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Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5-year-old child for supraventricular tachyarrhythmia and Wolff-Parkinson-White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia.

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.

Although surgery is the standard treatment for native coarctation in neonates, it carries a high risk of complications. Percutaneous balloon angioplasty may be considered as an alternative treatment. The materials used in the intervention should be selected carefully to reduce complications. We recommended the use of non-compliant balloons in risky babies. They are more effective in the treatment of strick stenosis than compliant balloons.

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.

Budd-Chiari syndrome (BCS) is a rare disease characterized by the obstruction of hepatic venous outflow due to occlusion of the hepatic vein (HV) or the inferior vena cava (IVC). The pathophysiology of IVC and HV membranous transformation, which can form in isolation or simultaneously, remains unclear in patients with combined-type BCS. Here we report three cases of patients with BCS demonstrating conversion from HV-type to combined-type. Three patients with only HV-type BCS underwent percutaneous balloon angioplasty (PTA) of the obstructed HV. During follow up, membranous transformation of the IVC was observed. This condition was subsequently treated with PTA of the IVC. These cases demonstrate that HV-type BCS may convert to combined-type BCS.

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 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.

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 common problem in the management of hemodialysis patients is central venous occlusive disease. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options to date include percutaneous balloon angioplasty, bare metal stents and surgical bypass. Unfortunately, all the available treatment options have poor long-term patency, requiring repetitive 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 on this technology, 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 venous access or intervention of the central venous system.

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.

The treatment of hypertension in children involves lifestyle modifications, drug therapy, and at times surgical intervention. Healthy eating patterns, increased exercise, and when appropriate, weight loss are the tenants of lifestyle modifications. Drug therapy is recommended for children with symptomatic hypertension and those children that do not respond to lifestyle modifications. The most common class of antihypertensive drugs used in children are the angiotensin converting enzyme inhibitors and the angiotensin receptor blockers. Surgical and interventional radiology procedures are most often used in the setting of renal vascular hypertension. Interventional procedures include percutaneous balloon angioplasty and surgical revascularization.

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.

Pedal bypasses, for salvage of a critically ischaemic limb, demonstrate excellent long-term outcomes. However, regular follow-up of patients and timely detection and treatment of a contingent haemodynamically significant bypass stenosis, which could cause its thrombosis, are prerequisites. The authors report a case of femoropedal bypass graft in which regular duplex follow-up detected critical stenoses at 18 months and at 36 months. Patch-angioplasty (at 18 months) and percutaneous balloon angioplasty (at 36 months) preserved the long-term patency of this pedal bypass graft.

About 1 million patients are treated for stenosis of coronary arteries by percutaneous balloon angioplasty annually worldwide. In many cases a so called stent is inserted into the vessel to keep it mechanically open. Restenosis is observed in about 20–30% of these cases, which can be treated by irradiating the stented vessel segment. In our approach, we utilized the stent itself as radiation source by ion implanting 32P. Investigations of the surface properties were performed with special emphasis on activity retention. Clinical data of about 400 patients showed radioactive stents can suppress instent restenosis, but a so called edge effect appeared, which can be avoided by the new “drug eluting stents”.

We experienced a rare case of 5-month-old male infant presenting with a pseudoaneurysm following percutaneous balloon angioplasty for aortic arch recoarctation after undergoing the Norwood procedure. The pseudoaneurysm, which measured 1 cm in diameter, was located between the left carotid artery and the left subclavian artery. Under deep hypothermic circulatory arrest, resection of the pseudoaneurysm and reconstruction of the neoaortic arch were performed successfully.

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.

Fibromuscular dysplasia has been described as a group of related idiopathic nonatherosclerotic arterial lesions, which result in various types of stenoses, with and without aneurysms. Percutaneous balloon angioplasty is widely accepted as the treatment of choice for fibromuscular dysplasia. This acceptance is based on the excellent clinical results and low morbidity of this form of treatment. In some series, cure rates greater than 50% and total benefit rates approaching 100% are reported. Lack of benefit despite a technically successful angioplasty in the adult is commonly attributed to the coexistence of essential hypertension. However lack of benefit may also be due to insufficient treatment and restenosis, conditions that can be limited by skilled interventional technique.

Percutaneous balloon angioplasty is an alternative therapy for the treatment of the typical type of coarctation. Its associated morbidity and mortality compares favorably when compared to the standard treatment surgery. While atypical coarctations are rare, the described cases have been treated surgically. We present a case of unusually located aortic coarctation successfully treated with percutaneous balloon angioplasty.

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

Purpose: Percutaneous transluminal coronary angioplasty (PTCA) is one of the most common therapies for obstructive coronary artery disease. Unfortunately, subsequent restenosis after percutaneous balloon angioplasty occurs in 30–50% of patients and remains one of the major unsolved problems of contemporary cardiology. The study of endovascular irradiation has been greatly stimulated by the discovery that the process of restenosis may be impaired by irradation. The objective of this study was to examine a custom-made commercial 32P wire and to determine whether the present source presentation is suitable for this application. Methods and Materials: Measurements of the dose distributon around a 3 mm logn 32P source with an activity of 0.414 GBq (11.2 mCi) were made by using LiF thermoluminescent dosimeters and a scintillation detector. The source had the dimensions of 0.3 mm in diameter and 3 mm in length, and was first encapsulated by a plastic tube and then encapsulated in a specially manufactured NiTi wire with a diameter of 0.4 mm and a length of 2.6 m. The detector size effect is removed from the measurements calculations. Loevinger's equation for the dose distribution around a 32P source was used for the calculations. Results: The dose rate at a radial to the axis of teh source in an approximately exponential manner, from 53-5.3 cGy/s per GBq (∼2 to 0.2 cGy/s per mCi) as radial distances increased from 0.2 to 0.4 g/cm2 (1.5 to 3.5 mm away from the center of the source). The treatment length parallel along the wire could be as long as 24 mm for eight source dwell positions with the average dose rate of 59 cGy/s per GBq (2.2 cGy/s per mCi) and a variation of ±2.3% at a radial distance of 1.5 mm. Conclusion: Our experiments show that the dose distribution is ideal for endovascular irradiation. The source was incorporated in the end of a flexible cable and with a half-life of 14.3 dyas is suitable for endovascular irradiation.

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.

The occurrence of central vein total occlusion results in upper arm edema, pain, and hemodialysis access failure in uremic patient. Previous studies have proven the effectiveness of percutaneous balloon angioplasty for central vein total occlusion. Here, we report a rare case of successful revascularization of central vein total occlusion via antegrade and retrograde approach. © 2010 Wiley-Liss, Inc.

Percutaneous balloon angioplasty offers an alternative to surgery for the alleviation of symptoms in upper limb arterial disease. This report documents 28 per-femoral dilatation procedures in 27 patients for 33 subclavian, two innominate, and two axillary lesions. Thirty-four stenoses and three occlusions were treated, with multiple dilatations in five patients. Indications for treatment were: arm ischaemia (15 patients); neurological (steal syndrome) symptoms (8); and combined ischaemia plus steal (5). Angioplasty was technically successful in 27 procedures with symptomatic relief in 25 cases up to a mean follow-up of 24 months (median 20 months, range 2-90 months). One patient had successful repeat angioplasty for recurrent ischaemic symptoms after 30 months. Angioplasty improved pulse deficits in all but two patients and reduced arm blood pressure differential to less than 30 mmHg in all but three patients. There were three complications: a femoral artery occlusion and a groin haematoma required surgical intervention and another patient suffered an extension of a contralateral stroke. Percutaneous balloon angioplasty has proved safe and effective. We recommend angioplasty as the first line treatment for ischaemic or neurological symptoms in upper limb vascular disease.

Although balloon angioplasty for the management of failing bypass grafts has been well documented, little mention has been made of its use in treating the occlusive lesion within the native artery after a failed bypass graft. We report our experience with five patients in whom successful balloon angioplasty was carried out subsequent to failure of a femoral popliteal bypass graft. Increasingly aggressive percutaneous therapy of arterial occlusive disease may now be expanded to include a unique group of patients with chronically failed bypass grafts and occlusive disease within the native artery conducive to percutaneous transluminal angioplasty. This group of patients would previously have been relegated to repeat bypass grafts with its inherently inferior patency and recognized added technical demands. Percutaneous balloon angioplasty appears to be a plausible alternative in selected cases for repeat lower extremity revascularization.

The use of suture-mediated arterial closure devices has dramatically increased with the increased number of percutaneous procedures being performed. Complications from suture-mediated closure devices have been underreported. Specifically, arterial stenosis resulting in claudication has not been previously described in detail. We present nine patients who presented with various leg symptoms after Perclose was used to achieve arterial hemostasis following percutaneous procedures. All cases were found to have significant arterial stenoses from the Perclose sutures. Once diagnosis was correctly made, the patients either underwent surgical repair or percutaneous balloon angioplasty and in all cases the symptoms abated.

Ten cases of Budd-Chiari syndrome associated with coeliac disease have been reported in the literature, most of them in North African subjects. Supporting this association, we report a new case in a young Spanish Caucasian man in whom the cause of the syndrome was the membranous obstruction of the inferior vena cava, an infrequent cause of Budd-Chiari syndrome in Western countries. A percutaneous balloon angioplasty was performed, with satisfactory outcome.

The authors have developed a nongaseous, ligand-targeted perfluorocarbon nanoparticle emulsion which can acoustically enhance the presence of molecular epitopes on tissue surfaces. In a two-part study, they first demonstrate how perfluorocarbons with varying phase velocities impact the acoustic reflectivity of plasma clots targeted with an anti-fibrin perfluorocarbon nanoparticle in vitro. The targeted perfluorocarbon contrast agents increased backscattered power from 18.2 to 23.4 dB with the greatest enhancement noted for formulations with low acoustic impedance. Porcine carotid arteries were injured by percutaneous balloon angioplasty and treated in situ with a tissue factor-targeted or control nanoparticulate immunoemulsion. Intravascular ultrasound images (30 MHz) of the arteries before and after application of contrast agent demonstrated the acoustic localization and enhancement of stretch-induced tissue factor expression within the carotid media, which was not apparent in the control vessels.

This study was to evaluate the clinical effects of percutaneous balloon angioplasty of Budd-Chiari syndrome (BCS) caused by inferior vena cava (IVC) obstruction. Between 1993 and 1999, 28 men and 14 women with mean age of 44+/-12 years underwent percutaneous balloon angioplasty for primary BCS. Color Doppler ultrasound and venography showed membranous and segmental obstruction of IVC in 29 and 13 patients, respectively. Fourteen patients also had left- and/or mid-hepatic vein obstruction. Angioplasty of IVC was successful in 41 patients (97.6%), resulting in a reduction of pressure gradient between IVC and the right atrium from 15.0+/-2.5 to 5.5+/-0.8 mmHg (P0.01). A stent was placed in the site of obstruction in the patient with unsuccessful balloon angioplasty. Patients with successful angioplasty or stent placement had significant improvement in clinical symptoms indicated by a reduction in hepatomegaly and the degree of ascites. No specific attempt was made to treat the occluded left- and/or mid-hepatic vein due to the presence of potent right hepatic vein. Over the follow-up period of 32+/-12 months, restenosis of IVC occurred in only one patient (2.4%), which was redilated successfully. Percutaneous balloon angioplasty is a safe and effective therapy for Budd-Chiari syndrome caused by IVC obstruction, therefore should be the first choice of treatment for this condition.

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

Rupture of the iliac artery during percutaneous angioplasty is a life-threatening condition that requires prompt diagnosis and treatment to rescue the patient. Recently, percutaneous angioplasty has become an outpatient procedure, but there is no reliable guideline for observation time in the hospital after percutaneous angioplasty. We describe a 67-year-old man with bilateral lesions in the iliac artery who experienced a delayed rupture of the iliac artery 2 days after percutaneous balloon angioplasty and placement of a self-expandable stent. The patient was successfully treated by endovascular intervention with a stent graft. In our department, percutaneous angioplasty is not performed in an outpatient clinic, and all patients are admitted to the hospital and observed for at least 3 days after percutaneous angioplasty. Because our patient was in the hospital when the iliac artery ruptured, prompt diagnosis and treatment were possible. Moreover, because appropriately sized stent grafts were prepared in the hospital, timely endovascular treatment could be performed, and the patient recovered successfully. From this case, we conclude that observing patients for a sufficient time in the hospital and preparing appropriately sized stent grafts are 2 important factors for the safety of patients who undergo percutaneous angioplasty.

A patient with previous implantation of two stents in the left renal artery (because of refractory arterial hypertension) developed, 7 months after implantation, a renal infarction due to late renal stent thrombosis. The early diagnosis by means of computed tomography of the abdomen and the rapid intervention by means of percutaneous balloon angioplasty lead to a favorable outcome.

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.

We evaluated the long-term angiographic outcome of balloon angioplasty by comparing original and follow-up target coronary narrowing. Rather than using restenosis to determine outcome, as in most angioplasty studies, we took an unusual approach and analyzed outcome in terms that are commonly used in progression and regression studies after medical interventions. Quantitative angiographic measurements were undertaken in 315 narrowings with an initial diameter stenosis90% before and after angioplasty and at follow-up. Angiographic deterioration (10% increase in follow-up diameter stenosis) was identified in 44 (14%) narrowings. Angiographic deterioration was not influenced by age, sex, risk factors, lipid profile, or the indication for angioplasty. Deterioration was also not predicted by the severity, length, or the location of the narrowing. The deteriorating narrowings had a higher recoil after dilatation compared with narrowings with angiographic improvement (21% +/- 31% vs 12% +/- 17%, p = 0.006); the residual stenosis after angioplasty was therefore higher. The late loss was also significantly increased compared with narrowings with angiographic improvement (65% +/- 26% vs 8% +/- 24%, p0.001). We conclude that the incidence of angiographic deterioration of coronary disease as a result of restenosis is uncommon but not negligible. Interventional cardiologists should resist the temptation to dilate mild, silent coronary narrowings because the procedure might have an unfavorable angiographic (and probably clinical) effect.

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

We reviewed 95 cases of vein graft and anastomotic lesions treated with percutaneous transluminal balloon angioplasty (PTA) and 30 cases treated surgically. The therapy was deemed a failure if the lesion recurred or if the graft closed. The 21-month patency rate of lesions treated surgically was 86%, which was significantly better than the 42% patency rate for all lesions treated with PTA (P0.01). An evaluation of the lesion and graft characteristics that could influence the patency of stenotic lesions treated with PTA included: lesion length, minimum graft diameter, lesion location, and lesion type. The 66% patency rate at 24 months for the 41 simple lesions (single, nonrecurrent,15 mm in length, and within graftsor = 3 mm minimal diameter) was significantly better than the 17% patency rate for the 50 complex lesions (multiple, recurrent,or = 15 mm in length, or within grafts3 mm in minimal diameter) (P0.01). In addition, the 21-month patency rate for the surgically treated group (86%) was not significantly better than that of the angioplasty-treated simple lesions (66%). When feasible, vein graft lesions are best treated with simple surgical interventions. PTA can be useful to maintain the patency of severely compromised grafts prior to surgical repair, to treat simple lesions difficult to reach surgically, and for patients with medical contraindications for an operation.