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Efficacy of balloon catheter dilatation for lower extremity atherosclerosis
Insights
Balloon catheter dilatation offers useful adjunctive treatment for advanced lower extremity atherosclerosis. While early results show good hemodynamic improvement, a high incidence of restenosis necessitates careful patient selection and hemodynamic monitoring.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Limited data exists on complications and long-term efficacy of balloon catheter dilatation for advanced lower extremity atherosclerosis.
- Balloon angioplasty is a common treatment for peripheral artery disease, but outcomes vary.
Purpose of the Study:
- To report the experience with balloon catheter dilatation in patients with advanced lower extremity atherosclerosis.
- To evaluate the complications and long-term efficacy of this procedure.
Main Methods:
- Retrospective analysis of 132 attempted balloon catheter dilatations in 88 patients.
- Procedures targeted aortoiliac, superficial femoral-popliteal, and peroneal lesions.
- Patients were monitored for hemodynamic improvement, complications, and restenosis at 1 month and 6 months or longer.
Main Results:
- Twenty procedures were technically unsuccessful, with three requiring urgent surgery.
- Thirty-one complications occurred in successful dilatations, with one emergency surgery and one arteriovenous fistula requiring closure.
- Hemodynamic improvement was observed in 52% at 1 month, with 10% occlusion.
- At 6 months or longer follow-up, 11 patients maintained significant improvement, but 11 reverted to baseline and 4 occluded.
- A trend towards restenosis was noted with increased follow-up duration.
Conclusions:
- Balloon catheter dilatation is a useful adjunctive procedure for lower extremity atherosclerosis with good early results.
- The incidence of recurrent stenosis is high, emphasizing the need for careful patient selection.
- Complications and indications are comparable to surgical interventions; hemodynamic monitoring is essential.
Abstract:
Since there are few data regarding complications and long-term efficacy of balloon catheter dilatation for advanced lower extremity atherosclerosis, we are reporting our experience with 132 attempted dilatations in 88 patients. Dilatation was attempted on 51 aortoiliac-common femoral lesions, 80 superficial femoral-popliteal lesions and 1 peroneal lesion. Twenty procedures were technically unsuccessful and led to urgent surgery in three patients. Thirty-one complications in the 109 technically successful dilatations led to emergency surgery in only one, but another required closure of an arteriovenous fistula at the site of catheterization. There were three episodes of embolism, but none required operation. In 109 dilatations monitored for 1 month, there was significant hemodynamic improvement in 52 and mild to moderate improvement in 37; 10 had no change; 10 occluded at the site of dilatation. Of the 42 patients observed 6 months or longer, 11 maintained a significant increase, and 15 had mild to moderate improvement; 11 reverted to predilatation levels; 1 had progressive worsening; 4 occluded. Sixteen patients who had significant increases in flow after dilatation and were followed longer than 6 months showed a trend to restenosis as the length of follow-up increased. We conclude that dilatation is a useful adjunctive procedure in treating lower extremity atherosclerosis, that the early results are good, and that the incidence of recurrent stenosis is high. Indications for dilatation and its complications are similar to those for operations. It should not be done without hemodynamic monitoring.