The complication rate of percutaneous peripheral balloon angioplasty

Belli, Anna‐Maria; Cumberland, D.C.; Knox, A.M.; Procter, A.E.; Welsh, Christopher L.

doi:10.1016/s0009-9260(05)80595-1

Cited by 122 publications

(40 citation statements)

References 12 publications

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“…5) These types of traumatization of arterial tissue are factors that contribute to acute procedural complications, which require either further catheter intervention or surgery. 2) In this case, dissection and embolization of the calcified atherosclerotic plaque occurred immediately after dilating the balloon on the SFA lesion. According to the previous literature, most embolisms or dissections following balloon dilatation were successfully treated during the course of the angioplasty by performing further procedures.…”

Section: Discussionmentioning

confidence: 80%

“…1-4) Although the incidence of PTA complications is quite low in these lesions, 2) PTA is traumatic to arterial tissue, causing plaque fissuring and/or dissection. 5) These types of traumatization of arterial tissue are factors that contribute to acute procedural complications, which require either further catheter intervention or surgery.…”

Section: Discussionmentioning

confidence: 99%

“…2) We report here on a rare experience of a cylindrical embolus that occurred during performing PTA in the superficial femoral artery (SFA). The embolus was removed through an arteriotomy site, and the patient displayed a good clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Balloon Embolectomy of a Cylindrical Dissected Plaque That Complicated Performing Superficial Femoral Artery Angioplasty

et al. 2008

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We report here on a case of successfully removing a calcified plaque embolus that complicated performing angioplasty. A 67 year-old woman underwent percutaneous transluminal angioplasty for a stenosis of the right superficial femoral artery (SFA). The angiogram showed a marked stenosis at the mid-portion of SFA and diffuse circular calcification along the atheroma rim was seen on the computed tomographic angiography. Although balloon inflation was attempted on the lesion, it was not fully dilated. After repeated balloon inflations, a radiopaque calcified atheroma was detached from the arterial wall and it migrated proximally along with withdrawing the balloon. The embolus was too extensive to be pulled out through the catheter sheath; therefore, a small balloon was inflated at the distal end of the embolic atheroma to anchor it and the embolus was removed with the balloon and the sheath system via an arteriotomized puncture site. A huge cylindrical atheroma that measured 4 cm in length was successfully removed. The final angiography showed a widened target site without any dye leakage.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Balloon Embolectomy of a Cylindrical Dissected Plaque That Complicated Performing Superficial Femoral Artery Angioplasty

et al. 2008

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“…Percutaneous transluminal angioplasty (PTA) has be come a very popular and widely used technique to improve peripheral blood perfusion in patients with disabling pe ripheral arterial occlusive disease (PAOD) [1,2]. However, such a procedure provokes a huge trauma to the arterial wall and potentially liberates fragments of atherosclerotic material [3], Acute occlusion, although relatively infre quent (1.7-3.1 %), has been shown to be the most common direct complication of the procedure [1,2,4], However, more distal infraclinical emboli following PTA might be much more frequent, as suggested by some experimental data [5,6], Thus, it has been postulated that microvascular impairment and distal atheromatous microembolism might explain the discrepancies reported between the suc cess of coronary recanalization procedures and the unex pected insignificant functional improvement as assessed by an impaired flow reserve [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…However, such a procedure provokes a huge trauma to the arterial wall and potentially liberates fragments of atherosclerotic material [3], Acute occlusion, although relatively infre quent (1.7-3.1 %), has been shown to be the most common direct complication of the procedure [1,2,4], However, more distal infraclinical emboli following PTA might be much more frequent, as suggested by some experimental data [5,6], Thus, it has been postulated that microvascular impairment and distal atheromatous microembolism might explain the discrepancies reported between the suc cess of coronary recanalization procedures and the unex pected insignificant functional improvement as assessed by an impaired flow reserve [7][8][9]. Although the clinical relevance of such microembolisms is obviously less marked in peripheral tissues than in the coronary circula tion, the former microcirculation, unlike the latter, can be studied easily and noninvasively in the skin by means of two sophisticated techniques, i.e., dynamic capillaroscopy and laser Doppler fluxmetry [10][11][12],…”

Section: Introductionmentioning

confidence: 99%

Effects of Percutaneous Transiuminal Angioplasty on Skin Microcirculation in Patients with Disabling Peripheral Arterial Occlusive Disease

Bongard¹,

Didier

Bounameaux³

1994

Int J Microcirc

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Percutaneous transiuminal angioplasty (PTA) provokes a huge trauma to the arterial wall and potentially liberates fragments of atherosclerotic material that may impair the microcirculation downstream. Incidence and clinical relevance of such embolisms are not known. This study was aimed at investigating the changes of the skin microcirculation in patients with peripheral arterial occlusive disease undergoing PTA of the lower limbs. Pedal transcutaneous oxygen tension (tcpO₂) and nailfold skin microcirculation were measured in 21 patients with disabling peripheral arterial occlusive disease before and after PTA. Sixteen matched patients undergoing arteriography alone were used as controls. The skin microcirculation was investigated at the nailfold of the great toe by the combination of laser Doppler fluxmetry and dynamic capillaroscopy. PTA was successful in all patients. The tcpO₂ decreased immediately after PTA (ΔtcpO₂ = -5 mm Hg; p < 0.004), whereas it tended to increase (ΔtcpO₂ = 1 mm Hg; NS) following arteriography as compared with baseline values. By contrast, blood flow increased in both groups, predominantly for the total circulation in the PTA group and for nutritional circulation (p < 0.0017) in the arteriography group, respectively. Consequently, the ‘nutritional index’, i.e., the index of nutritional versus total microcirculation, was decreased following PTA, particularly following mechanical recanalization (p < 0.02), but did not change in the controls. The changes of this ‘nutritional index’ and those of the tcpO₂ were positively correlated (r = 0.4, p = 0.023). The decrease of both the pedal tcpO₂ and the index of nutritional versus nonnutritional skin microcirculation and the lack of improvement of the reserve flow following PTA support the view that the procedure generates infraclinical microembolisms downstream in the microcirculation which may become of great clinical importance when PTA is performed in coronary arteries with compromised myocardium.

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