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Biomedical subjects

J A Oleaga

Publications and source records attributed to J A Oleaga.

At least 19 recordsLinked to original sources
PubMed1982

Percutaneous transluminal angioplasty treatment of renal transplant artery stenosis.

Since June 1979, percutaneous transluminal angioplasty (PTA) has been the procedure of choice for renal transplant artery stenosis (RTAS) at the Hospital of the University of Pennsylvania. Of 241 renal allograft recipients, 17 (7%) when studied by arteriogram because of suspected RTAS proved to have significant stenosis (the mean reduction in luminal width for the group being 68%) and underwent PTA. RTAS was equally prevalent in cadaver and related kidney allografts and was no less common in HLA-identical related donor grafts, arguing against the importance of immune factors in etiology. RTAS was equally prevalent whether the anastomotic technique was end to end or end to side. However, when RTAS occurred after end to side anastomoses, it was usually postanastomotic. Fifteen of 17 of the attempts at dilation by PTA were successful by angiographic analysis. Thirteen of the 15 successfully dilated patients had long-term allograft survival and in all of these instances blood pressure (BP) was decreased after PTA. After a mean of 67 weeks, BP decreased from a systolic of 184 +/- 24 mm Hg pre-PTA to 135 +/- 15 mm Hg (P less than 0.001) and from a diastolic of 115 +/- 10 mm Hg pre-PTA to 87 +/- 11 mm Hg (P less than 0.001). The majority of patients continue to require antihypertensive drugs but in a less vigorous regimen than pre-PTA. Serum creatinine level fell following PTA from 1.9 +/- 0.6 to 1.7 +/- 0.5 mg/100 ml (P less than 0.01). Repeat angiographic study was done in nine patients, an average of 61 weeks after PTA, and no recurrent RTAS was identified. Three minor complications of PTA occurred but none led to long-term sequelae. Thus, we believe PTA of RTAS is relatively safe, carrying less mortality and morbidity than operative treatment, and is capable of improving BP control and renal allograft function.

Adult↗
PubMed1981

Successful long-term percutaneous decompression of the biliary tract.

The efficacy of percutaneous transhepatic biliary drainage for long-term (greater than 3 months) decompression of biliary obstruction was evaluated in 35 patients with benign (10) and malignant (25) obstructing lesions. The results indicate that such drainage is a safe and effective means for long-term decompression of the biliary tract in selected patients, especially patients who are poor operative risks and those with metastatic or nonresectable malignancy. In addition, the procedure provides access to the biliary tract for percutaneous dilatation of selected common duct or anastomotic strictures.

Adult↗
PubMed1981

Transluminal angioplasty of the iliac and femoral arteries: follow-up results without anticoagulation.

With the advent of the angiographic balloon catheter, transluminal angioplasty has become a more effective procedure for the alleviation of symptoms of peripheral ischemia. In the past two and a half years we have performed this procedure on over 208 iliac and femoral arteries. One hundred twenty iliac arteries were dilated. Of these, 86% remained patent at one year and 83% at two years. Eighty-eight femoral arteries were dilated. Of these, 75% remained patent at one year and 67% at two years. These vessel survival rates are slightly less than those following surgery. However, the morbidity from transluminal angioplasty is very low and the mortality is essentially zero.

Adult↗
PubMed1981

Renal artery stenosis: anatomic classification for percutaneous transluminal angioplasty.

Most lesions that decrease renal blood flow originate within the renal artery; however; large, aortic, atherosclerotic plaques can overhang the renal ostium producing a functional renal artery stenosis. At the Hospital of the University of Pennsylvania, 45 consecutive percutaneous transluminal angioplasties were examined retrospectively and classified as to site of the obstructing lesions and clinical outcome. Stenoses within the renal artery responded very well to angioplasty, with 83% of patients showing either an excellent or good result. Conversely, when aortic plaques were responsible for inflow obstruction, 76% of patients responded poorly or not at all to balloon dilatation. It is proposed that this disparity of response reflects the anatomic differences in the orientation of elastic and collagen fibers of the muscularis and advential layers of the renal artery and the aorta.

Angioplasty, Balloon↗
PubMed1981

Percutaneous puncture of venous bypass grafts for transluminal angioplasty.

Percutaneous transluminal angioplasty was performed on 45 patients with vascular stenoses after vein bypass surgery. In 25 cases, the angioplasty catheter was introduced by direct puncture of the vein graft. The procedure was successful and reoperation was avoided in all but one of these cases. There were no complications. The experience has shown that in selected postoperative patients, direct puncture of the graft is safe and greatly facilitates performance of the angioplasty.

Angioplasty, Balloon↗
PubMed1981

Percutaneous transhepatic drainage preoperatively for benign biliary strictures.

In two patients, the value of percutaneous transhepatic decompression in the management of benign biliary strictures is illustrated. The procedure can help provide relief of jaundice, control of infection and improvement of nutritional status. Results of previous experience indicate that these factors play a major role in determining the over-all success rate in the surgical management of these patients.

Adult↗
PubMed1981

Dilatation of severe esophageal strictures by an inflatable balloon catheter.

Most benign strictures of the esophagus can be successfully dilated with conventional bougienage techniques. Occasionally strictures are so severe, lengthy, or irregular that these techniques fail, and surgery is required. We describe 2 patients with such severe esophageal strictures that conventional techniques were initially unsuccessful. However, esophageal dilatation of both strictures was successful using the Grüntzig balloon catheter. A torqueable guide wire was initially directed through the stricture under fluoroscopic control. The balloon catheter was then passed over the guide wire and inflated sequentially to a maximum diameter of 9 mm. Subsequent dilatations using conventional techniques were successful. The technique of negotiating severe, irregular esophageal strictures with a torqueable guide wire followed by Grüntzig balloon catheter dilatation may be valuable in the management of severe esophageal strictures.

Aged↗
PubMed1980

Balloon dilation of iliac stenosis with distal arterial surgery.

Seven patients with concomitant atherosclerotic iliac stenosis and femoral artery occlusive disease were treated with polyvinyl balloon catheter dilation of the iliac artery and subsequent distal operative arterial reconstruction. The iliac lesions were short, localized, common and external iliac stenoses and the femoral lesions were superficial femoral artery occlusions in six patients and a common femoral occlusion in another. All seven iliac stenoses were successfully dilated. Subsequent operative femoral artery reconstruction was successful in these patients, with restoration of popliteal or pedal pulses and relief of ischemic symptoms over a follow-up period of two to 14 months. One patient's femoral popliteal bypass graft thrombosed four months postoperatively.

Aged↗
PubMed1980

Early experience with percutaneous transluminal angioplasty using a vinyl balloon catheter.

The technique of transluminal dilatation of arterial stenoses has been greatly facilitated with the recent development of the vinyl balloon catheter by Gruntzig. Since these catheters became available to us in early 1978, we have utilized them to attempt dilatation of 62 arteries, including iliac, femoral and renal vessels. Immediate success was achieved in 57 of these vessels. There were five early complications (two distal embolizations and three prompt occlusions) and three late complications (two restenoses and one occlusion at ten days). The occlusions were all treated promptly surgically with good results and the stenoses redilated. Noninvasive pressure measurements were obtained on all patients whose iliac or femoral arteries were dilated both before and after the procedure, with objective improvement demonstrated by this method. The procedure itself is well tolerated by patients. It involves only minimal discomfort and risk and a markedly shortened hospital stay. The procedure can be easily accomplished by physicians who are thoroughly familiar with routine femoral catheterization techniques and it is believed that this technique will have a definite place in the future therapy of many cases of arterial stenosis.

Arterial Occlusive Diseases↗
PubMed1980

Replacing the "fallen out" catheter.

A simple method for replacing biliary drainage or nephrostomy catheters that have fallen out is described. The original catheter tract is used.

Biliary Tract↗