Percutaneous interventional therapy for whole body arterial occlusive disease

Choi, Seung Hyuk; Shim, Won Heum; Yoon, Young Sup; Pyun, Wook Bum; Choi, Dong Hoon; Jang, Yang Soo; Kim, Dong Ik; Chang, Byung Chul; Cho, Seung Yun

Abstract

BACKGROUND: The goal of percutaneous transluminal angioplasty(PTA) is recanalization of the arterial stenosis or occlusion. The low incidence of serious complications makes PTA an attractive form of treatment for selected patients, especially if the lesions are not severe enough to warrant surgery or the patient is at high operative risk. The purpose of this study was to assess the feasibility, safety, and efficacy of PTA as an alternative or primary therapy for whole body arterial occlusive disease.
METHODS
PTA was performed in 397 patients(male 342, female 55 : mean age 58.9+/-12.4 yr) with arterial occlusive disease. The patients were followed after PTA for a mean period of 22+/-11months. The information on restenosis, recurrence of symptom, redo-PTA, bypass surgery and amputation was obtained by follow-up angiography, plethysmography and self-administered questionnaire.
RESULTS
In the 313 patients who underwent PTA for low extremity vascular disease, the overall success rate was 80.6%. Technical success rate for the iliac lesions was 84.7%, for the femoropopliteal lesions 74.8%, and for the infrapopliteal lesions 78.6% respectively. These results showed that outcome for iliac lesions were significantly better than those for femoropopliteal lesions(p<0.001). The technical success rate for the low extremity vessels was greater in the stenting group than in the ballooning group(98.2% vs 68.9%, p<0.001). In 260 lesions followed after PTA for low extremity vascular disease, cumulative patency rate at 3 years was greater in the iliac artery group than in the femoropopliteal artery group (84.6% vs 50.8%, p<0.001). In femoropopliteal lesions, cumulative patency rate at 3 year was greater for intervention of stenotic lesions compared to occlusive lesions(60.3% vs 38.1%, p<0.05). Carotid artery stenting in 25 patients(35 lesions) was successful in all lesions. Angiography and/or duplex sonography which was performed at 5.5+/-2.6 months in 18 patients(24 lesions) followed after carotid stenting revealed no evidence of restenosis. Subclavian artery stenting in the 16 patients(17 lesions) was successful in 16 lesions(94%). Renal artery stenting in the 17 patients(18 lesions) was successful in all lesions. Angiography at 8.5+/-3.5 months in 6 patients(6 lesions) followed after renal stenting revealed no evidence of restenosis. PTA for total occlusion of abdominal aorta was successful in 11 lesions(84.6%) of the 13 lesions. Angiography at 13+/-12 months in 7 patients(7 lesions) followed after PTA for abdominal aorta revealed significant restenosis in 2 patients. Minor complications during the PTA for peripheral disease occurred in 25 patients of 397 patients.
CONCLUSION
PTA for whole body arterial occlusive disease can be performed with an excellent technical success rate and minimal morbidity and mortality. PTA for carotid, subclavian, renal, iliac artery or abdominal aorta represents a true alternative to vascular surgery as a first-line treatment. Despite acceptable initial success rate, PTA for femoropopliteal or infrapopliteal artery warrants further validation because it has high incidence of clinical restenosis during the follow-up periods.