Maximizing Angioplasty Results in Peripheral Interventions.

The field of Interventional Radiology is said to have begun in 1964, when Dotter successfully restored circulation to an 82-year-old woman's leg with critical limb ischemia and gangrene by percutaneously dilating a localized stenosis of the superficial femoral artery using a Teflon catheter. The dilation catheter was revolutionary in the inception of angioplasty, and progress evolved with the development of angioplasty balloons. As angioplasty became more widely utilized, the focus turned to improving its results. Several factors are important to consider with regards to maximizing angioplasty results in peripheral interventions. These factors include vessel size, lesion length, lesion location, and the anatomic vascular bed. Operators must make thoughtful decisions regarding balloon choice, diameter, length, inflation pressures, inflation time, and employ these devices with excellent technique to optimize outcomes. Complications from angioplasty include elastic recoil, vessel dissection, vessel rupture, distal embolization, and neointimal hyperplasia. The most widely recognized limitation of angioplasty is the longevity of treatment effect. In order to improve long-term outcomes, different specialty balloons have been developed to address lesions resistant to plain balloon angioplasty and combat neointimal hyperplasia to improve outcomes. Ultimately the goal is to maximize vessel patency for the longest duration possible, and many exciting new technologies are on the horizon.

Endovascular treatment of a portosystemic shunt presenting with hypoglycemia; case presentation and review of literature.

Here we present a rare case of hyperinsulinemic-hypoglycemia due to congenital intrahepatic and extrahepatic portosystemic shunts. Performing percutaneous closure of such shunts has been reported to improve symptomatic hypoglycemia in this setting. This case is unique given the type of shunt (both with intrahepatic and extrahepatic components) and the clinical improvement following placement of a single vascular plug to occlude both intrahepatic and extrahepatic connections.