[Arterial recanalization and angioplasty assisted by a laser].
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Biomedical subjects
Publications and source records attributed to J Struyven.
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Pseudoaneurysm is a classical but unusual complication of femoral catheterism. 22 cases are reviewed: 19 occurred after coronarography, 2 after peripheral percutaneous angioplasty and only one after a renal diagnostic arteriography. In all cases, the diagnosis of the pseudoaneurysm was established by I.V. D.S.A. 2 different medical teams are distinguished: the first using small catheters (4 and 5 F), the second using larger catheters (7 and 8 F) which are more aggressive. Two factors allow to avoid this complication: the diameter of the catheter and a correct compression dressing. The treatment of this complication, usually surgical, consisted in a simple manual percutaneous compression in 3 patients.
Bronchial tumors invading the mediastinum are no longer systematically regarded as inoperable. Curative surgery has produced a significant survival rate and led to the adaptation of the TNM classification. The degree of invasion of the pulmonary artery is a criterion of operability. The authors are trying to assess the role of MRI with regard to CT and DSA for the measurement of invasion. Their study deals with the prospective assessment of ten patients. The MRI examinations have been carried out with a 0.5 and 1.5 T supraconductive magnet (Philips Gyroscan). Cardiac gating has been used for acquisition. The planes of section are axial, transverse or oblique along the greater axis of the pulmonary arteries. CT examinations in 9-mm thick sections with and IV contrast injection demonstrate the contact of the tumor with the mediastinum. The digital angiograms have been taken with an intravenous injection into a vein of the bend of the elbow or into a femoral vein. Six cases have been verified at surgery. In all cases, the invasion predicted with MRI proved to be correctly assessed. In three cases, MRI provides additional information to the combined findings of CT and DSA. MRI is a good complement for the preoperative assessment of patients with large tumors invading the mediastinum but for which curative surgery is indicated.
The authors extracted 11 case files of patients undergoing radical prostatectomy following MRI studies from a series of 192 MRI examinations of the prostate with histological confirmation of the diagnosis. This series is part of a prospective study in which MRI was always interpreted prior to histological results. The diagnosis of prostatic cancer was confirmed in 9 cases on the basis of a hyposignal on T2-weighted scans. In 4 cases, extracapsular spread of the tumour was demonstrated by MRI and was confirmed at surgery. In the cases in which the cancer was visible on MRI, the diagnosis of local spread proved to be accurate. The debate concerning the role of MRI in prostatic disease is not definitively resolved, but this preliminary series indicates the potential and the limitations of this technique.
Two cases of cervical aberrant thymus in infants are reported; it's important to identify such ectopia because thymic tissue involutes spontaneously later on; neither surgery nor other treatment is needed. Ultrasonography is a method of choice for tissue characterization of ectopic thymus and differential diagnosis with other cervical masses.
The absence of cerebral blood flow is the best criteria of cerebral death. Intravenous digital subtraction angiography (DSA) was performed in 110 patients with clinical signs of brain death. In 105 cases DSA, confirmed the stop of the intracranial circulation. In the other 5 cases, repeated examination a few hours later demonstrated arrested cerebral circulation. Organs transplantations were performed in 30 cases. DAS represents a relatively non invasive and quick to perform method to demonstrate brain death.
We have performed cavernosography and cavernosometry in more than 400 impotent patients and in 10 normal volunteers. In patients without abnormal venous leakage, intracavernosal infusion at a flow rate of 80-140 ml/min produces a complete rigid erection with an intracavernous pressure greater than 90 mm Hg; 25-50 ml/min is necessary to maintain the erection. Abnormal venous leakage is characterized by the absence of erection without a significant increase in intracavernous pressure under the maximum standardized perfusion rate of 140 ml/min. Cavernosography provides good morphologic studies of the cavernous bodies and the penile venous network, but must always be associated with flow rate measurement and intracavernous pressure monitoring for reliable assessment of venous leakage.
Cavernosography and cavernometry were performed in 150 impotent patients and 10 normal potent volunteers. Opacification of the glans penis was noted in 5 normal volunteers, while among the impotent patients it was noted in 53 per cent of those with venous leakage and in 36 per cent of those without leakage. We believe that opacification of the glans during cavernosography must be regarded as a normal variant rather than as a sign of pathological shunts between the glans and the corpora cavernosa.
The value of magnetic resonance imaging in the differential diagnosis of non-obstructive dysfunction of renal allografts was studied in a series of 58 examinations at 0.5 T. Four parameters were evaluated: the corticomedullary differentiation; the relative thickness of the cortex; the evolution, with echo number, of the relative signal intensities of kidney parenchyma and adjacent fatty tissue on images generated by a long time to repeat multiecho sequence; and the proximal vascularization. The loss of corticomedullary differentiation is the major finding in acute rejection, but it is not specific as it is also observed in chronic rejection and in the much rarer acute glomerulonephritis. Thickening of the cortex is helpful for the detection of rejected transplants with visible corticomedullary delineation (26% of the cases). Uncomplicated acute tubular necrosis appears as a normal transplant.
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The majority of studies with MR imaging in prostate disease are based on a semiology obtained using images weighted in T1 and T2. A study was carried out to evaluate effects of images calculated in T1 and T2 obtained at 0.5 T. This preliminary study concerns 28 prostate examinations with spin-echo acquisition and inversion-recuperation parameters, and provided images calculated in T1, weighted and calculated in T2. Images allowed detection and characterization of prostate lesions. However, although calculated images accentuate discrimination of the method, the weighted images conserve their place because of their improved spatial resolution.
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The authors report their experience of laser thermal angioplasty in a series of 20 patients. An argon laser with a 1.5 or 2.0 millimeter diameter metalcapped optical fiber (Hot Tip Trimedyne Inc.) was used; the laser probe was pushed to the occlusion point; after a channel was produced through the obliteration, a conventional percutaneous balloon angioplasty was performed. The indications were: 4 primitive iliac occlusions, 15 femoral/popliteal occlusions and 1 subclavian obliteration. The immediate results were as follows (table I): 75% overall recanalization (50% at the iliac level, 87% at the femoral/popliteal level and failure at the subclavian level); 5 notable complications were observed (2 limb ischaemia, 2 voluminous inguinal haematoma and 1 aortic cross perforation) without clinical sequelae. The short term follow-up (1 to 8 months) of the successfully treated patients (table II) shows 100% permeability at the iliac level and 77% at the femoral/popliteal level. We conclude that laser thermal angioplasty is a very attractive method in the treatment of primitive iliac and femoral/popliteal occlusions. The well-defined indications must form the subject of a closely discussion between the angiologist, the vascular surgeon and the interventional radiologist.
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Evaluation of coronary artery bypass graft patency by intra-arterial digital subtraction angiography was performed in 201 patients. A first group of 150 asymptomatic patients was systematically evaluated for post-operative screening 8.5 days after surgery as an immediate check on surgical results. Grafts were found occluded in 2.3%. A second group of 51 patients complaining of recurrent angina was studied 10 months (range 2 months to 9 years) after operation. Angiography revealed that 90% of grafts were patent but 8 grafts stenoses were diagnosed. In both groups, opacification of the run-off was achieved in 83%, but the quality of opacification was very low.