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Background: Results of the SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) trial confirmed the safety but not the efficacy of renal denervation for treatment-resistant hypertension at 6 months post procedure., Objectives: This study sought to analyze the 12-month SYMPLICITY HTN-3 results for the original denervation group, the sham subjects who underwent denervation after the 6-month endpoint (crossover group), and the sham subjects who did not undergo denervation after 6 months (non-crossover group)., Methods: Eligible subjects were randomized 2:1 to denervation or sham procedure. Subjects were unblinded to their treatment group after the 6-month primary endpoint was ascertained; subjects in the sham group meeting eligibility requirements could undergo denervation. Change in blood pressure (BP) at 12 months post randomization (6 months for crossover subjects) was analyzed., Results: The 12-month follow-up was available for 319 of 361 denervation subjects and 48 of 101 non-crossover subjects; 6-month denervation follow-up was available for 93 of 101 crossover subjects. In denervation subjects, the 12-month office systolic BP (SBP) change was greater than that observed at 6 months (-15.5 ± 24.1 mm Hg vs. -18.9 ± 25.4 mm Hg, respectively; p = 0.025), but the 24-h SBP change was not significantly different at 12 months (p = 0.229). The non-crossover group office SBP decreased by -32.9 ± 28.1 mm Hg at 6 months, but this response regressed to -21.4 ± 19.9 mm Hg (p = 0.01) at 12 months, increasing to 11.5 ± 29.8 mm Hg., Conclusions: These data support no further reduction in office or ambulatory BP after 1-year follow-up. Loss of BP reduction in the non-crossover group may reflect decreased medication adherence or other related factors. (Renal Denervation in Patients With Uncontrolled Hypertension [SYMPLICITY HTN-3]; NCT01418261)., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

From January 2005 to July 2008, a retrospective study was conducted at a single institution to investigate technical success of the use of a reentry device (Outback LTD reentry catheter) in aortoiliac and femoropopliteal artery recanalization in 34 patients (18 men; mean age +/- SD, 72 years +/- 11) in whom the conventional guide wires and catheters failed to reenter the true lumen. True lumen reentry was achieved in 87% (n = 23) and 91% (n = 11) of patients with femoropopliteal and aortoiliac occlusions, respectively. The overall technical success rate with the device was 88% (n = 34). The device success rate in Transatlantic Inter-Society Consensus II class D lesions was significantly lower than in lower lesion classes (71.4% vs 100%; P < .05). No procedure-related complications were encountered. In conclusion, the use of the reentry catheter enhances the likelihood of successful subintimal recanalization of chronic occlusions in femoropopliteal and aortoiliac arteries.

Based on the assumptions mentioned previously, the author makes the following predictions regarding catheter-based angiography and related procedures: 1. Most diagnostic angiography will be performed with noninvasive methods. In the peripheral circulation. MRA will be the predominant method, with CTA having an important role in aortic imaging and coronary imaging. MRA will have increased use for elective diagnosis and in clinical emergencies. 2. Catheter-based angiography will have an important role as an adjunct or preliminary procedure related to interventions. This is significant for planning catheter development and functionality of future angiographic equipment. 3. The need for angiographic equipment will continue to grow despite this decrease in diagnostic application, as a result of increase in interventional therapy. This increase in therapy will be a result of a variety of factors, including aging population, early diagnosis, and increasing acceptance of less invasive therapy. 4. Interventionists should be considering and planning for vascular imaging devices--MRA, CTA, and US--to be included as part of the interventional sections and the workload. 5. Cardiovascular imaging should be a clinical imaging specialty, with patient interaction at the time of imaging. 6. These changes should be embraced by vascular interventionalists, who should incorporate these tools into their clinical practice. 7. The changes, if they occur as predicted, will create significant problems in training skilled interventionists who will not have the foundation of diagnostic angiography on which to build complex endovascular skills.

The conventional pigtail catheter was compared with the 5-F Tennis Racquet catheter for abdominal aortography with digital subtraction angiography. Resulting aortograms were judged on the basis of the quality of aortic opacification and renal artery visualization. The authors concluded that the Tennis Racquet catheter produces a more compact contrast material bolus, and its use is associated with acquisition of superior abdominal aortograms.

The cause of superior vena cava syndrome (SVCS) in two patients was identified by means of endovascular biopsy of the superior vena cava (SVC) performed with a percutaneous atherectomy catheter. In both cases, the extracted tissues were neoplastic, therefore obviating additional invasive procedures. After a specific diagnosis was established, external-beam radiation therapy was used to treat the SVCS. The atherectomy catheter was used in conjunction with other percutaneous techniques, including balloon angioplasty and endovascular stenting of the SVC.

The results of an ongoing five-year study of percutaneous transluminal angioplasty for the treatment of peripheral vascular disease are presented. A balloon catheter was used for iliac and superficial femoral and popliteal artery dilatation. Forty out of 43 procedures performed were considered to have initial success, with iliac angioplasty showing a greater success rate (96%) than superficial femoral angioplasty (90%). Complications requiring surgical intervention occurred in only 3 patients. Advantages of this technique include local anesthesia, early ambulation, reduced hospital stay, and reproducibility.

Intravascular occlusion of traumatic carotid cavernous fistulas, originally performed under direct visualization with fascia and/or muscle, has evolved into the use of catheters with pressure-sensitive detachable balloons that can be deflated and repositioned prior to final inflation and separation from the catheter. The balloon is filled with contrast material and can be identified with follow-up x-rays. Proptosis is often relieved immediately after this treatment. Detailed pre- and posttreatment ophthalmic evaluations of three consecutive patients with carotid-cavernous fistulas successfully treated with detachable balloon occlusion with a minimum 1-year follow-up are presented. Indications and timing of treatment are discussed. Following blunt head trauma, these patients presented with proptosis, decreased vision, orbital bruit, conjunctival chemosis, diplopia, orbital pain, ocular pulsations and diplopia; they often complained of "a ringing" in the ear on the involved side.

Forty patients have undergone percutaneous transluminal angioplasty (PTA) of the iliac or femoral-popliteal system with the Grüntzig balloon catheter. Technical problems ahve included experience with difficult antegrade puncture, production of intimal flaps, and loss of collateral vessels, as well as the need to develop an approach for recanalization of obstructions and for use of the balloon. Since problems in these areas may jeopardize the success of the procedure, they have been elucidated with some discussion of prevention. Preliminary results on the success of the procedure are included.

Diagnostic angiography combined with transcatheter therapeutic embolization is a simple and effective means of treating complex clinical situations associated with posttraumatic hemorrhage. Bleeding pseudoaneurysms, even when large, can be readily managed by this combined modality with resultant decrease in morbidity and hospital stay. Five patients with posttraumatic pseudoaneurysms are presented. All five were treated by transcatheter therapeutic embolization with Gelfoam. Of these five cases, three involved extremities, one involved the retroperitoneal space, and the last was of renal origin. Two of the five cases still required surgical intervention after initial successful therapeutic embolization, one for recurrent bleeding from collaterals and the other for evacuation of a massive pseudoaneurysm which was causing distraction of fracture fragments. The early use of angiography in suspected cases of posttraumatic hemorrhage, together with careful evaluation of potential collateral supply, is stressed. The use of transcatheter therapeutic embolization in the extremities as presented here is yet another example of the ever-broadening applicability of this technique.

"Blue toe syndrome" refers to digital ischemia of the foot in the presence of palpable or Doppler audible pedal pulses. This clinical syndrome is caused by microembolization to small vessels from a proximal source. The use of percutaneous transluminal atherectomy is described in the treatment of embologenic superficial femoral artery lesions in seven patients. All seven had prompt healing of the ischemic toes, and none required surgical revascularization or amputation. One patient developed a recurrent stenosis at the atherectomy site and had a second episode of digital ischemia, which was treated by means of atherectomy with a larger device. Histologic study of atherectomy specimens suggests that emboli arise from adherent fibrinoplatelet aggregates or thrombus and less often from cholesterol-rich atheromatous plaque. Although either percutaneous transluminal angioplasty or atherectomy can be used to treat the underlying stenosis, percutaneous atherectomy offers the advantage of nonsurgical removal of embologenic material and provides material for histologic study. Percutaneous atherectomy is an effective method of treating embologenic superficial femoral stenoses in patients with ipsilateral blue toe syndrome.

Percutaneous transluminal angioplasty has been used to treat lesions of the iliac, superficial femoral, and renal arterial systems in 70 patients. Overall initial success was achieved in 27/30 lesions, with 4/5 lesions documented to be patent for longer than two years. Although long-term follow-up is at present limited, the reduced cost and morbidity of this procedure are distinct advantages in appropriately selected patients. The close involvement of the vascular surgeon and a "team" approach are necessary. These preliminary results are part of a long-term study to evaluate the efficacy of transluminal angioplasty as well as to define factors that may be of predictive value in patient selection.