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Percutaneous
Transluminal
Angioplasty
Dr. Ahmed Alsharef Farah
Dr. Ahm
ed Alsharef Farah
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• Percutaneous Trans-luminal Angioplasty (PTA)is a therapeutic radiologic procedure designed todilate or reopen stenotic or occluded areaswithin a vessel using a catheter introduced bythe Seldinger technique.
Percutaneous trans-luminal angioplasty: Dr. Ahm
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• The most common form of arterial stenosistreated by trans-luminal angioplasty is causedby atherosclerosis.
• Trans-luminal angioplasty can be performedin virtually any vessel that can be reachedpercutaneously with a catheter.
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• First a guide wire is passed through thenarrowed area of a vessel.
• Then a smaller catheter is passed over the guidewire through the stenosis to begin the dilationprocess.
• Finally, a larger catheter is passed over thesmaller catheter to cause further dilation, thismethod is referred to as the "Dotter Method".
PTA using a coaxial catheter method:
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Coaxial angioplasty of atherosclerotic stenosis, " Dotter Method".
A. Guide wire advanced through stenosis.B. Small catheter advanced through stenosis.C. Large catheter advanced through stenosis.D. Post angioplasty stenotic area.
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• The double-lumen, balloon-tipped catheter.• One lumen allows the passage of a guide wire
and fluids through the catheter.The other lumen communicates with a balloonat the distal end of the catheter. When inflated,the balloon expands to a size much larger thanthe catheter.
Balloon angioplasty:
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• The balloon diameter used for a procedure isoften the measured diameter of the normalartery adjacent to the stenosis.
• After the guide wire is positioned across thestenosis, the angiographic catheter is removedover the wire.
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• The angioplasty balloon catheter is thenintroduced and directed through the Stenosisover the guide wire.The balloon is usually inflated with a dilutedcontrast medium mixture for 15 to 45 seconds,depending on the degree of stenosis and thevessel being treated. The balloon is thendeflated and repositioned or withdrawn from thelesion.
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• Contrast medium can be injected through theangioplasty catheter for a repeat angiogram todetermine whether or not the procedure wassuccessful.
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Balloon angioplasty of atherosclerotic stenosis.A. Guide wire advanced through stenosis.B. Balloon across stenosis.C. Balloon inftated.D. Postangioplasty stenotic area.
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• Balloon angioplasty can be used for dilation ofstrictures within the biliary system and alsoconducted in venous structures, ureters, andthe gastrointestinal tract.
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1. Laser-tipped angioplasty: Laser energy isdirected through a special catheter and pulsed atthe atheromatous mass to vaporize it.
2. Thermal angioplasty: A laser-heated probe isadvanced through an atheroma to recanalize thevessel lumen.
Other angioplasty technologies are used to treatatherosclerotic disease:
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• Percutaneous atherectomy is an angioplastytechnology that removes an atheroma by cuttingit.
• Compared with balloon angioplasty, thermalangioplasty creates a smoother surface so thatless restenosis occurs at the lesion site.
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• A final possibility for Percutaneous treatmentof vessel stenosis is the placement of vascularstents that is introduced through a cathetersystem and positioned across a stenosis to keepthe narrowed area spread apart.
Summary: Dr. Ahm
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• PTA is not indicated in all cases, however. Longsegments of occlusion, for example, may bebest treated by surgery.
• PTA has a lower risk than surgery but is nottotally without risk.
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• The recovery time is usually a matter of hours,and general anesthesia is normally not required.
• Therefore the hospital stay and the cost to thepatient are reduced.
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Transcatheter
Embolization
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• Transcatheter Embolization involves thetherapeutic introduction of various substances toocclude or drastically reduce blood flow withina vessel.
• Embolization is a permanent treatment, theeffects on the lesion are irreversible.
Transcatheter Embolization:
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• To stop active bleeding sites.• To control blood flow to diseased or malformed
vessels (e.g., Tumors or AVMs).• To stop or reduce blood flow to a particular area
of the body before surgery.
Main purposes for embolization: Dr. Ahm
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1. Aneurysm.2. Pseudoaneurysm.3. Hemorrhage.4. Neoplasms.5. Arteriovenous malformations (AVM).6. Arteriovenous fistula (AVF).7. Infertility (varicocele).8. Impotence due to venous leakage.9. Redistribution of blood flow.
Lesions amendable to embolization:
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• Include:1. Particulate agents.2. Metal coils.3. Liquid agents (Occluding, Sclerosing).4. Detachable balloons.5. Liquid adhesives.
Embolic agents:
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• The patient's condition and the situation must beconsidered when choosing an embolic agent.
• Many embolic agents are available, and thechoice of agent depends on whether theocclusion is to be temporary or permanent.
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• Temporary agents such as Gelfoam or avitene(Particulate agents) may be utilized as a meansto reduce the pressure head of blood to aspecific site (Chemo embolization).
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• When permanent occlusion is desired, as intrauma to the pelvis that causes hemorrhage orwhen vascular tumors are supplied by largevessels, the Gianturco stainless- steel coil maybe utilized to produce thrombogenesis.
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• This coil is simply a looped segment of guidewire with Dacron fibers attached to it.
• The coil is initially straight and is easilyintroduced into a catheter that has been placedinto the desired vessel.
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A. Hypervascular uterine fibroid.B. Post embolization, demonstrates total occlusion of both
uterine arteries (arrows).
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End of this lecture
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