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OBJECTIVE Coarctation of the aorta can be treated surgically or with balloon angioplasty. The objective of our study was to describe the results after percutaneous balloon angioplasty with or without stent implantation for coarctation of the aorta and establish the incidence of recovery during follow-up. METHOD Cohort study. 89 patients of any age where included in a follow up period of nine years. RESULTS Of the 89 patients included in the study, 69.0% were male. The mean follow-up for all participants was 33.66 months. 32.5% of the patients had a stent implanted during the angioplasty procedure; of which 24.1% suffered recoarctation during follow-up. In the group without stent implantation, 36.6% suffered recoarctation. There was not significant difference in the survival curves of the two groups (p = 0.899). CONCLUSIONS Stent implantation during balloon angioplasty to treat aortic coarctation did not influence in the incidence of aortic recoarctation; but factors such as preangioplasty arterial hypertension and the final angioplasty gradient > 20 mmHg is associated with aortic recoarctation.

Aim: The aim of this study was to evaluate the utility and reliability of temperature foot changes measured by infrared thermography (IRT) for the evaluation of patients with atherosclerotic peripheral arterial disease (PAD) before and after endovascular revascularisation. Methods: This is an observational prospective study carried out on symptomatic PAD patients. Evaluations consisted of a clinical examination, duplex scan with ankle–brachial index calculation (ABI) and IRT measurements with infrared camera FLIR-ONE connected to a smartphone with android technology. Locations on the foot sampled with IRT were the anterior tibial, pedal, posterior and arcuate arteries. Results obtained with IRT on the symptomatic foot were compared to the contralateral foot and with the ABI values obtained bilaterally before and 24 h after revascularisation. Results: Within one year, 40 patients were enrolled, among whom 87,5% suffered from critical limb ischaemia. In three patients, it was impossible to obtain ABI measurements because of ulcerations on the limb. Skin temperature changes obtained by IRT between the symptomatic limb and the contralateral limb had a mean difference of 1.7 °C (range: 1.1–2.2 °C), p &lt, 0.001. There was a positive correlation between ABI and temperature values of the limb needed for treatment before revascularisation (p = 0.025, r = 0.36) and after revascularisation (p = 0.024, r = 0.31). The technical success rate was 100% in all cases, achieving a significant increase in temperature at all points of the foot analysed, with a median change of 2 °C (p &lt, 0.001). Conclusion: IRT is a safe, reliable and simple application. It could be a valuable tool for the assessment of the clinical presentation and severity of foot blood perfusion in symptomatic PAD patients and the evaluation of the technical success of endovascular revascularisation. IRT might have a role in follow-up of revascularisation procedures.

Budd-Chiari syndrome (BCS) is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction. Abernethy malformation is a congenital vascular malformation defined by diversion of portal blood away from the liver. Both conditions are rare vascular diseases. We report here the first case of a patient with combined type II Abernethy malformation and Budd-Chiari syndrome from China. The inferior vena cava obstruction was treated with percutaneous balloon angioplasty; close follow-up was elected for the Abernethy malformation.

Objective: Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs. Methods: Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan–Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency. Results: 74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36–84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2–84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46–10.09] or anastomosis (HR = 1.90, 95% CI: 1.09–3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22–4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26–4.63) were significantly associated with decreased patency. Conclusion: In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction. Advances in knowledge: A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.

The aim of a drug eluting stent is to prevent restenosis of arteries following percutaneous balloon angioplasty. A long term goal of research in this area is to use modelling to optimise the design of these stents to maximise their efficiency. A key obstacle to implementing this is the lack of a mathematical model of the biology of restenosis. Here we investigate whether mathematical models of cancer biology can be adapted to model the biology of restenosis and the effect of drug elution. We show that relatively simple, rate kinetic models give a good description of available data of restenosis in animal experiments, and its modification by drug elution.

The paper presents a case of a 65 year old white male with atherosclerosis, severe left triple renal arteries stenoses and secondary renovascular hypertension (RVH). The patient was treated in a single session by percutaneous balloon angioplasty and stenting of the three left renal arteries with important atherosclerotic lesions. The uneventful evolution permitted patient's discharge next day after the intervention, with antihypertensive and antiplatelet therapy. The authors discuss successively the morphogenetic phenomena involved in multiple renal arteries apparition, the historical contribution of a Renascence anatomist to the description of renal blood supply variants and recent trends in atherosclerotic RVH (interventional versus medical approach).

Background: Although balloon angioplasty (BA) has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta (CoA) during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role of percutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods: The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient's weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results: The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture . The systolic peak pressure gradient (PG) across the coarctation was 41.0 ± 16.0 mmHg (range 13-76 mmHg). The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm (range 0.5-2.8 mm). All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg (range 0-40 mmHg), and the diameter of coarctation significantly improved to 3.8 ± 0.9 mm (range 2.5-5.3 mm). No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year: (1) The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; (2) in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; (3) tricuspid regurgitation and pulmonary hypertension improved in all patients; (4) all patients were doing well and were asymptomatic. Conclusions: Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.

Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive disease which results from mutations of the SLC2A10 gene. In this article, we describe the results of vascular imaging of an adult patient with ATS who was presented with pulmonary hypertension and after a complete evaluation, he was a candidate for interventional balloon angioplasty. Our patient is one of the very limited numbers of list patients in the studies for whom percutaneous balloon angioplasty performed successfully.

Drug-eluting stents have been used widely to prevent restenosis of arteries following percutaneous balloon angioplasty. Mathematical modelling plays an important role in optimising the design of these stents to maximise their efficiency. When designing a drug-eluting stent system, we expect to have a sufficient amount of drug being released into the artery wall for a sufficient period to prevent restenosis. In this paper, a simple model is considered to provide an elementary description of drug release into artery tissue from an implanted stent. From the model, we identified a parameter regime to optimise the system when preparing the polymer coating. The model provides some useful order of magnitude estimates for the key quantities of interest. From the model, we can identify the time scales over which the drug traverses the artery wall and empties from the polymer coating, as well as obtain approximate formulae for the total amount of drug in the artery tissue and the fraction of drug that has released from the polymer. The model was evaluated by comparing to in-vivo experimental data and good agreement was found.

Although the use of stents for treatment of limb-ischemia for femoro-popliteal lesions is related to improvement of clinical outcomes, the rate of in-stent re-stenosis (ISR) can be high prevalent. Other than treating this complication with percutaneous balloon angioplasty (PTA) the associated use of

Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective. Orv. Hetil., 2011, 152, 1745–1750.

Bare metal stents (BMS) have better patency results in the femoropopliteal (FP) arterial segments than conventional percutaneous balloon angioplasty (PTA). More recently, drug-coated balloons (DCB) have shown superior outcomes compared to PTA. DCB inhibit neointimal hyperplasia, but unlike BMS

A major challenge in the management of hemodialysis patients is central venous stenosis and obstruction. Placement of central venous catheters has been shown to result in a high incidence of central venous stenosis or obstruction. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options include percutaneous balloon angioplasty and bare metal stents. Unfortunately, all the available treatment options have variable rates of patency, requiring repeated intervention. More recently, covered stents have been mentioned in the literature for the treatment of central venous stenosis and obstruction. There is very little data to date, and further randomized controlled trials will be needed to compare the efficacy of percutaneous balloon angioplasty, bare metal stents, and covered stents. It appears prevention of this difficult problem is paramount, by limiting use of central venous catheters.

SUMMARY Cardiac Interventions in the Late Follow-Up ofAtrial Repair for Transposition of theGreat Arteries Obstruction of the venous pathways after atrial repair fortransposition of the great arteries is not uncommon andcan be, in some cases, fatal. The surgical treatment ofthese complications is a high-risk procedure. Nowadays,percutaneous balloon angioplasty or stenting have beenused with good results. We report two cases of percutaneoustreatment of systemic and pulmonary “baffle” obstructions. DESCRIPTORS: Stents. Transposition of great vessels. Heartatria, surgery. RESUMO A obstrucao dos tuneis intra-atriais, no pos-operatorio tardiode cirurgia de correcao atrial para o tratamento da trans-posicao das grandes arterias, nao e uma complicacaoinfrequente, podendo ate, em alguns casos, ser fatal. Otratamento cirurgico de tais lesoes pode apresentar altosindices de morbidade e mortalidade. Recentemente, otratamento percutâneo mediante implante de stent ou pormeio de angioplastia com cateter-balao tem sido utilizadocom bons resultados. Relatamos dois casos de tratamentopercutâneo de obstrucoes dos tuneis intra-atriais sistemicoe pulmonar.

Objective The main objective was to evaluate the safety and the efficacy of balloon angioplasty of post-surgical aortic recoarctation before one year of age. The secondary objective was to identify factors potentially associated with a failure of the procedure. Method Data from children who have one or more balloon angioplasty for aortic recoarctation before one year of age were retrospectively collected from 2006 to 2014. Results 14 children (17 procedures) have been included. The procedure immediately failed in 2 patients who underwent a new surgery. All the other 12 patients still remained free of recoarctation after one procedure for 10 of them, 2 procedures for another one and 3 procedures for the last one. Three complications due to the procedure occurred: one iliac artery thrombosis, one coronary embolism and one transitory stroke. These complications totally recovered before discharge. No aortic dissection or aneurysm has been reported. Comparing the 5 procedures which need a further intervention with the others, we observed that a higher peak gradient measured during the catheterization before (45mmHg (range 36-60) vs 32mmHg (range 10-47)) and after the angioplasty (36mmHg (range 30-50) vs 25mmHg (range 5-50)), and a lower ratio balloon size/transverse arch diameter (1.07 (range 0.88-1.20) vs 1.28 (range 0.94-1.82)) were associated with a failure of the procedure. Conclusion Balloon angioplasty of aortic recoarctation before one year of age is efficient. A lower ratio balloon size/transverse arch diameter was associated with a higher failure of the procedure that suggests the use of bigger balloon.

症例は64歳, 男性. 慢性腎不全にて1992年7月より血液透析に導入となり, 導入期内シャントが成長するまでの間, 左鎖骨下静脈よりダブルルーメンカテーテルを使用し, 血液透析を受けていた. 1998年6月頃よりシャント側の左上肢の腫脹が顕著となったため, 同年8月シャント造影を施行したところ左無名静脈が上大静脈へ流入する部位での狭窄を認め, 経皮的血管形成術 (percutaneous transluminal angioplasty PTA) を行い症状は改善した. 近年, ダブルルーメンカテーテルによる静脈の狭窄および閉塞が報告されており, 可能な限り同カテーテルの挿入回避, および挿入期間の短縮が望まれ, また大血管の狭窄病変に対してもPTAによる治療の有効性が報告されている. 本症例のように狭窄範囲が短い症例に対してはPTAが最も有効と考えられた.

ObjectivesThis study sought to report the long-term result (up to 8 years) of percutaneous transluminal balloon angioplasty (PTBA) for Budd-Chiari syndrome (BCS) caused by membranous obstruction of the inferior vena cava (MOVC).BackgroundWe previously reported on this nonoperative form of therapy in a smaller series of patients and found the short-term results to be excellent.MethodsWe studied the long-term results of PTBA in the treatment of BCS caused by MOVC in 42 patients who underwent PTBA with the Inoue balloon catheter between June 1988 and February 1996. There were 28 men and 14 women with a mean age of 35.6 years (range 16 to 56). MOVC was incomplete in 27 patients and complete in 15. PTBA was successful in 38 patients (91%). The longest follow-up period was 8 years.ResultsAll 38 patients who successfully underwent PTBA showed marked symptomatic improvement. Immediately after PTBA, the diameter of the inferior vena cava at the MOVC increased from 1.7±2 to 19.9±3.5 mm (p

Percutaneous balloon angioplasty and endovascular stent placement are becoming common techniques intended to reduce the need for surgical bypass procedures that may be more expensive or have higher morbidity rates. Prophylactic antibiotics are not currently used before stent placement in most centers even when implanted via the femoral route. Infectious complications have been rare. In the case presented here an infected common iliac pseudoaneurysm occurred after percutaneous balloon angioplasty and stent placement. The literature is reviewed.

Wstęp: Rokowanie w krytycznym niedokrwieniu kończyn jest złe. Skuteczna rewaskularyzacja ratuje kończynę, poprawia jakość życia i zmniejsza ogólne koszty terapii. Chociaż operacja rewaskularyzacyjna od dawna jest uznaną metodą leczenia, można ją wykonywać tylko u części pacjentów. Alternatywą jest leczenie wewnątrznaczyniowe. Celem badania była ocena średnioterminowych wyników leczenia chorych z krytycznym niedokrwieniem kończyn i zaawansowanymi zmianami zarostowymi w tętnicach poniżej kolana metodą przezskórnej angioplastyki balonowej. Materiał i metody: Prospektywna, otwarta, trwająca rok obserwacja kliniczna obejmująca 120 chorych z krytycznym niedokrwieniem kończyn, u których leczono 127 kończyn. Najwięcej chorych miało zmiany niedokrwienne typu 6. według klasyfikacji Rutherforda, a najmniej zmiany typu 4. Wyniki: Po 12 miesiącach 52 chorych żyło, miało zachowaną kończynę bez objawów krytycznego niedokrwienia kończyn (43%), 19 chorych zmarło (16%), amputowano 25 kończyn (20%). Częstość powikłań okołozabiegowych była jednak wysoka (14%), większość związana z nakłuciem tętnicy. Wnioski: Zastosowanie rewaskularyzacji przezskórnej w leczeniu chorych z krytycznym niedokrwieniem kończyn i zajęciem tętnic poniżej kolana jest uzasadnione. Wyniki po roku od wdrożenia terapii wewnątrznaczyniowej są znacznie lepsze od opisywanych wyników leczenia zachowawczego. Ostateczny efekt terapii można próbować poprawić, modyfikując technikę leczenia. Background: Critical limb ischemia (CLI) has an ominous prognosis. Effective revascularization saves the limb, improves the quality of life and is cost-effective. While bypass surgery has dominated treatment for decades it can be offered to a limited subset of patients. Endovascular treatment is an alternative method of revascularization. The aim of the study was to assess mid-term results of percutaneous balloon angioplasty in patients with CLI and severe obstructive lesions in below-the-knee arteries. Material and methods: This was an open, prospective 1-year observation of 120 CLI patients in whom 127 limbs were treated. The majority of patients were in Rutherford class 6, the minority in Rutherford class 4. Results: After 12 months 52 patients were still alive, did not present signs or symptoms of CLI and had the treated limb preserved (43%). 19 patients had died (16%) and there were 25 amputations (20%). However, the periprocedural complication rate was high (14%), with most of the complications being related to arterial puncture. Conclusions: Percutaneous revascularization is justified in CLI patients with below-the-knee obstructive lesions not amenable to surgery. After one year, the results of endovascular treatment are far better than the reported results of conservative treatment. Modifications in endovascular procedure techniques may improve final results.

Vascular Surgery has been defined by the Division in endovascular procedures not part of the curriculum, while in U.K. it is not mandatory. Training in endoand Board of Vascular Surgery of the Union Europeenne des Medecins Specialistes (UEMS), as the clinvascular surgery is mandatory in the other 12 countries, and in 9 of these, vascular surgery is an ical and scientific discipline concerned with the diagnosis, treatment and prevention of diseases afindependent specialty. These variations can be looked upon as weakness by some but as a strength by others. fecting arteries, veins and lymphatics. Modern vascular surgery took off as a dynamic and It seems that the vascular surgical community in Europe has to come to terms with some facts of life: rapidly evolving branch of general surgery in the 1950s largely due to technological developments in (1) Conventional percutaneous balloon angioplasty prosthetic grafts by the textile and polymer industries. (PTA) is now an established therapeutic modality. The recent introduction of endovascular techniques (2) The volume in absolute and relative terms of endoand devices has raised the question of whether vasvascular prostheses for aneurysmal and arterial cular surgeons should become involved with this new occlusive diseases is small despite its prominence technology. The answer comes from the past and the in the literature. origins of our specialty. Vascular surgeons were the (3) Endovascular procedures are currently performed first to adapt to new ideas and technological inin too many centres and in too small numbers per novations and it seems absurd to back away from centre. endovascular techniques just because they were not (4) Endovascular AAA repair is still an experimental taught to us during training. There are parallels here procedure with unknown long-term clinical with laparoscopic surgery: most surgeons undertaking results. laparoscopic procedures learned the technique after their initial training. Specialties should be based on For open vascular surgical procedures it is well body systems and diseases, not on treatment modestablished that surgeon and hospital volume are asalities. sociated with better outcomes for patients who unThe current status of training across the EU and dergo carotid endarterectomy and AAA repair both the involvement of vascular surgeons in endovascular in U.S.A. and Canada. In the same studies, cerprocedures are shown in Table 1. This shows the tification in vascular surgery was associated with statresults of a survey conducted in April 2001 among the istically better outcomes following AAA repair national representatives of the European Board of compared to non-certification in vascular surgery. Of Vascular Surgery (EBVS). We can see that in only three course, certification does not guarantee that a surgeon countries (Denmark, Ireland and Norway) is training will perform a better operation compared to a noncertified colleague. However, it does indicate that the individual has gone through a period of dedicated ∗ Please address all correspondence to: C. Liapis, 131, Vas. Sofias Str., 11521, Athens, Greece. training in a structured training programme. Why then

Behçet's disease (BD) is a multisystem vascular inflammatory disease. BD can affect blood vessels of nearly all sizes and types. Arterial involvement is a rare but serious condition in the course of BD. Here, we report a case of stenosis at the iliac artery bifurcation which was treated with percutaneous balloon angioplasty and stent implantation in a 37-year-old patient with BD.

The atherosclerosis plaques have different morphology from soft neointimal plaques to hard calcified lesions. Therefore, we sought to evaluate the efficacy of percutaneous balloon angioplasty (PTA) versus atherectomy (AT) endovascular revascularization which type was attuned by operator. Between

The purpose of this paper is to present our experience with percutaneous balloon angioplasty (PBA) for coarctation of the aorta (COA). The children between the ages of one month and 11 yea...

TransAtlantic Society Consensus (TASC)-II recommends bypass for TASC D and low-risk patients with TASC C lesions but does not specify graft types. Percutaneous balloon angioplasty/stenting (PTA/S) and above knee femoropopliteal bypass (AK-FPB) using polytetrafluoroethylene (PTFE) for these lesions were compared to determine if graft type should be part of the TASC-II recommendations for the treatment of TASC C lesions.Consecutive patients who underwent AK-FPB with PTFE, or PTA/S for TASC-II C (PTA/S-C) or D (PTA/S-D) SFA lesions between June 2001 and April 2007 were retrospectively analyzed. The primary end points were primary, assisted-primary, and secondary patency rates.In 127 patients (mean age, 68.7 +/- 10.0 years; median, 68; range, 49-97), 139 limbs were treated (46 AK-FPB, 49 PTA/S-C, 44 PTA/S-D). The mean occlusion and stented lengths were 9.9 +/- 3.8 and 24.3 +/- 6.6 cm (median, 10 and 20 cm) in PTA/S-C, and 26.6 +/- 5.5 and 30.0 +/- 5.2 cm (median, 26 and 29 cm) in PTA/S-D. Technical success was 84% in PTA/S-D and 100% in other groups. Mean follow-up was 26.4 +/- 18.0 months (median, 24). The 12- and 24-month primary patency was 83% +/- 6% and 80% +/- 7% for PTA/S-C; 54% +/- 8% and 28% +/- 12% for PTA/S-D; and 81% +/- 6% and 75% +/- 7% for AK-FPB (P.001 PTA/S-D vs PTA/S-C and AK-FPB); assisted-primary patency was 95% +/- 3% and 95% +/- 3% for PTA/S-C, 62% +/- 8% and 49% +/- 10% for PTA/S-D, and 81% +/- 6% and 75% +/- 7% for AK-FPB (P.001, PTA/S-C vs PTA/S-D; P = .003, PTA/S-C vs AK-FPB; and P = .03, PTA/S-D vs AK-FPB). Secondary patency was 98% +/- 3% and 98% +/- 3% for PTA/S-C; 72 % +/- 7% and 54% +/- 11% for PTA/S-D, and 81% +/- 6% and 78% +/- 7% for AK-FPB. Secondary patency was significantly better in PTA/S-C than AK-FPB (P = .003) and PTA/S-D groups (P.001). The difference was marginally better in AK-FPB than in PTA/S-D (P = .064).PTA/S for TASC-II C lesions has a superior midterm patency than AK-FPB using PTFE, and AK-FPB with PTFE has better primary and assisted-primary patency than PTA/S-D. The TASC-II recommendations should be modified to recommend treatment of SFA TASC-II C lesions by PTA/S rather than PTFE bypass for all patients. PTA/S of TASC-II D lesions should only be considered in high-risk patients who cannot tolerate a bypass procedure using PTFE.

This is a report of successful dilation of stenosis of the common trunk in a case of total anomalous pulmonary vein return into the left superior vena cava in a 3 month old infant. Percutaneous angioplasty was performed with a 6 mm diameter balloon catheter. Right ventricular systolic pressure decreased from 96 to 60 mm Hg, mean pulmonary vein pressure decreased from 26 to 14 mm Hg and left ventricular systolic pressure increased from 70 to 90 mm Hg.

Percutaneous transluminal angioplasty gained acceptance as an interventional radiologic procedure after development of the balloon technique [1 ], and numerous reports detail its extensive applications [2-1 3]. Because of the low procedural morbidity, however, the literature contains little information regarding the pathologic alterations produced by angioplasty. We describe the arterial morphologic changes induced by percutaneous balloon angioplasty in a