PTA is an Outpatient Procedure

Dotter and Judkins in 1964, the Dotter set was a combination of 8 and 12 Fr coaxial Teflon catheters. Under these conditions, which involved the risk of severe afterbleeding, possible pulsating hematomas, av-fistulas and acute rethromboses in the groin arteries, it was more than reasonable to perform interventional radiological procedures instead of vascular surgery only under stationary conditions in the hospital, with follow-up controls for at least 2–3 days. T o keep the puncture hole as small as possible, single Teflon catheters tapered from 5 to 9 Fr, varying in size, were used. , 5 At that time, between December 1968 and November 1971, our primary success rate was 79.7%. Reobliterations occurred within 14 days for 10% of these cases. Vascular surgery for acute rethrombosis was necessary in one patient. When using the caged balloon catheter, or Fogarty balloon catheter in addition to the coaxial Dotter set, the primary success in iliac artery stenoses was 78%, under angiographic and ankle pressure control. C o m p l i c a t i o n s occurred in 11.7% of the 128 patients in the treatment of femoropopliteal obliterations. Two developed a pulsating hematoma, or false aneurysm at the puncture site, which required vascular surgery, and one patient needed vascular surgery after rethrombosis in the groin. Between the 8 and 12 Fr catheters, we found intima, media and atheromata with the risk for peripheral embolization. Over the following years, the technique was refined. First, all patients received acetylsalicylic acid (ASA) as a thrombocyte aggregation inhibitor, in dosages between 1 and 1.5 g per day, before and after PTA. At the time of the procedure, each patient received 5,000 I.U. of heparin. During the following period of time there was some uncertainty as to whether patients should be treated only with aspirin, or with anticoagulation using Coumadin over a longer period — 6 months at a minimum — following the interventional measure. The technique was further refined with the introduction of balloon catheters by Andreas Grüntzig 0 a n d Fritz Olbert, 1 and later several modifications by the industry considerably improved the procedure, as the arterial defect at the site where the catheter was inserted was smaller. This opened up the possibility of using 6 and 7 Fr balloon catheters. The former balloon catheter was often rigid after dilatation, and in several cases the balloon extended the puncture hole. In contrast, the Olbert catheter always provided a perfectly smooth, atraumatic retraction after dilatation. Nevertheless, for both types of balloon catheters, the use of a sheath catheter system in 6, 7, or 8 Fr became the standard to reduce traumatization at the puncture site, followed by bleeding complications.