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[Rotation angioplasty--initial clinical results of peripheral vascular occlusions]
C Vallbracht1, M Schweitzer, J Kress
1Zentrum der Inneren Medizin: Abteilung für Kardiologie, Universitätsklinik Frankfurt.
Abstract:
After experimental investigations in postmortem human arteries, 19 patients with chronic peripheral artery occlusions were treated with a new technique between December 1986 and October 1987. In 17 patients the superficial femoral artery, and in two patients the popliteal artery, was completely occluded. The length of occlusions were between 5 and 25 cm (mean 10.9 cm); the duration (estimated according to patient's history) was 5-48 months (mean 17.2 months). In five patients, durations of up to 30 months had been documented by angiography. A flexible, blunt, motor-driven rotating catheter was introduced over an 8 or 9 F sheet and rotational angioplasty was performed at low speed, up to 200 rpm. In 11/14 patients in whom this new technique was used as the first attempt, the occlusions could be successfully reopened. In two patients after failure of the conventional technique the rotating catheter could not bypass the preexisting dissections in the same intervention. In 2/3 further patients after failure of the conventional technique the occlusions could be successfully reopened in a second intervention after several weeks. In none of our 19 patients did a perforation occur. It is concluded that by using the new technique, chronic peripheral artery occlusions can be reopened with a high success rate and without the danger of vessel wall perforation. The method can also be applied in patients in whom conventional techniques have failed.
Insights
This study introduces a new rotational angioplasty technique for chronic peripheral artery occlusions. The method successfully reopened occlusions in most patients, offering a safe alternative to conventional treatments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Context:
- Chronic peripheral artery occlusions (PAOs) significantly impair limb perfusion.
- Conventional angioplasty techniques have limitations in treating long and complex occlusions.
- Postmortem investigations informed the development of a novel rotational angioplasty device.
Purpose:
- To evaluate the safety and efficacy of a new motor-driven rotating catheter for treating chronic peripheral artery occlusions.
- To assess the success rate of rotational angioplasty in reopening completely occluded superficial femoral and popliteal arteries.
- To determine if this technique offers an advantage over conventional methods, particularly in challenging cases.
Summary:
- A flexible, blunt, motor-driven rotating catheter was used in 19 patients with chronic PAOs (mean occlusion length 10.9 cm, mean duration 17.2 months).
- Rotational angioplasty was performed at low speed (up to 200 rpm) via an 8 or 9 F sheath.
- Successful recanalization was achieved in 11 of 14 initial attempts. The technique was also effective in 2 of 3 patients after conventional method failure, with no reported vessel perforations.
Impact:
- The new rotational angioplasty technique demonstrates a high success rate for reopening chronic peripheral artery occlusions.
- This method provides a safe alternative, eliminating the risk of vessel wall perforation.
- The technique is applicable even in cases where conventional angioplasty has previously failed.