European Journal of Vascular & Endovascular Surgery
Volume 17, Issue 1 , Pages 47-55, January 1999

Effect and Outcome of Balloon Angioplasty and Stenting of the Iliac Arteries Evaluated by Intravascular Ultrasound

  • K.J Vogt

      Affiliations

    • Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
  • ,
  • J.G Rasmussen

      Affiliations

    • Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
  • ,
  • S Just

      Affiliations

    • Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
  • ,
  • T.V Schroeder

      Affiliations

    • Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark

Accepted 26 June 1998.

Article Outline

Abstract 

Objectivesto document the mechanism of percutaneous transluminal angioplasty (PTA) and stenting of the iliac arteries, and to relate the effect to patency.Materials and methodsthirty-seven stenotic iliac arteries were examined by intravascular ultrasound (IVUS) and arteriography before and after PTA, and after stent deployment (n=16). The patients were followed prospectively by duplex scanning at 3, 6, 12, 18 and 24 months after the intervention.Resultsthe effect of PTA was established by both compression and stretching with the major contribution arising from stretching. There were differences in the effect of PTA dependent on plaque morphology: in homogeneous eccentric lesions, stretching contributed significantly more than compression to the luminal gain, while stretching and compression contributed equally in concentric or heterogeneous plaques. Stenting of the arteries had no effect on the free luminal area as measured by IVUS. The primary 1-year patency rate was 72%. The patency was related to the free luminal area and diameter and the heterogenicity of the plaque as evaluated by IVUS. The arteriographic measurements did not have any predictive value.ConclusionIVUS was able to document the effect of PTA and stenting in the iliac arteries, and predict the outcome. The luminal gain and reduction in degree of stenosis seemed to be accomplished primarily by stretching of the arteries and to a lesser extent by plaque compression. Stenting did not change the IVUS measurements. Patency was related to the size of the free lumen and the heterogenicity of the plaque.

Keywords: Intravascular ultrasound, Percutaneous transluminal angioplasty, Peripheral arteries, Atherosclerosis.

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Braden GA, Herrington DM, Downes TR, Kutcher MA, Little WC. Qualitative and quantitative contrasts in the mechanisms of lumen enlargement by coronary balloon angioplasty and directional coronary atherectomy. J Am Coll Cardiol. 1994;23:40–48
  2. Potkin BN, Keren G, Mintz GS. Arterial responses to balloon coronary angioplasty: an intravascular ultrasound study. J Am Coll Cardiol. 1992;20:942–951
  3. Lugt van der A, Gussenhoven EJ. Comparison of intravascular ultrasound findings after coronary balloon angioplasty evaluatedin vitro. Am J Cardiol. 1995;76:661–666
  4. Marsico F, Kubica J, De Servi S. Influence of plaque morphology on the mechanism of luminal enlargement after directional coronary atherectomy and balloon angioplasty. Br Heart J. 1995;74:134–139
  5. Marsico F, De Servi S, Kubica J. Influence of plaque composition on luminal gain after balloon angioplasty, directional atherectomy, and coronary stenting. Am Heart J. 1995;130:971–975
  6. Honey J, Mahon DJ, Jain A. Morphological effects of coronary balloon angioplastyin vivo. Circulation. 1992;85:1012–1025
  7. Lugt van der A, Gussenhoven EJ, Mali WPTM. Effect of balloon angioplasty in femoropopliteal arteries assessed by intravascular ultrasound. Eur J Vasc Endovasc Surg. 1997;13:549–556
  8. The SHK , Gussenhoven EJ, Zhong Y. Effect of balloon angioplasty on femoral artery evaluated with intravascular ultra-sound imaging. Circulation. 1992;86:483–493
  9. Lyon RT, Zarins CK, Lu C-T, Yang C-F, Glagov S. Vessel, plaque and lumen morphology after transluminal balloon angioplasty. Arteriosclerosis. 1987;7:306–314
  10. Losordo DW, Rosenfield K, Pieczek A, Baker K, Harding M, Isner JM. How does angioplasty work? Serial analysis of human iliac arteries using intravascular ultrasound. Circulation. 1992;86:1845–1858
  11. Laskey WK, Brady ST, Kussmaul WG. Intravascular ultrasonographic assessment of the results of coronary artery stenting. Am Heart J. 1993;125:1576–1583
  12. Arko F, McCollough R, Manning L, Buckley C. Use of intravascular ultrasound in the endovascular management of atherosclerotic aortoiliac occlusive disease. Am J Surg. 1996;172:546–550
  13. Mintz GS, Popma JJ, Hong MK. Intravascular ultrasound to discern device-specific effects and mechanisms of restenosis. Am J Cardiol. 1996;78(Suppl. 3A):18–22
  14. Kern MJ, Dupouy P, Drury JH. Role of coronary enlargement in improving coronary blood flow after balloon angioplasty and stenting: a combined intravascular ultrasound doppler flow and imaging study. J Am Coll Cardiol. 1997;29:1520–1527
  15. Mudra H, Klauss V, Blasini R. Ultrasound guidance of Palmaz-Schatz intracoronart stenting with a combined intravascular ultrasound balloon catheter. Circulation. 1994;90:1252–1261
  16. Cavaye DM, Tabbara MR, Kopchok GE, Termin P, White RA. Intraluminal ultrasound assessment of vascular stent deployment. Ann Vasc Surg. 1991;5:241–246
  17. Moneta GL, Yeager RA, Antonovic R. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg. 1992;15:275–284
  18. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;I:307–310
  19. Vogt KC, Just S, Rasmussen JG, Schroeder TV. Prediction of outcome of femoropopliteal balloon angioplasty by intravascular ultrasound. Eur J Vasc Endovasc Surg. 1997;13:563–568
  20. De Scheerder I, De Man F, Herregods MC, De Geest H, Piessens J. Intravascular ultrasound versus angiography for measurement of luminal diameters in normal and diseased coronary arteries. Am Heart J. 1994;127:243–251
  21. Nakamura S, Mahon DJ, Maheswaran B, Gutf inger DE, Colombo A, Tobis JM. An explanation for discrepancy between angiographic and intravascular ultrasound measurements after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 1995;21:633–639
  22. Gussenhoven EJ, van der Lugt A, Pasterkamp G. Intravascular ultrasound predictors of outcome after peripheral balloon angioplasty. Eur J Vasc Endovasc Surg. 1995;10:279–288
  23. Sapoval MR, Chatellier G, Long AL. Self-expandable stents for the treatment of iliac artery obstructive lesions: long-term success and prognostic factors. AJR. 1996;166:1173–1179
  24. Johnston KW, Rae M, Hogg-Johnston SA. Five-year results of prospective study of percutaneous transluminal angioplasty. Ann Surg. 1987;403–413
  25. Jain SP, Jain A, Collins TJ, Ramee SR, White CJ. Predictors of restenosis: a morphometric and quantitative evaluation by intravascular ultrasound. Am Heart J. 1994;128:664–673
  26. Groenningsaeter A, Lie T, Bolz K-D, Heimdal A. Ultrasonographic stent-imaging artifacts. J Vasc Invest. 1995;1:140–149
  27. Waller BF, Orr CM, Pinkerton CA, van Tassel J, Peters T, Slack JD. Coronary balloon angioplasty dissections: ««the good, the bad and the ugly»». JACC. 1992;20:701–706
  • f1 Please address all correspondence to: K. C. Vogt, Department of Vascular Surgery RK 3111, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.

PII: S1078-5884(98)90692-X

doi:10.1053/ejvs.1998.0692

European Journal of Vascular & Endovascular Surgery
Volume 17, Issue 1 , Pages 47-55, January 1999