PRINCIPLES OF ANGIOPLASTYDr.Saurabh Joshi, MD, FNVIR

www.mirainterventions.com

Charles Dotter : Father of Interventional Radiology. Performed first angioplasty using a system of serial dialators in 1964

Andreas Gruentzig : German Cardiologist. Invented the Angioplasty Balloon in 1977

SYMPTOMS OF PVD

Rutherford Classification Of PVD

Category / Grade Symptom

Category 0 Assymptomatic

Category 1 Mild Claudication

Category 2 Moderate Claudication

Category 3 Severe Claudication

Category 4 Rest Pain

Category 5 Minor Tissue Loss

Category 6 Major Tissue Loss

Risk factor modification, Exercise, Cardiovascular Rehabilitation

Medications

Intervention Necessary

MECHANISM OF ANGIOPLASTY

• Rupture of plaque and fibers in the intima and media

• Compression of plaque / thrombus

• Compression of medial layers

• Distribution of plaque / thrombus at inner surface of artery

• Overstretching of artery

STEPS OF ANGIOPLASTY

Insure the patient is on Dual Antiplatelets !!

1.Pretreatment angiography with localization of the arterial obstruction

2.Crossing the lesion with a guidewire or catheter with a flexible tip

3.Advancement of the treating catheter or instrument over the guidewire and confirming patency of runoff arteries

4.Exchange of the diagnostic catheter for the balloon catheter or stent

5.Dilation of the stenosis with the angioplasty balloon, followed by deflation

6.Completion angiography followed by treatment of runoff vessels with different balloon catheters or stents

7.Exchange of catheter materials and occlusion of the arterial puncture site by manual compression or a closure device

8.Placement of a compression bandage above the puncture site, followed by patient monitoring for a minimum of 2 hours

TASC II CLASSIFICATION

• Trans-Atlantic Inter-Society Consensus

• TASC classification gives recommendations for the management of PVD secondary to atherosclerosis affecting the lower limbs.

TASC FOR AORTOILIAC DISEASE

TASC D Lesion

TASC FOR FEMORO-POPLITEAL DISEASE

TASC A LESION

TASC B Lesion

TASC C LESION

TASC FOR INFRAPOPLITEAL DISEASE

Angiography showed tight stenosis of tibio peroneal trunk and origins of peroneal and Posterior tibial arteries.

Angioplasty performed using dedicated Tibial balloon.

Post angioplasty angiogram showing good forward flow with no residual stenosis

• Thank You !