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[Balloon angioplasty of branches of the aortic arch]
M Krzanowski1, W Bodzoń, R Nizankowski
1Katedra Chorób Wewnetrznych Collegium Medicum UJ w Krakowie.
Insights
Balloon angioplasty is a safe and effective treatment for symptomatic brachiocephalic stenoses, offering good outcomes. However, recanalizing occlusions is more challenging and carries higher risks.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Context:
- Brachiocephalic occlusive disease significantly impacts patient health, leading to conditions like chronic limb ischemia and vertebrobasilar insufficiency.
- Balloon angioplasty is increasingly utilized as a primary treatment for these symptomatic lesions.
Purpose:
- To evaluate the efficacy and safety of balloon angioplasty in treating brachiocephalic occlusive disease.
- To analyze outcomes in patients with various indications, including chronic limb ischemia, vertebrobasilar insufficiency, and ischemic stroke.
Summary:
- The study reviewed 16 patients (18 vessels) treated with balloon angioplasty, with a femoral approach used predominantly.
- Successful lesion crossing was achieved in all stenoses and 4 of 6 occlusions. Residual stenosis was <30% in 10 patients, and transstenotic gradients were relieved in 11.
- Stents were used in 4 cases with poor angioplasty results. Complications included two cases of acute upper limb ischemia and reversible ulnar nerve paresis.
Impact:
- Balloon angioplasty demonstrates ease of use, safety, and effectiveness for brachiocephalic stenoses.
- Recanalization of occlusions presents greater difficulty and risk, suggesting treatment of stenoses should not be delayed.
- Timely intervention for stenotic lesions is recommended, reserving recanalization for advanced disease symptoms.
Abstract:
Balloon angioplasty has become a first-line therapy of symptomatic brachiocephalic occlusive disease. We review our own results of treatment of these lesions for the last two years. 16 patients (18 vessels--6 occlusions) with chronic limb ischaemia (9 cases), vertebrobasilar insufficiency (4 cases), ischemic stroke (2 cases); in one case angioplasty was performed as prevention before major abdominal surgery. Femoral approach was predominantly used; in 3 occlusions brachial approach was chosen. Stents were implanted in 4 cases of poor angioplasty result with severe limb ischaemia. Lesions were crossed in all stenoses and in 4 of 6 occlusions. Residual stenosis < 30% was attained in 10 pts. In 11 cases transstenotic gradient was relieved and a normal flow in vertebral artery was reestablished. There were two cases of acute upper limb ischaemia, one needed surgery. Reversible ulnar nerve paresis was noted in one patient, transient symptoms of postreperfusion syndrome in two. At follow up (mean 12 mo, range 1-30 mo) 1 restenosis was recorded. Balloon angioplasty is easy, safe and effective for treating brachio-cephalic stenoses. Recanalisation of occlusions is more difficult and risky. Treatment of stenoses should not be undully postponed; recanalisation should be reserved for patients with more advanced symptoms of the disease.