Role Of Percutaneous Transluminal Angioplasty Research Articles

Role of Doppler Ultrasound and Percutaneous Transluminal Angioplasty in Early Diagnosis and Management of Peripheral Artery Disease

BACKGROUND: Peripheral arterial disease (PAD) denotes vascular disorder which peripheral artery’s obstruction or constriction is found. PAD with diabetic history is more susceptible to ischemic ulcer than PAD with no diabetic. The presence of Diabetes mellitus (DM) in PAD can speed up 4 times greater risk of developing Critical Limb Ischemia. In our hospital, difficulty performing extremity perfusion assessment is often found because those examinations are not available, so possibility of PAD can be missed. Therefore, optimalization use of Doppler Ultrasound (DUS) is important in our case. AIM: The purpose of our case writing is to give information about substantial parameter of DUS in determine presence of PAD and define the role of percutaneous transluminal angioplasty (PTA) in PAD. The earlier PAD discovered, faster further treatment conducted, especially PTA. CASE REPORT: A 65-year-old female patient with intermittent left calf pain for 7 months who went to internal medicine outpatient has reported. She has history of type 2 DM and significant hyperlipidemia. On physical examination, vital signs revealed normal value. Body mass index was 28 kg/m2. Resting ankle-brachial index (ABI) measurement was 1.14 and 1.12 at the right and left dorsalis pedis, respectively. DUS showed spectral narrow, reversal flow and no clear spectral window in superficial femoral artery. There are clear spectral window, spectral narrow, and reversal flow in poplitea artery. No clear spectral window, no spectral narrow, and no reversal flow in anterior tibia artery. Clear spectral window, reversal flow, and no spectral narrow are appear in posterior tibia artery. Arteriogram of left inferior extremity showed middle part partial stenosis of anterior tibia artery. Dilatation with standard balloon for 1 min was done. After that, no stenosis in same location and she wasn’t feel calf pain again. CONCLUSION: Compared with two other parameters, reversal flow in DUS is most important parameter to establish presence of stenosis. PTA is adequate to give revascularization stenosis in PAD.

Multi-institutional Two-Year Outcomes in Dialysis Graft Management: Real-World Evidence

There remains substantial debate around the most appropriate management algorithm for dialysis access grafts. The role of percutaneous transluminal angioplasty (PTA) and stent grafts (SGs) remains controversial, and downstream effects of various treatment modalities remain unclear. Furthermore, there is an absence of a proper financial analysis to calculate the overall cost of care for these patients. The purpose of this study was to determine the optimal algorithm for the management of dialysis patients with an upper arm dialysis graft.

Role of percutaneous transluminal angioplasty for radiocephalic fistulae with junctional stenosis

Background Morbidity from end-stage renal disease is primarily from vascular access. Access thrombosis is the main cause of arterio venous (AV) access failure. Decreased fistula blood flow leads to access thrombosis in arteriovenous fistulae, which occurs secondary to venous stenosis. Junctional stenosis is a complication of arteriovenous fistulas. Surgical correction and percutaneous transluminal angioplasty may correct it. Our study aimed to clarify factors for primary success of percutaneous transluminal angioplasty of radiocephalic fistulae with stenosis at the arteriovenous junction with long-term patency on follow-up. Radiocephalic junctional stenosis of fistulae involves both the radial artery and cephalic vein and site of bifurcation. Usually, radiocephalic fistula stenosis is located in the venous limb near the arteriovenous junction. Patients and methods This prospective study included 50 percutaneous transluminal angioplasty cases with stenosis at the arteriovenous junction of radiocephalic fistulae. Demographic data including age, sex, site of fistula (right or left arm), and approach (radial artery or cephalic vein) were recorded. Analysis included primary percutaneous transluminal angioplasty success and long-term patency rates. Results The total primary success rate was 88%. The existence of total occlusion was recognized as the only factor significantly associated with a high procedural failure rate (83.3 vs. 16.6%, P=0.03). For long-term patency rate, the only significant factor was the involvement of proximal radial artery dilatation (P=0.023). The 6, 12, and 18-month patency rates were 66.4, 46.8, and 23.1%, respectively, for all procedures. Conclusion Percutaneous transluminal angioplasty for junctional stenosis at radiocephalic fistula involving both the radial artery and cephalic vein at the site of anastomosis without dilating the radial artery side of the arteriovenous junction reduces the long-term patency rate; however, the initial success rate will not be affected. Initial procedural failure depends on presence of occlusive lesion mainly.

A Review of Percutaneous Transluminal Angioplasty in Hemodialysis Fistula.

The number of patients in dialysis increases every year. In this review, we will evaluate the role of percutaneous transluminal angioplasty (PTA) according to patency of arteriovenous fistula and grafts. The main indication of PΤΑ is stenosis > 50% or obstruction of the vascular lumen of an arteriovenous fistula and graft. It is usually performed under local anesthesia. The infection rate is as low as the number of complications. Fistula can be used in dialysis in the same day without the need for a central venous catheter. Primary patency is >50% in the first year while primary assisted patency is 80–90% in the same time period. Repeated PTA is as durable as the primary PTA. An early PTA carries a risk of new interventions. Cutting balloon can be used as a second-line method. Stents and covered stents are kept for the management of complications and central outflow venous stenosis. PTA is the treatment of choice for stenosis or obstruction of dialysis fistulas. Repeated PTA may be needed for better patency. Drug eluting balloon may become the future in PTA of dialysis fistula, but more trials are needed.

Endovascular Interventions for Infrapopliteal Arterial Disease: An Update

Surgical revascularization has been the cornerstone of limb salvage for patients with critical limb ischemia due to infrapopliteal arterial atherosclerotic disease. Endovascular procedures such as balloon angioplasty and stenting are gaining popularity for treatment of such patients, although level 1 evidence to support the superiority of endovascular treatment over saphenous vein bypass is still lacking. A review of the literature from the past 2 years reveals that balloon angioplasty of the tibial arteries in patients with critical limb ischemia carried a 1-year primary patency rate between 33% and 37%, a secondary patency rate of 56% to 63%, and a limb-salvage rate of 75% to 100%. Two randomized controlled trials failed to show the superiority of primary infrapopliteal stenting over balloon angioplasty alone. One randomized controlled trial reported the benefit of drug-eluting stents over bare metal stents. Other studies documented good early results after secondary stenting, cryoplasty, and using retrograde access for tibial interventions. In conclusion, balloon angioplasty or stenting, if angioplasty fails, have emerged as reasonable options for limb salvage in patients with critical limb ischemia. More studies are needed to evaluate the role of percutaneous transluminal angioplasty as the primary modality of choice. There is a real need for a new randomized controlled trial to compare tibial angioplasty/stenting with autologous surgical bypass.

Upper Extremity Deep Vein Thrombosis: The Oft-forgotten Cousin of Venous Thromboembolic Disease

Upper extremity deep venous thrombosis (UEDVT) accounts for between 4% and 10% of all deep venous thromboses, and may be due to primary or secondary causes. The incidence of UEDVT is increasing, partly due to the exponential growth in the use of central venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices. UEDVT not only compromises future vascular access but results in significant morbidity and mortality, with symptomatic pulmonary embolus occurring in approximately 12%, post-thrombotic syndrome in 13%, and mortality ranging from 15-50%. Treatment of UEDVT depends on the underlying cause, primary or secondary. In this review, we will evaluate the management options and present a proposed treatment algorithm for primary UEDVT, involving catheter-directed thrombolysis, selective use of mechanical thrombectomy, anticoagulation and antithrombotic therapy, expeditious early first rib resection to decompress the thoracic outlet, and the role of adjunctive endovascular balloon angioplasty and stenting in improving axillo-subclavian vein patency. With regard to secondary UEDVT, we will present a treatment algorithm for managing central venous catheter (CVC) thrombosis; review the options for antithrombotic and anticoagulant therapy; and discuss the role of endovascular therapy. Finally, we will review the data supporting the growing role of percutaneous transluminal angioplasty (PTA) or venoplasty and endovascular stenting as the modality of choice in managing SVC obstruction, whether due to benign or malignant causes, and provide a brief description of the role, benefits and potential complications of SVC filter placement.

Clinical outcome and restenosis following percutaneous transluminal angioplasty for ischaemic rest pain or ulceration.

The role of percutaneous transluminal angioplasty in the management of severe leg ischaemia is controversial. To investigate further the efficacy of angioplasty and the clinical consequences of restenosis, a randomly selected cohort of 29 patients with ischaemic rest pain or ulceration was studied for 6 months after a technically successful balloon angioplasty. All patients had digital subtraction arteriography at the end of follow-up. Seven of 15 patients undergoing the procedure for rest pain had sustained relief from the initial dilatation. Partial or complete healing was noted in all 14 patients with ulceration and was maintained at 6 months in 11 despite significant (greater than 30 per cent) restenosis at the angioplasty site in eight. There were no complications or clinical deterioration associated with the procedure. Angioplasty is an effective method for treating the severely ischaemic leg, especially when used to achieve ulcer healing; restenosis is often clinically unimportant.

The Role of Percutaneous Transluminal Angioplasty in the Treatment of Carotid Fibromuscular Dysplasia

Fibromuscular dysplasia (FMD) is a disease of unknown aetiology, first typically presenting in the medium and large arteries of young to middle-aged women. It was first described by Leadbetter and Burkland in 1938 and is most commonly noted to involve the renal vessels. The management of FMD with severely stenotic and symptomatic lesions has historically been surgical.It has been shown previously that percutaneous transluminal angioplasty (PTA) works well in the setting of renal artery FMD.We report a case where PTA was used in the treatment of a patient with severe symptomatic internal carotid FMD.The results in this case appear to suggest that angioplasty can be used as a treatment for internal carotid FMD with good clinical resolution of symptoms. Further studies are required to assess efficacy, durability, and complication rates.

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.

The Increasing Role of Percutaneous Transluminal Angioplasty in the Primary Management of Critical Limb Ischaemia

Objective: to review the current role and results of angioplasty in the management of critical limb ischaemia (CLI) in a single institution.Methods: data on 526 patients with 608 ischaemic limbs, treated between January 1994 and December 1999 was collected prospectively and analysed retrospectively. Patients were divided into 3 groups according to the date of presentation: group 1 (1994–95), group 2 (1996–97) and group 3 (1998–99). The groups were comparable in terms of demographics, mode of presentation and level of disease.Results: Revascularisation was attempted in 87%, 81% and 91% for groups 1, 2 and 3 respectively (NS). Primary percutaneous transluminal angioplasty (PTA) rates increased from 44% (1994–95) to 69% (1998–99) (p < 0.001), and surgical revascularisation rates decreased correspondingly (p<0.01). Overall cumulative patient survival and limb salvage rates were 82% and 89% for 1 year and 45% and 87% for 5 years, respectively. No statistically significant difference existed between the three groups regarding patient survival, limb salvage rates and mean hospital stay (19, 12 and 12 days, respectively).Conclusion: PTA is increasingly replacing bypass surgery in the treatment of CLI, without compromising patient survival or limb salvage rates.

Percutaneous Transluminal Angioplasty in Patients with Ischemic Tissue Necrosis is Worthwhile

Purpose: Ischemic tissue necrosis is usually associated with long or sequential arterial obstructions. As a result, the role of percutaneous transluminal angioplasty (PTA), which addresses only short lesions, in patients presenting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic patients presenting with grade 4 Fontaine's classification. Method: Between January 1992 and December 1997, 1352 patients with aorto-iliac and/or infrainguinal occlusive diseases were admitted to our institution. Three hundred and ten patients who presented with distal gangrene (95.5%) or ischemic ulcers (4.5%) were identified. The patients consisted of 117 diabetics and 193 non-diabetics. PTA alone was performed In 26 diabetics (group 1) and in 30 non-diabetics (group 2). Their charts were retrospectively reviewed and the patients were recalled for clinical examination and non-invasive monitoring. Results: Follow-up was available for all patients and ranged from 1 to 4 years. The survival rate was significantly higher in diabetic patients than in non-diabetic patients (96% vs 77% at 1 year; p &lt; 0.05 and 91% vs 66% at 3 years; p &lt; 0.05). In group 1, the primary cumulative patency rate at 1 and 3 years was 76%. In group 2, the primary cumulative patency rate at 1 and 3 years were 85% and 80%, respectively. Three patients in group 1 required a redo PTA at 4 months, resulting in an assisted primary patency rate at 1 and 3 years of 88%. In contrast, no patients in group 2 required additional PTA. In group 1, the limb salvage rate at 1 and 3 years was 84%; and in group 2, 80% and 75%, respectively. Conclusion: The results of PTA in both groups were encouraging. Dilation of one or two short stenoses, despite multiple distal lesions, may improve distal flow sufficiently to promote wound healing. Thus, this procedure may be recommended in selected patients suffering from ischemic tissue loss. However, during the first 6 months following PTA, diabetic patients should be followed carefully with Duplex as they are prone to early restenosis.

Percutaneous transluminal angioplasty in patients with ischemic tissue necrosis is worthwhile

Purpose: Ischemic tissue necrosis is usually associated with long or sequential arterial obstructions. As a result, the role of percutaneous transluminal angioplasty (PTA), which addresses only short lesions, in patients presenting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic patients presenting with grade 4 Fontaine's classification. Method: Between January 1992 and December 1997, 1352 patients with aorto-iliac and/or infrainguinal occlusive diseases were admitted to our institution. Three hundred and ten patients who presented with distal gangrene (95.5%) or ischemic ulcers (4.5%) were identified. The patients consisted of 117 diabetics and 193 non-diabetics. PTA alone was performed in 26 diabetics (group 1) and in 30 non-diabetics (group 2). Their charts were retrospectively reviewed and the patients were recalled for clinical examination and non-invasive monitoring. Results: Follow-up was available for all patients and ranged from 1 to 4 years. The survival rate was significantly higher in diabetic patients than in non-diabetic patients (96% vs 77% at 1 year; p<0.05 and 91% vs 66% at 3 years; p<0.05). In group 1, the primary cumulative patency rate at 1 and 3 years was 76%. In group 2, the primary cumulative patency rate at 1 and 3 years were 85% and 80%, respectively. Three patients in group 1 required a redo PTA at 4 months, resulting in an assisted primary patency rate at 1 and 3 years of 88%. In contrast, no patients in group 2 required additional PTA. In group 1, the limb salvage rate at 1 and 3 years was 84%; and in group 2, 80% and 75%, respectively. Conclusion: The results of PTA in both groups were encouraging. Dilation of one or two short stenoses, despite multiple distal lesions, may improve distal flow sufficiently to promote wound healing. Thus, this procedure may be recommended in selected patients suffering from ischemic tissue loss. However, during the first 6 months following PTA, diabetic patients should be followed carefully with Duplex as they are prone to early restenosis.

Splenorenal Bypass as an Emergency Procedure

The role of percutaneous transluminal angioplasty (PTA) in the management of renovascular hypertension is controversial when the cause is known to be atherosclerotic disease. The authors report a life-threatening complication of PTA, wherein renal artery rupture was successfully managed by emergency splenorenal bypass with preservation of the kidney function. Close cooperation between radiologists and the surgical team is a prerequisite for such interventional technique.

796-1 Non Surgical Revascularization in Carotid Arteries: Role of Percutaneous Transluminal Angioplasty

The role of Percutaneous Transluminal Angioplasty (PTA) in the revascularization of carotid arteries is not well established. The aim of this study was to asses the efficacy of PTA in revascularizing patients with carotid arterial stenosis. Thirteen consecutive patients (mean age 68 ± 7.7 years) underwent 13 PTA procedures in the carotid arteries during September 1992 to March 1994. The indication for revascularization was recurrent ischemic attacks with severe (&gt;50%) carotid stenosis in the 13 cases. Time between symptoms onset to PTA was more than one month in all cases. The lesions were located in the internal carotid arteries (first extracraneal segment) in nine patients and in the common carotid arteries in four. This group included one patient treated by severe internal carotid stenosis with complete occlussion in the contralateral internal carotid vessel. PTA was performed using conventional technique. The balloon/artery ratio was 0.8–0.9/1 in all cases (Mean balloon size 5.3 ± 0.5 mm). PTA was successfully performed in all patients with the diameter stenosis reduced from, 77.5 ± 5% to 19.7 ± 4%. Four patients had bradycardia and hypotension during balloon inflation. Two patients had transient neurologic deficit immediately after the procedure, resolved within 24 hours. No patient had a residual neurologic deficit upon discharge (mean 48 hours). At late clinical follow up (mean time 10 ± 7 months) one patient had restenosis with a new successful PTA. This early experience showed that PTA can be performed successfully and safely in selected cases of patients with symptomatic severe stenosis in carotid arteries. However, larger groups of patients and longer follow-up should need to compare this technique with surgical-endarterectomy.

A twelve-year experience with the popliteal-to-distal artery bypass: The significance and management of proximal disease

The value of the popliteal-to-distal artery bypass in limb salvage is well documented. However, the influence of progression of disease in the superficial femoral artery or proximal popliteal artery, and the role of percutaneous transluminal angioplasty of these vessels before bypass have not been adequately assessed. To evaluate these and other factors, we reviewed our experience with 153 nonsequential popliteal-to-distal artery bypasses performed over a 12-year period. Limb salvage was the indication for all procedures, and 87% of the patients were diabetic. The 5-year primary and secondary graft patency rates were 55% and 60%, respectively, and the limb salvage rate was 73%. Preoperative arteriograms were evaluated for stenosis in the superficial femoral artery or popliteal artery proximal to the graft. Fifty-six grafts with a proximal stenosis 20% or less were identified and had primary graft patency of 77% at 2 years, similar to the 70% patency for the 20 grafts placed distal to a 21% to 35% stenosis. The 18 grafts placed distal to a stenosis greater than 35% had 53% 2-year primary graft patency (p = 0.25). Percutaneous transluminal angioplasty of a superficial femoral artery or popliteal artery stenosis (24% to 85% luminal narrowing) in 19 limbs resulted in 68% 2-year graft patency, not significantly lower than grafts with 35% or less proximal stenosis (75%, p = 0.25). Other factors associated with significant decreases in graft patency included a vein graft diameter less than 3.0 mm, a dorsalis pedis outflow site, and poor quality outflow. Thus the popliteal-to-distal bypass is a durable procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of percutaneous transluminal angioplasty in the treatment of critical ischaemia

In an attempt to establish the overall role played by percutaneous transluminal angioplasty in the treatment of critical ischaemia we studied 101 consecutive patients (110 limbs) who presented to one vascular unit over an 18 month period with this diagnosis. All patients underwent assessment with Doppler waveform analysis and arteriography and decisions about further management were made jointly by the surgical team and vascular radiologist. Results showed that only 24/110 limbs (22%) had lesions that were suitable for treatment with angioplasty alone. In addition one patient underwent angioplasty in conjunction with a distal bypass. Forty-one of the 110 limbs (37%) underwent reconstructive surgery, 18/110 (16%) primary amputation and 26/110 (24%) conservative treatment. Of those 24 limbs undergoing angioplasty, four were technically unsuccessful, and six were technically successful but without clinical improvement and all required alternative treatment. Only 12/110 limbs (11%) showed clinical improvement during their admission following angioplasty. We conclude that although angioplasty can be used successfully to treat critical ischaemia the overall numbers of patients who are suitable for treatment and who gain benefit from it is small.

The Role of Percutaneous Transluminal Angioplasty and Femoropopliteal Bypass in Patients with Threatened Limb

Fifty-two patients with no history of percutaneous transluminal angioplasty (PTA) or vascular surgery presented with a threatened limb and arteriographic findings showing suitability for femoropopliteal arterial reconstruction. Twenty-seven patients were treated by PTA (Group 1) and 25 were treated by femoropopliteal bypass (Group 2). The technical success rate was 85% for PTA and 100% for surgery. The hemodynamic success rate was 63% for PTA and 88% for surgery; the mean increase in ankle systolic pressure index (ASPI) was 0.34 following PTA and 0.57 following surgery. Complications occurred in 11 % of patients following PTA and 32% of patients following surgery. Follow-up ranged from six months to five years with a mean of two years. A clinically successful result was evident in 67% of patients having PTA and 76% of oper ated patients. The overall amputation rate for Group 1 was 7.4% and for Group 2 was 20%. It is concluded that, in the management of femoropopliteal occlusive disease, surgery is more likely to be initially successful than PTA and will give rise to a greater increase in ASPI and a higher incidence of clinically successful outcome; however, because the complication rate is higher for surgery, and fail ure is more likely to lead to amputation, PTA should be considered as a first-line treatment, particularly in patients who are at increased risk for surgery.

Angioplasty in peripheral vascular disease.

Percutaneous revascularization as an alternative to surgery in the management of peripheral vascular disease was first described in 1964 but gained little acceptance.' In 1974 the development of a doublelumen balloon catheter by Gruntzig and others made the technique a much more practical and effective one that has subsequently gained widespread acceptance.2 At first it was used in the peripheral arteries but soon extended to the renal and coronary arteries. In the 12 years since its introduction the technology of balloon catheters and the associated equipment has improved considerably. This in addition to the experience gained by radiologists has allowed the scope and range of angioplasty to be extended so that many more lesions can now be safely and effectively treated. Angioplasty techniques can be applied to such diverse lesions as branch stenoses of a renal artery or a distal tibial stenosis as well as to aortic and pulmonary valve stenosis. In this article the role of percutaneous transluminal angioplasty (PTA) in peripheral vascular disease only will be examined.

Compound angulation for the angiographic evaluation of renal artery stenosis.

The increasing role of percutaneous transluminal angioplasty in the therapy of renal artery stenosis has, in turn, emphasized the need to optimize imaging of the entire length of the main renal artery and its major branches. The usual angiographic positioning techniques for anteroposterior and oblique views may not be adequate to define the precise location and extent of a stenosis. The authors combine oblique projections with sagittal angulation of the x-ray tube to augment the standard imaging methods for selective renal arteriography.