ABSTRACT
Objectives To assess the impact on stent implantation rate and mid-term outcomes of prolonged high pressure angioplasty of femoropopliteal lesions. Methods We retrospectively enrolled 620 consecutive patients from January 2011 to December 2011 (75.6 ±12.3 years, 355 males, 76.5%in Rutherford class 5-6), referred for critical limb ischemia and submitted to prolonged high-pressure angioplasty of femoropopliteal lesions. The definition of prolonged high-pressure angioplasty includes dilation to at least 18 atm for at least 120 s. Proce-dural data, and clinical and instrumental follow-up were analyzed to assess stent implantation rate and mid-term outcomes. Results The preferred approach was ipsilateral femoral antegrade in 433/620 patients (69.7%) and contralateral cross-over in 164/620 (26.4%) and pop-liteal retrograde+femoral antegrade in 23/620 (3.7%). Techniques included subintimal angioplasty in 427/620 patients (68.8%) and endolu-minal angioplasty in 193/620 patients (31.2%). The prolonged high pressure balloon angioplasty procedure was successful in 86.2%(minor intra-procedural complications rate 15.7%), stent implantation was performed in 74 patients (11.9%), with a significant improvement of ankle-brachial index (0.29 ±0.6 vs. 0.88 ±0.3, P<00.1) and Rutherford class (5.3 ±0.8 vs. 0.7 ±1.9, P<0.01), a primary patency rate of 86.7%, restenosis of 18.6%on Doppler ultrasound and a target lesion revascularization of 14.8%at a mean follow-up of 18.1 ±6.4 months (range 1-24 months). Secondary patency rate was 87.7%. Conclusions Prolonged high pressure angioplasty of femoropopliteal lesions appears to be safe and effective allowing for an acceptable patency and restenosis rates on mid-term.
ABSTRACT
Objective Accelerated left main coronary stenosis (LMCS) is a known potential late complication of coronary artery catheter procedures. The aim of this study was to assess the current occurrence of LMCS as a delayed complication of percutaneous angioplasty (PTCA) of the left coronary branches in our institution. Methods The medical records of patients referred for coronary artery by-pass surgery from the same Cardiology Unit in the January 2003 to December 2006 period and presenting a significant (> 50%) LMCS as a new finding following a PTCA of the left coronary artery branches, were reviewed. Patients with retrospective evidence of any LMCS at previous coronary angiographies preceding the percutaneous procedure were excluded. Results Thirty-seven patients (5 females, mean age 71.1±8.6 years) out of 944 (4%) having undergone a PTCA, fulfilled the inclusion criteria, 19 (51%) after a procedure also involving the LAD coronary artery. Extraback-up guiding catheters were used in most cases. Use of multiple wires or balloons was observed in 3 cases (8%). Rotablator and proximal occlusion device were used in one case respectively (3%). Twenty patients (54%) have had more than one percutaneous coronary intervention on the left coronary branches. The mean time elapsed from the first angioplasty and surgical intervention was 18.1±7.8 months. Conclusions The potential occurrence of LMCS following a percutaneous intervention procedure, especially when complicated and repeated, should not be underestimated in the current era. This evidence may offer the rationale to schedule non-invasive imaging tests to monitor left main coronary patency after the procedure as well as to fuel further research to develop less traumatic materials.
ABSTRACT
Background and objectives Peripheral vascular disease (PVD) is a major risk factor in candidates for cardiac surgery and can impact morbidity and mortality in the perioperative and follow-up period. Elderly patients with PVD may benefit from endovascular treatment prior to cardiac surgery. We sought to assess the common clinical settings requiring prophylactic endovascular treatment before coronary surgery in elderly patients, the results, and the mid-term impact on subsequent revascularization. Methods Between November 2002 and June 2006, 37 patients (25 males, mean age 79.9±8.3 years, mean serum creatinine 1.9±0.6 mg/dl) underwent endovascular repair of PVD before cardiac surgery. For each patient, diagnostic methods, indications for intervention, types of interventions, procedural success, and complications were recorded. Results Four clinical settings were identified: renal artery stenting prior to coronary surgery (7 patients), iliac artery angioplasty and stenting (10 patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting prior to utilization of ipsilateral arterial conduits bypass surgery (5patients), and carotid artery stenting before coronary surgery (15 patients). Technical success was achieved in all patients (100%);complications included brachial artery occlusion (1 patient), minor stroke (2 patients), contrast nephropathy (1 patient), and minor bleeding at the puncture site (3 patients). All patients underwent successful coronary or valvular surgery; no patients died in the perioperative period. After a mean follow-up of 26.6±3.1 months, all patients are alive and free from anginal symptoms or valvular dysfunction without clinical or Doppler ultrasonography evidence of restenosis of the implanted peripheral vascular stents. Conclusions It is not unusual for elderly patients who are candidates for cardiac surgery to require endovascular intervention for significant PVD prior to coronary bypass or valvular surgery. The results showed a low complication rate. The cardiologists have a fundamental role,not only in the diagnosis of peripheral vascular stenosis, which was seen frequently in patients with significant CAD, but also in the appropriate endovascular management of these high-risk patients.