Total occlusion of iliac arteries: Results of balloon angioplasty

Gupta, Arun Kumar; Ravimandalam, K.; Rao, V. R. K.; Joseph, S.; Unni, Madhavan; Rao, A. Srinivasa; Neelkandhan, Kurur Sankaran

doi:10.1007/bf02641886

Cited by 58 publications

(21 citation statements)

References 41 publications

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“…Failure rates for iliac and femoropopliteal CTO are 3% to 36% [25][26][27][28][29][30][31][32][33] and 12% to 25%, 34,35 respectively. Novel alternative devices and techniques have had varied success for coronary and peripheral artery CTO recanalization, although to date none have prevailed clinically.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Magnetic Resonance Imaging–Guided Endovascular Recanalization of Chronic Total Arterial Occlusion in a Swine Model

et al. 2006

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Background-Endovascular recanalization (guidewire traversal) of peripheral artery chronic total occlusion (CTO) can be challenging. X-ray angiography resolves CTO poorly. Virtually "blind" device advancement during x-ray-guided interventions can lead to procedure failure, perforation, and hemorrhage. Alternatively, MRI may delineate the artery within the occluded segment to enhance procedural safety and success. We hypothesized that real-time MRI (rtMRI)-guided CTO recanalization can be accomplished in an animal model. Methods and Results-Carotid artery CTO was created by balloon injury in 19 lipid-overfed swine. After 6 to 8 weeks, 2 underwent direct necropsy analysis for histology, 3 underwent primary x-ray-guided CTO recanalization attempts, and the remaining 14 underwent rtMRI-guided recanalization attempts in a 1.5-T interventional MRI system. Real-time MRI intervention used custom CTO catheters and guidewires that incorporated MRI receiver antennae to enhance device visibility. The mean length of the occluded segments was 13.3Ϯ1.6 cm. The rtMRI-guided CTO recanalization was successful in 11 of 14 swine and in only 1 of 3 swine with the use of x-ray alone. After unsuccessful rtMRI (nϭ3), x-ray-guided attempts were also unsuccessful. Conclusions-Recanalization of long CTO is entirely feasible with the use of rtMRI guidance. Low-profile clinical-grade devices will be required to translate this experience to humans.

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Section: Discussionmentioning

confidence: 99%

Real-Time Magnetic Resonance Imaging–Guided Endovascular Recanalization of Chronic Total Arterial Occlusion in a Swine Model

et al. 2006

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“…The recanalization of the iliac occlusions is still debated, even though it reached a primary technical success in the percutaneous approach to iliac occlusions with PTA plus stenting close to 80% (9,13,14). Vorwerk et al, without performing the thrombolysis, reported a success in 81% of cases in terms of passing through the occlusion (9).…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis during the endovascular treatment of iliac artery occlusions

Taddei

Tamellini²,

Faccioli³

et al. 2009

Diagn Interv Radiol

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84C urrently the number of aortofemoral bypasses performed for iliac occlusive arterial pathology is decreasing (1-4). The causes of this turnaround are the increase of the patients' mean age and the increased frequency of concurrent pathologies. Moreover, surgery, which for a long time has been considered as the treatment of choice for this pathology, has almost completely been replaced by less invasive methodologies such as endovascular treatments (5-9). The role of thrombolysis to treat the iliac arterial occlusive pathology on an atherosclerotic basis during endovascular surgery is controversial. Although comparing experiences is difficult, the results of pharmacologic thrombolysis to treat iliac arterial obstructions with regard to the different methodologies of treatment, to the drugs used and to other nonstandardized variables seem encouraging (8). The first experiences with fibrinolytic therapy made us think it was unlikely that thrombolytic occlusions which had been present for longer than 1-2 weeks would adequately respond to these treatments. On the contrary, it was proved that injections of streptokinase or urokinase-type plasminogen activator (uPA) through the thrombus could also cause complete fibrinolysis in chronic occlusions (8). Recent thrombi (<15 days) are more sensitive to lysis, as shown by data from post-angioplasty thrombolysis (2, 5, 10). It is also true, however, that remarkable results may be achieved by using only percutaneous treatment angioplasty (PTA) associated with the stent technique (7).The purpose of this study was to assess the possible therapeutic advantage of thrombolysis prior to recanalization of iliac occlusions with PTA and stenting. Materials and methodsWe retrospectively evaluated 28 cases of iliac occlusions treated in 26 patients (in two cases there was a re-occlusion) over a six-year period. Our cases did not have contraindications for thrombolysis. No patients were diabetic. The presumed etiologies for the iliac occlusions were plaque thrombosis for acute patients and chronic atherosclerotic disease for chronic patients. Absolute contraindications were established such as cerebrovascular event (including transient ischemic attacks within last 2 months), active bleeding diathesis, recent gastrointestinal bleeding (<10 days), neurosurgery within last 3 months, and trauma within last 3 months (10, 11); relative major contraindications were cardiopulmonary resuscitation within last 10 days, major nonvascular surgery or trauma within last 10 days, uncontrolled hypertension (180 mmHg systolic or 110 mmHg diastolic), puncture of non-compressible vessel, intracranial tumor, and eye surgery; minor contraindications were hepatic failure, particularly those with coagulopathy, bacterial endocarditis, pregnancy, and hemorrhagic retinopathy (10, 11). INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Thrombolysis during the endovascular treatment of iliac artery occlusionsGiuseppe Taddei, Paolo Tamellini, Faccioli Niccolo, Iannello Antonio PURPOSEThe purpose of this study was to assess...

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“…The primary patency rate at 1 year after PTA of iliac arteries ranges between 77% and 96%. [1][2][3][4][5] For PTA of femero-popliteal arteries the reported 1 year primary patency rates are lower at 42-76%. 4,6 -10 Additional stent implantation improves these results in the iliac arteries to 87-98%, [11][12][13][14][15][16][17] however, in femoro-popliteal arteries stent placement results in no long-term improvement with 1 year primary patency rates of 22-81%.…”

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confidence: 99%