Percutaneous transluminal angioplasty of crural arteries

Article Abstract:

There are three main arteries that supply blood to the calf muscles, and these muscles also have a network of collateral vessels. This allows sufficient blood flow to continue even if one or two of the main arteries become stenosed (narrowed) or occluded (blocked). When all three main arteries become stenosed or occluded, treatment must be performed to reopen the vessels. Percutaneous transluminal angioplasty (PTA) is often the treatment used. It is a procedure in which a balloon-tipped catheter is threaded into the blood vessel and the balloon is then inflated to dilate the vessel at the point of narrowing. The problem with the use of PTA in these cases is that if it fails, only difficult treatments or no treatments might be left to consider. Therefore, PTA should only be used in the most serious cases; it is suggested that Fontaine stages III (pain at rest) or IV (gangrene) be reached before PTA is used. This study reevaluated the use of PTA in the arteries of the calf; 103 PTA treatments in 71 patients were included. The initial success rate of PTA treatment was 96 percent. Follow-up examinations in 29 cases found seven recurrent stenoses and 12 occlusions. The stenoses were all successfully reopened with PTA. Two of the occlusion cases required amputation, five received a combination of PTA and other treatments which succeeded, and four received conservative therapy which prevented further deterioration. Results were not significantly different between diabetic and non-diabetic patients. Complications included a ruptured artery, a hematoma (mass of clotted blood), and a flap causing an occlusion. The results indicate that advancements in the techniques of PTA have increased its safety and effectiveness. Expanding its use to include stage IIb disease (walking distance less than 100 meters) is indicated. In fact, the initial success rate is higher, and the risk of major complications is lower, in stage IIb patients than in stage III and IV patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Peripheral arterial obstructions: analysis of patency 1 year after laser-assisted transluminal angioplasty

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is frequently used in the treatment of blocked or obstructed peripheral arteries. Although there are a number of techniques for performing PTA, the procedure basically involves passing a balloon-tipped catheter past the point of blockage and then inflating the balloon to dilate the vessel. There are a number of ways in which the initial opening or recanalization is accomplished. This study examined the long-term outcome of PTA treatments when the recanalization was accomplished using continuous-wave argon laser energy. The laser-assisted PTA was performed on obstructed femoropopliteal or iliac arteries in 63 patients. Ankle-brachial index (ABI; a ratio indicating the degree of vascular function) was measured prior to PTA and immediately after PTA to determine the initial success of the procedure. ABI was measured periodically for up to 24 months after the PTA to assess long-term success. Initially, 59 of 68 (87 percent) cases were successfully treated with PTA, with all 10 cases of femoropopliteal stenoses (narrowings) successfully treated, 37 of 42 cases of femoropopliteal obstructions successfully treated, and 10 of 14 iliac obstructions treated successfully. Complications occurred in 10 of the 68 cases. In five of the 59 cases in which initial success was attained, the arteries reclosed soon after treatment and in 15 cases the arteries reclosed later on, leaving 39 successes at final follow-up. The rates of vessels that were still patent (open) at the end of one year were 91 percent for the femoropopliteal stenoses, 60 percent for the femoropopliteal occlusions, and 79 percent for the iliac occlusions. Initial severity of disease was related to one-year patency rate, but length of the obstruction was not. The results indicated laser-assisted PTA was valuable for treating peripheral arterial obstruction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Arteries

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Laser angioplasty: results of a prospective, multicenter study at 3-year follow-up

Article Abstract:

Angioplasty is the recanalization of blood vessels, usually involving opening or clearing clogged arteries and veins. Angioplasty that uses lasers to open these vessels has recently been deemed an improvement over present angioplasty techniques. The even more recent development of contact probes which are heated or energized by the laser to clear the clogged arteries has increased hopes for the use of laser angioplasty. This study examined the effectiveness and safety of laser angioplasty. The subjects were 338 patients with advanced clinical ischemic disease (lack of blood supply because of clogged vessels). All were treated with laser angioplasty using a sapphire contact probe. The procedure was initially successful in 288 (85 percent) of the patients, with improvements in Doppler rate (blood flow) seen in 280 patients (83 percent). In 9 percent of the patients, the surgery caused injury to vessel walls. All of these patients also reported a painful heat sensation during the procedure. After three years, 32 patients had restenoses (repeat narrowing of the vessels) and 39 patients had reocclusions (blocked vessels), which were treated with a repeat laser angioplasty procedure. The success rate for the treatment was 80 percent after 6 months, 70 percent after 1 year, 62 percent after two years, and 57 percent after three years for those whose initial treatment was successful. This meant that the three-year cure rate for all the patients initially treated was 48 percent. The initial success rate of this procedure is high, with long-term results comparable to more conventional angioplasty techniques. It was also found to be a safe procedure. Further research and improvements should refine this technique even further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Atherosclerosis, Vascular surgery, Laser angioplasty

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