Arterial percutaneous angioplasty in hemodialysis access: Endovascular treatment of hand ischemia

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.

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Impaired Maturation of Arteriovenous Fistula for Haemodialysis Due to Forearm Artery Stenosis: Percutaneous Endovascular Treatment

The Journal of Vascular Access ◽

10.5301/jva.5000782 ◽

2017 ◽

Vol 18 (6) ◽

pp. 503-507

Author(s):

Nicola Pirozzi ◽

Jacopo Scrivano ◽

Roberto Pirozzi ◽

Emanuela Cordova ◽

Giorgio Punzo ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Artery Stenosis ◽

Arterial Stenosis ◽

Low Flow ◽

Secondary Patency ◽

Percutaneous Transluminal

Introduction Distal autogenous arteriovenous fistula (dAVF), considered the “gold standard” vascular access for haemodialysis, suffers from a high rate of impaired maturation. One of the usual causes is low-flow associated forearm arterial stenosis. In such cases, endovascular treatment by percutaneous transluminal angioplasty represents a helpful option to enable maturation of the vascular access. Currently, there are few reports concerning the treatment of this complication. Therefore, we describe our single-centre experience based on a retrospective review of prospectively collected data. Patients and methods We treated 18 consecutive patients from July 2007 to January 2014 (16 radio-cephalic, 2 ulno-basilic distal AVF). A low flow due to forearm artery stenosis was diagnosed by duplex examination, as routinely performed one month after dAVF creation. An anterograde trans-brachial access was used for a 4-mm high-pressure angioplasty of the stenosed artery. Results All interventions resulted in patent fistulas. Isolated percutaneous transluminal angioplasty (PTA) was required without need of stent placement. Mean blood flow increased from 304 mL/min, preoperatively, to 671 mL/min (p<0.01), as checked one week after the procedure. One-year primary and secondary patency were 84% ±7.3% and 92% ± 9.2%, respectively. Under no circumstances did access-induced distal ischemia occurred during follow-up. Conclusions Endovascular approach is a helpful and minimally invasive procedure for treatment of delayed maturation of dAVF related to forearm artery stenosis.

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Feasibility of ischemic leg ulcer healing using percutaneous techniques: a real-life study

Acta Radiologica ◽

10.1177/0284185119862955 ◽

2019 ◽

Vol 61 (3) ◽

pp. 353-360

Author(s):

Elias Kehagias ◽

Christos V Ioannou ◽

Izolde Bouloukaki ◽

Evangelia Papadaki ◽

Nikolaos Galanakis ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Clinical Success ◽

Ankle Brachial Index ◽

Real Life ◽

Transluminal Angioplasty ◽

Artery Disease ◽

Percutaneous Transluminal ◽

Lower Extremity Artery Disease

Background Percutaneous transluminal angioplasty is established as the first-line vascular procedure in patients with lower extremity artery disease. Purpose We aimed to evaluate the technical and clinical effectiveness of percutaneous transluminal angioplasty in the management of ischemic foot ulcers. Material and Methods All consecutive patients presenting with a foot ulcer at the outpatient vascular surgery clinic of our hospital between June 2009 and June 2015 were evaluated using foot pulse assessment, ankle-brachial index, and duplex scanning. If non-invasive parameters suggested lower extremity artery disease, CT angiography and/or digital subtraction angiography were performed and a percutaneous transluminal angioplasty was carried out when feasible during the same session. All patients were followed until healing, amputation, death, or for at least two years. Short- and long-term clinical success was evaluated based on ulcer size and appearance. Patients with worsening ulcers after percutaneous transluminal angioplasty underwent bypass grafting or amputation. Results Percutaneous transluminal angioplasty was performed in 161 patients (100%) with stenoses > 50%, including cases lesions > 10 cm and/or multiple/calcified lesions, 144 of which completed the study. In 88 (61.2%) patients, percutaneous transluminal angioplasty was performed in the suprapopliteal axis exclusively, in 10 (6.8%) patients in the infrapopliteal axis only, and in 46 (31.9%) in both levels. Percutaneous transluminal angioplasty was technically successful in 141 (98%) patients. After 3.1 years, the rate of healing was 68%, limb salvage 88%, overall survival 69.5%, and amputation-free survival 64%. Conclusion Our data suggest that percutaneous transluminal angioplasty for ischemic foot ulceration treatment is in the majority of patients feasible, effective, and safe with high rates of healing and limb salvage.

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INFRAPOPLITEAL PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY FOR LIMB SALVAGE

Acta Radiologica ◽

10.1034/j.1600-0455.2000.041001073.x ◽

2000 ◽

Vol 41 (1) ◽

pp. 73-77

Author(s):

L. Boyer ◽

T. Therre ◽

J. M. Garcier ◽

N. Perez ◽

A. Ravel ◽

...

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Percutaneous Transluminal

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Successful transluminal angioplasty of renal arterial stenosis using the transcarotid approach

Cardiology in the Young ◽

10.1017/s1047951102001075 ◽

2002 ◽

Vol 12 (6) ◽

pp. 589-591 ◽

Cited By ~ 5

Author(s):

Kiyohiro Takigiku ◽

Gengi Satomi ◽

Satoshi Yasukochi

Keyword(s):

Renal Artery ◽

Renovascular Hypertension ◽

Coronary Arteries ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Left Ventricular ◽

Arterial Stenosis ◽

Left Renal Artery ◽

Ventricular Failure ◽

Percutaneous Transluminal

We successfully performed percutaneous transluminal angioplasty to treat severe renovascular hypertension with left ventricular failure in a 5-month-old infant. Using the transcarotid approach, we dilated the stenotic left renal artery without any difficulties, using progressively larger balloons designed for dilation of coronary arteries.

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Efficacy of multiple arterial levels of percutaneous transluminal angioplasty on limb salvage

The Egyptian Journal of Surgery ◽

10.4103/ejs.ejs_94_18 ◽

2018 ◽

Vol 37 (4) ◽

pp. 569

Author(s):

Mahmoud Soliman ◽

AymanM Samir ◽

Amro Elboushi ◽

AsserA Goda ◽

HosamA Tawfek

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Percutaneous Transluminal

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Endovascular Treatment of Thromboangiitis Obliterans (Buerger’s Disease)

Vascular and Endovascular Surgery ◽

10.1177/1538574417744085 ◽

2017 ◽

Vol 52 (2) ◽

pp. 124-130 ◽

Cited By ~ 5

Author(s):

Mohammad-Hadi S. Modaghegh ◽

Shahab Hafezi

Keyword(s):

Clinical Response ◽

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Thromboangiitis Obliterans ◽

Technical Failure ◽

Rest Pain ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Percutaneous Transluminal

Purpose: When critical limb ischemia (CLI) occurs in patients with thromboangiitis obliterans (TAO) or Buerger’s disease, smoking cessation alone may be insufficient to relieve rest pain and promote wound healing. Accordingly, adjunctive measures are warranted to restore adequate blood flow required for limb salvage. This study aimed to evaluate the feasibility and efficacy of percutaneous transluminal angioplasty (PTA) for the treatment of patients with TAO and CLI. In addition, a review of the literature on endovascular management of TAO is included. Methods: Between April 2012 and June 2017, all patients with TAO and CLI who underwent PTA were studied retrospectively. Patient demographics, presentation, procedural details, and clinical response were recorded. Patients were monitored at 1 week, 1, 2, 3, and 6 months after revascularization and at least every 6 months thereafter. Results: Thirteen patients with TAO and CLI, who presented with rest pain only (n = 1), ischemic ulcer (n = 4), or gangrene (n = 8) underwent endovascular interventions with primary and assisted primary technical success of 85% and 92%, respectively. A below-knee amputation was eventually done in the only patient with technical failure (limb salvage rate: 92%). Following the procedures, 11 patients had clinical response, one of whom also received intra-arterial vasodilator to achieve complete symptom relief. The other patient who failed PTA underwent a successful lumbar sympathectomy. In addition, all ulcers healed and eight minor amputations were performed due to already established gangrene. During follow-up (mean: 19.4 months), four patients needed reintervention. Patients who continued to smoke experienced more severe ischemia ( P = .017) and were more likely to require reintervention ( P = .009). Conclusion: Percutaneous transluminal angioplasty can be considered as a technically feasible and potentially effective treatment for patients with TAO and CLI, as well as a last resort for limb salvage when other options have failed. However, reintervention may be required, especially in patients who continue smoking.

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Angioplasty of an Idiopathic Intracranial Arterial Stenosis

Interventional Neuroradiology ◽

10.1177/159101990601200403 ◽

2006 ◽

Vol 12 (4) ◽

pp. 307-311

Author(s):

K.F. Layton ◽

D.F. Kallmes ◽

H.J. Cloft

Keyword(s):

Medical Therapy ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Intracranial Stenosis ◽

Arterial Stenosis ◽

Pharmacologic Therapy ◽

Presenting Symptoms ◽

Atherosclerotic Stenosis ◽

Percutaneous Transluminal ◽

Multiple Episodes

Treatment of symptomatic intracranial atherosclerotic stenosis usually involves maximizing medical therapy. In patients with medically refractory symptoms despite maximum pharmacologic therapy, intracranial angioplasty and/or stenting has become an accepted treatment option. The use of percutaneous transluminal angioplasty (PTA) for idiopathic intracranial stenoses has not been reported to date. We describe a case of idiopathic intracranial stenosis which was refractory to medical therapy and was successfully treated with percutaneous transluminal angioplasty. The presenting symptoms included multiple episodes of aphasia and right-sided weakness as well as a left basal ganglia infarct. The patient underwent treatment with two intracranial angioplasty procedures. There was a recurrence of the stenosis and symptoms following the first procedure. However, after a second treatment with a slightly larger balloon, flow in the MCA normalized. Furthermore, the symptoms attributed to her MCA stenosis had essentially resolved. This case suggests that patients with medically refractory idiopathic intracranial stenosis can be successfully treated with percutaneous transluminal angioplasty.

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