Infrapoliteal percutaneous transluminal angioplasty: A safe and successful procedure

Aim:To review outcome of 40 consecutive infrapopliteal percutaneous transluminal angioplasty (PTA) procedures performed over a 65 month period.Chief outcome measures:The indication for PTA was intermittent claudication in 20 (50%) cases and rest pain, ulceration or gangrene in the remainder.Results:There was one technical failure; the remaining 39 limbs were all clinically improved by 24 h and this improvement was maintained at 3 months in 36 (90%). There were no deaths nor limb loss related to PTA and 2 embolic complications were successfully treated percutaneously. The primary and secondary symptomatic patencies at 24 months were 59 and 79% respectively. The actuarial limb salvage rate at 1 year for the 20 limbs presenting with critical ischaemia was 77%, and 10 of the 14 procedures performed for ulceration or gangrene resulted in healing with only minor surgical intervention.Conclusions:With modern endovascular techniques, infrapopliteal PTA is a safe, worthwhile and durable procedure

Results of surgery and angioplasty for the treatment of chronic severe lower limb ischaemia

Objective:The aim of this study was to assess and compare the efficacy of PTA and surgery in the treatment of severe lower limb ischaemia.Design:Prospective 12-month study of 180 consecutive patients with severe chronic lower limb ischaemia.Methods:PTA was used as first line therapy whenever possible and appropriate. Surgical revascularisation, primary amputation and conservative therapy were used in the remaining patients. Patient survival and limb salvage were derived using life table analysis.Results:Revascularisation was attempted in 135 (75%) patients, with PTA in 82 (46%), surgery in 49 (27%) and a combination of both in four (2%). Overall 12-month survival and limb salvage was 75% and 71%, respectively. Surgery and PTA had significantly higher survival rates (91% and 78%) than primary amputation or conservative therapy (57% and 52%) (p<0.0001 log rank test). Revascularisation with either surgery or PTA achieved the same limb salvage rate of 76%.Conclusion:A large proportion of patients with severe chronic lower limb ischaemia can be managed by PTA. This management strategy produces a clinically effective outcome at 1-year

Techniques for the endovascular management of complications following lower limb percutaneous transluminal angioplasty

AbstractObjectives: to determine the incidence of early complications following percutaneous transluminal angioplasty and to describe their management and outcome. Materials: five hundred and fifty consecutive patients undergoing angioplasty of 648 limbs, containing 1053 anatomical segments during a two year period were reviewed retrospectively. Results: early complications affected 109 segments (10%) in 92 limbs (14%) of 84 patients (15%). Of the 109 segments affected by early complications, 106 (97%) were managed by endovascular techniques with surgery being required on only three (3%) occasions. There were no deaths attributable to angioplasty. Conclusions: although early complications occur in 14% of limbs undergoing percutaneous transfemoral angioplasty, the majority (97%) can be managed by endovascular techniques.Eur J Vasc Endovasc Surg 25, 125–130 (2003

Reprinted Article “Subintimal Angioplasty of Femoropopliteal Artery Occlusions: The Long-term Results”

AbstractThe technique of subintimal angioplasty has been attempted on 200 consecutive femoropopliteal artery occlusions of median (range) length 11 (2–37) cm. The principle of the technique is to traverse the occlusion in the subintimal plane and recanalise by inflating the angioplasty balloon within the subintimal space. The technical success rate was 159/200 (80%) and was not significantly different for occlusions <10 cm (81%, n = 73), 11–20 cm (83%, n = 63) or >20 cm (68%, n = 23), p = 0.20. There were no deaths nor limb loss resulting from the procedure. The median (range) ankle-brachial pressure index increased from 0.61 (0.21–1.0) preangioplasty to 0.90 (0.26–1.50) postangioplasty. The actuarial haemodynamic patencies of technically successful procedures at 12 and 36 months were 71% and 58% respectively, the symptomatic patencies were 73% and 61%. A multiple regression analysis showed that smoking multiplied the risk of reocclusion by 2.70 (p < 0.001), each additional run-off vessel reduced the risk by 0.54 (p < 0.001) and the risk increased by 1.73 (p = 0.020) for every 10 cm of occlusion length. In conclusion, the technical success rate (80%) of subintimal angioplasty for femoropopliteal occlusions is unrelated to occlusion length and for all procedures, including technical failures, cumulative symptomatic and haemodynamic patencies of 46 and 48% can be achieved at 3 years. The factors influencing long-term patency were smoking, the number of calf run-off vessels and occlusion length

Effects of noise exposure on young adults with normal audiograms II: Behavioral measures

An estimate of lifetime noise exposure was used as the primary predictor of performance on a range of behavioral tasks: frequency and intensity difference limens, amplitude modulation detection, interaural phase discrimination, the digit triplet speech test, the co-ordinate response speech measure, an auditory localization task, a musical consonance task and a subjective report of hearing ability. One hundred and thirty-eight participants (81 females) aged 18–36 years were tested, with a wide range of self-reported noise exposure. All had normal pure-tone audiograms up to 8 kHz. It was predicted that increased lifetime noise exposure, which we assume to be concordant with noise-induced cochlear synaptopathy, would elevate behavioral thresholds, in particular for stimuli with high levels in a high spectral region. However, the results showed little effect of noise exposure on performance. There were a number of weak relations with noise exposure across the test battery, although many of these were in the opposite direction to the predictions, and none were statistically significant after correction for multiple comparisons. There were also no strong correlations between electrophysiological measures of synaptopathy published previously and the behavioral measures reported here. Consistent with our previous electrophysiological results, the present results provide no evidence that noise exposure is related to significant perceptual deficits in young listeners with normal audiometric hearing. It is possible that the effects of noise-induced cochlear synaptopathy are only measurable in humans with extreme noise exposures, and that these effects always co-occur with a loss of audiometric sensitivity