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Miscellaneous
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
The main indication is coronary artery stenosis. Coronary Angioplasty can be done as an emergency or electively. Balloon angioplasty can also be used for other parts of the body. These include the carotids and other arteries in the extremities for peripheral vascular disease. Intracranial vessels can also be unblocked using this method.
Vascular Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Yiu-Che Chan, John Wang, Julian Wong, Edward Choke, Tjun Tang
Balloon angioplasty re-established patency at the SFA CTO segment but there is a residual 50% stenosis. What are your treatment options?Repeat balloon angioplasty with prolonged inflation (3–5 minutes).Angioplasty with slightly larger diameter balloon, maximal oversize 20%.Stenting if repeat balloon angioplasty still shows ≥ 50% stenosis.
The infrarenal aorta, aortic bifurcation, and iliac arteries: Advice about balloon angioplasty and stent placement
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
After sheath placement, repeat iliac arteriography through the sheath is usually performed after the image intensifier has been optimally positioned. External marking tape may also be placed. The appropriate balloon catheter is selected, as described in earlier sections regarding iliac arteries. Catheters 75–80 cm in length are usually adequate to reach the contralateral groin. Balloon angioplasty is performed. The contralateral femoral area should be prepped into the field and the pulse is available for palpation. The balloon catheter is withdrawn but the guidewire position is carefully maintained. Completion arteriography is performed through the sheath.
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
Cephalic turn down is another surgical intervention which has shown promising outcomes in the management of CAS. Kian et al. [65] investigated the role of cephalic vein turndown in the management of CAS in 13 patients. The authors compared the patency rates for angioplasty procedure prior to the surgical revision which were 23%, 8%, and 0%, at 3, 6, and 12 months, respectively. The secondary patency rates for balloon angioplasty before surgical revision were 100%, 39%, and 8%, at 3, 6, and 12 months respectively. Primary patency rates for angioplasty after surgical revision were 92%, 69%, and 39%, at 3, 6, and 12 months respectively (P .0001). Following the surgical revision, all patients required percutaneous balloon angioplasty for access dysfunction. Secondary patency following surgical revision was 92% at 3, 6, and 12 months [65]. Studies indicate that surgical intervention can prolong subsequent patency rates for percutaneous balloon angioplasty without increasing the complication rates.
Drug loaded implantable devices to treat cardiovascular disease
Published in Expert Opinion on Drug Delivery, 2023
Masoud Adhami, Niamh K. Martin, Ciara Maguire, Aaron J. Courtenay, Ryan F. Donnelly, Juan Domínguez-Robles, Eneko Larrañeta
Drug eluting stents are implanted using percutaneous interventions (PCI). PCI is a technique that is used in the treatment of an expanding range of these diseases and was initially performed with balloon angioplasty alone [11,12]. Original procedures involved expanding a balloon of low burst pressure within the artery, and subsequently removing it once the artery lumen had been mechanically opened [13]. This type of intervention was first performed in 1977 by Dr. Andreas Grüntzig [9]. However, after plain balloon angioplasty, it was observed that up to 10% of the patients experienced vascular recoil post-intervention. Moreover, up to 30% of the patients who underwent balloon angioplasty suffered restenosis in less than 6 months post-intervention [14,15]. To address this issue, bare-metal stents (BMS) were developed to prevent blood vessel recoil [15]. Stents were designed to maintain the patency of blood vessels, and their superior performance over balloon angioplasty has been demonstrated [16,17]. However, despite its success, up to 30% of the patients treated with bare-metal stents suffer from in-stent restenosis. A potential solution for this is to incorporate drugs within the surface of this type of medical device. Interestingly, there is an alternative to balloons and drug-eluting stents: drug-coated balloons [18]. This type of device is used to administer anti-proliferative drugs into the vessel walls to prevent restenosis. However, this type of system will not be discussed in this review as they are not implantable devices and rather constitute a transient application.
Interventions in Congenital Heart Disease:A Review of Recent Developments: Part I
Published in Structural Heart, 2021
Despite important advances in the understanding of this disease, management of PVS remains challenging, with neither surgical nor transcatheter interventions yielding satisfactory long-term results. The introduction of “sutureless” surgical techniques has been useful in treating proximal disease, but results remain disappointing in cases of distal disease.70 In this regard, transcatheter intervention has become a component of various treatment strategies. Conventional balloon angioplasty and cutting balloon angioplasty (BA) are of comparable efficacy in providing acute hemodynamic and angiographic relief. However, restenosis is the norm with no difference in reintervention rates (freedom from reintervention at 1 year 4% for cutting balloon and 23% for conventional BA).71 There are no data comparing outcomes of stent versus balloon angioplasty. The largest published experience of bare metal stents (BMS) in primary pediatric and postoperative PVS reported freedom from reintervention of only 42 ± 7% at 1 year, despite excellent acute gradient relief. A stent implant with larger diameter, ≥7 mm, was associated with longer freedom to reintervention.72 Hybrid pulmonary vein stenting has been proposed as a useful adjunct at the time of surgical intervention for recurrent and malignant PVS.73