Fate of patients undergoing transluminal angioplasty for lower-limb ischemia

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is a relatively new technique for treating narrowed or blocked blood vessels. It involves inserting a balloon-tipped catheter into the vessel and inflating the balloon to open the vessel. PTA has proven to be as effective as surgical reconstruction of blood vessels in the lower limbs, with fewer associated complications. This study examined the results from patients who underwent PTA, and examined the fate, or outcome, of patients in which it failed. The study involved following 370 patients who had undergone a total of 500 PTA treatments for ischemia (reduced blood flow) in the lower limbs. The success rate of the PTA treatments was 51 percent, with no significant difference between male and female success rates. One percent of the patients died within 30 days as a result of PTA. Most of the failed PTA treatments occurred within the first month. Thirteen percent of these patients underwent a second PTA treatment successfully. The others were given a variety of treatments. The successful PTA patients tended to be younger and to have less critical cases. This group was more likely to have normal calf vessels and to have narrowing in the femoropopliteal vessel, while the unsuccessful patients were more likely to have occlusions (blockages) in these vessels. Improvements in post-exercise ankle-brachial systolic pressure index (ABPI) were seen in patients successfully treated with PTA; ABPI is indicative of improvement in circulation. Failure of PTA can often be attributed to selection of an inappropriate patient. Unsuccessful PTA has dramatic effects on future treatment, often leading to bypass grafts or amputation. Patients with unsuccessful PTA treatments were twice as likely to die within five years of treatment as those with successful treatments. The results indicate that PTA can be a safe and effective treatment of first choice for the appropriate patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surgery, Blood vessels, Leg, Ischemia, Extremities, Lower

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Renal artery rupture complicating transluminal angioplasty: successful conservative management

Article Abstract:

The renal artery is the major blood vessel supplying the kidneys. Percutaneous transluminal renal angioplasty (PTRA) is a procedure involving inflation of a balloon at the end of a catheter to treat abnormal narrowing or blockage of the renal artery. In rare cases, the catheter guide wire can cause the renal artery to rupture. Prompt treatment is required to stop the bleeding resulting from the rupture and to resume blood flow to the kidney. Surgery would be the most likely choice for treatment, but should be avoided if other options are available. The case is discussed of a patient who experienced renal arterial rupture during PTRA, which was treated nonsurgically. The patient was a 47-year-old woman with a clogged left renal artery. She underwent PTRA to open the vessel. A number of balloons were inserted and inflated across the narrowed area. The patient experienced pain in her left flank and diagnostic imaging showed that contrast material was leaking out of the artery in the area where the PTRA was being performed. A balloon catheter was inserted into the injury site and was used to put pressure on it to stop any loss of blood. After fifteen minutes, the catheter was removed and further imaging tests showed that no further leakage from the vessel was occurring. This case illustrates that PTRA can cause arterial rupture and that surgical repair is not necessarily required to treat the rupture, depending on severity of the rupture as well as other factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Complications and side effects, Arteries, Arterial occlusions, Arterial occlusive diseases

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Low-speed rotational angioplasty in chronic peripheral artery occlusions: experience in 83 patients

Article Abstract:

Patients with chronic peripheral artery occlusions were implanted with low-speed rotating catheters that were able to reopen occlusions with a high degree of success. This technique has the added benefit of eliminating the danger of vessel-wall puncture and eliminates fluid without damaging the vessel wall. The rotating catheter is able to follow sharp bends within occluded arteries, which is a major advantage over conventional techniques. Low speed rotational angioplasty is successful in cases where conventional methods have failed. In 82 percent of the 60 patients studied, the new technique succeeded in reopening the artery occlusions. Researchers insist that broader clinical trials are needed in order to fully assess this effectiveness of the technique.

Research, Innovations, Arterial catheterization, Angioplasty

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