Endovascular Treatment of Iliac Occlusive Disease: Review and Update

Vascular ◽  
2007 ◽  
Vol 15 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Albeir Y. Mousa ◽  
Robert B. Beauford ◽  
Lucio Flores ◽  
Peter L. Faries ◽  
Prem Patel ◽  
...  
Keyword(s):  
Transluminal Angioplasty ◽  
Occlusive Disease ◽  
Success Rates ◽  
Endovascular Interventions ◽  
Late Failure ◽  
Therapeutic Measures ◽  
Comparison Of Techniques ◽  
Open Versus ◽  
Angioplasty And Stenting

Use of endovascular interventions for arterial occlusive lesions continues to increase. With the evolution of the technology supporting these therapeutic measures, the results of these interventions continue to improve. In general, a comparison of techniques for revascularization of iliac occlusive diseases shows similar initial technical success rates for open versus percutaneous transluminal angioplasty. Angioplasty is often associated with lower periprocedural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency, although late failure of percutaneous therapies may occur but still can be treated successfully with reintervention. The perpetual buildup of experience with angioplasty and stenting will eventually characterize its role in the management of occlusive disease. This review outlines the current consensus and applicability of endovascular management of iliac occlusive diseases.

Endovascular Procedures for Mesenteric Ischemia

2017 ◽  
Author(s):  
Gregory L. Moneta ◽  
Enjae Jung ◽  
Cherrie Z Abraham
Keyword(s):  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Success Rates ◽  
Arterial Embolism ◽  
Endovascular Interventions ◽  
Catheter Directed Thrombolysis ◽  
Endovascular Approach ◽  
Open Versus ◽  
Angioplasty And Stenting

Mesenteric ischemia is a condition caused by compromised blood flow to the small and large intestines. Patients can present with chronic mesenteric ischemia (CMI), most commonly due to atherosclerosis, or acute mesenteric ischemia (AMI), most commonly due to arterial thrombosis or arterial embolism. Endovascular options for CMI include angioplasty and stenting, whereas options for AMI include catheter-directed thrombolysis and suction embolectomy followed by angioplasty and stenting of the underlying lesion. For treatment of CMI, an endovascular approach is associated with lower morbidity and mortality with good immediate technical success rates but may be less durable than surgical intervention, with reported lower long-term patency and a higher recurrence rate. There are no randomized trials comparing open versus endovascular interventions for AMI. Even after successful endovascular treatment, there should be a low threshold for laparotomy to visually inspect the bowel. Postoperative imaging is important, and close follow-up is mandatory.  This review contains 8 figures, and 26 references. Key words: acute mesenteric ischemia, angioplasty, catheter-directed thrombolysis, chronic mesenteric ischemia, stenting (balloon versus self-expandable, covered versus bare metal), suction embolectomy

Techniques for Endovascular Recanalization of Supra-Aortic Trunks

1996 ◽  
Vol 3 (4) ◽  
pp. 405-413 ◽  
Author(s):  
Frank J. Criado ◽  
Mordechai Twena
Keyword(s):  
Balloon Angioplasty ◽  
High Flow ◽  
Occlusive Disease ◽  
Endovascular Recanalization ◽  
Endovascular Interventions ◽  
Atherosclerotic Occlusive Disease ◽  
Angioplasty And Stenting ◽  
Aortic Lesions

The supra-aortic arteries are no stranger to endovascular interventions. Since the 1980s, interventionists have been evaluating and refining the use of transluminal techniques for recanalizing stenotic and occlusive lesions in these large-bore, high-flow vessels. The authors present their methodologies for evaluating, selecting, and treating supra-aortic lesions with balloon angioplasty and stenting. Helpful suggestions are offered for optimizing the outcome of these endovascular approaches to atherosclerotic occlusive disease in the supra-aortic trunks.

Langzeitergebnisse der systemischen Thrombolysetherapie bei aorto-iliakaler Verschlusskrankheit

VASA ◽  
2001 ◽  
Vol 30 (3) ◽  
pp. 212-218
Author(s):  
Robert A. Bucek ◽  
G. Schnürer ◽  
M. Haumer ◽  
M. Reiter ◽  
A. Ahmadi ◽  
...  
Keyword(s):  
Patency Rate ◽  
Clinical Success ◽  
Prospective Trial ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Long Term Results ◽  
Primary Patency Rate ◽  
Lysis Therapy

Background: Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate. Patients and methods: 72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or – after at least 3 cycles – no progress in recanalization could be stated on two consecutive days by duplex scanning. Results: Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0,001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency. Conclusion: Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.

Percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease: The experience of a single stroke centre

2021 ◽  
pp. 159101992110518
Author(s):  
Manuel Machado ◽  
Gonçalo Borges de Almeida ◽  
Marta Sequeira ◽  
Filipa Pedro ◽  
Alberto Fior ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Basilar Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Artery Occlusion ◽  
Occlusive Disease ◽  
Basilar Artery Occlusion ◽  
Basilar Artery Stenosis ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale <2. Twelve presented with acute basilar artery occlusion and were submitted to mechanical thrombectomy before percutaneous transluminal angioplasty and stenting, while the remaining had severe basilar artery stenosis. Successful stent placement was achieved in 22 (88%). Procedure-related complications included new small ischemic lesions (16%), basilar artery dissection (8%), vertebral artery dissection (12%) and death (12%). At 3 months post-percutaneous transluminal angioplasty and stenting, 10 out of 23 patients (43.5%) were independent (mRS ≤ 2) and six died. Fourteen patients underwent transcranial Doppler ultrasound 3 months post-percutaneous transluminal angioplasty and stenting: 12 showed residual stenosis, one significant stent restenosis and one presented stent occlusion. Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.

Carotid axillary artery bypass: an option following failed open and percutaneous procedures

Vascular ◽  
2013 ◽  
Vol 22 (3) ◽  
pp. 198-201 ◽  
Author(s):  
Vicente Orozco ◽  
Paul Impellizzeri ◽  
Rotem Naftalovich ◽  
Herbert Dardik
Keyword(s):  
Axillary Artery ◽  
Artery Bypass ◽  
Innominate Artery ◽  
Transluminal Angioplasty ◽  
Alternative Methods ◽  
Long Term Results ◽  
Percutaneous Procedures ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

Percutaneous transluminal angioplasty and stenting is being employed with increasing frequency for stenosis involving the brachiocephalic circulation. However, the efficacy of these procedures is limited by intimal hyperplasia and subsequent re-stenosis. Long-term results for treating lesions of the subclavian or innominate artery have shown significant re-stenotic rate. Accordingly, carotid–subclavian bypass remains as an important procedure. Alternative methods may still be required, particularly after failure of open re-vascularization and percutaneous techniques. This report describes an underused technique that enables upper extremity revascularization following prior attempts at endovascular and standard open techniques.

In Vivo Quantification of the Deformations of the Femoropopliteal Segment

2016 ◽  
Vol 24 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Can Gökgöl ◽  
Steffen Schumann ◽  
Nicolas Diehm ◽  
Guoyan Zheng ◽  
Philippe Büchler
Keyword(s):  
Stent Implantation ◽  
Treatment Method ◽  
Transluminal Angioplasty ◽  
Patient Specific ◽  
3 Dimensional ◽  
Endovascular Interventions ◽  
Leg Flexion ◽  
Percutaneous Transluminal

Purpose: To quantify the deformations of the femoropopliteal (FP) segment in patients undergoing endovascular revascularization and to compare the posttreatment deformations caused by primary nitinol stent implantation to those produced by percutaneous transluminal angioplasty (PTA). Methods: Thirty-five patients (mean age 69±10 years; 20 men) scheduled for endovascular therapy were recruited for the study. During endovascular interventions, angiographic images were acquired with the legs straight and with a hip/knee flexion of 20°/70°. Image acquisition was performed before PTA for all patients, after PTA in 17 patients receiving this treatment only, and after primary stent implantation in the remaining 18 patients. A semiautomatic approach was used to reconstruct the 3-dimensional patient-specific artery models from 2-dimensional radiographs. Axial shortening and curvature changes in the arteries in vivo were calculated for the calcified, dilated, and stented regions, as well as the regions that were distal and proximal to the diseased and treated segments. Results: Leg flexion resulted in shortening of the artery in all investigated FP segments. The dilated arteries exhibited greater shortening compared with their stented counterparts (post-PTA 7.6%±4.9%, poststent 3.2%±2.9%; p=0.004). Leg flexion also led to an increase in the curvatures of all the sections of the FP segment. While stented arteries had significantly higher curvature values than PTA within the regions proximal to the treated sections, the choice of the treatment method did not affect the curvature of the other segments. Despite this, 40% of the stented arteries exhibited kinking during leg flexion. Conclusion: The choice of the treatment method affects the postinterventional axial deformations of the FP segment but does not influence the curvature behavior. While PTA results in a more flexible artery, stents restrict the arteries’ shortening capabilities. Depending on the anatomical position of the stents, this axial stiffening of the arteries may lead to chronic kinking, which may cause occlusions and, consequently, affect the long-term success of the procedure.

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