Percutaneous Transluminal Angioplasty: Technique, Early and Late Results PDF
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Percutaneous Transluminal Angioplasty Technique, Early and Late Results Edited by c. T.Dotter A. R. Griintzig W. Schaap E.Zeitler With 179 Figures Springer-Verlag Berlin Heidelberg NewYork Tokyo 1983 CHARLEST.DaHER, M.D.,UniversityofOregon,Health SciencesCenter, DepartmentofDiagnosticRadiology,Portland,Oregon97201,USA ProfessorDr. ANDREASR.GRONTZIG,EmoryUniversitySchool ofMedicine, DepartmentofMedicine,1364Clifton Road, N.E.,Atlanta, Georgia30322USA ProfessorDr. WERNERSCHaap,Aggertalklinik,D-5250Engelskirchen ProfessorDr. EBERHARDZEITLER, Klinikum Niirnberg,RadiologischesZentrum, Flurstr. 17,D-8500Niirnberg ISBN-13:978-3-540-12654-6 e-ISBN-13:978-3-642-69278-9 001:10.1007/978-3-642-69278-9 LibraryofCongressCataloginginPublicationData.Mainentryundertitle:Percutaneoustransluminalangioplasty. Bibliography:p.Includesindex. I.Transluminalangioplasty- Addresses,essays, lectures.I. Dotter.CharlesT. [DNLM: I. Angioplasty,Transluminal - Congresses. WG 300 P429 1982] RD598.5.P47 1983 617'.413 83-19581 Thisworkissubjecttocopyright. Allrightsarereserved,whetherthewholeorpartofthematerialisconcerned, specificallythose oftranslation, reprinting, re-use of illustrations,broadcasting, reproduction by photocopying machineorsimilarmeans,andstorageiodatabanks.Under§54ofthe GermanCopyrightLawwhere copiesare madeforotherthanprivateuseafeeispayableto"VerwertungsgesellschaftWort",Munich. ©bySpringer-VerlagBerlinHeidelberg1983 Theuseofregisterednames,trademarks,etc.inthepublicationdoesnotimply,evenintheabsenceofaspecific statement,thatsuchnamesare exemptfrom therelevant protectivelawsandregulationsandthereforefree for generaluse. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereofcontained inthisbook.Inevery individualcasetherespectiveusermustcheck itsaccuracybyconsulting otherpharmaceuticalliterature. Typesetting,printing,andbookbinding:v.Starck'scheDruckereigesellschaftm.b.H.,6200Wiesbaden 2127/3130-543210. Preface Inthe past ten years, there have been significant advances in the diagnosis and therapy of arterial vascular disease. While long-term morbidity can only be improved by changingthe patient's life-style and removing any risk factors that maybepresent(hypertension,hyperlipidemia,obesity,diabetesmellitus,nicotine abuse), symptomatic relief may be obtained by various procedures. Besides conservative treatment of arterial occlusive disease (physical therapy, medical treatment) and surgical vascularinterventions (thromboendarterectomy,bypass procedures),ballooncathetersintroducedpercutaneouslyunderlocal anesthesia have found increased application in virtually all areas for the dilatation and recanalizationofobstructive lesions inthe past fewyears. The technique of balloon dilatation, as introduced by Griintzig as a further development of the percutaneous interventions by Dotter and Judkins, is no longerthe decisive issue.The main objectiveofpresentclinicalresearchisto de termine the proper indications and patient selection for this procedure, which has found itsplace between conservative treatmentand surgery. The contentsofthis Symposium should providesome guidelinesfor the indi cations and postprocedural therapy for the referring physician, the angiologist, and for the radiologist andcardiologistperformingthe dilatation. We owe ourthanks to allthe specialistsinvolved,who have provided uswith the benefits of their experience.Mrs. H. Beilmann and Dr. M. Wojtowycz con tributed substantially to the preparation of the text. Iwould like to thank them and the staff of Springer-Verlag for their conscientious work in the interest of composition and publication quality. The large number of patients suffering peripheral vascular and coronary arterialdisease whocould behelpedobjectivelyandsubjectivelybypercutaneous transluminal angioplasty (PTA) underscores the special value of this mode of treatment. In addition, PTA also shows that close interdisciplinary communi cation and cooperation serves the best interestsofthe patient. E. ZEITLER Contents 1. TransluminalAngioplasty:Method,Indications,andRoleinTherapy.C.T.DOTIER... I.Diagnosis 2. Noninvasive Diagnosis and Natural Course of Arteriovascular Obstruction. W. SCHOOP 4 3. Ultrasound Techniques for Follow-up of Hemodynamic Changes After Peripheral TransluminalAngioplasty.A.BOl.LlNGER.With4 Figures. ..................... 6 4. DigitalSubtractionAngiography- AMethodofFollowingPercutaneousTransluminal Angioplasty.W.SEYfERTH,G.DILl3AT,E.ZEITLER,andG.BOLLE.With6Figures. ... 13 5. Evaluation of Peripheral Transluminal Angioplasty by a Score System Applied to Routine Arteriographic Images. A. BOLLINGER, E. SCHNEIDER, G. POULIADIS. C. TORRES, and M. SCHLUMPF. With 2 Figures ............................. 20 6. ExposureofPhysiciansand Patientsto Radiation DuringTransluminalDilatationand Recanalization AccordingtoDotter. F.aLBERT,M.NELL,andH.BAUMRUCK....... 24 n.PercutaneousTransluminalAngioplasty:InstrumentationandTechnique 7. SingleTeflon Catheters.E. ZEITLER.With 4 Figures.......................... 26 8. BasicTechnologyofBalloon Catheters. J.E. ABELE. With 2 Figures ............ 31 9. DilatationandtheExpandingBalloonCatheter.Advantagesofthe ExpandingBalloon Catheter. F.a LBERT,and N. MUZIKA.With 10Figures '" .., 37 III.PercutaneousTransluminalAngioplasty:MechanismandMorphology 10. The Morphological Concept of Percutaneous Transluminal Angioplasty. H. J. LEU. 46 With7Figures . II. Pathological Basis for Percutaneous Catheter and Bailon Revascularization. D. SINAPIUS. With 4 Figures ............................................ 56 12. Results of Animal Experiments With Bailon Dilatation. C. L. ZOLLIKOFER, W.R.CASTANEDA-ZUNGIA,and K.AMPLATZ.With 10Figures " .. . .. 60 13. Radiological Pattern at and After Angioplasty. F.-J. ROTH, G. CAPPIUS, and E. FINGERHUT.With 8 Figures........................................... 73 IV.MedicalTreatment 14. PercutaneousTransluminal Angioplasty: Adjunct DrugTherapy. E.-I. RICHTERand E. ZEITLER. With 4 Figures ............................................. 84 15. Platelet Activation at the Time of Percutaneous Transluminal Angioplasty. W. BLATILER, N. FOUl.LON, G. CAPPIUS, and F.-J. ROTH. With 4 Figures ....... 91 16. Results With Additional Use of SP 54 in Percutaneous Transluminal Angioplasty. L. HORVATH,K. FENDLER,and I. ILLES. ................................... 95 17. Nafazatrom: A New AntithromboticCompound.F.SEUTER.With 3Figures ....... 98 VIII Contents V.PrimaryResults:Leg Arteries 18. FemoropoplitealArteries.E.ZEITLER,E.-I.RICHTER,andW.SEYFERTH.With8Figures 105 19. AngioplastyoftheIliacandInguinalArteries.F.-J.ROTHandG.CAPPIUS.With6Figures I15 20. PercutaneousTransluminalAngioplastyinCasesofStenosisintheRegionofthe Infra renalAbdominal Aorta and the Aortoiliac Bifurcation. H. INGRISCH, W. SEYFERTH, and G. KOFER. With 2 Figures 127 2I. Relapse Treatment by Percutaneous Transluminal Dilatation. I. SCHMIDTKE and F.-J. ROTH.......................................................... 131 VI.PercutaneousTransluminalAngioplastyinCombinationWithFibrinolysis 22. Fibrinolysis and Transluminal Catheter Treatment: A Multistage Approach for the Removal of Chronic Arterial Occlusions. M. MARTIN, B. J. O. FIEBACH, and T.GODULA.With IFigure............................................... 140 23. Clot LysisinPeripheralArteries.H. HESS.With 6Figures...................... 145 24. EarlyExperienceofCatheter Lysis.F.-J.ROTH,G. CAPPIUS,and I.SCHMIDTKE.With 4Figures ............................... I54 VII.Complications 25. Complications During and After Percutaneous Transluminal Angioplasty. W. SEYFERTH, M. ERNSTING,R.GROSSE-VORHOLT, and E.ZEITLER.With 5 Figures ... 161 26. PreventionofComplicationsinPercutaneousTransluminalAngioplasty.L. HORVATH, I. ILLEs.and K. FENDLER............................................... 170 VIII.PercutaneousTransluminalAngioplasty:LateResultsinLegArteries 27. Long-TermPatencyRatesAfter PercutaneousTransluminalAngioplastyforIliacand Femoropopliteal Obstructions. E. SCHNEIDER, A. GRONTZIG, and A. BOLLINGER 175 28. Ten-Year Resultsof PercutaneousCatheterTreatment in Cases ofFemoropopliteal ArterialOcclusion inStage II. I.SCHMIDTKE.With 3 Figures................... 18I 29. Late Resultsof PercutaneousTransluminalAngioplastyofLegArteriesWith Special Referencetothe PopliteocruralRegion.W.OSTHEIM-DzEROWYCZ.With4Figures... 191 30. LateResultsofPercutaneousCatheterTreatmentinIliacStenoses- A Retrospective Study.H.RIEGER,F.-J.ROTH.E.ZEITLER,T.PALDEN.M.WEGENER,andW.SCHOOI'. With IFigure 194 3I. FactorsInfluencingEarlyandLateFollow-upResultsAfterPercutaneousTransluminal Angioplasty of the Lower Limb Arteries. F. MAHLER, A. GALUNO, P. PROBST, and B. NACHBUR......................................................... 199 32. Long-Term ResultsofIliacandFemoropopliteal Angioplasty.R.F.COLAI'INTO.With 6Figures ........................................................... 202 33. Long-Term Results of Transluminal Angioplasty of the Femoral Arteries. H. D. BERKOWITZ, R. K. SPENCE, D. B. FREIMAN, C. F. BARKER, B. ROBERTS, G.MCLEAN,and E.RING.With 5 Figures.................................. 207 34. LateResultsAfterPercutaneousTransluminalAngioplastyofiliacandFemoropopliteal Obstructive Lesions - A Cooperative Study. H. GAlLER, A. GRONTZIG, and E. ZEITLER. With 2 Figures ............................................. 215 35. Late ResultsAfter Percutaneous TransluminalAngioplastyfor Iliac ArteryStenosis. W.OSTHEIM-DzEROWYCZ.With 3 Figures.................................. 219 36. PercutaneousTransluminal Angioplastyfor Limb Salvage - ProgressinTherapyfor Severe Leg Ischemia With Rest Pain and Gangrene. E. SCHNEIDER, A. GRONTZIG, and A. BOLLINGER.................................................... 222 Contents IX IX. PercutaneousTransluminalAngioplastyofCoronaryArteries 37. PercutaneousCoronary Angioplasty - A CriticalReview of ItsClinicalApplication. A. R. GRONTZIG,J. W. HURST, and C. R. HATCHER. ........................ 227 38. TransbrachialCoronaryDilatation:Technique,Indications,Results,andComplications. G.KOBER,N.D.SCHERER,S.DOWINSKY,R.HOPF,andM.KALTENBACH.With6Figures 230 39. Transbrachial Transluminal Dilatation of Abdominal and Peripheral Arteries. K. BACHMANN and G.RAAB.With 2 Figures ............................... 236 X. PercutaneousTransluminalAngioplastyfor Supra-aorticStenoses 40. Percutaneous Transluminal Angioplasty of the Vertebral Arteries. A. MOTARJEME, J.W.KEIFER,A.J.ZUSKA,andP.NABAVI.With1Figure. ...................... 241 40a.Percutaneous Transluminal Angioplasty of the Supra-aortic Arteries. E. ZEITLER, G.BERGER,and R.SCHMITr-ROTH.With 6Figures........................... 245 XI. PercutaneousTransluminalAngioplastyofRenalArteries 41. Long-Term Results of Percutaneous Transluminal Angioplasty for Renovascular HyperternsionUsingtheCoaxialCatheterTechniqueinPatientsWithAtherosclerosis and Fibromuscular Dysplasia.F. MAHLER,Z. GLOCK,P.PROBST,P.WEIDMANN,and B.NACHBUR.With 5 Figures. ........................................... 262 42. Treatmentof RenovascularHypertensionby PercutaneousTransluminalAngioplasty ofTwo Renal Arteries in a 5-Year-Old Boy. F.MAHLER, R.GHISLA,M. HAERTEL, O.OETLIKER,A.KRNETA,andE.Rossr,With IFigure........................ 269 43. Follow-upin Patients UndergoingPercutaneous Transluminal Angioplastyfor Renal Artery Stenosis and Occlusion. W.-D. BUSSMANN, P. GROTZMACHER, R.RUMINSKY, W.FASSBINDER,S.DOWINSKY,D.RUMMEL,M.KALTENBACH,andW.SCHOEPPE.With 8Figures ........................................................... 272 44. RenalAngioplastyinHypertension:Technique,RadiologicalandClinicalResults,and Complicationsin 134Dilatations.C.B.A.J.PUIJLAERT,G.G.GEYSKES,J.H.J.RUIJs, H. P.J.WOSTEFELD,andW. P.T. MALI. ................................... 279 45. PercutaneousTransluminalAngioplastyofRenalArteries- ATherapeuticPrinciple. Case Report of 128 Patients With Renovascular Hypertension. E. LOHR, H. C. WEICHERT,H. HARTJES,andA. SCHRIJVERS.With IFigure..................... 281 46. Technique, Indications, Complications and Results of Percutaneous Transluminal RenalArteryDilatation.E.-I.RICHTER,E.KRONERT,andE.ZEITLER.With 6Figures 286 XII.Indicationsfor PercutaneousTransluminalAngioplasty 47. Special IndicationsforAngioplasty.F.-J.ROTHand G.CAPPIUS.With 7 Figures.... 296 48. Resultsof PercutaneousTransluminalAngioplastyof the DeepFemoral Artery - A PreliminaryStudy.H.RIEGER,F.-J.ROTH,and W.SCHOOP.With 2 Figures ....... 308 49. PercutaneousTransluminalAngioplastyasaComplementtoSurgery.A. MOTARJEME, J.W.KEIFER,A.J.ZUSKA,andP.NABAVI.With 5Figures...................... 312 50. The Place of PercutaneousTransluminal Angioplasty in the Therapyof a Clinicfor VascularDiseases.M.KOHLER,C. DEMMER,and F.-J.ROTH................... 321 51. Indicationsfor Percutaneous Transluminal AngioplastyFrom the Surgeon's Point of View. H. DENCK. With 2 Figures. ....................................... 324 52. Indications for Percutaneous Transluminal Angioplasty: The Nephrologist's View. E.Lux andD.SEYBOLD.With 1Figure .................................... 327 53. Indications for Percutaneous Transluminal Angioplasty: The Angiologist's Point of View. W. SCHOOP .. .................................................. 332 x Contents XIII. PercutaneousTransluminalAngioplastyTodayandintheFuture 54. Percutaneous Transluminal Angioplasty: State of the Art and Future Perspectives. A.BOLLINGER,E.SCHNEIDER,U.KUHLMANN,G.POULIADISandU.BRUNNER....... 335 55. TransluminalAngioplasty:ResultsandFuture Outlook.C.T.DOTIER............ 337 Appendix 56. TransluminalAngioplasty:AComprehensive,ChronologicalBibliography1964-1982. C. T. DOTIERand E. J. RUBLE.......................................... 339 Subject Index ............................................................ 363 List of Collaborators J.E.ABELE MEDI-TECH INC. 480 Pleasant St., P.O.B. 7407, Watertown, MA02172USA K. AMPLATZ Department of Radiology, University of Minnesota Hospitals, 420 DelawareStreetS.E.,Minneapolis,MN55455 USA K.BACHMANN Medizinische Poliklinik, Universitat Erlangen-Niirnberg, D-8520 Erlangen C.F.BARKER Department of Surgery, Hospital of the University of Pennsyl vania,4Silverstein,Philadelphia,PA 19104 USA H.BAUMRUCK Physikalisch-technische Priifanstalt fur Radiologie und Elektro medizin.AllgemeinesKrankenhaus,Alserstr.4,A-1190Wien G.BERGER Neurologisch-psychiatrische Klinik, Neurophysiologische Abtei lung,Klinikum Niirnberg,Flurstr. 17,D-8500 Niirnberg H.D.BERKOWITZ Hospital of the University of Pennsylvania, 4th Floor Silverstein Pavilion,3400SpruceStreet,Philadelphia.Pa.19104 USA W.BLii,TTLER PraxisfiirGefiiBerkrankungen,Eisengasse 2,CH-8008Ziirich GISELA BOLLE RadiologischesZentrum,DiagnostischeAbteilung,KlinikumNiirn berg,Flurstr. 17,D-8500Niirnberg91 A. BOLLINGER Department fiir InnereMedizin,Poliklinik,Angiologische Abtei lung,Universitatsspital,Ramistr.100,CH-8091 Ziirich U.BRUNNER Abteilung fiir Periphere Vaskulare Chirurgie, Chirurgie B, Uni versitatsspital,Ramistr.100,CH-8091Ziirich W.-D.BUSSMANN ZentrumderInnerenMedizin,AbteilungfiirKardiologie,Klinikum der J. W. Goethe-Universitat, Theodor-Stern-Kai 7, D-6000 Frankfurt/M.70 GABRIELE CAPPIUS Aggertalklinik,D-5250Engelskirchen W. R.CASTANEDA-ZUNGIA Department of Radiology, University of Minnesota Hospitals, 420DelawareStreetS.E., Minneapolis,MN55455USA R.F.COLAPINTO Toronto General Hospitals, 101 College Street, Toronto, Ont. M5G IL7Canada CORNELIADEMMER Aggertalklinik,D-5250 Engelskirchen H.DENCK Krankenhaus der Stadt Wien-Lainz, I. Chirurgische Abteilung, Wolkersbergenstr. I,A-1130Wien G.DILBAT RadiologischesZentrum,DiagnostischeAbteilung,KlinikumNiirn berg,Flurstr. 17,D-8500Niirnberg91 C.T.DOTTER University of Oregon, Health Sciences Center, Department of DiagnosticRadiology,Portland,Oregon97201USA XII ListofCollaborators S.DOWINSKY ZentrumderinnerenMedizin,AbteilungfiirKardiologie,Klinikum der J. W. Goethe-Universitat, Theodor-Stern-Kai 7, D-6000 Frankfurt/M.70 MARIANNEERNSTING RadiologischesZentrum,DiagnostischeAbteilung,KlinikumNiirn berg,Flurstr. 17,D-8500Niirnberg91 W.FASSBINDER Zentrum der Inneren Medizin, Abteilung fiir Kardiologie, Klini kum derJ. W. Goethe-Universitat,Theodor-Stern-Kai7, D-6000 Frankfurt/M. 70 K.FENDLER Radiologische Klinik,H-7643 Pecs B.J.O.FIEBACH Zentrale Strahlendiagnostik und Neuroradiologie,Stadtische Kli niken Duisburg,Zu den Rehwiesen9,D-4100Duisburg1 E.FINGERHUT Aggertalklinik,D-5250Engelskirchen N.FoULLON AggertalklinikfiirGcfatlkrankheiten,D-5250Engelskirchen D.B.FREIMANN Department of Radiology, Presbyterian-University of Pennsyl vania, Medical Center, 51 North 39th Street, Philadelphia, PA 19104USA H.GAlLER Radiologisches Zentrum, Abt. Diagnostik, Klinikum Niirnberg, Flurstr. 17,D-8500 Niirnberg A.GALLINO MedizinischeUniversitatsklinik,Inselspital,CH-30I0Bern G.G.GEYSKES Department of Nefrology, University Hospital, Catharijnesingel 101,NL-3500CG Utrecht R.GHISLA Universitatskinderklinik,Inselspital.CH-30I0Bern Z.GLOCK Medizinische Universitatsklinik,1nselspital,CH-30I0Bern T.GODULA Stadtische Kliniken Duisburg, Geriatrische Klinik, Zu den Reh wiesen 9,D-4100 Duisburg I R.GROSSE-VORHOLT RadiologischesZentrum,DiagnostischeAbtcilung,KlinikumNiirn berg,Flurstr. 17,D-8500Niirnberg91 A.R.GRONTZIG Emory University School of Medicine, Department of Medicine, 1364CliftonRoad,N.E.,Atlanta,Georgia30322 USA P. GROTZMACHER ZentrumderInnerenMedizin,AbteilungfurKardiologie,Klinikum der J. W. Goethe-Universitat, Theodor-Stern-Kai 7, D-6000 Frankfurt/M.70 M.HAERTEL Institutfur Radiologie,Kantonsspital,CH-9000St.Gallen I-I.HARTJES Rontgendiagnostisches Zentralinstitut,Universitats-Klinikum Es sen,Hufelandstr.55, D-4300Essen I C.R.HATCHER Emory University School of Medicine, Department of Medicine, 1364Clifton Road,N.E.,Atlanta,Georgia30322USA H. HESS Medizinische Poliklinik der Universitat Miinchen, Pettenkofer str. 8a,D-8000Miinchen2 R. HOPF ZentrumderinnerenMedizin,AbteilungfiirKardiologie,Klinikum der J. W. Goethe-Universitat, Theodor-Stern-Kai 7, D-6000 Frankfurt/M.70 L. HORVATH Radiologische Klinik,H-7643Pees J.W.HURST Emory University School of Medicine, Department ofMedicine, 1364 CliftonRoad,N.E.,Atlanta,Georgia30322 USA I. ILLES Radiologische Klinik,H-7643 Pees H.INGRISCH Radiologische Klinik und Poliklinik der Universitat Miinchen, Poliklinik,Pettenkoferstr.8a,8000Miinchen2
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