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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2002 December;9(4):347-55

language: English, Italian

Percutaneous transluminal angioplasty stent implantation and intravascular high dose rate brachytherapy in femoro-popliteal arteries

Boselli G. 1, Benincasa A. 1, Lò G. 1, Casali G. 1, Tusini N. 1, Vecchiati E. 1, Armaroli L. 2

1 Unit of Vascular Surgery
2 Unit of Radiotherapy Azienda Osped­a­liera A.S.M.N., ­Reggio ­Emilia


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Back­ground. Resten­osis ­remains a ­major ­problem ­after per­cut­aneous trans­lu­minal angio­plasty of cor­o­nary and periph­eral ­arteries. Arte­rial ­response to PTA-­stenting, ­because of myoin­timal ­cell pro­life­ra­tion and ­intimal hyper­plasia, ­causes resten­osis and re-ob­struc­tion of ­femoro-pop­li­teal seg­ments in 40% of ­cases. Ion­izing radi­a­tion to con­trol ­intimal pro­life­ra­tion is ­known and has ­been ­recently ­applied to endo­vas­cular sur­gery. We ­report our expe­ri­ence ­with endo­vas­cular 192Ir ­high ­dose ­rate bra­chy­therapy.
­Methods. ­From ­June 1999 to Sep­tember 2001 we ­treated 24 ­single or mul­tiple occlu­sions and 21 ste­noses of ­femoro-pop­li­teal ves­sels in 45 non­ran­dom­ized ­patients (20 in Fon­taine ­stage 3 or 4, 21 in ­stage 2b). Imme­di­ately ­after the endo­vas­cular pro­ce­dure, ­patients ­received endo­vas­cular 192Ir HDR bra­chy­therapy (1400 cGy).
­Results. Imme­diate ­results of arte­rial ­patency ­were 95%, ­with no mor­bidity or mor­tality; ­long-­term ­patency was ­achieved in 80% ­versus 72% in an anal­o­gous ­series ­without bra­chy­therapy.
Con­clu­sions. Endo­vas­cular 192Ir HDR bra­chy­therapy was ­found to be ­safe and fea­sible. ­Long-­term ­results of arte­rial ­patency ­seem to be prom­ising. ­More ­studies are ­needed to dem­on­strate treat­ment effi­cacy in the pre­ven­tion of resten­osis.

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