Endovascular treatment of focal aortic arch branch lesions.
Explore the source record for details and available documents.
Angioplasty, Balloon↗
Biomedical subjects
L A Queral
Publications and source records attributed to L A Queral.
Miniincisional ligation of incompetent perforating veins of the legs.
PURPOSE: The purpose of this study was to determine the effectiveness of a new surgical procedure for interrupting incompetent perforating calf veins in patients with recalcitrant venous ulcers. METHODS: Eighteen patients with venous ulcerations in 26 limbs had incompetent perforators diagnosed by duplex scanning. All were taken to the operating room, where the fascial defects through which the perforators coursed were obliterated by a "pursestring" permanent suture placed on the leg fascia. Follow-up duplex scanning was carried out within 2 weeks of the procedure and every 6 months thereafter. The mean follow-up in this series was 22 months. RESULTS: Initial success in obliterating the perforators was noted in 24 (92.3%) of 26 legs. Three subsequent failures occurred within 6 months for a midterm success rate of 80.7%. No wound complications or infections occurred. All ulcers healed within 6 weeks of the procedure (mean, 23 days) in the successfully treated patients. CONCLUSIONS: Miniincisional ligation of incompetent perforating veins is easy to perform and has very encouraging early results.
Adult↗
The treatment of focal aortic arch branch lesions with Palmaz stents.
PURPOSE: The purpose of this study was to evaluate the safety and effectiveness of Palmaz stents as a less morbid alternative to traditional surgery for focal aortic arch branch lesions. METHODS: Twenty-two patients with symptoms and a mean age of 61.3 years were treated from July 1991 to May 1995 with 26 stents at the following locations: 8 innominate artery, 5 left common carotid artery, 1 right common carotid artery, and 12 left subclavian. Procedures were carried out in an operating room with patients receiving either local anesthetic in 12 cases or general anesthetic in 10. Surgical exposure of either the cervical common carotid or brachial artery allowed precautionary distal clamping before retrograde stent deployment to prevent atheroembolization. RESULTS: Initial success was possible in 92.3% (24 of 26) of cases. There were no strokes or deaths. During a mean follow-up period of 27 months, 22 of 26 (85%) vessels have remained patent and the patients symptom free. CONCLUSION: Focal aortic branch lesions can be effectively and safely treated with Palmaz stents.
Adult↗
The role of angioplasty and stenting in the treatment of occlusive lesions of supra-aortic trunks.
PURPOSE: To review the authors' four-year experience with endoluminal treatment of stenotic and occlusive lesions of supra-aortic trunks, and to compare the results obtained with those achievable with more conventional surgical reconstruction. METHODS: The authors' four-year experience (7/1/91-6/30/95) with 30 endoluminal brachiocephalic procedures on 26 patients was reviewed retrospectively. The type of occlusive lesion encountered, arterial involvement, symptoms, and indications for treatment were noted. Patients were followed and reexamined at six-month intervals and information from this assessment constituted the source of information to determine success and patency rates. Only one patient was lost to follow-up at three months post intervention, at which time the recanalized subclavian artery was patent and the patient was asymptomatic. RESULTS: There were no operative mortalities or strokes. One patient developed a large cervical wound hematoma which required surgical evacuation. Immediate (technical) success was achieved in 27 arterial segments out of 30 which were approached with intention to treat, for a success rate of 90%. The three immediate failures involved totally occlusive lesions of the left proximal subclavian artery which proved unresponsive to retrograde transluminal recanalization. Long-term arterial patency was achieved in 24 of 30 instances, for a success rate of 80%. The three failure occurred respectively eight (right common carotid artery), 12 (right subclavian artery), and 18 months (left subclavian artery) after the initial procedure, and they all involved restenosis following angioplasty/stenting. CONCLUSIONS: The retrospective review reported herein demonstrates that angioplasty/stenting of focal stenotic and occlusive lesions of supra-aortic trunks would seem to produce immediate and long-term success rates which are quite acceptable, and may approach those achievable with more conventional surgical reconstruction. Further reporting of larger series of patients followed up for longer periods of time will be necessary for more définitive conclusions regarding these less invasive therapeutic options.
Adult↗
Endovascular treatment of aortic arch occlusive disease.
Explore the source record for details and available documents.
Angioplasty, Balloon↗
Carotid-axillary artery bypass: a ten-year experience.
PURPOSE: The purpose of this study was to review our 10-year experience with carotid-axillary artery bypass in the treatment of occlusive lesions of the proximal subclavian artery. METHODS: Our 10-year experience with 26 carotid axillary bypasses for occlusive disease of the subclavian artery was reviewed retrospectively. The review focused on the indication for the operation, the surgical technique used, and the development of immediate and late postoperative complications. Long-term bypass graft patency and clinical success were determined on the basis of information gleaned from the office records of all patients. Only three patients were lost to follow-up at 12, 36, and 38 months. RESULTS: There were no operative deaths. Two patients had small cervical wound hematomas, and two others experienced transient symptoms of brachial plexus irritation, which subsided spontaneously. Permanent nerve or lymphatic complications did not occur. In a mean follow-up of 47 months, carotid-axillary bypass graft patency was 96%, and 88% of the patients enjoyed symptom-free sustained clinical success. CONCLUSIONS: This retrospective review demonstrates that a carotid-axillary bypass constructed with ringed synthetic graft material tunneled under the clavicle performs well and can be considered a reasonable alternative to the more standard carotid-subclavian bypass for the same indications.
Aged↗
Retrograde iliofemoral endarterectomy facilitated by balloon angioplasty.
PURPOSE: The purpose of this study was to explore the feasibility of iliofemoral endarterectomy performed through a single groin incision. METHODS: Thirty-two patients aged 34 to 75 years (mean age 63.4 years) with a male/female ratio of 20:12 underwent 36 lower extremity inflow reconstructions from July 1989 to September 1994. Surgical indications were for limb-threatening ischemia in 24 patients and for claudication in eight patients. The procedures were done for occlusive disease of the external iliac artery and common femoral artery with patients under either spinal (n = 24) or local (n = 12) anesthesia. Intraoperative balloon angioplasty with fluoroscopic guidance preceded open retrograde iliofemoral endarterectomy. Adjunctive procedures included 18 profundaplasties, eight femorofemoral, nine femoropopliteal, and one femorotibial bypasses. RESULTS: Thirty-three of the 36 cases were initially successful. The three failures were in patients with extensive calcification. The mean follow-up has been 36.4 months, and the patency rate was 80.5% at 3 and 4 years. The four failures noted on follow-up were caused by three common iliac artery stenoses and one iliac system occlusion. The former group was successfully treated with balloon angioplasty/stent, and the latter patient required an aortofemoral bypass. No operative deaths or limb loss occurred in this series. CONCLUSIONS: Retrograde iliofemoral endarterectomy facilitated by balloon angioplasty is a safe, easy-to-perform, and viable option for patients with combined external iliac artery and common femoral artery occlusive disease. Midterm results (36.4 months) are favorable, and most hemodynamic failures are easy to correct with standard endovascular techniques.
Adult↗
Endoluminal aortic aneurysm repair using a balloon-expandable stent-graft device: a progress report.
We describe our experience with endoluminal repair of abdominal aortic aneurysms using the stent-graft device. Twenty-four patients underwent 25 procedures in the 27-month period ending December 31, 1992. Twenty-one of the patients were considered high-risk candidates for conventional surgical repair. The endoluminal stented grafts were aortoaortic in 16 procedures and unilateral aortoiliac in eight. One patient underwent a second procedure consisting of an ilioiliac graft to repair a separate common iliac artery aneurysm. Technical problems were primarily related to retrograde transluminal access across the iliac arteries, tortuous aneurysms, and misjudgments as to measurement of length. One patient died and another required secondary deployment of a distal stent at 4 months; subsequent aneurysm expansion mandated surgical replacement at 18 months. It is clear that this device and methodology will have to undergo further refinement before the technique is acceptable for wider clinical application. Current experience, however, is encouraging. Aneurysm exclusion with an endoluminal prosthesis is likely to become an important therapeutic alternative over the next several years.
Aged↗
Endovascular surgery in daily practice: a re-appraisal.
For more than 10 years, endoluminal therapy has been marked by an explosion in the number and variety of devices designed to enhance or supplant its first and still most commonly used technique, balloon angioplasty. Among all these innovative catheter-based technologies, only stents have emerged as a truly effective device capable of achieving results comparable or superior to balloon angioplasty. In combination with thrombolysis and balloon dilation, they form the triadic foundation of endovascular surgery today. The prudent and judicious use of these tools, and a few other "niche" devices, such as atherectomy, in conjunction with classical vascular surgical techniques is the special and unique purview of the vascular surgeon. His development of a therapeutic plan, whose components include patient selection, lesion assessment, device decisions, procedure monitoring completion evaluation, and follow-up, is incumbent upon an appreciation of the capabilities of each available intraluminal device in the various arterial segments and lesion pathologies. The strategies that facilitate optimum matching of endoluminal tools and techniques to each patient situation form the basis of this report. They offer today's vascular surgeon a guide to the use of intraluminal therapies in daily practice. On the horizon is the new and exciting technique of endoluminal grafting, which, if it proves efficacious, will bring about profound changes in our specialty.
Angioplasty↗
The role of endovascular therapy in lower extremity revascularization. Lessons learned and current strategies.
Percutaneous endovascular therapy has emerged as an important modality in the treatment of lower extremity ischemia. Its role is relatively small but better defined at present. Balloon angioplasty remains as the most useful and versatile of all catheter interventions. Common iliac artery lesions, if short and stenotic, are best managed with angioplasty. Percutaneous therapy of femoral-popliteal lesions is less satisfactory but applicable in a small subset of patients with favorable lesions. Intravascular stents and thrombolysis are viewed as major developments in the field. Critically ischemic limbs are seldom amenable to endovascular recanalization. The subspecialty of endovascular therapy should become increasingly the focus of attention by the contemporary vascular surgeon. Catheter technology is destined to influence profoundly current strategies and techniques in the treatment of vascular diseases.
Adult↗
A simple technique to protect subcutaneous vein grafts.
Explore the source record for details and available documents.
Blood Vessel Prosthesis↗
Jugular venous vasopressin increases during carotid endarterectomy after cerebral reperfusion.
Several recent reports have suggested that pressor hormones may be released during and after carotid endarterectomy and that release of these factors may be associated with postoperative hypertension and other postoperative morbidity. We measured vasopressin, adrenocorticotropic hormone, and cortisol in jugular venous blood during carotid endarterectomy under general anesthesia in 43 patients with routine carotid shunting. Jugular venous vasopressin increased significantly after the second period of carotid occlusion for shunt removal and remained increased at closure. Vasopressin did not change during the initial carotid occlusion for shunt placement or during the endarterectomy itself, and neither ACTH nor cortisol changed at any sample time. Greater resting vasopressin and cortisol and larger responses of vasopressin were observed in patients receiving phenylephrine to correct intraoperative hypotension. There were no correlations between postoperative hypertension or postoperative complications and intraoperative hormone values. These results suggest (1) basal intraoperative vasopressin values reflect the blood volume of the patient, (2) increased vasopressin was not related to postoperative morbidity, and (3) intraoperative increases in pressor hormones are most likely physiologic responses to specific stimuli such as hypovolemia or hypotension rather than pathologic phenomena. We speculate that the increase of vasopressin after the second carotid occlusion and reperfusion of the brain may be due to the action of humoral factors released into the carotid circulation from the endarterectomy site.
Aged↗
Laser angioplasty in the lower extremities: an early surgical experience.
From July 1988 through December 1988 laser "hot tip" angioplasties coupled with balloon dilations were performed on 95 patients at the Union Memorial and University of Maryland hospitals. The patients ranged in age from 42 to 84 years (mean, 66.4 years), and there were 61 men and 34 women in the study. Indications for the procedure included claudication in 70 (74%) and severe ischemia in 25 (26%). Noninvasive studies were performed on all patients before and after the procedure. One hundred seventeen segments were treated in 28 iliac arteries and 89 superficial femoral/popliteal arteries. No tibial arteries were treated. Fifty-two stenoses and 65 occlusions occurred. The procedures were performed percutaneously in 52 patients (55%), and open surgical technique was used in 43 patients (45%). Nine immediate failures (9.5%) and 86 successes (90.5%) were noted within 24 hours of the procedure. Follow-up ranged from 1 to 6 months with a mean of 3.2 months. Late failures within this time period occurred in 21 patients (22%). The total failure rate was 30/95 or 31.5%. Only one of the patients was made worse by a failed laser-assisted balloon angioplasty. Immediate complications consisted of formation of subcutaneous hematoma in 20 of the 52 patients having percutaneous procedures (38%) and healing difficulty in 3 of the 43 patients having open surgical procedures (7%). Hospital stay was usually 1 day longer in the latter group. No patient required surgical intervention for bleeding as a result of a vessel perforation. However, this phenomenon was noted during the course of three superficial femoral artery laser-assisted balloon angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The role of sclerotherapy as an adjunct to Unna's boot for treating venous ulcers: a prospective study.
Ankle ulcers associated with venous disease have been traditionally treated by Unna's compressive bandages. However, successful healing of an ulcer with this therapeutic modality is slow and tedious. The purpose of this study is to investigate whether adjunctive sclerotherapy of large venous channels near the ulcers enhances healing. Twenty-eight patients with perimalleolar venous ulceration were entered into this study. Ulcer size ranged from 6.0 to 25 cm2. All were examined for the presence of large venous channels adjacent to the ulcer bed. A portable continuous-wave Doppler supplemented digital examination of the area. Twenty-five out of 28 patients had easily detectable venous channels, and these were randomized into two groups: group I, treated by weekly changes of Unna's compressive boots; group II, treated by weekly change of Unna's compressive boots and sclerotherapy with 3% sodium tetradecyl sulfate (Sotradecol). All patients had the size of the ulcer measured during their weekly visits. Patients in group II took a mean of 2.1 weeks to exhibit 50% healing and 4.3 weeks to fully heal. Conversely patients in group I took a mean of 3.2 weeks to achieve 50% healing and 6.1 weeks to fully heal. Thus, healing was significantly faster (p less than 0.05) in group II. In conclusion, the therapeutic efficiency of Unna's compressive bandaging is significantly enhanced by the adjunctive sclerotherapy of adjacent venous channels.
Adult↗
Interventional procedures for the treatment of vascular disease: recommendations regarding quality assurance, development, credentialing criteria, and education. Regional Vascular Society Committee on Interventional Therapy.
Explore the source record for details and available documents.
Credentialing↗
Physiochemical characterization of cardiovascular calcified deposits. I. Isolation, purification and instrumental analysis.
Calcified human aortic atherosclerotic deposits and calf ventricular assist device bioprosthetic deposits were isolated and deproteinated by hydrazine treatment. Detailed chemical and instrumental analyses were applied to gain comprehensive physicochemical information which makes possible establishing compositional and structural similarities between the 2 types of pathologic mineral deposits which form on different host surfaces. These microcrystalline deposit materials are morphologically very heterogeneous and can be represented chemically as carbonate substituted apatite which, in some of its properties, significantly differs from hydroxyapatite. It is indicated that the mechanism for the formation of cardiovascular deposits proceeds through hydrolysis of octacalcium phosphate precursor.
Adult↗
Symptomatic abdominal aortic aneurysm misdiagnosed as nephroureterolithiasis.
From January 1977 through December 1986, 134 patients with symptomatic AAAs were examined in the emergency room; 24 patients (mean age 72.4 years) had an initial misdiagnosis of "nephrolithiasis." Ten patients had the correct diagnosis of a ruptured AAA established within five hours of the initial examination and were promptly taken to surgery. Fourteen patients had delay greater than five hours while extensive diagnostic evaluations were performed (intravenous pyelograms in 12, computerized tomographic scans in 7, ultrasonography in 6). All patients underwent emergency surgery and six patients operated upon within five hours of initial examination survived. All patients who had extensive diagnostic evaluation lasting more than five hours died. The only diagnostic procedure that definitively established a ruptured aneurysm in all cases was the CT scan. In patients with confusing physical and laboratory findings but in whom the diagnosis of a ruptured AAA is entertained, an emergency CT scan is recommended as the diagnostic procedure of choice.
Aged↗
Synchronous left subclavian and axillary artery aneurysms associated with melorheostosis.
Melorheostosis is a benign, rare congenital disorder of hyperostosis of one or more bones. A case of melorheostosis associated with synchronous left subclavian and axillary artery aneurysms necessitated resection of the aneurysms and replacement with a Gore-Tex interposition graft (W. L. Gore & Associates, Inc., Elkton, Md.) and a reversed saphenous vein graft, respectively. Numerous soft-tissue and vascular anomalies have been noted in patients with melorheostosis, although arterial aneurysms have not been reported previously.
Aneurysm↗