As the techniques for endovascular treatment of aortic bifurcation disease become more widely known, it is not enough for interventional radiologists (IR) to be merely technically excellent at the procedural aspects of this important intervention. They must also become expert at managing the patient, and establishing direct contact not only with the patient, but also with the patient’s primary doctor, usually their general practitioner. Younger IR physicians may have not had the opportunity to perform as many arterial catheter studies as their grayer counterparts for two main reasons: the shift towards non-invasive studies (US/CTA/MRA), and the encroachment of other specialties on the endovascular field of play. This is not a cause for despair. If you offer the best service, with the best results, you will, in time, get the referrals. However, you must be prepared to offer more than a glorified angiography service: critical to this is the establishment of an Interventional Radiology Clinic, as this then becomes the target for referrals from a variety of other specialties.

Endovascular management of aorto-iliac occlusive disease

OBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7%). The neointimal hyperplasia volume ranged from 49.02 mm3 to 112.87 mm3 (mean, 80.33 mm3). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors.

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Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico

quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7%). The neointimal hyperplasia volume ranged from 49.02 mm 3 to 112.87 mm 3 (mean, 80.33 mm 3 ). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors.

Volumetric assessment of neointimal hyperplasia in iliac arteries after metal stent implantation* Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico

L. Pedrini

Papers

Considerations about TASC II: is it a suitable document for specialists?