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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.

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.

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 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.

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.

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

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.

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).

Vascular stenting has a great attention as a treatment for coronary arteries diseases as compared with percutaneous balloon angioplasty. In-stent restenosis and thrombosis are side effects resulting from using bare metal stent (BMS). Employing platelet therapy allowed to reduce the rate of thrombosis, however, the rate of restenosis remains a major problem. In 2002, drug-eluting stents (DESs) were introduced as an effort to reduce the restenosis. The commercially available DESs continue to suffer from coating defects that might lead to a series of adverse effects. Most importantly, multiple concerns remain regarding the polymer coating integrity on metal surfaces or the relation of polymer irregularities to long- term adverse events.

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

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

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.

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.

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.