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Objectives The aim of this study was to seek expert consensus regarding the features that predict adverse outcomes in order to develop a dedicated angiographic classification system for femoropopliteal artery dissection. Background Dissection of the femoral and popliteal arteries is common after percutaneous angioplasty. Its classification is important. However, all current classification systems have significant limitations. Methods Delphi consensus methodology was performed over 3 rounds, using an expert panel of 17 interventionalists. Each was asked to rank dissection features with the potential to lead to acute technical failure and/or early restenosis and then which combination of features would require the placement of a metallic scaffold to avoid those outcomes. Results were used to develop a novel grading system and dissection treatment algorithm. Results Four main characteristics were identified from a comprehensive preliminary list. There was a good level of agreement between panelists from 773 responses (48 combinations). All panelists recommended scaffolding if a dissection produced a ≥50% diameter reduction (100%). Most recommended scaffolding if the dissection had a spiral shape (73%-100%), was severely flow limiting (93%-100%), or had complex morphology defined by long and multiple dissections (65%-100%). Multiple combinations of those features were more likely to receive a recommendation to scaffold. Conclusions Scaffolding of a postangioplasty dissection is recommended in the presence of significant diameter reduction, spiral shape, flow impairment, or adverse morphology (DISFORM). The DISFORM classification system has been developed as a tool to provide uniform language to standardize reporting and for discussion of dissection treatment and prognosis.

Background: Hemodialysis access–induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access–induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. Methods: Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. Results: Twenty-nine patients were referred for arterial angiography after hemodialysis access–induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding ( n = 2) and finger amputation ( n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. Conclusion: Hemodialysis access–induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.

Background and aim A 73-year-old female patient had right coronary button stenosis following aortic root replacement. Methods Myocardial ischemia led to hemodynamic instability followed by cardiogenic shock, which was successfully managed using venoarterial extracorporeal membrane oxygenation-supported right coronary button angioplasty. Results and conclusion Although the incidence of such complications is low, it is a life-threatening event that requires prompt diagnosis and it may pose a challenging clinical scenario for the treating team.

Aims In peripheral artery disease (PAD), endovascular treatment success of heavily calcified lesions is often compromised by a number of vascular complications, such as recoils, dissections and need for target vessel re-interventions. The increasing use of scoring balloon techniques has raised the hope for better periprocedural outcomes; however, the knowledge regarding the actual benefits of the scoring balloon technique in comparison to standard therapy is still limited. Thus, the aim of the current study was to determine the safety and effectiveness of scoring balloon angioplasty in a real-life patients’ collective with PAD. Methods and Results A total of 425 patients with moderate to severely calcified femoropopliteal lesions received interventional treatment between 2011 and 2018 at the single center; 230 received a treatment with a scoring balloon (AngioSculpt™), and 195 received a plain procedure without AngioSculpt™. Key questions of this analysis were: (1) whether AngioSculpt™ can be used as a safe and effective stand-alone treatment in heavily calcified lesions in a 24-month follow-up, as well as (2) whether target lesion preparation with scoring balloon bears additional benefits to standard treatment (PTA ± stent implantation). In terms of freedom from target lesion revascularization there were no significant differences between AngioSculpt™ and standard procedure (82.3% vs. 78.1%, P > 0.05). Vessel preparation with balloon angioplasty had no additional effects on survival and amputation rates in comparison to standard treatment without AngioSculpt™ (P > 0.05). The deployment of a scoring balloon did not reduce the subsequent need for additional stent implantations (32.6%, and 32.3%, P > 0.05). Conclusion Lesion preparation with AngioSculpt™ scoring balloon represents a safe and effective tool in the treatment of complex femoropopliteal lesions. In this retrospective analysis, AngioSculpt™ scoring balloon angioplasty did not significantly improve vessel patency- both when used as an adjunctive in preparation for stenting and as stand-alone treatment. A prospective study is needed to further investigate the scoring balloon treatment options. Graphic abstract

Objective 75% of men with coronary artery disease confirmed by coronarography have erectile dysfunction in history, while 75% of patients with a vascular etiology of ED have significant stenoses in penile arterial vascularization. Patients with coronary artery disease have shown a relationship between the range of the lesions in the coronary vessels and erectile dysfunction intensity. This paper aims at attempting to systematize the knowledge of the benefits and drawbacks of nonsurgical endovascular treatment methods for erectile dysfunction with confirmed vascular causes. It analyzes seven studies which assess the results of erectile dysfunction treatment with percutaneous angioplasty. It also mentions the limitations of the cited works and formulates relevant conclusions. Conclusion Conclusions: The analysis shows that endovascular procedures in erection-related arteries are safe in a specially selected group of men. It is necessary to conduct further studies to define an appropriate group of patients who have a chance of benefiting optimally from the endovascular treatment of erectile dysfunction in a long-term follow-up.

Resume Introduction Les stenoses des arteres renales (SAR) peuvent etre symptomatiques. Le traitement de ces lesions est en premier lieu medical, mais peut parfois necessiter une revascularisation chirurgicale ou endovasculaire. L’angioplastie des SAR est bien maitrisee, mais ses resultats sont discutes. L’objectif de ce travail etait de rapporter les resultats a court et a long termes du traitement endovasculaire des arteres renales de notre centre. Methodes Nous rapportons une etude retrospective, realisee entre 2013 et 2018, incluant des patients ayant beneficie d’un traitement endovasculaire pour une SAR symptomatique serree (≥75 %). Resultats Notre population comportait 17 patients. L’âge median etait de 57 ± 10 ans, le sex-ratio de 2,4. Le motif de decouverte de la SAR etait une HTA secondaire resistante au traitement medical pour 16 patients et une insuffisance renale rapidement progressive pour un patient. L’etiologie retenue etait : l’atherosclerose (9 cas), la dysplasie fibromusculaire (6 cas) et la maladie de Takayasu (2 cas). Le taux median de stenose etait de 84 ± 8 %. Nous avons realise une angioplastie simple dans 47 % des cas et un stenting dans 53 %. Le taux de succes technique etait de 100 %. A 1 mois, les taux de morbi-mortalite etaient nuls. Le suivi moyen etait de 12 mois [6–36 mois]. Les patients ayant une HTA renovasculaire ont presente une diminution de la pression arterielle, avec arret du traitement antihypertenseur dans 62,5 % des cas et la degression des doses dans 37,5 % des cas. Le taux de permeabilite etait de 100 % a 1 an, de 94 % a 2 ans et de 94 % a 3 ans. Un patient a presente une thrombose de stent asymptomatique au 18e mois. Le taux de restenose etait nul. Conclusion Dans notre cohorte de patients avec SAR toutes causes confondues, associee a une HTA resistante ou une insuffisance renale et pris en charge par angioplastie, nos resultats mettent en evidence un benefice en termes de baisse tensionnelle avec une permeabilite primaire se maintenant sur le moyen terme.

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

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Objective Thrombosis of a hemodialysis arteriovenous fistula (AVF) is a serious complication that needs urgent treatment. Most cases are treated surgically, but recently, endovascular strategies have become a viable alternative. This study is an evaluation of the success and patency rate of percutaneous balloon angioplasty of thrombosed hemodialysis fistulas using a drug-coated balloon (DCB) contrasted with a standard balloon (SB). Methods The data of 33 patients with a thrombosed native hemodialysis AVF treated percutaneously in a tertiary care center were analyzed retrospectively. Success of the procedure was defined as restoration of flow with less than 30% residual stenosis and resumption of dialysis through the hemodialysis AVF. The success rate of the procedure and the patency rate at 1, 6, and 12 months were evaluated. The effect on patency of a DCB was compared to that of a SB. Results Twenty-five radiocephalic and 8 brachiocephalic thrombosed hemodialysis AVFs were treated during the study period. Flow was restored in 23 thrombosed fistulas, a success rate of 69.7%. The patency rate of successfully treated fistulas was 95.6% at 1 month, 76.1% at 6 months, and 57.9% at 12 months. Ten of the 23 re-established AVFs were treated with a DCB and the remainder were treated with a SB. The patency of the fistulas treated with a DCB was similar to that of a SB at 1 month (100% vs 92.3%, respectively; p=0.393). The patency rate of a DCB was greater than that of a SB at 6 months (88.9% vs 66.7%, respectively; p=0.258) and 12 months (75% vs 45.4%, respectively; p=0.219). Conclusion Percutaneous intervention for thrombosed hemodialysis AVFs is a safe, minimally invasive, and effective procedure. There was a positive trend in the patency rate of patients treated with a DCB at 6 and 12 months compared with a SB.

Stenosis in the femoral-popliteal and infrapopliteal vein bypass grafts may occur in distal, midsegment, or proximal site (in reversed vein) and is secondary to myointimal hyperplasia or thickened valve. Duplex imaging of the vein bypass is essential for proper diagnosis. Percutaneous angioplasty is preferred as first-line approach. Role of antegrade puncture in endovascular treatment of infrainguinal occlusive disease is discussed.

The management of antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a challenge cardiologists face daily. The main difficulty is represented by finding the right balance between the prevention of thrombotic risk and the inevitable increase in bleeding. Most guidelines recommend the use of both oral anticoagulants and dual antiplatelet therapy in combination (triple therapy) in patients with FA undergoing PCI, suggesting however immediate use of dual antithrombotic therapy in patients with prevalent bleeding risk. Many studies show that triple therapy is associated with high frequency of major bleeding, thus stimulating the research for new therapeutic strategies. We report the case of a patient suffering from hypertension, dyslipidemia and epistaxis, hospitalized for the onset of angina associated with moderate efforts. Despite scientific evidence to support the use of dual therapy with dabigatran, the patient's detailed clinical history shows that this type of approach has not yet entered into current clinical practice, although the final therapeutic choice is in line with the results of the RE-DUAL PC study (Cardiology).

Key Clinical Message Spontaneous coronary artery dissection (SCAD) is a common cause of acute coronary syndrome particularly in younger women. Good outcomes with conservative management are generally expected. However, there is uncertainty of how to manage symptomatic or unstable patients. Percutaneous angioplasty may propagate the subintimal hematoma compromising coronary blood flow. Cutting balloon angioplasty can relieve the compressive effects of a propagated subintimal hematoma in SCAD.

Percutaneous angioplasty (PTA) for dysfunctional hemodialysis is usually performed by radiologists, but not cardiologists, in Taiwan, so that the radiation dose in patients and physicians are usually unknown and related studies are rare. In this study, we are pioneering an investigation into the radiation dose in percutaneous angioplasty for arteriovenous shunt assembling and the effect of RADPAD device, a lead-free surgical drape containing Bi and Ba, on the decrease of a radiation dose in the non-targeted organs of the patient and also the operator. The radiation dose in a typical digital subtraction angiography (DSA) by the PTA protocol under a fixed field of view (FOV), was measured with optically simulated luminescent dosimeters arranged in a PIXY RS-102 anthropomorphic phantom. The results indicate that there is a significant dose reduction at the hands (0.022±0.002 mGy before treatment vs. 0.014±0.001 mGy after treatment; P=0.021), but not at the lens (0.027±0.003 mGy before treatment vs. 0.018±0.001 mGy after treatment; P=0.058), and the gonads (0.026±0.003 mGy before treatment vs. 0.020±0.001 mGy after treatment; P=0.058), of the cardiologist/operator after treatment with the RADPAD drape. At the patient's abdomen, the dose significantly decreased from 1.597±0.104 mGy to 0.031±0.002 mGy (P In conclusion, the RADPAD drape significantly reduced radiation exposure to the patient during the PTA for the arteriovenous shunt assembling, which is suggested should be applied to the current cardiac catheterization.

Purpose: The aim of this study was to investigate the effectiveness of a new pull-through technique through a brachial artery approach combined with angioplasty for the treatment of arteriovenous fistula. Methods: In this retrospective study, a total of 56 arteriovenous fistula patients with high-grade stenosis induced by arteriovenous fistula, which was divided into pull-through technique through a brachial artery approach (pull-through group, n = 28) and solely through a venous approach (control group, n = 28), were analyzed. Both groups underwent percutaneous transluminal angioplasty treatments simultaneously. Results: The success rate of the pull-through group (89.3%, 25 out of 28) was similar to that of the control group (75.0%, 21 out of 28, p = 0.296). Fistula restenosis occurred with time in both groups but no significant differences in the post-operative fistula patency were found between the pull-through and control groups in follow-ups at 3, 6, and 12 months (71.4% vs 67.9%, 57.1% vs 60.7%, and 20.0% vs 30.0%, respectively, p > 0.05). No significant difference in the post-operative patency rate in patients with diabetes, hypertension, or coronary disease was found between the pull-through and control groups in the follow-ups at 3 and 12 months, respectively. The pull-through group had significantly shorter operation times compared with the control group (45 ± 9 min vs 65 ± 15 min, p Conclusion: The pull-through technique combined with percutaneous transluminal angioplasty is an effective, safe and lasting option to treat high-grade arteriovenous fistula stenosis in the upper limb.

IntroductionThe role of atherectomy (ATHERO) for the treatment of symptomatic infra-inguinal arterial lesions remains controversial. We evaluated the effectiveness and safety of atherectomy-assisted endovascular interventions in comparison with percutaneous angioplasty (PTA).Material and methodsA systematic search utilizing MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials was conducted for studies comparing ATHERO with PTA from February 1995 to May 2018. Only studies comparing ATHERO to PTA for symptomatic infra-inguinal disease were included. Random-effects meta-analysis was used to pool the data and endpoints across studies. Study endpoints included vessel dissection, distal embolization, residual stenosis (> 30%), vessel patency at 6 months, target lesion revascularization (TLR) at 12 months and major amputation rates at 1, 6, and 12 months.ResultsA total of 2923 patients were included from 8 studies. PTA was associated with higher vessel dissection (OR = 4.00, 95% CI: 1.15–13.86) and lower 12-month major amputation rates (OR = 0.73, 95% CI: 0.59–0.90). There was no significant difference between ATHERO and PTA groups in terms of distal embolization (OR = 0.45, 95% CI: 0.04–4.63), residual stenosis (OR = 1.28, 95% CI: 0.58–2.80), vessel patency at 6 months (OR = 1.27, 95% CI: 0.50–3.22), TLR at 12 months (OR = 1.07, 95% CI: 0.46–2.51), or limb amputation at 1 month (OR = 0.69, 95% CI: 0.44–1.07) or 6 months (OR = 1.54, 95% CI: 0.38–6.15).ConclusionsIn patients undergoing infra-inguinal endovascular interventions, PTA was associated with higher peri-procedural vessel dissection and lower 12-month major amputation rates. Both modalities were associated with similar distal embolization, residual stenosis, and 6-month vessel patency and amputation rates.

Fibromuscular dysplasia is a rare noninflammatory vascular disease predominantly affecting the renal arteries. It is a rare cause of hypertension accounting for 10% of cases of renovascular hypertension. The classical angiographic appearance of ‘string of beads' seen in medial fibroplasia type which is most common. There are various imaging modalities for diagnosis but conventional angiography is still considered as gold standard. The various treatment option includes medical therapy, interventional revascularization of renal arteries and rarely surgical. Percutaneous angioplasty is the treatment of choice in patients of renal artery fibromuscular dysplasia with hypertension. Various studies concludes 40–50% cure rate of hypertension by percutaneous angioplasty. Early diagnosis and treatment is important to achieve good long-term results.

Background Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. Methods Percutaneous mechanical thrombectomy, percutaneous angioplasty and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. Results The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. Conclusions Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hours may cause permanent neurological damage.

Radiation induces complicated vascular occlusions due to scarring, adventitial fibrosis, elastic degeneration, and accelerated atherosclerosis. Such occlusions were typically treated by vascular surgery bypassing the stenosis. However, minimally invasive percutaneous transluminal angioplasty (PTA)

To evaluate the safety and efficacy of low-frequency, high-intensity ultrasound using a new dedicated ultrasound catheter following a conventional balloon angioplasty to treat calcified below-the-knee (BTK) lesions. The ULYSSE registry was a prospective, nonrandomized single-center registry that

Objective: To review the outcomes of central venoplasty in the treatment of symptomatic central vein stenosis in patients undergoing haemodialysis via an ipsilateral arteriovenous fistula (AVF). Methods: Data were collected retrospectively, and included all the consecutive cases of central venoplasty between January 2008 and December 2015. Results: A total of 132 central venoplasties in 76 patients were performed, with incidence of symptomatic central vein stenosis at 7.4%. Of the patients, 66% were male and the mean age was 61 years. The most frequent indication was decreased dialysis access flow rates (58%) and 52% of all the patients had symptoms of upper limb swelling. The patients who had previous ipsilateral tunneled internal jugular vein dialysis catheters made up 58% of the patients. The mean time from AVF creation to first central venoplasty was 24 months, and 74% of the cases required a second central venoplasty and the mean time to second venoplasty was 7 months. The overall post intervention assisted primary patency rate was 87%, 74%, 63%, and 42% at 6, 12, 18, and 24 months respectively. Statistically significant differences were found in primary assisted patency (p=0.025) and time to second procedure (p=0.039) comparing those with and without a history of ipsilateral tunneled dialysis catheter. Conclusion: Central venoplasty is technically feasible with low procedural risk. The maintenance of the AVF patency usually requires multiple procedures at average interval of 7 months. Patients with a history of upper limb tunneled dialysis catheter ipsilateral to the side of central vein stenosis or AVF have a less favorable outcome compared to those without.

Background Ultrasound-guided percutaneous angioplasty of arteriovenous fistulas (AVFs) makes it possible to avoid contrast agents and X-rays, to optimize the puncture site and to locate some stenoses on the fistulography, but is it really useful? Our objective is to report the results of our experience. Methods Between November 2012 and November 2017, all the patients treated according to this method in our center were collected retrospectively. The surgical indications were an insufficient maturation of the AVF, an increase in the venous pressure, an inadequate outflow, difficulties in puncture, a prolonged bleeding time, a flow drop, or an aneurysmal evolution. Results During this period, 50 patients had 72 ultrasound-guided angioplasties, 64 on native AVFs (88.9%) and 8 on prosthetic AVFs (11.1%). The technical success rate was 100%. The average preoperative flow of AVFs was 506.8 ± 302.2 vs. 955.9 ± 371.4 mL/min after angioplasty. The mean duration of follow-up was 13.4 ± 12.9 months. The cumulative rates of primary, assisted primary, and secondary patency were 43.5%, 68.8%, 81.5% at 1 year and 31.7%, 63.9%, 76.8% at 2 years, respectively. Conclusions AVF angioplasty under ultrasound guidance only is feasible, effective, and represents an interesting alternative. A controlled study comparing ultrasound guidance with angioplasties performed under conventional angiographic guidance as the reference technique would better clarify the value of this technique.

Percutaneous angioplasty of the superficial femoral artery (SFA) with paclitaxel-coated balloon, intended to reduce restenosis, has been proven safe and effective in recent randomized controlled trials.To assess outcome results of angioplasty of the SFA with paclitaxel-coated balloon in claudicants in real-world practice of a single center.A continuous prospective cohort study of 53 claudicants (62 lower limbs) from January 2015 to December 2016. Study end points include primary patency, freedom from clinically driven target-lesion revascularization and symptom relief.It concerns 17 women (32%) and 36 men (68%) with a mean age of 67.8 years, suffering life-style-limiting claudication. Only short to intermediate-length stenoses or occlusions (30.6%), with a mean length of 59.6 mm were selected for percutaneous angioplasty with a paclitaxel-coated balloon. Technical success was 100%. At 16 months, primary patency attained 92.0% (3 early occlusions, 2 restenoses). There were two re-interventions at 6 and 9 months, resulting in a clinically driven target lesion revascularization rate of 3.2%. At the end of the follow-up of 16 months, all but two patients (96.2%) remained symptom-free. Two patients died during follow-up (no procedure-related deaths).Paclitaxel-coated balloon angioplasty of the SFA gives in routine clinical practice excellent midterm results, with a restenosis rate of 6.5% at 1 year. This procedure has authors' preference as first-choice technique for correction of short- and intermediate-length symptomatic stenoses of the SFA.

We report a case of a patient with recurrent symptoms of superior mesenteric ischemia 7 months after successful percutaneous angioplasty and implantation of a stent in the superior mesenteric artery (SMA). Stent fracture and stent displacement were observed. To the best of our knowledge, this is the first report of SMA stent fracture with stent displacement.

Background and Aims: The objective of this study is to analyze outcomes of the first experiences with drug-eluting balloons in native arteries, vein grafts, and vascular accesses. The study is also a pilot for our future prospective, randomized, and controlled studies regarding the use of drug-eluting balloons in the treatment of the stenosis in bypass vein graft and dialysis access. Materials and Methods: A total of 93 consecutive patients were retrospectively analyzed and in the end 81 were included in the study. Inclusion criteria included at least one previous percutaneous angioplasty to the same lesion. Patients were divided into three groups according to the anatomical site of the lesion: native lower limb artery, vein bypass graft, or vascular access. Time from the previous percutaneous angioplasty to the drug-eluting balloon was compared to the time from the drug-eluting balloon to endpoint in the same patient. Endpoints included any new revascularization of the target lesion, major amputation, or new vascular access. Results: The median time from the drug-eluting balloon to endpoint was significantly longer than the median time from the preceding percutaneous angioplasty to drug-eluting balloon in all three groups. This difference was clearest in native arteries and vein grafts, whereas the difference was smaller from the beginning and disappeared over time in the vascular access group. No significant differences were seen between the groups with regard to smoking, antiplatelet regime, diabetes, Rutherford classification, or sex. Conclusion: Although the setup of this study has several limitations, the results suggest that there could be benefit from drug-eluting balloons in peripheral lesions. Very little data have been published on the use of drug-eluting balloons in vein grafts and vascular accesses, and randomized and controlled prospective studies are needed to further investigate this field.

Surgically placed dialysis access is an important component of dialysis replacement therapy. The vast majority of patients undergoing dialysis will have surgically placed accesses at some point in the course of their disease, and for many patients these accesses may represent their definitive renal replacement option. Most, if not all, arteriovenous fistulae and grafts will require interventions at some point in time. Percutaneous angioplasty is the typical first treatment performed for venous stenoses, with stents and stent grafts being reserved for patients in whom angioplasty and surgical options are exhausted. In some salvage situations, stent graft placement may be the only or best option for patients. This article describes, using case illustrations, placement of stent grafts in such patients; a focus will also be made on the techniques utilized in such salvage situations.

We report a case involving an acute chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via bilateral trans femoral approach. This case emphasized that endograft occlusion treatment after endovascular aortic aneurysm repair (EVAR) is feasible.

Peripheral vascular disease affects 20% of the population >55 years of age. Patients who become symptomatic are managed by a number of technique's including medical management, percutaneous angioplasty, bypass surgery, and in nonreconstructable situations, limb amputation. Clinicians treating patients by means of angioplasty have traditionally carried out these procedures on an inpatient basis. Limited resources and pressure on the availability of inpatient beds has necessitated clinicians to reevaluate how many of these patients are managed. Treating suitable patients as day cases is an attractive option that frees up resources and is financially advantageous. This paper examines the feasibility of same-day discharge after angioplasty, with a particular emphasis on achieving safe patient outcomes. It explores how advances in endovascular technologies and techniques have contributed to making same-day discharge an ever more feasible option. Nurse led pre-admission clinics run by specialist nurses facilitate safe and appropriate patient selection, where patients at risk for postprocedural problems can be identified effectively based on predefined clinical criteria.

A 55-year-old man with nonischemic dilated cardiomyopathy who had undergone HeartMate II (HM2) (Thoratec, Pleasanton, California) implantation for destination therapy was readmitted 1.5 years later because of low-flow alarms with dizziness. Transesophageal echocardiogram showed decreased velocity

Objective: to evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation. Method: risk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival. Results: vascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter ≤ 3 mm, donor‐to‐recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts. Conclusion: the choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation. Resumo: Objetivo: Avaliar a frequência e os fatores associados a complicações vasculares após transplante hepático pediátrico. Método: Os fatores de risco foram avaliados em 99 pacientes com mais de 18 anos de idade com doença hepática crônica submetidos a transplante hepático cadavérico (THC) entre março de 1995 e novembro de 2009 no Hospital de Clínicas de Porto Alegre, Brasil. As variáveis analisadas incluíram: idade, sexo e peso dos doadores e receptores; indicação de transplante; escores PELD/MELD; aspectos técnicos; complicações vasculares pós‐operatórias; e sobrevida. Resultados: Ocorreram complicações vasculares em 19 pacientes (19%). Os eventos arteriais foram mais comuns, tendo ocorrido precocemente no pós‐operatório, e foram associados a altas taxas de perda do enxerto e mortalidade. Em uma análise multivariada, foram identificados os seguintes fatores: diâmetro da veia porta ≤ 3 mm, proporção de peso do doador/receptor (DRWR), tempo de isquemia prolongado e uso de enxertos arteriais. Conclusão: A escolha do tratamento depende do momento do diagnóstico; contudo, nessa série, a cirurgia de revisão, ou correção cirúrgica, produziu resultados piores que a angioplastia percutânea. A redução dos fatores de risco e a detecção precoce de complicações vasculares são fundamentais para um transplante bem‐sucedido. Keywords: Thrombosis, Hepatic artery, Portal vein, Morbidity, Mortality, Palavras‐chave: Trombose, Artéria hepática, Veia porta, Morbidez, Mortalidade

Despite recent advances, post-renal transplant vascular complication rate remains stable. We report a case of a 55-year-old male, chronic smoker with extensive atherosclerotic disease who underwent right orthotopic live related renal transplantation. On 6th post-operative day, the patient had sudden drop in urine output and graft site pain and found to have acute anastomotic transplant renal artery stenosis (TRAS), which was managed successfully with percutaneous angioplasty (PA) and stenting. His post-operative course was uneventful and has normal renal functions at 6 months post-transplant period.

Background The aim of this study was to assess the midterm results of percutaneous angioplasty in patients with critical limb ischemia (CLI) and long tibial occlusions. Methods Between January and September 2011, 34 consecutive patients with patent femoropopliteal artery and 49 segmental tibial occlusions >8 cm were included in our prospective, single-center cohort study. Clinical success (defined as wound healing and survival without major amputation), patency, and freedom from target vessel revascularization (TVR) were examined. Results The median age of the patients was 75 (53–89) years, 74% were diabetic, and 89% of the limbs studied were Rutherford 5 and 6. Median follow-up was 12.5 (1–15) months. The 1-year clinical success rate was 65%, higher among patients with technical success (76% vs. 25%, P = 0.01) and patients with 2 or 3 patent tibial arteries after the procedure (90% vs. 41% in patients with only 1 patent artery, P = 0.003). At 1 year, primary and secondary patency rates were 13% and 32%, respectively (24% and 58% without technical failures). The 1-year freedom-from-TVR rate was 34%. Conclusions Despite high technical failure rates and the need for repeat procedures, percutaneous angioplasty of long tibial occlusions enhances wound healing, especially when integrated into a maximal revascularization approach.

Isolated critical stenosis of left main coronary artery (LMCA) due to atherosclerosis is very rare and affects about 0.2% of patients. We present the case of a 39-year-old, non-smoker women with risk factors for diseases of the cardiovascular system in the form of hypercholesterolaemia and hypertension, in addition to positive family history and chronic oral contraception. Sick from occurring since atypical angina masked depressive symptoms, with a critical stenosis of LMCA and little suggestive symptoms of ischaemia because of the existing collateral circulation.

The anomalous origin of the entire coronary system from the right coronary sinus is a very rare anomaly. Here a patient with this rare anomaly, who developed acute coronary syndrome, requiring revascularization, is presented and treated successfully. His coronary angiographic findings are also discussed. We would like to highlight the rarity of the origin of all 3 coronary arteries from a single coronary trunk. The case also highlights the importance of using Amplantzer AR1 guiding catheter for such anatomical variations arising in the right coronary cusp.

Aorto femoral bypass is usually the recommended therapy for diffuse disease involving the aorta and iliac arteries. In this case report, a case involving a chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via a transbrachial and transfemoral approach is presented. This case emphasized that occlusion of an endovascular abdominal aortic stent graft can also be treated, primarily, with an endovascular technique.

Background Percutaneous angioplasty for atherosclerotic iliac disease is commonly performed via the femoral and/or brachial route. In the coronary field a transradial approach has been shown to reduce both major and minor access site bleedings, in experienced hands. However, this route has not yet been well studied for the majority of peripheral interventions, like those involving the iliac arteries. Methods We investigated the feasibility and safety of a transradial approach in a consecutive series of patients undergoing percutaneous iliac intervention at our center, comparing it to a similar series of patients treated with a transfemoral approach in the same period. Endpoints of the study were procedural success, duration of procedure and event free survival at one month. Results From our database we enrolled 42 patients undergone iliac percutaneous interventions (21 with a transradial and 21 with a transfemoral approach); the 2 populations had similar baseline characteristics. Procedural success was achieved in all of our patient population. Among the secondary study endpoints analyzed we observed similar duration of the procedure and one-month clinical follow up. Technical aspects of the transradial approach are discussed. Conclusions A transradial approach is feasible for the treatment of atherosclerotic iliac disease and does not increase procedural time in experienced hands. Further studies are needed to confirm if this approach is as safe as the transfemoral one.

Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT) arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

There are various options for the treatment of occluded femoropopliteal (fem-pop) bypass graft. Although surgical revision is the gold standard, it is also associated with higher rates of complications such as nerve injury, wound and graft infection, and bleeding. In this case report we present the case of fem-pop in graft occlusion in which percutaneous angioplasty and stenting was performed to the occluded native fem-pop artery via transpedal pathway. With this case we tried to emphasise that percutaneous intervention to the native artery could be an alternative to surgical treatment.

IntroductionHepatic artery complication represents recognized sequel of liver transplantation that carries significant morbidity and mortality. Besides retransplantation, hepatic artery recanalization is provided surgically, or by percutaneous angioplasty and stent placement. This study provides an analysis of a single center experience comparing surgical and interventional treatments in cases of early hepatic artery complications.MethodsIn this retrospective single center study, 25 of 365 liver transplant recipients were enrolled who developed early hepatic artery complication after transplantation. Percutaneous intervention was performed in 10 cases, while surgical therapy in 15 cases. Mean follow-up time was not different between the groups (505±377 vs. 706±940 days, respectively).Results6 patients in the Intervention Group and 10 patients in the Surgery Group are alive. The retransplantation rate (1 and 3) was lower after interventional procedures, while the development of biliary complications was higher. The mortality rate was higher after operative treatment (2 and 5).ConclusionInterventional therapy is a feasible and safe technique for treatment of early hepatic artery complication after transplantation. Being less invasive it is an invaluable alternative treatment having results comparable to surgical methods.

Atherectomy (ATHRO) role for treatment of symptomatic infrainguinal arterial lesions is controversial. In this study, we aim to evaluate the effectiveness and safety of atherectomy-assisted endovascular interventions in comparison with percutaneous angioplasty (PTA). Medline, PubMed and the

A female patient suffering from dermatomyositis in whom symptoms of heart failure without angina is described. An impairment of left ventricular function and significant coronary lesions were diagnosed using noninvasive and invasive procedures. Coronary angioplasty with stent implantation was successfully applied to improve the quality of life and clinical symptoms.

Three recently completed randomized studies of carotid artery stenting (CAS) versus endarterectomy-Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE), Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S), and Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy (SPACE)-reached vividly different conclusions about the safety of stenting versus endarterectomy. The methodologies of these studies differed from each other in many respects. In an attempt to explain the disparate results of SAPPHIRE, EVA-3S, and SPACE, this focused review compares and contrasts these studies, with specific reference to inclusion and exclusion criteria, technical considerations, and the experience level of the interventional operators.