Percutaneous Transluminal Angioplasty: Technique, Early and Late Results

384 Pages·1983·14.118 MB·English

by  C. T. Dotter (auth.), Charles T. Dotter M. D., Professor Dr. Andreas R. Grüntzig, Professor Dr. Werner Schoop, Professor Dr. Eberhard Zeitler (eds.)

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
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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