Brachytherapy for prophylaxis of restenosis after long-segment femoropopliteal angioplasty: pilot study.
OBJECTIVE
To evaluate in a pilot study the feasibility and efficacy of endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA) without stent implantation in a group of patients with a high risk of restenosis.


METHODS
Ten patients (six women, four men; mean age, 68 years) with long-segment (mean length, 16 cm; range, 9-22 cm) restenosis underwent PTA followed by endovascular irradiation with high-dose-rate afterloading of an iridium-192 rod. A dose of 12 Gy was targeted to the inner intimal layer of the vessel. Follow-up examinations until 12 months after PTA included measurement of the ankle-brachial index, color duplex ultrasonography (US) with calculation of the peak velocity ratio, and intraarterial angiography when recurrence was suspected.


RESULTS
Irradiation was technically feasible in all patients without complications. In six patients, the dilated and irradiated segment remained widely patent at color US, with corresponding excellent hemodynamic and clinical results after 12 months. In four patients, clinical and laboratory findings indicated recurrence and arteriography demonstrated restenosis with a diameter reduction of 60%, 70%, 80%, or 90%.


CONCLUSIONS
Considering the negative selection of patients with a high risk of restenosis, the results of our pilot study are promising concerning the possibility of reduction of restenosis by means of endovascular brachytherapy after long-segment femoropopliteal PTA without stent implantation. The value of this approach should now be determined definitively in randomized trials.
Minar
E
E
Department of Medical Angiology, University Clinic Vienna, General Hospital Vienna, Austria.
Pokrajac
B
B
Ahmadi
R
R
Maca
T
T
Seitz
W
W
Stümpflen
A
A
Pötter
R
R
Ehringer
H
H
D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000628:therapy; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001918:Brachytherapy; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000528:radiation effects*; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000528:radiation effects*; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D017539:Tunica Intima / Q000528:radiation effects; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
D007496:Iridium Radioisotopes; D019275:Radiopharmaceuticals