Abstract:

Aim: was to assess dynamics of angiographic parameters of coronary artery rehabilitation, spasm throughout, below chronic coronary occlusion (CCO), after recanalization and balloon angioplasty, with survey of 8-10 weeks, basing on dynamics of anatomical and morphological characteristics of the artery with a major idea to optimize conditions for stenting.

Materials and methods: research analyzes results of two-stage treatment of 26 patients with CCO, complicated by a spasm, by which result after a recanalization of occlusion, was a contrasted artery with diameter less than 1 mm.

In these cases angioplasty with balloons with a diameter up to 3 mm doesn’t yield desirable results and diameter of an artery below a place of occlusion averaged 1,5 mm, and the difference of diameters of proximal and distally department averages 1,78 mm that is an adverse factor for stenting as is followed by high level of restenosis and thrombosis.

Results: within 4-8 weeks (on average 68 days) all arteries remained passable with equal contours, without angiographic signs of dissection, which took place right after balloon angioplasty Diameter of an artery increased with 1,5 mm to 2,64 mm; a difference of diameters of proximal and distally departments of an artery at the level of CCO decreased from 1,78 mm to 0,45 mm that was a favorable condition for stenting.

Conclusion: within 4-8 weeks after recanalization under normal pressure and blood flow occurs a readaptation of artery, expressed in a significant increase in the diameter of the artery below the CCO, which contributes to the optimization of stenting.

References

1.    Morino Y, Kimura T., Hayashi Y, Muramatsu T., Ochiai M., Noguchi Y, Kato K., Shibata Y, Hiasa Y, Doi O., Yamashita T., Morimoto T., Abe M., Hinohara T., Mitsudo K.; J-CTO Registry Investigators. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010 Feb;3(2): pp. 143-51.

2.    Buller C.E., Dzavik V., Carere R.G., Mancini G.B., Barbeau G., Lazzam C., Anderson T.J., Knudtson M.L., Marquis J.F., Suzuki T., Cohen E.A., Fox R.S., Teo K.K. Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA). Circulation. 1999 Jul 20;100(3): pp. 236-242.

3.    Gould K.L. Coronary collateral function assessed by PET. In: « coronary artery stenosis and reversing atherosclerosis», Ed. By Gould KL,2-nd edition, New York, NY: Oxford University Press, 1999; pp. 275-282.

4.    Pixmeo company. Dr. Antoine Rosset, Prof. Osman Ratib and Joris Heuberger ( Geneva, Switzerland ), 2004;

5.    Okabe T., Mintz G.S., Buch A.N., Roy P, Hong YJ., Smith K.A., Torguson R., Gevorkian N., Xue Z., Satler L.F., Kent K.M., Pichard A.D., Weissman N.J., Waksman R. Intravascular ultrasound parameters associated with stent thrombosis after drug-eluting stent deployment. Am. J. Cardiol. 2007 Aug 15;100(4):615-20. Epub 2007 Jun 29.

6.    Costa M.A,, Angiolillo D.J., Tannenbaum M., Driesman M., Chu A., Patterson J., Kuehl W., Battaglia J., Dabbons S., Shamoon F., Flieshman B., Niederman A., Bass T.A.; STLLR Investigators. Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial). Am. J. Cardiol. 2008 Jun 15; 101 (12): 1704-11. doi: 10.1016/j.amjcard.2008.02. 053. Epub 2008 Apr 9.

7.    Hong M.K., Mintz G.S., Lee C.W., Park D.W., Choi B.R., Park K.H., Kim YH., Cheong S.S., Song J.K., Kim J.J., Park S.W., Park S.J. Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation. Eur. Heart J. 2006 Jun;27(11):1305-10.

8.    Werner G.S., Jandt E., Krack A., Schwarz G., Mutschke O., Kuethe F., Ferrari M., Figulla H.R. Growth factors in the collateral circulation of chronic total coronary occlusions: relation to duration of occlusion and collateral function. Circulation Oct. 2004; 110(14): pp. 1940-1945.

9.    Sakurai R.L., Ako J., Morino Y, Sonoda S., Kaneda G., Terashima M., Hassan A.H., Leon M.B., Moses J.W.. Popma J.J., Bonneau H.N., Yock PG., Fitzgerald PJ., Honda Y. Predictors of edge stenosis following sirolimus-eluting stent deployment (a quantitative intravascular ultrasound analysis from the SIRIUS trial). SIRIUS Trial Investigators. Am. J. Cardiol. 2005 Nov 1;96(9):1251-3. Epub 2005 Sep 6.

10.  Cosby R.S., Giddings J.A., See J.R. Coronary collateral circulation. Chest Jul. 1974; 66(1): pp. 27-31.

11.  Kathryn Maiellaro, W. Robert Taylor. The role of the adventitia in vascular inflammation. Cardiovascular Research 2007 Sep 1;75(4): pp. 640-8.

Abstract:

Case report is devoted to atypical recanalization of chronic occlusions of the common iliac artery Today, there are several ways for recanalization of chronic occlusions of arteries of lower limbs. Recanalization is known to be the major point of endovascular procedures. The success of endovascular surgery at recanalization depends mainly on 2 factors. One of the most important factors is the choice of access. Another factor is the choise of recanalization method . In case of rare failures - performing open surgery.

Refrrences 

1.    Pokrovsky A.V. and other. Russian consensus. Recommended standards for the evaluation of patients with chronic lower limb ischemia. M. 2001; 16 [In Russ].

2.    Koshkin V.M. Outpatient treatment of atherosclerotic lesions of lower extremities. Angiology and Vascular Surgery. 1999; 1: 106-113 [In Russ].

3.    Saket R.R. et al. Novel intravaskular ultrasound-guided method to create transintimal arterial communications: initial experience in peripheral occlusive disease and aortic dissection. J.Endovasc. Ther. 2004; 11 (3): 274-280.

4.    Troickij A.V., Behtev A.G., Habazov R.I., Beljakov G.A., Lysenko E.R., Kolodiev G.P. Gibridnaja hirurgija pri mnogojetazhnyh ateroskleroticheskih porazhenijah arterij aorto-podvzdoshnogo i bedrenno-podkolennogo segmentov. Diagnosticheskaja i intervencionnaja radiologija. 2012; 6(4): 67-77 [In Russ].

5.    Zatevakhin 1.1., Shipovskiy V.N., Zolkin V.N. Balloon angioplasty for lower limb ischemia. M. 2004; 176-229 [In Russ].

Abstract:

Purpose: on the basis of long-term results of renal angioplasty and stenting, the authors define the indications for endovascular interventions in patients with renovascular hypertension (RVH).

Materials and methods: since 1992-2008 in Tashkent Medical Academy Vascular Surgery Center were performed 131 endovascular interventions in 119 patients for renal arteries (RA) stenoses of various origins. 97 patients underwent balloon angioplasty (BA) of renal arteries (105 interventions), and stenting was performed in 22 cases (26 stenting procedures). Systolic blood pressure varied from 170 to 300 mm Hg (219,4±23,1 mmHg), with diastolic blood pressure from 170 to 300 mm Hg (118,1±8,9 mm Hg). Average arterial hypertension history was 5,2±3,7 years (6 months - 16 years).

Results: technical success rate was 85,6% for balloon angioplasty, and 100 % for stenting procedures. Immediate hypotensive effect was good to satisfactory. Complication rate was 2,5% (3 patients). Long-term results were assessed in 76 cases of balloon angioplasty (78,4%), and in all patients with renal arteries stenting. The average follow-up was 72±32,5 months (6-144 months) for balloon angioplasty, and 6-24 months for stenting group. In the angioplasty group long-term hypotensive effect lasted in 54(71,1%) of patients, and the restenosis rate was as high as 28,9% (22 cases). In the stenting group, the long-term hypotensive effect was preserved in all the patients, and there were no cases of restenosis.

Conclusions: high rates of technical and clinical success, as well as low rates of restenosis, allow the renal artery stenting procedure to be seen as the method of choice for renovascular hypertension.

References

1.      Клиническая ангиология в 2 томах. Под редакцией А.В. Покровского. М.: Медицина. 2004; 2: 94-114.      

2.      Алекян Б.Г.,  Бузиашвили Ю.И.,  Голухова Е.З. и др. Ближайшие и отдаленные результаты стентирования почечных артерий у больных с вазоренальной гипертензией. Ангиология   и   сосудистая   хирургия.   2006;1: 55-62.

3.      Carmo M., Bower T.C. Surgical мanagement of renal fibromuscular dysplasia. Challenges    11.in the endovascular era. Ann. Vasc. Surgery. 2005; 19: 208-217.

4.      Baert A.L., Wilms G., Amery A., Vermylen J.,Suy R. Percutaneous transluminal renal angioplasty: initial results and long-term follow-up in 202 patients. Cardiovasc. Intervent. Radiol. 1990; 13: 22-28.

5.      WongJ.M., Hansen K.J., Oskin T.C. et al. Surgery after failed percutaneous renal artery angioplasty.J. Vasc. Surg. 1999; 30: 468-483.

6.      Yutan E., Glickerman D.J., Caps M.T. et al.Percutaneous transluminal revascularizationfor renal artery stenosis. Veterans affairs puget sound health care system experience. J. Vasc. Surg. 2001; 34: 685-693.

7.      Петровский Б.В., Гавриленко А.В. 40-летний опыт реконструктивных операций при вазоренальной гипертензии. Ангиология и сосудистая хирургия. 2003; 2: 8-12.

8.      Троицкий А.В., Елагин О.С., Хабазов Р.И. и др. Одномоментная реконструкция висцеральных ветвей аорты и почечных артерий. Ангиология и сосудистая хирургия. 2006; 2: 132-136.

9.      Крылов В.П., Реут Л.И., Дергачева И.М. и соавт. Отдаленные результаты хирургического лечения вазоренальной гипертензии. Клиническая кардиология. 2004; 2: 34-39.

10.    Bonelli F.S., McKusick M.A., Textor S.C. et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo. Clinic. Proc. 1995; 70: 1041-1052.

11.    Surowiec S.M., Sivamurthy N., Rhodes J.M. et al. Percutaneous therapy for renal artery fibromuscular dysplasia. Ann. Vasc. Surg. 2003; 17: 650-655.

12.    Galaria I.I., Surowiec S.M., Jeffrey M. Percutaneous and оpen renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surg. 2005; 25: 218-224.

Abstract:

Aim: was to evaluate morphological features of lesions in lower limb arteries before percutaneous transluminal angioplasty (PTA) and its arterial complications in patients with critical lower limb ischemia (CLI) combined with diabetes mellitus(DM).

Materials and methods: for the period from September 2010 to June 2013, a prospective single-center study was conducted involving 171 patients with CLI and DM (80(47%) men, mean age 64,1[54-68] years, mean HbA1c 8,3[7,4-9,6]%, mean duration of diabetes 16,5[8-23] years, diabetes type 1/2-18/153) who underwent PTA in 193 lower limbs. Myocardial infarction and brain stroke in anamnesis had 53(31%) and 19(11%) patients, respectively Chronic kidney disease (CKD) 3-4 stages had 40 patients(24%), end-stage renal disease - 16 cases (10%). Diagnosis of CLI was based on recommendation of TASC II. Patency of arteries of lower limbs was evaluated by duplex ultrasound (DU) before PTA and during early follow-up period (30 days). PTA in all patients was considered technically successful in restoring continuous arterial flow to the foot of at least one crural artery without residual stenosis >50%.

Results: stenosis>50% and occlusions of tibial arteries were found in all patients. Peripheral arterial disease 4-6 classes according Graziani L. classification was marked in 180(93%) cases. Extensive tibial arterial calcification was found in 123(64%) cases, in patients with residual stenosis (> 50% remaining diameter) -113 (89%). The mean value of transcutaneous oxygen pressure (tcpO2) before PTA was 14,7(8-25) mmHg, after PTA - 35,2 (31-38) mmHg. After PTA , residual stenosis (>50%) in treated arteries was in 125(79,1%) cases, thrombosis in treated arteries - 9(5,7%), intimal dissection - 18(11,4%), incomplete stent disclosure - 3(1,9%), incomplete capture stent area stenosis - 2(1,3%), dislocation of the stent - 1(0,6%). Repeat PTA in the early follow-up period was performed in 15 patients with clinically significant complications (6%).

Conclusion: CLI in diabetic patients is characterized by having severe morphological lesions of lower limb arteries, infrapopliteal arterial calcification. DU plays important role in evaluation of arterial patency and PTA complications in early follow-up period. The high level of residual stenosis of tibial arteries after PTA is associated with chronic complications of diabetes mellitus, including renal insufficiency Timely reintervention in diabetic patients with clinical significant PTA complications promotes optimal arterial patency and permission of CLI in theese cases. 

Reference

1.     Ajubova N.L., Bondarenko O.N., Galstjan G.R., Manchenko O.V., Dedov 1.1. Osobennosti porazhenija arterij nizhnih konechnostej i klinicheskie ishody jendovaskuljarnyh vmeshatel'stv u bol'nyh saharnym diabetom s kriticheskoj ishemiej nizhnih konechnostej i hronicheskoj pochechnoj nedostatochnost'ju [Peculiarities of arteries' lesions of lower limb, and clinical outcomes of PCI in patients with critical ishemia of lower limbs with diabetes mellitus and chronic renal insufficiency]. Saharnyj diabet. 2013; 4:85-94 [In Russ].

2.     TASC. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J.Vasc Surg., 2000;31(1 part2):S1-287.

3.     Lumley J.S. Vascular management of the diabetic foot- a British view. Journal Annals of the Academy of Medicine, Singapore. 1993, Vol 22, N 6, P 912-6 

4.     M.Doherty T., Lorraine A.F., Inoue D., Jian-Hua Qiao, M.C.Fishbein, R.C.Detrano, PK.Shan, T.B. Rajavashisth. Molecular, endocrine, and genetic mechanisms of arterial calcification. Endocrine Reviews. 2004, 25 (4):629-672

5.  Bublik E.V., Galstjan G.R., Mel'nichenko G.A., Safonov V.V., Shutov E.V., Filipcev P.Ja. Porazhenija nizhnih konechnostej u bol'nyh saharnym diabetom s terminal'noj stadiej hronicheskoj pochechnoj nedostatochnosti, poluchajushhih zamestitel'nuju pochechnuju terapiju [Lower limbs’ lesions in patients with diabetesmellitus with end-stage chronic renal insufficiency, receiving replacement therapy]. Saharnyj diabet. 2008; 2: 17-23 [In Russ].

6.     Jager K.A., Phillips D.J., Martin R.L., Hanson C., Roederer G.O., Langlois YE. et al. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med. Biol. 1985;11: 515-21.

7.     Ciaverella A., Silletti A., &Mustacchio A., et al. Angiographic evaluation of the anatomic pattern of arterial obstructions in diabetic patients with critical limb ischemia. Diabet. Metab. 1993;19:586-589.

8.     Jude E.B., Oyibo S.O. & Chalmers N., et al. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24:1433-1437.

9.     Bandyk D.F. Surveillance after lower extremity arterial bypass. perspect vasc surg endovasc ther. Eur Heart J. 2007;19:376-83.

10.   Faglia E., Mantero M. & Caminiti M. et al. Extensive use of peripheral angioplasty, especially infrapopliteal, in the treatment of ischemic foot ulcer: clinical results of a multicentric study of 221 consecutive diabetic subjects. J. Intern. Med. 2002; 252:225-232.

11.   Adam D.J., Beard J.D., Cleveland T., Bell J., Bradbury A.W., Forbes J.F. et al.; BASIL Trial Participants. Bypass versus Angioplasty in Severelschaemia of the Leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366:1925-34.

12.   Norgen L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes FGR. Inter-society Consensus for the Management of Peripheral Arterial Disease (TASC II). J. Vasc. Surg. 2007; 45(Suppl S):S5-67.

13.   Hirsch A.T., Haskal Z.J., Hertzer N.R., Bakal C.W., Creager M.A., Halperin J. et al; American Association for Vascular Surgery/Society for Vascular Surgery;Society for Cardiovascular Angiography and Interventions;Society for Vascular Medicine and Biology; Society for Inerventional Radiology; ACC/AHA TASC Force on Practice Guidelines. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower exteremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA TASC Forc on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations. Circulation. 2006 113: e463-654,

14.   Dick F., Ricco J.B., Davies A.H.: Chapter VI: Follow-up after Revascularisation. Eur. J. Vasc. Endovasc. Surg. 2011; 42: S75-S90.

15.   Bondarenko O.N., Ajubova N.L., Galstjan G.R., Dedov 1.1. Dooperacionnaja vizualizacija perifericheskih arterij s primeneniem ul'trazvukovogo dupleksnogo skanirovanja u pacientov s saharnym diabetom i kriticheskoj ishemiej nizhnih konechnostej [Preoperative visualization of peripheral arteries with the help of ultrasonic duplex scanning in patients with critical ischemia of lower limbs and diabetes mellitus]. Saharnyj diabet. 2013; 2: 52-61 [In Russ].

16.   Arvela E., Dick F: Surveillance after Distal Revascularization for Critical Limb Ischemia. Scandinavian Journal of Surgery. 2012; 101:119-124. 

17.   Diehm N., Baumgartner I., Jaff M., Do D.D., Minar E., Schmidli J. et al. A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischemia of lower limb arteries. Eur. Heart J. 2007; 28: 798-805.

Abstract:

Primary angioplasty in patients with ST elevation myocardial infarction reduces mortality and reinfarction rate. Immediate restoration of myocardial perfusion has a direct impact on one-year mortality Achieving TIMI 3 flow in epicardial arteries does not mean that the myocardial perfusion has normalized. In addition to that, it is vital to evaluate alternative markers such as rapid resolution of the ST-segment elevation and restoration of optimal distal flow, blush grade 2-3. The intracoronary infusion of adenosine, administered prior to the opening of the artery limiting the size of the infarction and decreases the incidence of no-reflow phenomenon. Direct stent implantation without pre dilation significantly minimizes the incidence of adverse effects. The Amicath catheter (IHT-Cordynamic, Spain) that we use in patients with ST elevation myocardial infarction allow us to obtain an effective myocardial reperfusion, in different clinical situations avoiding the displacement of the thrombus, or a distal embolism, and preventing the no-reflow phenomenon.

References

1.     Stone G.W., Grines C.L., Cox D., et al. A prospective, randomized trial comparing balloon angioplasty with or without abciximab to primary stenting with or without abciximab in acute myocardial infarction: primary endpoint analysis from the CADILLAC trial. Circulation 2000; 102: II-664 (abstract).

2.     Stone G.W., Peterson M.A., Lansky A.J., et al.. Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction. J. Am. Coll. Cardiol. 2002 Feb. 20;39(4): 591-7.

3.     Napodano M., Pasquetto G., Saccа S., et al. Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction. J. Am. Coll. Cardiol. 2003; 42: 1395-1402.

4.     Svilaas T., Vlaar PJ., Iwan C., et al. Thrombus Aspiration during Primary Percutaneous Coronary Intervention. N. Engl. J. Med. 2008; 358:557-567 February 7, 2008 DOI: 10.1056/NEJ Moa 0706416.

5.     Mahaffey K.W., Puma J.A., Barbagelata N.A., et al. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J. Am. Coll. Cardiol. 1999 Nov 15; 34(6): 1711-20.

6.     Marzilli M., Orsini E., Maraccini P., Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000; 101: 2154-59.

7.     Loubeyre C., Morice M., Lefe'vre T., et al. A Randomized Comparison of Direct Stenting With Conventional Stent Implantation in Selected Patients With Acute Myocardial Infarction. JACC. 2002:39(1): 15-21.

8.     Gibson C.M., Maehara A., Lansky AJ., et al. Rationale and design of the INFUSE-AMI study: A 2Ч2 factorial, randomized, multicenter, single-blind evaluation of intracoronary abciximab infusion and aspiration thrombectomy in patients undergoing percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction. Am. Heart. J. 2011 Mar; 161 (3): 478-486.e 7. doi: 10.1016/j. ahj. 2010.10.006. Epub 2011 Jan 28. 

Abstract:

A literature review is devoted to endovascular treatment of occlusive and stenotic lesions in arteries of femoral-popliteal segment.

Currently, 2-3% of the RF population suffer from atherosclerotic lesions of arteries of lower limbs. In the structure of cardiovascular disease, atherosclerosis of lower limbs has the level about 20%. In 82% the cause of vascular disease is atherosclerosis. In the structure of atherosclerotic arterial disease of lower limbs more often (47% to 65%) occurs defeat of the femoral-popliteal segment particularly in patients older than 60 years; that is confirmed by numerous statistical observations. The aim of the article was to compare results of endovascular treatment of arterial lesions of the femoral-popliteal segment.

This article presents results of a solo balloon angioplasty, balloon angioplasty with drug-eluting balloons, subintimal angioplasty, stenting drug-eluting and bare-metal stents, cryo-plastics,catheter atherectomy, hybrid interventions and compare results of open and endovascular interventions. Data of STAR register, published in 2001, show that the correction of lesions category C, TASC II, using balloon angioplasty is quite possible to count on similar results in category B.

According to Conrad M. et.al, Amato B. et.al and Dey C., despite the high incidence of the primary success of endovascular interventions for femoral-popliteal segment long-term results often look depressing.

Great importance is given to study the possibility of the use of drug-eluting stents, which have proven effectiveness in suppressing the inflammatory response and intimal hyperplasia after stenting of coronary arteries, as evidenced by research SIROCCO, SIROCCO II, STRIDES, Zilver PTX. Thus, the use of drug-eluting stents in the femoral-popliteal segment did not reduce the frequency of restenosis.

THUNDER, FemPac and LEVANT researches indicate that drug-eluting balloons provide some benefits that are absent in other endovascular techniques such as solo balloon angioplasty and stenting.

The final stage of a multicenter randomized trial BASIL, which carried out a comparative analysis of FPB and PTA groups, was reached in 2010. As a result, the preservation of limbs and survival did not differ significantly

Thus, the literature report reveals a clear tendency of domination of endovascular strategies in defeated limb blood-flow recovery Minimally invasive balloon angioplasty and stenting compared with results of bypass operations, reconstructions - is not worse and consider endovascular treatment strategy in the surgical treatment of femoral-popliteal segment to be method of first choice. 

References

1.     Pokrovskij A.V., Koshkin V.M., Kirichenko A.A. i dr. Vazaprostan (prostaglandin E1) v lechenii tjazhelyh stadij arterial'noj nedostatochnosti nizhnih konechnostej. [Vazaprostan (prostaglandin E1) in treatment of severe arterial insufficiency of lower limbs.] [in Russ.] Posobie dlja vrachej. M.: Medicina, 1999; 16 st.

2.     Haimovici's vascular surgery. -5th ed., p.139, 534.

3.     Zatevahin I.I., Shipovskij V.N., Zolkin V.N. Ballonnaja angioplastika pri ishemii nizhnih konechnostej. [Balloon angioplasty at ishemia of lower limbs] M.: Medicina, 2004; 83. [in Russ.]

4.     Diagnostika i lechenija bol'nyh s zabolevanijami perifericheskih arterij: rekomendacii Ros. Obshhestva angiologov i sosudistyh hirurgov. [Diagnostics and treatment of patients with peripheral arterial disease: recommendations of Rus. Society of Angiology and Vascular Surgery.] M., 2007; 135 S. [in Russ.]

5.     Norgen L., Hiatt W.R., Dormandy J.A., Nehler M.R. et. al. TASC II Working group. Inter-society consensus for the management of peripheral arterial disease (TASC II), Eur. J. Vasc. Endovasc. Surg. 2007; 33; suppl 1.

6.     Varty K., Nydahl S., Nasim A., Bolia A. et. al. Results of surgery and angioplasty for the treatment of chronic severe lower limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 1998;16:159-163.

7.     Lenti A.F. et al. Endovascular treatment of long lesions of the superficial femoral artery: Results from a multicenter registry of a spiral, covered polytetrafluoroethylene stent. J. Vasc. Surg. 2007;45:32-9.

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9.     Johnston K.W. et al. Femoral and popliteal arteries: Reanalysis of results of balloon angioplasty. Radiology 1992;183:767-771.

10.   Baril M. et al. Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions. J. Vasc. Surg. 2008; 48: 627-33.

11.   Liapis C.D., Balzer K., Benedetti-Valentini F., Fernandes e Fernandes J. European Manual of Medicine. Vascular Surgery (ed) 2007; 427-434.

12.   Becker G.J., Katzen B.T., Dake M.D. Noncoronary angioplasty Radiology. 1989; 170: 921-940.

13.   Clark T.W., Groffsky J.L., Soulen M.C. Predictors of long-term patency after femoropopliteal angioplasty: results form the STAR registry J. Vasc. Interv. Radiol. 2001; 12: 923-933.

14.   Conrad M.F., Cambria R.P., Stone D.H. Et al. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J. Vasc. Surg. 2006; 44(4): 762-769.

15.   Amato     B., Iuliano G.P., Markabauoi A.K. et.al. Endovascular proceduras in critical leg ischemia of elderly patients. Acta Biomed Ateneo Parmense. 2005: 76(1): 11-15.

16.   Dey C. Annual congress of the cardiovascular and interventional radiological society of Europe (CIRSE - 2009); Lisbon, Portugal.

17.   Duda S.H., Bosiers M., Lammer J., Scheinert D., Zeller T., Oliva V., Tielbeek A., Anderson J., Wiesinger B. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J. Endovasc. Ther. 2006; 13(6): 701-710.

18.   Dake M.D., Scheinert D., Tepe G., Tessarek J., Fanelli F., Bosiers M., http://www.ncbi.nlm.nih.gov/ pubmed?term=Ruhlmann%20C%5BAuthor%5D&cau- thor=true&cauthor_uid=21992630Kavteladze Z., Lottes A.E. et. al. Nitinol stents with polymer-free paclitaxel coating for lesions in the superficial femoral and popliteal arteries above the knee: twelve-month safety and effectiveness results from the ZilverPTX single-arm clinical study. J. Endovasc. Ther. 2011. 18(5):613-23.

19.   Diehm N.A., Hoppe H., Do D.D. Drug eluting balloons. Tech. Vasc. Interv. Radiol. 2010 Mar;13(1):59-63.

20.   Tepe G. Annual congress of the cardiovascular and interventional radiological society of Europe (CIRSE - 2011); Munich, Germany.

21.   Micari A., Cioppa A., Vadala G., Stabile E., et.al. A new paclitaxel-eluting balloon for angioplasty of femoropopliteal obstructions: acute and midterm

results. EuroIntervention. 2011. May; 7. Suppl K:K77-82.

22.   Wildgruber M.G., Berger H.J. Cryoplasty for the prevention of arterial restenosis Cardiovasc. Intervent. Radiol. 2008; 31; (6):1050-1058.

23.   Ansel G.M., SampleN.S., Botti III C.F. Jr et.al. Cutting balloon angioplasty of the popliteal and infrapopliteal vessels for symptomatic limb ischemia Catheter Cfrdiovasc. Interv. 2004; 61: 1-4.

24.   Florenes T., Bay D., Sandbaek T., Jorgensen J.J. et al. Subintimal angioplasty in the treatment of patients with intermittent claudication: long term results. Eur. J. Vasc. Endovasc. Surg. 2004; 28: 645-650.

25.   Minko P Annual congress of the cardiovascular and interventional radiological society of Europe (CIRSE - 2009); Lisbon, Portugal.

26.   Derksen W.J., Gisbertz S.S., Pasterkamp G., De Vries J.P, Moll F.L. Remote superficial femoral artery endarterectomy J. Cardiovasc. Surg.(Torino). 2008; 49(2): 193-8.

27.   Galaria I.I., Surowiec S.M., Rhodes J.M., Shortell C.K., Illig K.A., Davies M.G. Implications of early failure of superficial femoral artery endoluminal interventions. Ann. Vasc. Surg. 2005. Nov; 19(6): 787-792.

28.   Greiner A., Rantner B., Greiner K., Kronenberg F.. Schocke M., Neuhauser B., Bodner J., Fraedrich G., Schlager A. Neuropathic pain after femoropopliteal bypass surgery. J. Vasc. Surg. 2004. Jun; 39(6): 1284-1287.

29.     Forbes J.F., Adam D.J., Bell J., Fowkes F.G., Gillespie I., Raab G.M., Ruckley C.V., Bradbury A.W. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis. J. Vasc. Surg. 2010 May; 51(5 Suppl):43S-51S. 

Abstract:

Coronary flow limitation during high risk angioplasty in acute coronary syndrome (ACS) patients is an important problem, connecting with inadequate myocardial protection during the coronary intervention.

Aim: was to compare intraoperative cardiohemodynamic in ACS patients during the high risk angioplasty of difficult stenoses in anterior heart arteries with- or without a coronary venous retroperfusion support.

Methods: intervention results of 14 ACS patients were analyzed. In 1st group there were 6 patients (42,9%) with intraoperative myocardial retroperfusion support. In 2nd group - 8 patients (57,1%) without any intraoperative myocardial perfusion support.

Results: during the retroperfusion support in the 1st group , «ST»-segment elevation at 60 sec left main (LM) or left anterior descending artery (LAD) occlusion was significantly lower (ST in V4-V6 - 1,9±1,7 mm) than in patients without retroperfusion (ST in V4-V6 - 3,1±1,7; p = 0,043). In the 2nd group, patients without coronary flow support the «ST»-segment elevation at 60 sec LM or LAD occlusion was significantly higher (ST в V4-V6 - 2,5±0,5; p = 0,043) than at 5 sec LM or LAD occlusion. No significant differences between «ST»-segment and «T»-wave deviation in the beginning and in the end of intervention were in both groups. The same dynamics was demonstrated at the time of blood pressure indexes measurement.

Conclusion: coronary venous retroperfusion is an effective method of coronary flow support during the high risk angioplasty in ACS patients. Retroperfusion technology had no influence on cardiohemodynamic, but reduced the risk of intraoperative adverse cardiac events. 

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Abstract:

Article describes results of single-balloon angioplasty and stenting in patients with occlusive-stenotic lesions of femoral-popliteal segment for the period of 30 months. It was performed 209 endovascular interventions, single-balloon angioplasty in 95 patients; stenting - 114 patients. Long-term results of primary patency: 43,1% in group of single-balloon angioplasty 57,1% - in group with stenting.

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12.   Dake M., Ansel G., Jaff M., et al. Zilver PTX: a prospective, randomized trial of the polymer-free paclitax-eleluting stent compared to balloon angioplasty with provisional bare metal stenting in patients with superficial femoral artery disease (abstr). Paper presented at: Twenty-Second Annual Transcatheter Cardiovascular Therapeutics Symposium;September 21-25; Washington, DC. J. Am. Coll. Cardiol. 2010;56. 

Abstract:

Aim: was to estimate the importance of restoring blood flow in vertebral arteries in the segment V1 by stenting in patients with multivessel lesions of extracranial arteries and vertebrobasilar insufficiency (VBI).

Material and methods: study include 59 patients with a dominant, long-existing clinic of vertebrobasilar insufficiency, with multivessel lesions of brachiocephalic arteries, lower brain tolerance to ischemia, with the presence of stenosis of segment V1 of vertebral artery more than 70%, which is regarded by neurologists, as the main reason for VBI. All patients should have been undergone carotid revascularization. However, due to multivessel lesions and low perfusion reserve, all patients as the first stage of treatment - underwent stenting of V1 segment of vertebral artery. In 38 patients bare-metal stent were used, in 14 - drug-eluting stents, in 7 - renal stents. Distal protection was used in 12 patients. In remaining patients - stenting was performed without protection.

Results: in immediate postoperative period, technical, angiographic success and clinical improvement were noticed in 100% of patients. All 59 patients underwent the second and subsequent stages of cerebral revascularization without ischemic episodes. The duration of follow-up was from 6 months to 6 years. After 3 months, 55(93,2%) patients sustained clinical improvement, with no restenosis in stents. 4 patients (6,8%) had no clinical improvement: in one patient after 3 months developed ischemic stroke (IS) in vertebrobasilar system(VBS), due to the occlusion of the stent. 1 patients had stent restenosis with the increase of clinical manifestations of VBI, which required additional stenting. After 14 months, 1 patient after stenting had IS in VBS due to stent fractures caused by bone compression.

Conclusion: stenting of V1 segment of vertebral artery in patients with multivessel lesions of brachiocephalic arteries and clinic of VBI, can be considered as the first stage of cerebral revascularization in case of significant stenosis segment V1 vertebral artery and low tolerance to cerebral ischemia.

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15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240.