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Percutaneous
Transluminal
Angioplasty
Dr. Ahmed Alsharef Farah
Dr. Ahm
ed Alsharef Farah
1
• 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
ed Alsharef Farah
2
• 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.
Dr. Ahm
ed Alsharef Farah
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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:
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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:
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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 The balloon is thendeflated and repositioned or withdrawn from thelesion.
Dr. Ahm
ed Alsharef Farah
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• Contrast medium can be injected through theangioplasty catheter for a repeat angiogram todetermine whether or not the procedure wassuccessful.
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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:
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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Dr. Ahm
ed Alsharef Farah
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Transcatheter
Embolization
Dr. Ahm
ed Alsharef Farah
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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:
Dr. Ahm
ed Alsharef Farah
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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
ed Alsharef Farah
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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:
Dr. Ahm
ed Alsharef Farah
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• Include:1. Particulate agents.2. Metal coils.3. Liquid agents (Occluding, Sclerosing).4. Detachable balloons.5. Liquid adhesives.
Embolic agents:
Dr. Ahm
ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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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ed Alsharef Farah
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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.
Dr. Ahm
ed Alsharef Farah
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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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ed Alsharef Farah
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A. Hypervascular uterine fibroid.B. Post embolization, demonstrates total occlusion of both
uterine arteries (arrows).
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ed Alsharef Farah
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End of this lecture
Dr. Ahm
ed Alsharef Farah
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