioplasty (PTA) in the surgical treatment of the diabetic foot. Methods: Retrospective analysis of 83 cases of diabetic foot patients, 95 limbs, 95 wounds were conscripted from September 2011 to September 2014 in our hospital. Rendering to whether the PTA treatment is not accepted PTA treatment of the conventional treatment group 43 cases (wound 51) and PTA treatment of PTA group 40 cases (44). The granulation growth rate of the wound was intended at 3, 6, 9, and 12 days after debridement. The spell of wound preparation was logged before operation. According to the Wagner classification, the survival rate of the skin graft and the healing of the suture in the 2 groups were statistically analyzed. Statistics of two groups of patients were followed up for six months, the monthly review of ABI, and ulcer recurrence. Data were processed with χ² test and t-test. Results: The good rate of granulation growth of the wound in the conventional treatment group was slower than that of the control group. The good granulation growth rate of the wound was less than 20% on the 12th day after treatment. The granulation growth rate of the wound in the PTA group increased visibly from the 9th day, all grow well. On the 9th and 12th day of treatment, the granulation growth rate of the wound in PTA group was ominously advanced than that in the conventional treatment group (P&lt;0.01). The time of wound preparation was (24 ± 10) days in the conventional treatment group, which was significantly higher than that in the PTA group (15 ± 3) days, t=5.709, P&lt;0.01. The Wagner 2,3,4 grade wounds were suggestively greater in the PTA group than in the conventional treatment group (χ2=6.741~24.498,P&lt;0.01). ABI was significantly higher in the PTA group than in the conventional treatment group (t=5.411~9.583,P&lt;0.01). There was no recurrence of the ulcer in the 4 months before the follow-up. There were 1 and 2 cases of ulcer recurrence in the 5- and 6-months follow-up. There was no recurrence in the PTA group after 6 months follow-up. Conclusion: PTA is effective in the surgical treatment of diabetic foot patients, and has assured clinical application value.

Percutaneous Transluminal Angioplasty in the Treatment of Diabetic Foot

Background: Diabetic foot is the foot tissue damage, ulceration, secondary segmental necrosis in diabetic patients. The prevalence of diabetes is predominantly due to long-term high blood sugar, high blood lipids in the state, the systemic arterial prone to atherosclerosis, lower limb arteries are more prone to endometrial damage, and then there is stenosis or occlusion, distal extremity ischemia, Leading to diabetic foot ulcers. Objective: To assess the value of percutaneous transluminal angioplasty (PTA) in the surgical treatment of diabetic foot. Methods: Retrospective analysis of 83 cases of diabetic foot patients, 95 limbs, 95 wounds were conscripted from September 2011 to September 2014 in our hospital. Rendering to whether the PTA treatment is not accepted PTA treatment of the conventional treatment group 43 cases (wound 51) and PTA treatment of PTA group 40 cases (44). The granulation growth rate of the wound was intended at 3, 6, 9, and 12 days after debridement. The spell of wound preparation was logged before operation. According to the Wagner classification, the survival rate of the skin graft and the healing of the suture in the 2 groups were statistically analyzed. Statistics of two groups of patients were followed up for six months, the monthly review of ABI, and ulcer recurrence. Data were processed with χ² test and t test. Results: The good rate of granulation growth of the wound in the conventional treatment group was slower than that of the control group. The good granulation growth rate of the wound was less than 20% on the 12th day after treatment. The granulation growth rate of the wound in the PTA group increased visibly from the 9th day, all grow well. On the 9th and 12th day of treatment, the granulation growth rate of the wound in PTA group was ominously advanced than that in the conventional treatment group (P &lt;0.01). The time of wound preparation was (24 ± 10) days in the conventional treatment group, which was significantly higher than that in the PTA group (15 ± 3) days, t = 5.709, P &lt;0.01. The Wagner 2, 3, 4 grade wounds were suggestively greater in the PTA group than in the conventional treatment group (χ2 = 6.741 ~ 24.498, P &lt;0.01). ABI was significantly higher in the PTA group than in the conventional treatment group (t = 5.411 ~ 9.583, P &lt;0.01). There was no recurrence of ulcer in the 4 months before the follow-up. There were 1 and 2 cases of ulcer recurrence in the 5 and 6 months follow-up. There was no recurrence in the PTA group after 6 months follow-up. Conclusion: PTA is effective in the surgical treatment of diabetic foot patients, and has assured clinical application value.

Outcomes of balloon angioplasty for failing upper extremity dialysis access

Background Percutaneous transluminal angioplasty (PTA) is the mainstay of treatment in stenosed hemodialysis access. Being less invasive and outpatient procedure, PTA is a safe and useful intervention to maintain access patency in patients with failing hemodialysis arteriovenous fistulas (AVFs). The aim of this study was to evaluate the efficacy of balloon angioplasty in treatment of patients with failing upper extremity hemodialysis access. Methods This is a prospective study of all adult patients who underwent balloon angioplasty for the treatment of patients with symptoms of a failing dialysis access due to presence of significant stenosis in dialysis access circuit. The study conducted at the Department of Vascular and Endovascular Surgery, Assiut University Hospital (a tertiary referral hospital), between January 2017 and December 2018. Both the primary and assisted primary patency rates were analyzed by the Kaplan-Meier plot method. Results 149 patients underwent PTA for treatment of failing dialysis access symptoms. The most common site of stenosis in our study was the juxta-anastomotic site (49 %). The overall success rate was 96.6%. Balloon angioplasty was performed in all patients without stent placement. Sixteen (10.7%) complications were encountered in the study. At 1 year, the primary patency and the assisted primary patency rates was 60.5% and 80%, respectively. Age of the fistula (P=0.017), presence of multiple lesions (P=0.016), total lesion length >5cm (P=0.030), and diabetes mellitus (P=0.012) were significant independent predictors of loss of primary patency. Conclusions Balloon angioplasty is safe and effective treatment modality for treatment of stenosis in failing hemodialysis access patients with good technical success and acceptable short-term primary patency rates. Repeated interventions are required to maintain patency.

Randomized controlled trial of orchid drug-coated balloon versus standard percutaneous transluminal angioplasty for treatment of femoropopliteal artery in-stent restenosis.

To assess the efficacy and safety of Orchid drug-coated balloon (DCB) for treatment of femoropopliteal (FP) artery in-stent restenosis (ISR) in Chinese patients. The study is a prospective, single center, single-blinded, randomized controlled trial (RCT) that randomized (1:1) 74 patients to DCB group (N.=38) and PTA group (N.=36). The primary efficacy endpoint was primary patency of the target lesion at 12 months. Second efficacy endpoint included clinically-driven target-lesion revascularization (CD-TLR) and ABI change at 12 months. The primary safety endpoint included peri-operative death at 30 days, all-cause death, major amputation, and other major adverse events (MAEs) at 12 months. The primary functional endpoint included Walking Impairment Questionnaire (WIQ), quality-of-life measures (EQ-5D) and 6-minute walking test (6MWT). The DCB group had higher primary patency (87.9% vs. 51.6%; P=0.001) and lower rates of CD-TLR (6.1% vs. 35.5%; P=0.003) than the PTA group at 12 months. There were no peri-operative deaths, and no major amputations at 12 months in two groups. There were 1(2.6%) in the DCB group and 2 (5.6%) in the PTA group of all-cause deaths (P=0.524). Results from the study showed superior treatment effect with Orchid DCB versus PTA for the treatment of FP ISR, and without an apparent difference in safety.

Treatment of failing arterio-venous dialysis graft by angioplasty, stent, and stent graft: Two-years analysis of patency rates and cost-effectiveness.

The objective of this prospective randomized single-center study was to compare primary and secondary patency rates, number of percutaneous transluminal angioplasty (PTA) interventions and cost-effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts (AVG) due to restenosis in the venous anastomosis or the outflow vein. Altogether 60 patients with failing AVG and restenosis in the venous anastomosis or the outflow vein were randomly assigned to either PTA, placement of a stent (E-Luminexx®) or stent graft (Fluency Plus®). After the procedure, patients with stent or stent graft received dual antiplatelet therapy for the next three months. Follow-up angiography was scheduled at 3, 6, and 12 months unless requested earlier due to suspected stenosis or malfunction of the access. Subsequently, angiography was performed only if requested by the clinician. During a median follow-up of 22.4 (IQR=5.7) months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0, 18 and 65% at 12 months and 0, 18 and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures in the first two years was €7,900±€3,300 in the PTA group, €8,500±€4,500 in the stent group, and €7,500±€6,200 in the stent graft group (P=0.45). We conclude that the treatment of failing dialysis vascular access by the deployment of a stent graft significantly improves its primary patency rates and decreases the number of secondary PTA interventions; however, the reduction in costs for maintaining AVG patency is not significant.

Real-world outcomes of endovascular treatment in a non-selected population with peripheral artery disease - prospective study with 2-year follow-up.

Background: The study aimed to evaluate the outcomes of percutaneous transluminal angioplasty (PTA) in lower-extremity peripheral artery disease (PAD) patients. Patients and methods: A multi-centre, observational study was performed with 32 German and Austrian centres contributing data to the PTA registry. Data of 1,781 patients with lower-leg and pelvic PAD who were suitable for endovascular PTA treatment were contributed from participating centres. Data from 1,533 patients are reported here (1,055 male and 478 female). This study did not have exclusion criteria. Quality of life (QOL) questionnaire (EQ-5D) scores, Rutherford classification, mortality, patency rate and details of major adverse cardiovascular events were collected at 6-, 12-, 18-, and 24-month follow ups. Results: PTA with/without stenting achieved 90.3%, 86.5%, 82.7%, and 71.9% technical success (recanalisation achieving ≥70% patency, no evidence of embolisation, recoiling or dissection) in iliac, femoral, popliteal, and below-the-knee arteries, respectively. Procedural/postprocedural complications occurred in 142 (9.3%, 1death) and 74 (4.8%) patients. QOL, mobility, self-care, activity, and pain/discomfort scores improved (p<0.01), anxiety/depression was insignificantly improved. During follow-up, 409 (26.7%) patients were hospitalised for PAD, 281 (18.3%) required reintervention, and 145 (9.5%) died or needed amputation (n=49; 3.2%). Multivariate analysis demonstrated poorer outcomes in patients with comorbidities. Conclusions: PTA with/without stenting is effective, safe, and widely applicable, with few complications. It improves QOL, but not anxiety/depression.

Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis.

Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an immune-mediated disease. It has been hypothesised that intraluminal defects, compression, or hypoplasia in the internal jugular or azygos veins may be important factors in the pathogenesis of MS. This condition has been named 'chronic cerebrospinal venous insufficiency' (CCSVI). It has been suggested that these intraluminal defects restrict the normal blood flow from the brain and spinal cord, causing the deposition of iron in the brain and the eventual triggering of an auto-immune response. The proposed treatment for CCSVI is venous percutaneous transluminal angioplasty (PTA), which is claimed to improve the blood flow in the brain thereby alleviating some of the symptoms of MS. This is an update of a review first published in 2012. To assess the benefit and safety of venous PTA in people with MS and CCSVI. We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group's Specialised Register up to 30 August 2018, CENTRAL (in the Cochrane Library 2018, issue 8), MEDLINE up to 30 August 2018, Embase up to 30 August 2018, metaRegister of Controlled Trials, ClinicalTrials.gov., the Australian New Zealand Clinical Trials Registry, and the World Health Organization (WHO) International Clinical Trials Registry platform. We examined the bibliographies of the included and excluded studies. We included randomised controlled trials (RCTs) in which PTA and sham interventions were compared in adults with MS and CCSVI. Two authors independently assessed study eligibility and risk of bias, and extracted data. We reported results as risk ratios (RR) with 95% confidence intervals (CI). We performed statistical analyses using the random-effects model; and we assessed the certainty of the evidence using GRADE. We included three RCTs (238 participants) in this update. One hundred and thirty-four participants were randomised to PTA and 104 to sham treatment. We attributed low risk of bias to two (67%) studies for sequence generation and two (67%) studies for performance bias. All studies were at a low risk of detection bias, attrition bias, reporting bias and other potential sources of bias.There was moderate-quality evidence to suggest that venous PTA did not increase the proportion of patients who had operative or post-operative serious adverse events compared with the sham procedure (RR 3.33, 95% CI 0.36 to 30.44; 3 studies, 238 participants); nor did it increase the proportion of patients who improved on a functional composite measure including walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity over 12-month follow-up (RR 0.84, 95% CI 0.55 to 1.30; 1 study, 110 participants); nor did it reduce the proportion of patients who experienced new relapses at six- or 12-month follow-up (RR 0.87, 95% CI 0.51 to 1.49; 3 studies, 235 participants). There was no effect of venous PTA on disability worsening measured by the Expanded Disability Status Scale, which was reported at follow-up intervals of six months (one study), 11 months (one study) and 12 months (one study). Quality of life was reported in two studies with no difference between treatment groups. Moderate or severe pain during or post venography was reported in both PTA and sham-procedure participants in all included studies. Venous PTA was not effective in restoring blood flow assessed at one-month (one study) or 12-month follow-up (one study). This systematic review identified moderate-quality evidence that, compared with sham procedure, venous PTA intervention did not provide benefit on patient-centred outcomes (disability, physical or cognitive functions, relapses, quality of life) in people with MS. Venous PTA has proven to be a safe technique but in view of the available evidence of its ineffectiveness, this intervention cannot be recommended in people with MS. All ongoing trials were withdrawn or terminated and hence this updated review is conclusive. No further randomised clinical studies are needed.

Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis

To evaluate the clinical efficacy of percutaneous mechanical thrombectomy (PMT) combined with percutaneous transluminal angioplasty (PTA) in the treatment of iliofemoral deep vein thrombosis. Ninety-four patients with iliofemoral deep vein thrombosis were identified in this retrospective study in our institution from November 2015 through December 2017. Patients were divided into two groups:PMT+PTA group (n=50) and PMT only group (n=44). Clot lysis rates, the retrieving and the embolism of the interior vena cava filter, as well as the incidence of complications were compared between two groups. The changes of serum creatinine, lactate dehydrogenase and hemoglobin were also measured perioperatively. All procedures were completed successfully. The average clot lysis rate was higher and the procedure time was shorter in PMT+PTA group than those in PMT group (both P<0.01). No significant differences were found in the rates of venous stenosis, catheter-directed thrombolysis and stent placement between two groups (all P>0.05). The interior vena cava filter was taken out in 82.0% (41/50) patients of PMT+PTA group and 81.8% (36/44) patients of PMT group (P>0.05). There were no significant differences of the changes in serum creatinine, lactate dehydrogenase and hemoglobin (all P>0.05). In PMT+PTA group, symptomatic pulmonary embolism and puncture bleeding occurred in 1(2.0%) and 2(4.0%) patients, while in PMT group, it was 0 and 2(4.5%), respectively (P>0.05). PMT combined with PTA is more effective than PMT alone for the treatment of iliofemoral deep vein thrombosis with less procedure time and without more incidence of pulmonary embolism.

Prospective study of clinical, neurophysiological and urodynamic findings in multiple sclerosis patients undergoing percutaneous transluminal venous angioplasty

ObjectiveVerify whether Percutaneous Transluminal Angioplasty (PTA) may affect neural conduction properties in Multiple Sclerosis (MS) patients, thereby modifying patients’ disability, with prospective neurophysiological, urodynamic, clinical and subjective well-being evaluations. MethodsIn 55 out of 72 consecutively screened MS patients, the following procedures were carried out before (T0), at 2–6 months (T1) and at 6–15 months (T2) after a diagnostic phlebography, eventually followed by the PTA intervention if chronic cerebrospinal venous insufficiency (CCSVI) was diagnosed: clinical/objective evaluation (Expanded Disability Status Scale, EDSS), ratings of subjective well-being, evaluation of urodynamic functions and multimodal EPs (visual, acoustic, upper and lower limbs somatosensory and motor evoked potentials). ResultsThe number of dropouts was relatively high, and a complete set of neurophysiological and clinical data remained available for 37 patients (19 for urological investigations). The subjective well-being score significantly increased at T1 and returned close to basal values at T2, but their degree of objective disability did not change. Nevertheless, global EP-scores (indexing the impairment in conductivity of central pathways in multiple functional domains) significantly increased from T0 (7.9 ± 6.0) to T1 (9.2 ± 6.3) and from T0 to T2 (9.8 ± 6.3), but not from T1 and T2 (p > 0.05). Neurogenic urological lower tract dysfunctions slightly increased throughout the study. ConclusionsThe PTA intervention did not induce significant changes in disability in the present cohort of MS patients, in line with recent evidence of clinical inefficacy of this procedure. SignificanceAbsence of multimodal neurophysiological and functional testing changes in the first 15 months following PTA suggests that conduction properties of neural pathways are unaffected by PTA. Current findings suggest that the short-lived (2–6 months), post-PTA, beneficial effect on subjective well-being measures experienced by MS patients is likely related to a placebo effect.