Hey Dr. S if I understand correctly you are now using shorter length wise balloons to stop damage unnecessarily when popping valve annulus's.
Very clever and good timing for Cece's office visit.
nigel, not quite correct. I think most interventionalists would desire to reduce the effect of dilatation on vein that is not stenotic. However shorter balloons are more difficult to center on the stenosis and often slip up or down, like a watermelon seed squeezed between your fingers.
we use longer balloons to trap the balloon on either side of the stenosis. We do that all the time and that is what i am and continue to do. I am now more respectful of the vein above the stenosis. By placing the upper "shoulder" of the balloon at the stenosis and by allowing much of the balloon to occupy the larger parent vessel, I am attempting to reduce the trauma on the smaller upstream vessel.
i am using IVUS to more precisely determine which size balloon to use and how to place it.
Because the vein above the stenosis does not need to be dilated. i am basing my balloon choice on accurate and precise cross sectional area of the vein. Better than estimation, ivus helps avoid over dilating the normal vein.
After venoplasty i repeat the ivus to determine whether there are still some valvular stricture or valve fusion. if still present, i will increase balloon size slightly and redilate.
So you can see as i learn and understand the IVUS, i believe i am precising the dilatation. by starting at a smaller balloon size i am avoiding injuries. by re-evaluating with ivus and determining whether increased angioplasty is necessary i am trying to finese the size of the balloon.
Now, i admit i am going to try to use shorter balloons but i am not sure that i can seat them securely before the pressure is applied.
with the aid of IVUS i am measuring the cross sectional area of the vein above the stenosis and then selecting a balloon of a cross sectional area that does not exceed the area of the vein.
but while this is exciting to the technogeeks in the group (including me) the real bottom line is: can we maximize stenosis reduction while minimizing unncessary trauma, thrombosis and intimal hyperplasia.
and further to the point, the really really bottom line is can we prolong time to disability by any of these techniques