scholarly journals Outcome after Hybrid Outflow Interventions for Chronic Limb-threatening Ischemia

2020 ◽  
pp. 145749692097560
Author(s):  
J. Serna Santos ◽  
M. Söderström ◽  
R. Helminen ◽  
P. Aho ◽  
K. Halmesmäki ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Arterial Disease ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
University Hospital ◽  
Free Survival ◽  
Open Surgical Procedure ◽  
Percutaneous Transluminal ◽  
Ischemic Ulcers

Background and Aims: Because chronic limb-threatening ischemia (CLTI) is often associated with multilevel arterial disease, it usually requires revascularization at different sites of the limb vasculature. We aim to assess the outcome of the hybrid interventions including open surgical revascularization together with outflow segment percutaneous transluminal angioplasty (PTA) in patients with chronic limb-threatening ischemia. Material and Methods: This study included all hybrid outflow-PTA interventions (n = 80) on patients suffering from CLTI performed in Helsinki University Hospital between 2003 and 2015. Follow-up ended on 31 December 2019. Patient data were prospectively collected into our vascular registry and scrutinized retrospectively. Thirty-one patients (39%) suffered from rest pain (Rutherford category IV) and 49 patients (61%) had ischemic ulcers (Rutherford category V–VI). The most common open surgical procedure was femoral endarterectomy (n = 63, 79%) and the most common endovascular procedure was superficial femoral artery percutaneous transluminal angioplasty (n = 65, 81%). Mean follow-up time was 56 months (range: 4 days–183 months). Results: Limb salvage was at 30 days—92%, at 1 year—91%, and at 5 and 10 years—86%. Survival and amputation-free survival were at 30 days—93% and 86%, at 1 year—80% and 76%, at 5 years—51% and 48%, and at 10 years—21% and 21%. Wound healing at 3, 6, and 12 months was 48%, 71%, and 87%. Freedom from target lesion revascularization was at 30 days—97%, at 1 year—88%, at 5 years—72%, and at 10 years—66%. Conclusion: Hybrid outflow revascularization is an important tool in the vascular surgeon’s armamentarium for treatment of patients with multilevel arterial disease causing chronic limb-threatening ischemia.

scholarly journals Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis

1998 ◽  
Vol 5 (6) ◽  
pp. E7
Author(s):  
Giuseppe Lanzino ◽  
Robert A. Mericle ◽  
Demetrius K. Lopes ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Artery Stenosis ◽  
Cardiac Complications ◽  
Neurological Event ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis. The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: Drug-coated balloons versus angioplasty

2018 ◽  
Vol 20 (2) ◽  
pp. 209-216 ◽  
Author(s):  
Domenico Patanè ◽  
Giovanni Failla ◽  
Giovanni Coniglio ◽  
Giorgio Russo ◽  
Walter Morale ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Type A ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Secondary Patency ◽  
Type B ◽  
Arteriovenous Fistulas ◽  
Percutaneous Transluminal ◽  
Drug Coated Balloon

The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

2019 ◽  
Vol 21 (5) ◽  
pp. 596-601
Author(s):  
Cemal Kocaaslan ◽  
Ahmet Oztekin ◽  
Mehmet Senel Bademci ◽  
Emine Seyma Denli Yalvac ◽  
Nurgul Bulut ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Anastomotic Stenosis ◽  
Arteriovenous Fistulas ◽  
Study Results ◽  
Significant Difference ◽  
Percutaneous Transluminal ◽  
Drug Coated Balloon

Background: Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas. Methods: A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon – percutaneous transluminal angioplasty (n = 44) and plain balloon – percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24–75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon – percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon – percutaneous transluminal angioplasty group (p = 0.24). Results: There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon – percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01). Conclusion: Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

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