Bifurcated grafts in the aorto-femoral tract.
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Biomedical subjects
Publications and source records attributed to E Viver Manresa.
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Laser angioplasty represents an attractive alternative to overcome the limitations of balloon angioplasty. We describe our results with laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans in the lower limbs after two years clinical follow up. We also analyse the influence of lesion characteristics on immediate results. Thirty seven patients (34 men), whose mean age was 58 +/- 9 years, were included in this study. Occlusive arterial disease (Fontaine stage II-IV), with 39 significant haemodynamic arterial lesions were present in all of them. Ankle/brachial Doppler index was O,51 +/- 0,17. Eighteen lesions were located in the iliac area (13 stenoses 2,3 +/- 1 cm of length and 5 occlusions 4,2 +/- 3 cm) and 21 lesions in femoro-popliteal area (5 stenoses 2,6 +/- 2 cm and 16 occlusions 5,7 +/- 3 cm). A percutaneous procedure was used in 38 cases and only in one case a femoral dissection was necessary. The laser source was argon in 26 cases and Nd-YAG in 13. The overall immediate angiographic and clinical success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0,01) and/or calcium (p less than O,05) influenced negatively the immediate results. No major complications were observed. Seven (17%) minor complications occurred, but no emergency surgery was necessary. The ankle/brachial Doppler index after treatment was 0,82 +/- 0,21. Cumulative clinical patency was 91% for successfully treated patients after two years follow up. We conclude that LTBA represents an effective and less aggressive way to treat atherosclerosis obliterans.(ABSTRACT TRUNCATED AT 250 WORDS)
One hundred and sixteen patients with proximal deep venous thrombosis (DVT) confirmed venographically had perfusion and ventilation lung scans performed 48 hours after admission to assess the incidence of asymptomatic pulmonary embolism (PE). Sixty-six patients had normal lung scans, 29 had high-probability defects suggestive of PE, and 21 had indeterminate-probability of PE. Chest X-ray, electrocardiogram and arterial blood gases were of no value in assessing the lung scan results. Six out of 29 patients with a baseline lung scan of high probability of PE experienced acute signs and/or symptoms suggestive of pulmonary embolism while on heparin therapy. A repeated scan this time did not disclose new perfusion defects in any patients. In the absence of a baseline study, these scans may be interpreted as demonstrating pulmonary embolism on treatment and lead to unnecessary caval interruption procedures for failed heparin therapy.
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