Use Of Percutaneous Transluminal Angioplasty Research Articles

Failed percutaneous transluminal renal angioplasty: Experience with lesions requiring operative intervention

Percutaneous transluminal angioplasty (PTA) has received widespread publicity as a safe, simple, and successful alternative to operation for the management of renal artery stenoses and renovascular hypertension (RVH). Although, in our institution, the primary management of RVH remains operative revascularization, with more than 750 such procedures having been done, we have had the opportunity to manage a spectrum of PTA failures in nine patients during the last 5 years. These include (1) acute dissection of atherosclerotic lesions and occlusion of the distal renal artery requiring emergency operation; (2) unilateral perforation and bilateral thrombosis of fibrodysplastic branch renal artery lesions requiring staged ex vivo reconstruction; (3) cholesterol embolization and recurrence to total occlusion of orificial atherosclerotic lesions with loss of excretory renal function; (4) chronic dissection from repeated ”temporarily successful“ PTAs of medial fibrodysplastic lesions; and (5) rapid recurrence and acceleration of hypertension in a 17-year-old girl with congenital renal artery stenoses. In each instance operation was complicated by an intense perivascular inflammatory response from the previous PTA and required a more complex reconstruction than would have been needed originally. These sequelae argue for moderating enthusiasm for the use of PTA and for limiting its routine use to nonorificial atherosclerotic lesions and fibrodysplastic lesions restricted to the main renal artery. Orificial atherosclerotic lesions, branch fibrodysplastic lesions, and congenital stenoses have a high probability of failure, complications, or both when treated by PTA and should be considered for primary operative intervention.

Failed percutaneous transluminal renal angioplasty: experience with lesions requiring operative intervention.

Percutaneous transluminal angioplasty (PTA) has received widespread publicity as a safe, simple, and successful alternative to operation for the management of renal artery stenoses and renovascular hypertension (RVH). Although, in our institution, the primary management of RVH remains operative revascularization, with more than 750 such procedures having been done, we have had the opportunity to manage a spectrum of PTA failures in nine patients during the last 5 years. These include (1) acute dissection of atherosclerotic lesions and occlusion of the distal renal artery requiring emergency operation; (2) unilateral perforation and bilateral thrombosis of fibrodysplastic branch renal artery lesions requiring staged ex vivo reconstruction; (3) cholesterol embolization and recurrence to total occlusion of orificial atherosclerotic lesions with loss of excretory renal function; (4) chronic dissection from repeated "temporarily successful" PTAs of medial fibrodysplastic lesions; and (5) rapid recurrence and acceleration of hypertension in a 17-year-old girl with congenital renal artery stenoses. In each instance operation was complicated by an intense perivascular inflammatory response from the previous PTA and required a more complex reconstruction than would have been needed originally. These sequelae argue for moderating enthusiasm for the use of PTA and for limiting its routine use to nonorificial atherosclerotic lesions and fibrodysplastic lesions restricted to the main renal artery. Orificial atherosclerotic lesions, branch fibrodysplastic lesions, and congenital stenoses have a high probability of failure, complications, or both when treated by PTA and should be considered for primary operative intervention.

The changing pattern of vascular surgery: the effect of percutaneous transluminal angioplasty.

The pattern of vascular surgery at Westmead Hospital from 1979 to 1985 has been reviewed. There has been an upward trend in the number of patients having repair of abdominal aortic aneurysm and carotid endarterectomy. However, the number of operations for peripheral vascular disease has not increased. This may be due to the increasing use of percutaneous transluminal angioplasty (PTA), but it may also be associated with the increasing difficulty in obtaining hospital admission for patients with conditions not immediately life or limb threatening.

Usefulness of percutaneous transluminal angioplasty for aortitis syndrome

Usefulness of percutaneous transluminal angioplasty for aortitis syndrome

Usefulness of Percutaneous Transluminal Angioplasty for Aortitis Syndrome

A woman with aortitis syndrome who had had severe hypertension for more than 30 years, despite the administration of various antihypertensive drugs, underwent percutaneous transluminal angioplasty (PTA) a total of three times. The operation resulted in good control of BP and with an improvement of other hemodynamics without any medication for one year after PTA.

Reconstruction of the renal artery after unsuccessful percutaneous transluminal angioplasty in children

The use of percutaneous transluminal angioplasty as the primary treatment of renovascular stenosis in adults has recently been described. Previously, only three children have been reported to have undergone transluminal angioplasty for stenosis of the renal artery and hypertension. At our hospital, transluminal angioplasty was attempted in four children with renal artery stenosis; one attempt was successful and three were unsuccessful. The three patients who required surgical repair of the renal artery after unsuccessful transluminal angioplasty have been described in detail. The histopathology of the stenotic vessels is also discussed. Based on the analysis of the three children, certain criteria have been derived to select pediatric patients with renovascular hypertension either for attempted transluminal angioplasty or for primary surgical revascularization.

The Use of Percutaneous Transluminal Angioplasty for Renal Artery Stenosis in Patients with Generalized Atherosclerosis

From April 1979 to March 1981 percutaneous transluminal angioplasty was attempted in 27 patients with atherosclerotic renal artery stenosis. In 13 patients percutaneous transluminal angioplasty was considered successful with a decrease in blood pressure and/or improvement in renal function. Dilation of the stenosed renal artery was not technically possible in 4 patients and was unsuccessful in 10. Eight patients required surgical intervention after percutaneous transluminal angioplasty, including 4 elective operations and 4 done on an emergency basis. In our series 5 patients sustained intimal tears of the renal artery during percutaneous transluminal angioplasty with intramural dissection and/or thrombosis. Continued multidisciplinary evaluation of percutaneous transluminal angioplasty in the treatment of renal artery stenosis is recommended.