Balloon angioplasty can cause shear stress and tear of the vascular endothelium during mechanical dilatation, leading to increased inflammation and coagulation reactions of the vascular endothelium. Herein, a worst case of active rheumatoid vasculitis is described, where due to progressing ischemic necrosis of the leg, endovascular intervention was unavoidably performed in the presence of active rheumatoid vasculitis. After percutaneous balloon angioplasty, the patient developed recurrent thrombotic occlusion of the leg arteries, and finally, limb amputation resulted in despite vigorous treatment including medication, immunosuppression, catheter-directed thrombolysis, and post-thrombolysis anticoagulation. This case report indicates that endovascular intervention may be detrimental to the active rheumatoid vasculitis. Until the development of treatment guideline to prevent or control inflammatory reaction, endovascular intervention for the active rheumatoid vasculitis may not be appropriate as a first line therapy even though there is progressing ischemic necrosis.
Amputation ; Angioplasty, Balloon ; Arteries ; Dilatation ; Endothelium, Vascular ; Extremities ; Humans ; Immunosuppression ; Inflammation ; Leg ; Necrosis ; Rheumatoid Vasculitis ; Tears ; Thrombosis

BACKGROUND AND OBJECTIVES: We investigated the effectiveness of balloon dilatation of homograft conduits in the pulmonary position in delaying surgical replacement. SUBJECTS AND METHODS: We reviewed the medical records of patients who underwent balloon dilatation of their homograft in the pulmonary position from 2001 to 2015. The pressure gradient and ratio of right ventricular pressure were measured before and after the procedure. The primary goal of this study was to evaluate the parameters associated with the interval to next surgical or catheter intervention. RESULTS: Twenty-eight balloon dilations were performed in 26 patients. The median ages of patients with homograft insertion and balloon dilatation were 20.3 months and 4.5 years, respectively. The origins of the homografts were the aorta (53.6%), pulmonary artery (32.1%), and femoral vein (14.3%). The median interval after conduit implantation was 26.7 months. The mean ratio of balloon to graft size was 0.87. The pressure gradient through the homograft and the ratio of right ventricle to aorta pressure were significantly improved after balloon dilatation (p<0.001). There were no adverse events during the procedure with the exception of one case of balloon rupture. The median interval to next intervention was 12.9 months. The median interval of freedom from re-intervention was 16.6 months. Cox proportional hazards analysis revealed that the interval of freedom from re-intervention differed only according to origin of the homograft (p=0.032), with the pulmonary artery having the longest interval of freedom from re-intervention (p=0.043). CONCLUSION: Balloon dilatation of homografts in the pulmonary position can be safely performed, and homografts of the pulmonary artery are associated with a longer interval to re-intervention.
Allografts* ; Angioplasty, Balloon ; Aorta ; Catheters ; Dilatation* ; Femoral Vein ; Freedom ; Heart Ventricles ; Humans ; Medical Records ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Rupture ; Transplants ; Ventricular Pressure

A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patient's nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patient's postoperative course was uneventful.
Aged ; Arrhythmias, Cardiac ; Constriction, Pathologic* ; Dilatation ; Double-Balloon Enteroscopy ; Edema ; Enteritis* ; Fibrosis ; Hemosiderin ; Hospitalization ; Humans ; Ileum ; Ileus ; Intestines ; Ischemia ; Mucous Membrane ; Nutritional Status ; Ulcer ; Vomiting

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels* ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction* ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis*

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis ; Liver ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis

Transcatheter treatment of aortic coarctation, with balloon angioplasty or stent implantation, is now an acceptable alternative to surgical repair. However these procedures may result in complications, such as vascular wall injury and re-stenosis of the lesion. A nitinol self-expandable stent, when deployed at the coarctation site, produces low constant radial force, which may result in a gradual widening of the stenotic lesion leaving less tissue injury ('stretching rather than tearing'). For an adolescent with a native aortic coarctation, a self-expandable stent of 20 mm diameter was inserted at the discrete stenotic lesion of 5 mm diameter without previous balloon dilatation procedure. No further balloon dilatation was done immediately after the stent insertion. With the self-expandable stent only, the stenosis of the lesion was partially relieved immediately after the stent deployment. Over several months after the stent insertion, gradual further widening of the stent waist to an acceptable dimension was observed.
Adolescent ; Angioplasty, Balloon ; Aortic Coarctation ; Constriction, Pathologic ; Dilatation ; Humans ; Stents

Extrinsic compression of the left main coronary artery (LMCA) secondary to pulmonary artery dilatation is a rare syndrome. Most cases of pulmonary artery hypertension but no atherosclerotic risk factors rarely undergo coronary angiography, and hence, diagnoses are seldom made and proper management is often delayed in these patients. We describe a patient that presented with pulmonary hypertension, clinical angina, and extrinsic compression of the LMCA by the pulmonary artery, who was treated successfully by percutaneous coronary intervention. Follow-up coronary angiography showed patent stent in the LMCA in the proximity of the dilated main pulmonary artery. This case reminds us that coronary angiography and percutaneous coronary intervention should be considered in pulmonary hypertension patients presenting with angina or left ventricular dysfunction.
Angina Pectoris/etiology ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Stenosis/radiography/therapy ; Coronary Vessels/radiography/*ultrasonography ; Dilatation, Pathologic ; Female ; Humans ; Hypertension, Pulmonary/etiology/radiography ; Middle Aged ; Pulmonary Artery/radiography/*ultrasonography ; Stents ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left

There is no current guideline for percutaneous coronary angioplasty in stenotic ectatic coronary arteries because of the heterogeneity of the coronary artery morphology. We report two successful angioplasty cases in coronary artery ectasia with different clinical scenarios. One case showed atherosclerotic stenosis in the ectatic portion of the right coronary artery that was aggravated after a coronary artery bypass graft. In this case, balloon angioplasty alone without stenting showed acceptable results at the 6-month follow-up coronary angiography. In the other case, we used a peripheral artery balloon and stent for stenosis in the ectatic portion of a large coronary artery. Six-month follow-up coronary angiography showed excellent patency of the previously implanted peripheral stent.
Angioplasty ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Dilatation, Pathologic ; Follow-Up Studies ; Humans ; Population Characteristics ; Stents ; Transplants

Intestinal lymphangiectasia (IL) is a rare disorder, characterized by dilatation of intestinal lymphatics and leakage from ruptured lacteals to the intestinal lumen. Primary IL may be due to a congenital malformation of the lymphatic system, whereas secondary IL is caused by decreased lymph flow from thoracic ductsdue to elevated left subclavian vein pressure as a result of a preceding inflammatory or neoplastic disease. IL can present as protein-losing enteropathy with clinical manifestations of hypoproteinemia, hypoalbuminemia, edema, ascites, or pleural effusions. In very rare cases, it can present as severe intestinal bleeding. We experienced a 48-year-old woman presenting with recurring hematochezia and melena. She was diagnosed bydouble balloon enteroscopy, and surgical resection was needed to stop bleeding. In conclusion, IL can present clinically as painless chronic blood loss. If IL is locally distributed, surgical resection may be needed to control bleeding and to exclude other underlying causes in some patients.
Ascites ; Dilatation ; Double-Balloon Enteroscopy ; Edema ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Lymphatic System ; Melena ; Middle Aged ; Pleural Effusion ; Protein-Losing Enteropathies ; Subclavian Vein

BACKGROUND/AIMS: Endoscopic papillary balloon dilation (EPBD) is a safe and effective method for the treatment of choledocholithiasis, but previous studies have rarely reported the appropriate ballooning time (BT). We prospectively evaluated the safety and efficacy of EPBD according to BT in patients undergoing bile duct stone removal. METHODS: Seventy consecutive patients with bile duct stones were randomly assigned to receive EPBD with either conventional (n = 35, 60 seconds) or short (n = 35, 20 seconds) BT. RESULTS: EPBD alone achieved complete bile duct clearance in 67 patients (long BT, n = 33, 94.3%; short BT, n = 34, 97.1%; p = 0.808). We also found no significant difference in the rate of complete duct clearance, including procedures that used mechanical lithotripsy, between the long and short BT groups (97.1% vs. 100%; p = 0.811). Mild pancreatitis was noted in four (11.4%) patients in the long BT group and two (5.7%) patients in the short BT group, but this incidence was not significantly different. CONCLUSIONS: The study showed that EPBD using both 20-sec and 60-sec BTs is safe and effective for the treatment of bile duct stones. Short and long BTs produced comparable outcomes.
Aged ; Aged, 80 and over ; Balloon Dilatation/adverse effects/*methods ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis/radiography/*therapy ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Treatment Outcome