90459
document
The nature and importance of changes in toe-brachial pressure indices following percutaneous transluminal angioplasty for leg ischaemia . OBJECTIVES To document changes in toe-brachial pressure indices ( TBPI ) during the 6 months following percutaneous transluminal angioplasty ( PTA ) and relate these changes to restenosis . Furthermore , to ascertain the effect of administering a vasodilator , glyceryl trinitrate ( GTN ) , immediately following PTA . DESIGN Eighty-three technically successful PTA procedures were studied . Fifty-six were for intermittent claudication , 14 for ischaemic rest pain , and 13 for non-healing ulcers . Immediately following balloon dilatation an intra-arterial bolus of either 150 micrograms GTN , with or without a 10 mg GTN patch for 24 h , or a saline placebo was administered . TBPI were measured before and for 6 h after PTA and then at 24 h , 1 week , 1 month and 6 months . At this time , patency at the PTA site was determined by arteriography . RESULTS There was continuing TBPI improvement over 1 month in patients given saline following PTA . In patients given GTN , peak TBPI was achieved by 1 week , and corresponded with the TBPI observed immediately following GTN administration . Restenosis occurred in 27 ( 33 % ) patients , and was significantly more frequent following the procedures for rest pain or ulceration , or where a TBPI increase of more than 0.15 by 1 week was observed . CONCLUSIONS Haemodynamic changes following PTA continue for at least 1 month , can be modified by GTN administration , and are predictive of subsequent restenosis . Measuring the TBPI increase during the first week following PTA underestimates total improvement , and may give false reassurance with respect to recurrent disease .
90460
Intervention_Surgical
percutaneous transluminal angioplasty
90461
Intervention_Surgical
percutaneous transluminal angioplasty ( PTA )
90462
Intervention_Pharmacological
glyceryl trinitrate ( GTN )
90463
Intervention_Surgical
PTA
90464
Intervention_Physical
balloon dilatation an intra-arterial bolus
90465
Intervention_Pharmacological
150 micrograms GTN
90466
Intervention_Physical
GTN patch
90467
Intervention_Control
saline placebo
90468
Intervention_Control
saline
90469
Intervention_Pharmacological
GTN
90470
Intervention_Pharmacological
GTN
90471
Intervention_Pharmacological
GTN
90472
Outcome_Physical
toe-brachial pressure indices ( TBPI )
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Outcome_Other
effect
90474
Outcome_Physical
TBPI
90475
Outcome_Physical
TBPI
90476
Outcome_Physical
peak TBPI
90477
Outcome_Physical
TBPI
90478
Outcome_Physical
Restenosis
90479
Outcome_Physical
TBPI
90480
Participant_Condition
PTA procedures
90481
Participant_Condition
ischaemic rest pain
90482
Participant_Condition
non-healing ulcers