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Monastiriotis S, Loh S, Tassiopoulos A, Labropoulos N. Clinical characteristics and outcome of isolated infrarenal aortic stenosis in young patients. J Vasc Surg 2018; 67:1143-1149. [DOI: 10.1016/j.jvs.2017.07.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
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Abstract
Patients with aortoiliac occlusive disease (AIOD) may be asymptomatic or may have intermittent claudication or critical limb ischemia. Treatment options for AIOD include management of risk factors, endovascular intervention, and/or surgical revascularization.
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Affiliation(s)
- Melissa J Neisen
- Minneapolis Vascular Physicians, Minneapolis Radiology Associates, Plymouth, Minnesota
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Poncyljusz W, Falkowski A, Garncarek J, Karasek M, England S, Zawierucha D. Primary stenting in the treatment of focal atherosclerotic abdominal aortic stenoses. Clin Radiol 2006; 61:691-5. [PMID: 16843753 DOI: 10.1016/j.crad.2006.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 03/20/2006] [Accepted: 04/12/2006] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the results of primary stent placement in focal atherosclerotic aortic stenoses using balloon expandable stents. MATERIALS AND METHODS Twenty-six primary balloon expandable stent placements in the abdominal aorta were performed and reviewed. All the aortic stenoses were atherosclerotic. Patients were followed up by ankle/brachial pressure indices (ABPI) and Doppler ultrasound (US) at 24h after procedure and at 12 and 24 months. Follow-up angiograms were performed at 12 months. RESULTS Twenty-six stents in 26 patients were placed in the infrarenal aorta. All procedures were technically successful and immediate clinical success was obtained. The mean ABPI significantly improved from 0.52+/-0.10 to 0.94+/-0.09 within 24h after procedure, and remained at 0.90+/-0.12 between 12 and 24 months follow-up (mean 18 months). There was full haemodynamic success at hospital discharge and at 12 and 24 months after the procedure. Clinical success at 12 and 24 months (mean 18 months) was defined as an improvement in the Fontaine classification by at least one class compared with the pre-procedure class and was shown to be 100%. CONCLUSION In summary, we report that primary stenting is a safe and effective alternative to surgery in cases of symptomatic stenosis of the infrarenal abdominal aorta. The excellent intermediate term results suggested that we would recommend primary stenting as the treatment of choice for focal atherosclerotic stenoses of the infrarenal aorta in selected patients.
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Affiliation(s)
- W Poncyljusz
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University of Szczecin, SPSK-1, Unii Lubelskiej 1, 71-252, Szczecin, Poland.
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Simons PCG, Nawijn AA, Bruijninckx CMA, Knippenberg B, de Vries EH, van Overhagen H. Long-term results of primary stent placement to treat infrarenal aortic stenosis. Eur J Vasc Endovasc Surg 2006; 32:627-33. [PMID: 16859934 DOI: 10.1016/j.ejvs.2006.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 05/11/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease. DESIGN Retrospective observational study. PATIENTS AND METHODS From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39-80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions. RESULTS Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1-86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years. CONCLUSION Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates.
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Affiliation(s)
- P C G Simons
- Department of Radiology, HAGA Hospital, Hague, The Netherlands.
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Schedel H, Wissgott C, Rademaker J, Steinkamp HJ. Primary Stent Placement for Infrarenal Aortic Stenosis: Immediate and Midterm Results. J Vasc Interv Radiol 2004; 15:353-9. [PMID: 15064338 DOI: 10.1097/01.rvi.0000121411.46920.27] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the safety and the long-term clinical and hemodynamic results of primary stent placement of atherosclerotic calcified stenosis of the infrarenal aorta. MATERIAL AND METHODS Between July 1996 and July 1999, 15 patients (nine male, si- female; mean age, 53.9 years) with symptomatic, calcified aortic stenosis were treated with primary stent placement. Patients underwent abdominal aortography and bilateral lower extremity arteriography. Follow-up was performed in all 15 patients. Technical success was defined as residual stenosis of less than 30% or a resting trans-systolic pressure gradient of less than 10 mm Hg after stent placement. Clinical patency was defined as the absence or improvement of symptoms after stent placement. Hemodynamic patency was defined as a normal triphasic Doppler waveform in the common femoral artery, an ankle-brachial index greater than 0.90, or the absence of a thigh-brachial pressure gradient at rest in either limb. RESULTS Technical success was achieved in 13 of 15 patients. The two patients considered to be technical failures had resting trans-systolic pressure gradients of 12 and 13 mm Hg, respectively, after stent placement. After the mean follow-up of 36 months, primary clinical and hemodynamic patency rates were 85% and the secondary hemodynamic patency rate was 100%. Two of five symptomatic recurrences during the 36-month follow-up period (range, 12-46 months) were a result of aortic restenosis and were treated with repeated percutaneous transluminal angioplasty. None of the patients required aortic surgery. Complications of the primary procedure included one puncture site infection, one pseudoaneurysm, and one distal embolization, which delayed discharge of three patients. There was no morbidity during the secondary interventions. CONCLUSION Primary stent placement as treatment of calcified infrarenal aortic stenosis proved to be safe and also provided durable long-term clinical improvement.
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Affiliation(s)
- Hannes Schedel
- Reha-Klinik, Kellberg bei Passau, Department of Radiology, Berlin, Germany
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Yilmaz S, Sindel T, Yeğin A, Erdoğan A, Lüleci E. Primary Stenting of Focal Atherosclerotic Infrarenal Aortic Stenoses: Long-Term Results in 13 Patients and a Literature Review. Cardiovasc Intervent Radiol 2004; 27:121-8. [PMID: 15259805 DOI: 10.1007/s00270-003-2724-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 +/- 9.1 years (mean +/- SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 +/- 23 months (mean +/- SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta.
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Affiliation(s)
- Saim Yilmaz
- Department of Radiology, Akdeniz University School of Medicine, Arapsuyu, Antalya, Turkey.
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Stoeckelhuber BM, Meissner O, Stoeckelhuber M, Wiesmann M, Kueffer G. Primary Endovascular Stent Placement for Focal Infrarenal Aortic Stenosis: Initial and Midterm Results. J Vasc Interv Radiol 2003; 14:1443-7. [PMID: 14605111 DOI: 10.1097/01.rvi.0000096768.74047.1e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objectives of this retrospective study were to determine the technical success, safety, and midterm results of primary stent placement of infrarenal aortic stenosis. Eight stenoses and one occlusion were treated with stent placement after balloon pre-dilation. Primary technical success was achieved in all patients. Five patients showed reperfusion or restored normal direction of flow of the inferior mesenteric artery. No complications occurred. There was a mean follow-up of 12 months (range, 3-20 months). Primary clinical and hemodynamic patency rates were 100% on follow-up examinations. Stent placement after balloon pre-dilation in properly selected patients with isolated infrarenal aortic stenosis is a promising durable treatment.
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Affiliation(s)
- Beate Maria Stoeckelhuber
- Department of Radiology, Universitätsklinikum der Medizinischen Universität zu Lübeck, Lübeck, Germany.
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Feugier P, Toursarkissian B, Chevalier JM, Favre JP. Endovascular Treatment of Isolated Atherosclerotic Stenosis of the Infrarenal Abdominal Aorta: Long-term Outcome. Ann Vasc Surg 2003; 17:375-85. [PMID: 14670015 DOI: 10.1007/s10016-003-0022-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this multicenter study was to assess the long-term outcome of endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta on the basis of clinical and ultrasound examination. Clinical, ultrasound, and angiographic findings from 36 women and 50 men (mean age, 53.2 years) treated for atherosclerotic stenosis of the infrarenal abdominal aorta were reviewed. Patients had claudication in 74 cases and rest pain in 4. Seven patients presented trophic manifestations and one had blue toe syndrome. Mean preoperative systolic index was 0.71. Mean diameter reduction was 77%. Circumferential calcification was partial in 36 cases (41%) and complete in 30 cases (35%). Percutaneous transluminal angioplasty was performed using the single-balloon technique in 60 cases and double-balloon technique in 26 cases. A stent was placed in 76 cases (88%) by necessity in 34% of cases (22 residual stenoses, 4 dissections). Completion angiographic findings were considered good in 82 cases (95%). The remaining four patients had residual stenosis with a diameter reduction >30%. One patient died during the immediate postoperative period from septicemia unrelated to treatment (early mortality, 1.2%). Aortic angioplasty was complicated by stent detachment from the angioplasty balloon in two patients, retroperitoneal hematoma in one, peripheral embolism in two, puncture-site hematoma in three, myocardial infarction in one, and thrombophlebitis of deep femoral artery in one patient (early morbidity, 9.3%). All patients underwent follow-up with clinical and hemodynamic evaluation (mean follow-up, 31 months). Actuarial survival at 3 years was 91%. Primary actuarial patency was 94% at 1 year, 89% at 3 years, and 77% at 5 years. Aortic restenosis occurred in seven patients and was treated by angioplasty in two, aortobifemoral bypass in four, and surveillance in one. Mean systolic index was 0.89. Statistical analysis of patency demonstrated no factor predictive of long-term complication. From the long-term follow-up findings in this study, we conclude that aortic angioplasty is a reliable minimally invasive technique for treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta.
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d'Othée BJ, Haulon S, Mounier-Vehier C, Beregi JP, Jabourek O, Willoteaux S. Percutaneous endovascular treatment for stenoses and occlusions of infrarenal aorta and aortoiliac bifurcation: midterm results. Eur J Vasc Endovasc Surg 2002; 24:516-23. [PMID: 12443747 DOI: 10.1053/ejvs.2002.1751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE evaluation and comparison of the endovascular treatment of isolated aortic and aortoiliac atherosclerotic lesions (stenoses and occlusions). METHODS a percutaneous endovascular procedure was performed in 52 patients (38 men and 14 women) with a mean age of 52 years (range, 25-85 years). The baseline angiogram showed 35 aortic lesions (31 stenoses, 4 occlusions) and 17 aortoiliac lesions (14 stenoses, 3 occlusions). Percutaneous techniques used in this series included variable combinations of transluminal angioplasty and stenting. All stents placements were performed over-the-wire using the transfemoral route (most often bilateral approach). Clinical examination and Duplex-scan were performed at discharge, 1 month, 6 months, 12 months, and then yearly. RESULTS technical success was 100% for aortic and aortoiliac lesions. Angiographic success rates were comparable for aortic (91%) and aortoiliac (94%) lesions. No death occurred during or early after the endovascular intervention. Duplex-scan confirmed 100% patency rate at discharge. There was no significant difference between the aortic (94%) and aortoiliac (96%) groups regarding immediate clinical improvement. Mean follow-up was 34+/-31 months (range, 0-130 months). The cumulative primary patency rate at 36 months was 85% in the aortic group and 86% in the aortoiliac group. Clinical success, defined as a symptom-free status at the end of follow-up, was also similar in both groups. CONCLUSION endovascular treatment of isolated aortic lesions of the infra-renal aorta has favorable outcomes comparable to those of aortoiliac lesions.
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Affiliation(s)
- B J d'Othée
- Department of Vascular Radiology, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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AL-MUBARAK NADIM, LIU MINGW, DEAN LARRYS, AL-SAIF SHUKRIM, AL-SHAIBI KHALIDF, TYER SIRAMS, ROUBIN GARYS. Primary Stenting of Infrarenal Abdominal Aortic Stenoses: A Report of Seven Cases and Review of the Literature. J Interv Cardiol 2000. [DOI: 10.1111/j.1540-8183.2000.tb00273.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Elkouri S, Hudon G, Demers P, Lemarbre L, Cartier R. Early and long-term results of percutaneous transluminal angioplasty of the lower abdominal aorta. J Vasc Surg 1999; 30:679-92. [PMID: 10514207 DOI: 10.1016/s0741-5214(99)70107-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the early and long-term results of percutaneous transluminal angioplasty (PTA) of atherosclerotic lower abdominal aorta stenosis. METHODS This study was performed as a retrospective study. From 1980 to 1997, 46 patients with chronic lower limb ischemia with moderate to severe claudication as the result of isolated infrarenal disease or aortoiliac disease underwent PTA. All patients underwent angiography before and after angioplasty and Doppler ultrasound scan examination with ankle-brachial index determination. No stents were used. RESULTS The technical success rate was 96% (44 of 46 cases). Thirty-eight patients (83%) immediately showed clinical, hemodynamic, and angiographic improvement. The initial success rate for patients with isolated infrarenal or bifurcation disease was 92%, whereas it was 71% for aortoiliac disease. Among the eight patients with no initial improvement, four had clinical deterioration and two required emergency surgical revascularization. There were no other complications. Fifty-six percent of the patient conditions (95% confidence interval [CI], 38% to 74%) remained clinically improved at the 5-year follow-up examination. Recurrence of symptoms was caused by femoropopliteal disease in most patients. The primary patency rate assumed with maintenance of hemodynamic improvements was 70% (95% CI, 52% to 88%) and 64% (95% CI, 44% to 84%) at 4 and 5 years of follow-up, respectively. The primary patency rate at 4 years for patients with isolated infrarenal or bifurcation disease was 83% (95% CI, 64% to 100%), whereas it was 55% for aortoiliac disease (95% CI, 30% to 80%; P =.06) The variables that were statistically predictive of patency failure were poor runoff (P =. 01) and presence of aortoiliac atherosclerotic disease (P =.04). CONCLUSION Our results suggest that PTA is an excellent treatment for chronic arterial insufficiency of the lower extremities as the result of isolated atherosclerotic lower abdominal aortic occlusive lesions because of good long-term patency. Aortic PTA for those patients with iliac involvement or with poor runoff gives acceptable results but carries lower patency and clinical success rates.
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Affiliation(s)
- S Elkouri
- Department of Cardiovascular Surgery, Montreal Heart Institute, Québec, Canada
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Westcott MA, Bonn J. Comparison of conventional angioplasty with the Palmaz stent in the treatment of abdominal aortic stenoses from the STAR registry. SCVIR Transluminal Angioplasty and Revascularization. J Vasc Interv Radiol 1998; 9:225-31. [PMID: 9540904 DOI: 10.1016/s1051-0443(98)70261-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To retrospectively compare the safety and short-term efficacy of conventional percutaneous transluminal angioplasty (PTA) and PTA with the Palmaz balloon-expandable intravascular stent for the treatment of infrarenal abdominal aortic atherosclerotic stenoses. PATIENTS AND METHODS The records of 25 patients with infrarenal aortic stenoses treated by means of percutaneous techniques were retrieved from the SCVIR Transluminal Angioplasty and Revascularization (STAR) Registry and analyzed. Thirteen patients were treated with PTA alone and 12 were treated with the Palmaz intravascular stent. RESULTS Technical success was achieved in 92% of patients treated with PTA alone and in 100% of those treated with the Palmaz stent. Significant improvements in lesion morphology, hemodynamics, clinical status, and ankle arm indexes were shown in both groups. There was no statistically significant difference in percent stenosis reduction, decrease in trans-stenotic gradient, or initial clinical outcome between the group treated by means of PTA and the group treated by means of PTA with the Palmaz stent. CONCLUSIONS PTA and intravascular stent placement of atherosclerotic stenoses involving the infrarenal aorta are both safe and efficacious therapeutic modalities. At present, it does not appear that primary stent placement confers any short-term benefits over technically successful PTA in aortic stenoses.
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Affiliation(s)
- M A Westcott
- Thomas Jefferson University Hospital, Division of Cardiovascular and Interventional Radiology, Philadelphia, Pennsylvania, USA
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Wiskirchen J, Duda SH, Steger V, Schott U, Ziemer G, Claussen CD. Suture-mediated percutaneous closure of the arterial puncture site after abdominal aortic stent implantation. MINIM INVASIV THER 1998. [DOI: 10.3109/13645709809152875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hedeman Joosten PP, Ho GH, Breuking FA, Overtoom TT, Moll FL. Percutaneous transluminal angioplasty of the infrarenal aorta: initial outcome and long-term clinical and angiographic results. Eur J Vasc Endovasc Surg 1996; 12:201-6. [PMID: 8760983 DOI: 10.1016/s1078-5884(96)80107-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Report of 1-8 year follow-up of patients treated by percutaneous transluminal angioplasty (PTA) for obstructive atherosclerosis of the infrarenal aorta. DESIGN Cohort study. MATERIALS Thirty-eight patients aged 26-81 years (mean 50 years) were submitted to undergo percutaneous transluminal angioplasty of the infrarenal aorta. All patients had symptomatic isolated stenotic lesions of the aorta located below the renal arteries and above the bifurcation. Stenoses at bifurcation-level and the iliac arteries were excluded. METHODS PTA of the aorta was performed under local anaethesia in the radiological department. Clinical symptoms and ankle/brachial indices were registered before, directly after the procedure and at follow-up. Angiography was performed in all patients pre- and post-procedure, and at follow-up. All patients received angiography in March 1995. Clinical data were analysed based on intention-to-treat. RESULTS Initial clinical and angiographic success was achieved in 36 patients (94%). Mean follow-up was 34 months (range 1-92). Recurrent stenosis was seen in seven patients (19%) at follow-up. Only five (13%) of these had recurrent symptoms and were treated successfully with a second PTA. No major complications were seen. CONCLUSION These results show PTA to be a safe, minimally-invasive and effective alternative to surgery in case of symptomatic stenosis of the infrarenal abdominal aorta.
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Affiliation(s)
- P P Hedeman Joosten
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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