Pulmonary Vascular Disease Specialists Add Balloon Angioplasty as a Treatment Option for Patients Not Eligible for Surgery
Percutaneous balloon angioplasty joins surgical thromboendarterectomy and acute embolectomy in the arsenal of therapies offered at the Brigham and Women’s Hospital Heart & Vascular Center that aim at revascularizing pulmonary vessels to improve ventilation, flow balance, and right-ventricular function.
“Balloon angioplasty may be a valuable option for clearing vascular obstruction in patients who are not candidates for surgical thromboendarterectomy and those who have had a less-than optimal outcome from surgical intervention,” said Aaron Waxman, MD, PhD, Director of the Pulmonary Vascular Disease Program.
“While the surgical approach can effectively clear obstructions in the larger proximal pulmonary vessels, balloon angioplasty is capable of reaching and restoring blood flow in the narrower, more distal vessels,” he explained. “The goal is to intervene in smaller more distal vessels to maximize downstream blood flow.”
“Often, there are several vessels to treat,” said Dr. Waxman. “A less-invasive option, like balloon angioplasty, allows us to take a staged approach, treating five to eight vessels at a time during several procedures. Strategies to reduce reperfusion injury have led to patients feeling better typically much sooner after the procedure than after cardiopulmonary bypass and surgical endarterectomy."
Balloon angioplasty for pulmonary lesions is considered by some experts to be a less complete solution than thromboendarterectomy and, in some ways, it is. After surgical intervention, many patients will no longer need medical therapy, which is not often the case after angioplasty.
“Balloon angioplasty is not intended to replace thromboendarterectomy,” explained Michael J. Landzberg, MD, Director, Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Group. “It rounds out the full arsenal of pulmonary vascular disease therapies, making the Heart & Vascular Center prepared to treat all aspects of pulmonary artery disease, whether a patient needs revascularization of proximal or distal vessels or an emergency embolectomy.”
“Balloon angioplasty may also have potential as a bridge therapy to prepare complex patients for surgical intervention or as part of a hybrid surgery-angioplasty approach in patients with complex disease,” said Dr. Landzberg.
- Aaron Waxman, MD, PhD,
Director, Pulmonary Vascular Disease Program
- Michael J. Landzberg, MD,
Director, Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Group
