Percutaneous transluminal balloon angioplasty of the aorta in patients with aortitis.

Abstract

Four patients with aortitis and stenotic lesions of the aorta were successfully treated by percutaneous transluminal balloon angioplasty. The peak systolic gradient across the constrictions decreased from 82.5 ± 35.7 to 37.5 ± 18.5 mm Hg immediately after dilatation. Repeat angiography in the first three patients performed 2 months later showed a further decrease in the gradient to 13.8 + 9.5 mm Hg. There were no complications during or after the procedure, and all the patients have shown remarkable symptomatic relief during the follow-up. Circulation 76, No. 3, 597-600, 1987. AORTITIS is a form of vasculitis with the characteristic feature of "pulselessness. MethodsFour male patients with aortitis (ages 12 to 32 years, mean 22.2 ± 8.6) were subjected to percutaneous transluminal balloon angioplasty. Their main presenting symptom was dyspnea on exertion. One of them had associated features of nephrotic syndrome, and all four had hypertension. In the first three patients, femoral pulses were very feeble compared with the upper extremity pulses, and the other lower limb pulsations were not palpable. In the fourth patient, lower limb pulsations, though palpable, were feeble compared with the upper extremity pulses (table 1).Laboratory investigations showed normal leukocyte count, and the erythrocyte sedimentation rate was elevated in two. Studies for the lupus erythematosus cell and antinuclear factor were negative. One patient showed heavy proteinuria, hypoalbuminemia, and hypercholestrolemia. Results of urinalysis were normal in the others. The electrocardiogram showed left ventricular hypertrophy in all four. Three had cardiomegaly on the chest roentgenogram.With the tentative diagnosis of aortitis, these patients were subjected to cardiac catheterization and aortography. Under local anesthesia, a No. 8F pigtail catheter was passed through the right femoral artery percutaneously. Pressures were recorded at different levels in the aorta, and gradients across the constrictions were obtained. The aortogram performed in anteroposterior and lateral views showed features of aortitis.After determination of the site, the diameter of the constricted segment and of the "normal" aorta was calculated after correcting for the magnification factor. A flexible-tip, 300 cm long, 0.038 inch guidewire was then passed through the pigtail catheter, and its tip was advanced into the ascending aorta. Heparin (2500 U) was given intravenously. With the exchange guidewire kept in position, the pigtail catheter was taken out and a deflated air-free No. 9F (Meditech,12 to 20 mm diameter) balloon catheter was passed over the guidewire and positioned across the first constriction. The balloon size was selected as 60% to 100% of the normal aortic segment, but this did not exceed three times the constricted segment.4 The balloon was inflated with half-597

Percutaneous transluminal angioplasty of the aorta in children with nonspecific aortoarteritis: Acute and follow-up results with special emphasis on left ventricular function

“…Balloon angioplasty for NSAA has been found to be 94.4 -100% successful in various series; all of these have patients predominantly over 12 years of age [3][4][5][7][8][9]. We achieved immediate success in 15 of 17 patients, although the transstenotic gradients fell to below 20 mmHg in 8 cases immediately after the procedure.…”

“…Surgery is difficult due to the widespread and diffuse nature of the disease and complexity of pathological changes in the wall of the aorta [15]. Balloon dilation of these obstructive lesions seems to be an alternative to surgery and there are several reports of the same; however, the experience with balloon dilation in children with NSAA is limited to few case reports only [4,7,9].…”

“…Percutaneous transluminal balloon angioplasty has also been utilized to dilate these obstructive lesions with encouraging results [3][4][5]. Nonspecific aortoarteritis in younger age group has a more severe clinical course with higher morbidity and mortality than in adults; however, the application of balloon angioplasty to treat obstructive lesions of aorta in children has been described in only a few cases [4,[7][8][9]. We describe our experience of percutaneous transluminal balloon angioplasty in 17 children with NSAA.…”

Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis

“…10,11,[15][16][17] Several reports came from small series. Data were encouraging, with initial success rates ranging from 74% to 100% and shortterm restenosis occurring in Ͻ25% of cases.…”

Percutaneous transluminal angioplasty in Takayasu arteritis

“…Experience with percutaneous transluminal balloon angioplasty (PTBA) of stenotic lesions in Takayasu arteritis is limited [4][5][6][7][8][9][10][11][12][13][14] and long-term follow up studies are not available. Since our initial success with balloon dilatation of the aorta in aortoarteritis [15] we have attempted balloon dilatation of stenotic arterial lesions in 87 patients with Takayasu arteritis. Here we report our initial and follow up results of PTA of stenotic vascular lesions in Takayasu arteritis.…”