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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.

Fully biodegradable polymeric stents are thought to be the third revolution in minimally invasive cardiology. After the breakthrough development of percutaneous balloon angioplasty and the dawn of the drug eluting stents era, increasing interest is being brought to the concept of temporary implants that fulfill the mission and step away.Copyright © 2009 by ASME

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

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.

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.

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.

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.

The current clinical application and technique of percutaneous transluminal balloon angioplasty (PTA) are the culmination of work which began in 1964, when Dotter and Jenkins dilated vascular lesions using a rigid coaxial catheter system. Catheters were later modified into tapered tubes by Van Andel and Staple. A balloon catheter was introduced by Porstmann in 1973, and Gruntzig developed the double-lumen, non-elastomeric, polyvinyl balloon catheter in 1974. The Gruntzig device permitted catheter placement over a guidewire and controlled balloon inflation, and it formed the basis for modern PTA techniques.

Intravascular ultrasound is a promising new technique that provides tomographic, cross-sectional images of the vessel lumen and wall in vivo. The development of intravascular ultrasound started in the early 1970s when Bom and coworkers [1] designed a phased-array device with 32 elements mounted on a 9-F catheter tip; this system provided two-dimensional, real-time ultrasound images. The increasing use of percutaneous balloon angioplasty and the development of other interventional devices in the 1980s renewed the interest in intravascular ultrasound imaging [2]. During the past 5 years various catheter designs have been developed and are now commercially available. The experience from several centers using intravascular ultrasound indicates that this technique may have some advantages over other modalities currently used for coronary imaging.

Two cases of Takayasu's arteritis with severe renovascular hypertension are described. Both patients underwent successful percutaneous balloon angioplasty with attenuation of the systemic hypertensive response. The role of angioplasty as an alternative to surgery for revascularization of symptomatic ischemia in this disease is reviewed.

Percutaneous balloon angioplasty was successful initial treatment for 2 infants who, early after operation, developed obstruction at the proximal anastomotic site of a modified Blalock-Taussig shunt. Two years later the first child had not required reoperation and the dilatation site was patent angiographically. The other baby progressed well after angioplasty but because of surgical concern about the long-term success of angioplasty, shunt surgery was repeated, the baby dying after reoperation. Angioplasty of proximal obstruction in these shunts is feasible and satisfactory long-term palliation can be achieved avoiding repeat shunt surgery before the more definitive Fontan-type procedure.

Percutaneous balloon angioplasty represents a firmly established non — surgical treatment of ischaemic disease in peripheral and coronary circulation. Major problems of this method involve: failure to cross occlusions, failure to dilate stenosis offectively, acute complications and re — stenosis within six months (1). Some of these difficulties may be related to the mechanism of balloon angioplasty — fracture of the atherosclerotic intima and stretching of the media (1). Therefore new angioplastic approaches have been sought.

The authors describe the use and advantages of percutaneous balloon angioplasty to treat pulmonary valve stenosis.

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

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

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

Percutaneous coronary atherectomy is currently under investigation as an alternative procedure to percutaneous balloon angioplasty for the relief of high grade obstructive lesions. With this method, tissue is mechanically resected from the area of stenosis. Because the depth of resection cannot be controlled with the device used, it is possible to remove not only intimal atherosclerotic material but also deeper arterial structures. In this regard, it is of interest that catheter disruption of the internal elastic lamina in animal studies, with exposure of underlying medial elements, resulted in subsequent thrombotic occlusion of the damaged vessel. 1 Although mechanical resection of tissue by atherectomy may result in the exposure of medial or even adventitial tissues, the risk of deep arterial resections in humans with coronary atherectomy has not been reported.

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

Six infants with coarctation of the aorta underwent percutaneous balloon angioplasty over a 6-month period ending July 1985. These infants had associated cardiac defects including aortic stenosis, ventricular septal defect, and patent ductus arteriosus. Catheters used carried 5 to 10 mm balloons; 4 to 8 atm pressure was applied for 10 to 15 seconds, and the procedure was repeated at least three times. No significant complications were encountered during the procedure. The mean systolic pressure gradient across the coarctation decreased from 44.2 +/- 4.7 mm Hg to 11.7 +/- 9.4 mm Hg (P less than 0.001) after angioplasty, and the diameter of the coarcted segment increased from 2.9 +/- 0.7 mm to 6.3 +/- 1.2 (P less than 0.001). Long-term follow-up indicated excellent results in four patients; the other two infants required additional treatment (repeat angioplasty and surgical resection, respectively). No aneurysm was seen in any infant. Based on this experience and the reported high mortality and high recurrence rate after surgical repair in neonates and young infants, we recommend balloon angioplasty as the therapeutic procedure of choice for relief of severe, previously unoperated coarctation of the aorta in neonates and young infants.

Pulmonary artery stenosis complicates the management of patients with tetralogy of Fallot, may be impossible to correct surgically, and affects the longterm outcome.

Forty-six patients with malfunctioning hemodialysis access fistulas were treated with balloon angioplasty. The initial percutaneous transluminal angioplasty procedure was successful in 16 (89%) of 18 patients with stenoses and in 13 (46%) of 28 with occlusions. In ten patients (seven with stenoses and three with occlusions) repeated dilation (two to five times; mean, two times) became necessary due to recurrent malfunction 1-24 months (mean, 6 months) after the first intervention. In the 16 patients with stenoses, the patency rate after 6 months was 93%; after 1 year, 91%; and after 2 years, 57%. In the 12 patients with occlusions, the rates were 80%, 50%, and 14%, respectively. Dilation of stenoses in malfunctioning hemodialysis fistulas is the procedure of choice. If hemodialysis shunts malfunction, immediate dilation of stenotic lesions should be performed to prevent occlusion.

Recent use of lasers to vaporize plaque in coronary and femoral arteries of living humans suggests that the 1980s will be a developmental decade for laser revascularization as the 1970s were for percutaneous balloon angioplasty. After the pioneer work 20 years ago, balloon angioplasty evolved through peripheral vessel trials in the early 1970s to coronary vessel trials, performed without opening the chest, beginning in late 1977 ( JAMA [Medical News] 1978;240:1117-1119; 1979; 241:11-12; 1980;243:99-101). Now, laser angioplasty, also building on some 20 years of experience, similarly is moving toward the percutaneous approach to cleaning out coronary vessels. But it's going to take time, say researchers from the University of Florida College of Medicine, Gainesville. George S. Abela, MD, and C. Richard Conti, MD, who presented some of their team's work during the American Heart Association's (AHA) annual scientifiic sessions in Anaheim, Calif, predict that initial experience will be gained by doing