In Reply to: 597 07 -- PTA of a femoral-posterior tibial graft stenosis posted by Editor on May 15, 1997 at 16:59:58:
This case demonstrates our ability to deal with distal vascular
problems, something that the vascular surgeouns are reluctant to
give us credit for. In our institution the vascular surgeons would
never allow us to deal with a problem like this. If you're never
given a chance, how can you show your ability?
There are two possible mechanisms for the lesion demonstrated in this
case: 1. Progression of atherosclerosis. 2. Intimal hyperplasia.
I believe that atherosclerosis would respond better to angioplasty
compared to intimal hyperplasia and this, perhaps, was the reason for
your success in this case. In cases where there is thrombus in addition
to the underlying lesion, an over-the-wire thrombectomy (technology
that is becoming available) may be beneficial. Our interventional
cardiology friends have a lot of success with small short stents in
the coronary arteries. Perhaps this approach with small Wallstents
could work in distal vessels. I believe that brachytherapy holds a lot
of promise as a strategy against restenosis due to intimal hyperplasia.
In summary, I think that we have a lot to offer in the distal vessels,
but getting the patients is the major hurdle.