Heme Oxygenase-1 Gene Promoter Microsatellite Polymorphism is Associated with Restenosis after Percutaneous Transluminal Angioplasty

2001 ◽  
Vol 8 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Markus Exner ◽  
Martin Schillinger ◽  
Erich Minar ◽  
Wolfgang Mlekusch ◽  
Gerald Schlerka ◽  
...  
Keyword(s):  
Heme Oxygenase ◽  
Percutaneous Transluminal Angioplasty ◽  
Protective Factor ◽  
Ankle Brachial Index ◽  
Balloon Dilation ◽  
Gene Promoter ◽  
Transluminal Angioplasty ◽  
Heme Oxygenase 1 ◽  
Dinucleotide Repeats ◽  
Percutaneous Transluminal

Purpose: To determine if an association exists between postdilation restenosis and heme oxygenase-1 (HO-1), which is induced by balloon injury and inhibits neointimal formation through the action of endogenous carbon monoxide. A dinucleotide repeat in the promoter region of the HO-1 gene shows a length polymorphism that modulates the level of gene transcription. Methods: This cohort study included 96 consecutive patients (64 men; median age 69 years, interquartile range 60–75) who underwent successful balloon dilation in the femoropopliteal segment. Six-month patency was evaluated using oscillography, ankle-brachial index, and duplex sonography. The association of patency and the length of (GT) repeats in the HO-1 gene promoter was assessed in univariate and multivariate analyses. Results: Restenosis was found in 23 (24%) patients within the first 6 months. Patients with short (<25 GT) dinucleotide repeats in the HO-1 gene promoter on either allele had restenosis significantly less often than patients with longer (≥25 GT) dinucleotide repeats (p = 0.01). Multivariate analysis revealed a significantly reduced risk for restenosis in these patients compared to patients without the short allele (odds ratio 0.2, 95% CI 0.06 to 0.70, p = 0.007). Conclusions: Genetic risk factors for restenosis after percutaneous transluminal angioplasty have not been investigated. In this patient population, short repeat alleles of the heme oxygenase-1 gene promoter polymorphism were associated with reduced postdilation restenosis at 6 months. Upregulation of HO-1 may be an important protective factor after balloon angioplasty by inhibition of vascular smooth muscle cell proliferation.

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI

2021 ◽  
pp. 20210215
Author(s):  
Nikolaos Galanakis ◽  
Thomas G Maris ◽  
Georgios Kalaitzakis ◽  
Nikolaos Kontopodis ◽  
Nikolas Matthaiou ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Intravoxel Incoherent Motion ◽  
Healthy Individuals ◽  
Imaging Protocol ◽  
Percutaneous Transluminal

Objectives: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. Methods: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. Results: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10−5 mm2/s to 331.51 ± 31 10−5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10−5 mm2/s vs 332.47 ± 22.95 10−5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64–0.93). Conclusions: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. Advances in knowledge: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

Percutaneous Transluminal Angioplasty of Supra-aortic Vessels

1996 ◽  
Vol 3 (2) ◽  
pp. 171-181 ◽  
Author(s):  
Amir Motarjeme
Keyword(s):  
Vertebral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Carotid Arteries ◽  
Balloon Dilation ◽  
Percutaneous Treatment ◽  
Transluminal Angioplasty ◽  
Long Term Results ◽  
Percutaneous Technique ◽  
Stent Deployment ◽  
Percutaneous Transluminal

Purpose: To retrospectively review the techniques and results of percutaneous transluminal angioplasty (PTA) in the supra-aortic vessels. Methods: Over a 5-year period, 112 patients underwent percutaneous treatment of 151 lesions in the innominate, subclavian, carotid, and vertebral arteries. The percutaneous technique included standard retrograde femoral artery access in the majority of patients with balloon dilation of the lesion site. In the more recently treated patients, stents were deployed for suboptimal PTA; primary stent deployment was used rarely. Symptom resolution and > 50% increase in flow were criteria necessary for a successful procedure. Results: In this population, 141 (93%) of 151 lesions were successfully treated. PTA achieved 100% success in stenotic lesions in the internal (n = 9) and external (n = 2) carotid; common carotid (n = 8); subclavian (n = 67); and innominate (n = 13) arteries. Ninety-two percent (36/39) of vertebral artery stenoses were successfully treated. In 13 cases of subclavian occlusion, however, only 6 (46%) were recanalized. There were 3 periprocedural complications, but only 1 was major; a focal stroke manifesting as right arm weakness occurred in a patient with left common carotid PTA and stenting. Five cases of reocclusion have been seen in 5 years of follow-up. All occurred in the subclavian artery, and 3 of the 5 were in arteries originally occluded. Conclusions: Brachiocephalic PTA can achieve excellent immediate and long-term results in proximal stenoses. Subclavian occlusions do not respond well to PTA, and those successfully recanalized have a high restenosis rate (50%). PTA of the arch vessel branches, particularly the vertebral artery, should be attempted only by experienced interventionists. Atherosclerotic lesions in the internal carotid arteries are best treated with endarterectomy at present, but fibromuscular dysplasia in the carotid arteries is an appropriate indication for PTA therapy.

Comparison of the Results of Percutaneous Transluminal Angioplasty and Stenting with Medical Treatment for Claudicants Who Have Superficial Femoral Artery Occlusive Disease

Vascular ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Samuel Wilson ◽  
Dmitri Gelfand ◽  
Juan Jimenez ◽  
Ian Gordon
Keyword(s):  
Medical Treatment ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Transluminal Angioplasty ◽  
Walking Distance ◽  
Control Group ◽  
Early Results ◽  
Percutaneous Transluminal

The outcomes of medical management of peripheral vascular disease localized to the superficial femoral artery (SFA) were compared with those obtained by percutaneous transluminal angioplasty (PTA) with or without stenting in a review of selected studies. The natural history of localized SFA disease is favorable, with major amputation rates less than 10% and revascularization in only 18% of patients over a 10-year interval. Conservative treatment of claudicants shows increases (150%) in walking distance if the ankle brachial index (ABI) is over 0.6 and patients stop smoking. Analysis of 10 trials (882 patients) of PTA with or without stenting found that the overall primary patency rates at 12 months were 71.1% for PTA plus stenting and 58.3% for PTA alone. Technical success with PTA with or without stenting is over 90%, and early results at 6 months are superior to those with exercise. In three randomized controlled trials, however, the difference between PTA and medical treatment at 2 years, whether measured by walking distance or ABI, was not significant, nor was the quality of life. For long-term improvement in walking distance (> 1 year) in the claudicant, intervention is not superior to medical treatment and a monitored exercise program. Consideration should be given to including a nonintervention control group and 2-year outcomes in the evaluation of new SFA stents.

Heme Oxygenase-1 Genotype is a Vascular Anti-inflammatory Factor following Balloon Angioplasty

2002 ◽  
Vol 9 (4) ◽  
pp. 385-394 ◽  
Author(s):  
Martin Schillinger ◽  
Markus Exner ◽  
Wolfgang Mlekusch ◽  
Ramazanali Ahmadi ◽  
Helmut Rumpold ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Heme Oxygenase ◽  
Balloon Angioplasty ◽  
Gene Promoter ◽  
Heme Oxygenase 1 ◽  
Inflammatory Factor ◽  
Dinucleotide Repeats ◽  
Acute Phase Reactants ◽  
Amyloid A ◽  
Anti Inflammatory

Purpose: To investigate the association of the heme oxygenase-1 (HO-1) genotype, which has potent anti-inflammatory capability, and the inflammatory response induced by balloon angioplasty. Methods: Three hundred seventeen patients (188 men; median age 70 years, range 57–77) undergoing femoropopliteal balloon angioplasty (n=150) or stenting (n=61) were evaluated for upregulation of the HO-1 genotype; 106 patients undergoing lower limb angiography served as controls. The acute phase reactants C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen were measured 24 and 48 hours postintervention and compared to baseline values. An association of the relative increase (Δ, %) of these inflammatory markers with short (<25) (GT)n dinucleotide repeats in the HO-1 gene promoter was assessed. Results: The HO-1 genotype was significantly associated with ΔCRP24 (p<0.0001), ΔCRP48 (p<0.0001), ΔSAA24 (p=0.02), and ΔSAA48 (p=0.006) after balloon angioplasty; Δfibrinogen showed no association. Patients with a higher ΔCRP48 after balloon angioplasty exhibited significantly reduced odds for the presence of short (<25) (GT)n repeats. The adjusted odds reduction in the multivariate model was 80% (p=0.002) in the third quartile of ΔCRP48 values and 90% (p=0.001) in the fourth quartile. No association of HO-1 genotype and inflammatory response was found 24 and 48 hours after stenting (p=0.3, p=0.5) or angiography (p=0.2, p=0.6). Conclusions: The HO-1 promoter genotype is independently associated with the inflammatory response seen after balloon angioplasty. Short alleles (<25 GT repeats) seem to be an intrinsic vascular anti-inflammatory factor.

Infrared thermography as option for evaluating the treatment effect of percutaneous transluminal angioplasty by patients with peripheral arterial disease

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Erik Staffa ◽  
Vladan Bernard ◽  
Lubos Kubicek ◽  
Robert Vlachovsky ◽  
Daniel Vlk ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Infrared Thermography ◽  
Treatment Effect ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Significant Difference ◽  
Peripheral Arterial ◽  
Percutaneous Transluminal

Aim of this study was to evaluate the possible use of infrared thermography as a supplementary method to the ankle-brachial index used in assessing the treatment effect of percutaneous transluminal angioplasty. The study included 21 patients, mean age was 60.22 years. Healthy control group included 20 persons, mean age was 55.60 years. Patients with symptomatic peripheral arterial disease (Fontaine stages I–III) were admitted for endovascular treatment by percutaneous transluminal angioplasty. Thermal images and ankle-brachial index values were obtained before and after treatment by percutaneous transluminal angioplasty. Median temperature change in the treated limb was 0.4℃, for non-treated limb was –0.5℃. The median value of ankle-brachial index in the treated limb increased by 0.17 from 0.81 after the procedure. The median value of ankle-brachial index in the non-treated limb decreased by 0.03 from the value of 1.01. Significant difference between treated limb and non-treated limb in change of ankle-brachial index was found with p value = .0035. The surface temperature obtained by the infrared thermography correlates with ankle-brachial index. We present data showing that the increase of ankle-brachial index is associated with increase of skin temperature in the case of limbs treated by percutaneous transluminal angioplasty. Our results also suggest potential of the use of infrared thermography for monitoring foot temperature as a means of early detection of onset of foot ischemic disorders.

Restenosis after Percutaneous Transluminal Angioplasty in the Femoropopliteal Segment: The Role of Inflammation

2001 ◽  
Vol 8 (5) ◽  
pp. 477-483 ◽  
Author(s):  
Martin Schillinger ◽  
Markus Haumer ◽  
Gerald Schlerka ◽  
Wolfgang Mlekusch ◽  
Markus Exner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Value ◽  
Odds Ratio ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Duplex Sonography ◽  
Transluminal Angioplasty ◽  
Technical Success ◽  
Reactive Protein ◽  
Percutaneous Transluminal

Purpose: To determine the value of baseline C-reactive protein (CPR), fibrinogen, and white blood cell (WBC) counts in predicting 1-year patency after percutaneous transluminal angioplasty (PTA) in the femoropopliteal segment. Methods: In a retrospective cohort study, 168 consecutive patients (103 men; median age 70 years, interquartile range 61–77) who underwent successful PTA of the femoral and/or popliteal arteries were analyzed. Twelve-month patency was evaluated using oscillography, ankle brachial index, duplex sonography, and angiography. The predictive value of inflammatory markers was assessed in a multivariate model controlling for cardiovascular risk factors, technical success, and hemodynamic factors. Results: Transient WBC elevation was found 6 hours after PTA, but this returned to baseline after 24 hours. Fibrinogen was elevated at 24 hours. Duplex scanning disclosed restenosis in 66 (39%) patients within the first 12 months after PTA. Only residual postdilation stenosis (≥30%) in the target segment (odds ratio 3.6, p=0.001) and baseline CRP levels (odds ratio 4.2, p=0.02) were independent predictors of outcome; neither WBC counts nor fibrinogen levels at any time point was associated with restenosis. Conclusions: Primary technical success and postinterventional hemodynamic flow at the dilated segment seem to be more important for intermediate-term patency than atherogenic risk factors. The predictive value of preprocedural serum CRP levels on restenosis should be further investigated.

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

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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