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Biomedical subjects

G Biamino

Publications and source records attributed to G Biamino.

At least 37 records · Page 2Linked to original sources
PubMed1999

[PTLA (percutaneous transluminal laser angioplasty) recanalization of femoral artery stenoses/occlusions after Angio-Seal administration].

PURPOSE: To demonstrate desobliration of Angio-Seal-induced femoral artery stenosis and occlusion by Excimer-laser assisted angioplasty and PTA. PATIENTS AND METHODS: The Angio-Seal hemostatic closure device was applied to the puncture site in 1500 patients after diagnostic or therapeutic coronary artery catheterisation. In 5 of 1500 cases symptoms of claudication occurred. Following the determination of the walking distance and ankle-brachial systolic pressure index (ABI) and diagnostic angiography, therapeutic percutaneous transluminal laser angioplasty (PTLA) and PTA was performed. RESULTS: 5 patients with acute symptoms of peripheral artery disease presented with superficial femoral artery occlusions (three cases) and high grade stenoses of the common femoral arteries (two cases). Angiographic and clinical improvement was achieved after PTLA/PTA in all five patients. The mean walking distance increased from 61 meters to 600 meters. The average ankle-brachial systolic pressure index increased from 0.40 to 0.82. CONCLUSIONS: PTLA/PTA is a satisfactory therapeutic method for femoral artery occlusion or high-grade stenosis following Angio-Seal application.

Aged↗
PubMed1999

[Results of "cross-over implantation of Palmaz-stents" with cross-over sheaths].

PURPOSE: Presentation of technique of cross-over stent implantation of Palmaz stents using a cross-over sheath. MATERIAL AND METHODS: Between 1996 and March 1997 72 patients presenting symptoms of peripheral artery disease received 136 Palmaz stents, which were implanted in a cross-over technique with the aid of a cross-over sheath. RESULTS: As indications for stent implantation occurred: occlusion (n = 14), recoil (n = 11), distinctive calcification (n = 32), recurring stenosis/occlusion (n = 32), perforation (n = 3), dissection (n = 31), and aneurysms (n = 2). The cross-over technique with the aid of a cross-over sheath was successful in all 136 cases. Within the first 24 hours 3 acute reocclusions occurred (all femoral). For stents placed in the iliac artery the primary patency rate was 93.3% at 12 months and for stents placed in the femoral artery 72.0%. Furthermore, this techniques allows for simultaneous stenting of pelvic, femoral or lower leg arteries (n = 17). By using this technique, stenting of the distal external iliacal artery, common femoral artery (CFA) and proximal superficial femoral artery becomes either possible for the first time or easier. CONCLUSION: If Palmaz stents with a length of 2-7.8 cm should be implanted in the cross-over technique, the use of a cross-over sheath is recommended.

Aged↗
PubMed1998

[The value of a fabric-coated self-expanding stent in iliac arterial occlusions or aneurysms--the primary and long-term results].

PURPOSE: The objective of this study was to analyze the primary and long-term results of implanting self-expanding covered nitinol stents (EndoPro I) in iliac arteries. MATERIAL AND METHODS: A total of 48 EndoPro (length 8.3 +/- 4.2 cm) were implanted in 39 patients. In 22 cases (group A) the implantation was performed after excimer laser-assisted recanalization (PTLA) of long iliac occlusions (mean 9.8 +/- 3.9 cm). Other indications were aneurysmatic lesions (n = 16) and one arterial perforation (group B). RESULTS: In 21 of 22 patients of group A the patency of the blood vessel was successfully restored. In all cases of group B the aneurysmatic lesions were finally excluded. This was correlated with a clinical improvement of at least one grade (Rutherford criteria) in 86.4% of patients (group A). The primary patency rate based on clinical examination (treadmill test) and color-coded Doppler was evaluated at 6 (89.7%), 12 (87.1%), and 24 (84.2%) months follows up, respectively. Subacute thromboses occurred in two, relevant restenoses in three cases (group A). In three of these 5 cases the vessel segment was successfully reopened by PTLA or rt-PA thrombolysis, leading to secondary patency rates of 94.9% at 6 and 92.1% at 12 and 24 months, respectively. CONCLUSION: In cases of relevant dissection following PTLA of long pelvic artery occlusions implantation of covered stents is effective to stabilize the results. Furthermore, the device is well applicable to seal arterial ruptures or aneurysms.

Adult↗
PubMed1998

[Endovascular reconstruction of the infrarenal abdominal aortic aneurysm--experiences with 3 endovascular stent prosthesis systems].

Seventeen patients were treated with endovascular stent grafts for AAA (seven Stentor, two Vanguard, three Talent and three EVT grafts). Intraoperative conversion to open procedure was necessary in three cases. One patient had open operation 24 h postoperatively for graft thrombosis. All patients had uneventful recovery. During follow-up (1-35 months) nine patients did not require reintervention. One patient had open repair for persistent endoleak: within 2 months postoperatively one midgraft endoleak, one graft limb thrombosis and one groin infection were treated. We did not observe any late complications.

Aged↗
PubMed1997

[Value of Doppler blood flow velocity measurements in peripheral percutaneous laser-assisted angioplasties].

PURPOSE: The aim of the study was to establish the prognostic value and clinical implications of blood flow velocity measurements by Doppler guide wires during peripheral laser-assisted percutaneous transluminal angioplasty (PTLA). METHODS: 39 patients presenting with symptomatic peripheral arterial obstructive disease underwent angiography and blood flow velocity assessment by Doppler guide wire (0.018") prior to and following PTLA. Both quantitative angiography (QCA) for measurement of luminal diameters and Doppler assessment of maximum peak velocities (MPV) were performed 2 cm proximal, over and 2 cm distal to stenoses. The results were compared with the following clinical endpoints: 1. Short-term clinical improvement by AHA-criteria during first follow-up examination and 2. criteria for patency suggested by Rutherford [12] within 1 year (1-22 months). RESULTS: Angiography demonstrated initial success of PTLA in all patients. Relative diameter stenosis decreased from 70 +/- 0.04% to 17 +/- 0.05%. Mean clinically category improved from 2.7 +/- 0.1 to 1.2 +/- 0.1 following intervention. Mean grade of clinical improvement was 2.8 +/- 0.1. 22/39 patients demonstrated event-free follow-up examinations. Doppler measurements of MPV post PTLA in the proximal reference segment correlated with clinical outcome. MPV > or = 90 cm/s was associated with good primary success, unlimited walking capacity and event-free follow-up. MPV > or = 70 cm/s predicted an improvement of short-term clinical outcome by 2 grades (predictive value 80%). MPV < 70 cm/s was associated with both minor primary clinical improvement (+/- 0, +1) and increased incidence of restenosis during follow-up. CONCLUSION: Following PTLA, MPV adds information to angiographic success. MPV > or = 90 cm/s in a proximal reference segment following PTLA predicts good clinical outcome, whereas MPV < 70 cm/s is associated with minor primary clinical success and increased rates of restenosis.

Adult↗
PubMed1997

[Post-interventional pseudoaneurysm: technique, status and indications of color Doppler-controlled compression treatment].

In a prospective 6-year study including 155 pts. with false aneurysm (FA) after peripheral interventions, treatment by color doppler-guided compression (CDGC) was evaluated. Diagnosis and treatment were performed 1-42h (mean. 21.5 h) after intervention, using 7.5 MHz transducers. The technique was to apply pressure on the tract connecting FA and artery, to occlude it until thrombosis would induce FA closure. The treatment was successful in 152/155 cases (98.1%), requiring compression for 7 to 65 min. (mean: 28.8 min.). In 3/155 pts. (1.9%) under coumarin therapy (INR > 3.0) a second treatment was necessary (INR < 2.3) to obtain FA closure. The treatment was well tolerated, only 42/155 pts. (27.1%) needed analgetics. During CDGC, in 19 cases (5.9%) vagal reactions were observed, furthermore 2 FA ruptures (1.3%, without sequelae). 2 cases developed a FA relapse (1.3%), both could be permanently closed by a second CDGC. In conclusion, under the condition of early diagnosis CDGC is a rapid, very effective, safe and non-invasive method to treat postinterventional FA. Conservative, interventional or surgical treatment is limited to few cases when CDGC is not feasible (infection, compression syndrome), or not successful.

Aneurysm, False↗
PubMed1996

[Radiation exposure in interventional radiology as exemplified by the chemoembolization of hepatocellular carcinoma and laser angioplasty of the pelvic arteries].

PURPOSE: Estimation of radiogenic risks for patient and radiologist in chemoembolisation of hepatocellular carcinoma (HCC) and laser angioplasty of the pelvic arteries. METHODS: In 5 chemoembolisations of HCC (4 males, one female) and 6 laser angioplasties of the pelvic arteries (5 males, one female) the surface doses received by patient and operator were measured using thermoluminescent dosimeters in standardised positions. The organ doses of the patient were derived by conversion factors employed on the measured surface doses. Effective dose was determined according to the recommendations of ICRP 60. RESULTS: The risk of lethal malignant disease and genetic disorder derived from the doses in the patient was found to be of the magnitude of 10(-4)-10(-5). The thresholds for transient erythema of the skin and depression of hematopoiesis can be reached after high expositions. A theoretical maximum of 700 laser angioplasties of the pelvic arteries allowable in one year was calculated based on the dose to the operator's left hand. For chemoembolisation of HCC, the dose to the left eye lens would reach the yearly maximum after approximately 1000 procedures. Remarkable risks for malignant disease of skin and thyroid as well as detectable opacities of the eye lens can occur after frequent interventions for many years. CONCLUSIONS: Because of the lower life expectancy the patient's risk for stochastic effect can be seen as minimal. No clinically relevant deterministic effects will occur. In the case of frequent interventions, the dose absorbed by the radiologist is likely to exceed the prescribed dose limit and to cause remarkable risk for stochastic and non-stochastic effects after many years.

Aged↗
PubMed1995

Changes of fluid-dynamic parameters in peripheral stenoses with transcutaneous interventions.

UNLABELLED: Peripheral vessels provide a useful in vivo haemodynamic model allowing evaluation of local intravascular fluid dynamics. Velocity measurements using a 0.018 inch Doppler-tipped angioplasty guidewire, quantitative angiography and laboratory data were gathered from 45 patients with a total of 48 percutaneous transluminal laser assisted angioplasties (PTLA) in the superficial femoral, in the iliac, in the popliteal artery and in the peroneal artery. From these data, blood flow, whole blood viscosity, Reynold's numbers, Womersley numbers and shear stress were calculated, evaluated as to their changes post PTLA and correlated with clinical improvement at early follow-up. The clinical result was quantified as categorial improvement according to the American Heart Association guidelines. The primary angiographic results of angioplasty were satisfactory in all patients. Clinically 17/45 patients showed a marked, 6/45 a moderate, 18/45 a minimal, and 4/45 no improvement. The mean values of maximal peak velocity at stenosis decreased from 235 +/- 28 cms-1 to 84 +/- 8 cms-1 after PTLA (P < 0.01). The minimal intrastenotic cross section increased from 7.7 +/- 0.9 to 21.9 +/- 1.6 mm2 (P < 0.01). Mean trans-stenotic flow increased after intervention by about 50% (P < 0.01) and improved further by 135% after administration of adenosine triphosphosphate i.a. (P < 0.01). Reynold's numbers were elevated intrastenotically (1285 +/- 198) pre-intervention as compared to values proximal (564 +/- 81) and distal (449 +/- 66) to the stenosis and were reduced significantly (P < 0.05) at stenosis by PTLA, whereas values proximally and distally increased significantly (P < 0.01) post PTLA (proximal 829 +/- 84, intra 773 +/- 107, distal 676 +/- 98). Shear stress, reflecting mechanical interaction between flow and vessel wall, was elevated at stenosis pre-intervention to 44 +/- 8.9 Pa and reduced at post-stenoric vessel sites to 2.4 +/- 0.5 Pa. PTLA caused a decrease in stenosis to 6.3 +/- 1 Pa (P < 0.01) and an increase distally to 4.6 +/- 1 Pa (P < 0.01). Whereas in single stenoses removal of the obstruction was associated with a significant (P < 0.05) increase in trans-stenotic flow and shear stress distally, there was only auenuated increase in trans-stenotic flow in multiple lesions despite an angiographically good PTLA result. Shear stress distally remained low in those patients. Velocities and Reynold's numbers were lower in these vessels even pre PTLA. Residual flow, Reynold's number and minimal cross-section pre-intervention correlated significantly with clinical outcome. Pooling cases with no or minimal, as opposed to those with marked or moderate improvement, 81% of patients were correctly classified using the Reynold's numbers pre- and post-PTLA. CONCLUSION: Peak velocity monitoring is feasible and safe during angioplasty. Velocity provides clinically relevant physiological information in addition to angiography. Combining quantitative angiography, velocity measurements and laboratory data allow the calculation of blood flow, Reynold's numbers and shear stress, thereby providing complex fluid dynamic information. Thus the evaluation of haemo-dynamics in single and multiple obstructions before and after intervention is improved. Fluid dynamic parameters pre-and post-PTLA are significantly correlated with clinical short-term result.

Adult↗
PubMed1994

CT angiography of the pelvic arteries.

UNLABELLED: A comparison was performed between CT angiography and digital subtraction angiography (DSA) on 55 patients with atherosclerotic obstructions of the pelvic arteries. Two post-processing algorithms were employed, maximum intensity projection (MIP) and 3D technique. RESULTS: (a) MIP: conformity with DSA: 20/23 occlusions and 24/36 stenoses; underestimation: three occlusions, seven stenoses; overestimation: five stenoses. (b) 3D display: conformity with DSA: 19/23 occlusions and 16/36 stenoses; underestimation: four occlusions, 17 stenoses; overestimation: three stenoses. The MIP technique proved to be the only method to display the localisation of vascular calcifications with their exact topographical relationship to the stenoses and occlusions. MIP also proved to be valuable in controlling the position of intravascular stents. Complementary to DSA, the MIP method therefore seems to be a clinically valuable technique for calcified and non-calcified stenoses, and for displaying intravascular stents. Its use in interventional procedures could therefore become increasingly important.

Adult↗
PubMed1994

[CT angiography and arterial DSA in the evaluation of occlusive processes in pelvic arteries. Initial results].

UNLABELLED: 32 patients with iliac artery stenosis and occlusion were studied by means of CT angiography. The results were compared with the results of intraarterial digital subtraction angiography (DSA). Postprocessing was performed with Maximum Intensity Projection (MIP) and 3-D-display. RESULTS: 1. MIP: 27/37 stenoses/occlusions were correctly assessed, underestimation of 5 stenoses/occlusions (4 stenoses, one occlusion), overestimation of 5 stenoses. 2. 3-D-Display: 22/37 stenoses/occlusions were correctly assessed, underestimation of 9/37 (8 stenoses, one occlusion), two false negative results (one stenosis, one occlusion), overestimation of 4/37 stenoses. The MIP technique proved to be the only method to display the localisation of vascular calcifications with their exact topographical relationship to the stenoses and occlusions. MIP also proved to be valuable in controlling the position of intravascular stents. Complementary to DSA, the MIP method therefore seems to be a clinically valuable technique for calcified and noncalcified stenoses.

Adult↗
PubMed1993

[Priapism: our experience in 9 cases].

We report our experience with 9 cases of priapism treated with decompressive puncture of the corpora cavernosa or with spongiosum-cavernosum shunt. No significant difference in result between these two surgical approaches was found: we conclude that early treatment is decisive for the preservation of potency.

Adolescent↗
PubMed1992

First clinical experiences with a new angioscopic system for diagnosing peripheral vascular changes.

Conventional angiography allows a global view of regional vascular anatomy but precise information can only be deduced indirectly using contrast medium. The use of the three-dimensional picture of angioscopy, however, allows a direct evaluation of the vascular system. In order to extend our experiences with angioscopy, we employed a new micro-cardio-angioscopic system which consists of four components: a CCD color camera (360,000 pixels); a highly flexible optical probe which can be resterilised (1.4-0.6 mm diameter) incorporating 10,600-6,000 glass fibers, with a viewing angle of 140 degrees, 70 degrees, and 50 degrees and a focusing system that allows a distance from 2 mm to infinity; a high power light source and an insertion catheter with inflatable balloon. Using a known technique (intermittent blood-flow blockage and continual rinsing with NaCl solution), 36 cases involving 27 patients were examined before and after desobliteration of the femoral artery. In 88% of the cases it was possible to control the result of the intervention by angioscopy. Smaller intimal lips, the thrombotic wall, and intimal ruptures were clearly visible. Quantification of the stenoses was also successful in 88% of the cases, and in 8 patients the angioscopic findings deviated from the conventional angiogram. In 14% of the cases, angioscopic examination of the recanalisation result showed that thrombolytic therapy was necessary. Angioscopy offers the possibility of qualitative vascular diagnosis. It is a valuable addition to angiography.

Angioplasty, Laser↗
PubMed1991

Acute hemodynamic effects of intravenous diperdipine, a new dihydropyridine derivative, in coronary heart disease.

The acute hemodynamic effects of a new dihydropyridine calcium channel blocker, diperdipine, which is suitable for intravenous administration, were studied by right and left cardiac catheterization in 16 patients with coronary heart disease. Diperdipine markedly reduced systemic vascular resistance and improved stroke index and left ventricular ejection fraction. Mean pulmonary artery and wedge pressures were slightly increased as a possible consequence of enhanced venous return, whereas right atrial and left ventricular end-diastolic pressures were not significantly changed. Nevertheless, an increase in preload was clearly indicated by an augmented left ventricular end-diastolic volume index after administration of diperdipine. Left ventricular contractility, which was estimated by the end-systolic pressure-volume ratio and by dP/dt max was not significantly changed, though analysis of individual data suggests a minimally negative inotropic effect. However, such a minor effect on left ventricular contractility was largely counterbalanced by the marked reduction of afterload, which produced a sharp improvement of stroke index. Enhancement of left ventricular ejection fraction and reduction in systemic vascular resistance were inversely and directly correlated to control values. Overall, diperdipine was well tolerated, but one patient had a major untoward reaction that consisted of an ischemic episode that was possibly related to drug administration. In conclusion, intravenous diperdipine appears to be a potent arteriolar dilating agent that does not affect left ventricular contractility.

Calcium Channel Blockers↗
PubMed1987

Long-term treatment of hypertrophic cardiomyopathy with verapamil or propranolol in matched pairs of patients: results of a multicenter study.

The effects of a 2-year treatment with high-dose propranolol (mean, 340 +/- 135 mg/day) and verapamil (mean, 493 +/- 136 mg/day) were compared in two groups of patients with hypertrophic cardiomyopathy. Both groups were broadly identical at the beginning of the trial and were formed of matched pairs. Out of 137 patients entering the study, 37 pairs completed the 2 year follow-up. The mean group symptomatology (NYHA-classification) improved significantly only following verapamil treatment. Individual improvement was seen more often following verapamil (V), but deterioration was almost exclusively seen during propranolol (P) treatment. Reduction of the Sokolow-index was significant in the V group only. Reduction in the resting heart rate and maximum gradient was more pronounced following P. No correlation could be found between the change in clinical symptoms and electrocardiographic, echocardiographic or hemodynamic data, nor to the dosage of V or P administered. From clinical and echocardiographic findings and in respect of side effects, V is advantageous over P in the treatment of hypertrophic cardiomyopathy, although a considerable number of patients improve after P. Objective data do not allow one to anticipate responders or non-responders to either treatment.

Cardiomyopathy, Hypertrophic↗
PubMed1987

[Doppler echocardiographic findings in hypertrophic cardiomyopathy].

This study was performed to evaluate diastolic and systolic flow parameters in patients with hypertrophic cardiomyopathy as assessed by Doppler echocardiography. We examined 45 patients with hypertrophic cardiomyopathy (35 of which had an obstruction) and compared the results of diastolic and systolic measurements with those of two groups of normals (less than 25 years, n = 15; greater than 40 years, n = 10). For the diastolic parameters the isovolumetric relaxation time showed a significant prolongation with 107 +/- 23 ms as compared to normals (greater than 40 years) with 86 +/- 10 ms. No differences were found for the time-to-peak velocity in early diastole. The ratio of the time-velocity-integrals of early and late diastolic filling (E/A) with 2.4 +/- 1.3 was significantly lower as compared to young normals with 4.0 +/- 1.9 but not for the group of normals greater than 40 years with 2.5 +/- 1.0. The time-to-peak velocity in systole (TPVS) of the left ventricular outflow was prolonged in patients with an intracavitary obstruction, and the ratio of TPVS/LVET significant lower as compared to normals. Pressure gradients measured with Doppler showed good correlations to invasive measurements with an r = 0.88, SEE 28.5 mmHg. In color-coded Doppler echocardiography turbulent flow is portrayed as a color-mosaic. The location of turbulence in the outflow tract as well as an accompanying mitral insufficiency are immediately visible, but color-flow Doppler does not allow for quantifying the degree of an obstruction. Conventional and color-coded Doppler echocardiography is an enhancement of noninvasive diagnostics also in hypertrophic cardiomyopathy with respect to the assessment of pathologically changed systolic and diastolic flow parameters, the localization and quantification of an obstruction and the assessment and semiquantification of an concomitant mitral regurgitation.

Adolescent↗
PubMed1985

Follow-up after coronary arterial reperfusion with intravenous streptokinase in relation to residual myocardial infarct artery narrowings.

Short- and long-term changes in residual stenosis of the myocardial infarct-related coronary arteries in patients with successful reperfusion by intravenous streptokinase have not been determined until now. In 15 patients the residual diameter stenosis decreased significantly from 62 +/- 9% after 24 hours to 55 +/- 13% in the fourth week (p less than 0.005). Quantitative angiographic analyses in 61 patients with patent infarct-related coronary arteries in the fourth week revealed a mean diameter stenosis of 61 +/- 13%. The patients were followed up 34 +/- 10 months. Sixteen had elective coronary artery bypass surgery or percutaneous transluminal coronary angioplasty (PTCA). Eighteen without coronary artery bypass surgery or PTCA had undergone repeat angiography after 26 +/- 9 months. Twenty-five (41%) have had a residual diameter stenosis greater than 65% in the fourth week. A stenosis greater than 65% was found in: 4 of 5 patients with late reinfarction; 3 of 7 with 1-vessel coronary artery disease and persistent angina, compared with none of 11 with a stenosis less than 65%; 6 of 7, whose silent reocclusion had been found at long-term follow-up compared with 1 of 9 with a residual stenosis less than 65%. In 8 patients with persistent patency of the infarct artery, the stenosis had decreased significantly from 55 +/- 6% to 36 +/- 12% (p less than 0.005). Correspondingly, there was a significant improvement in the infarct-related left ventricular wall motion disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗