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Biomedical subjects

M Sapoval

Publications and source records attributed to M Sapoval.

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

Preoperative assessment of the efficacy of distal radial artery ligation in treatment of steal syndrome complicating access for hemodialysis.

Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We report here a case in which we applied a new diagnostic method to assess the efficacy of distal radial ligation to treat this syndrome. A favorable comparison of distal radial artery pressure measurements before and after temporary occlusion of the artery with a balloon catheter indicated that perfusion of the hand would be dramatically improved after surgical artery ligation.

Angiography↗
PubMed1999

[Immediate results and 2-year follow-up of percutaneous transluminal angioplasty in intermittent claudication in patients over 70 years of age].

PURPOSE: This retrospective study was aimed at assessing immediate and mid-term results of percutaneous transluminal angioplasty for intermittent claudication in patients over 70 years of age, and the overall morbidity and mortality during follow-up. METHODS: Fifty-one percutaneous transluminal angioplasties were performed between 1993 and 1997 in 30 men and eight women (mean age: 78 +/- 5.2; range 71-91) for intermittent claudication (walking distance < 250 m). RESULTS: Angioplasties were supra-inguinal in 24 cases (47%) and infra-inguinal in 27 cases (53%). Clinical success (walking distance > 500 m) was obtained in 92% of the patients. Significant complications (5.9%) were inguinal hematoma requiring subsequent surgery in one patient and common femoral false aneurysms in two patients. Mean duration of hospitalization was 3 days and a half. After a mean follow-up of 25 months (range: 4-51 months), improvement in the walking distance was still present in 31 patients (82%). The condition of seven (18%) patients did not improve. No patient presented with critical ischemia. As well, no patient underwent surgical revascularization or amputation. However, the condition of eight (21%) patients required subsequent percutaneous transluminal angioplasty. Four (10.5%) patients died. Following percutaneous transluminal angioplasty, six (18%) patients presented with a major non-fatal clinical event. All the patients lived at home. CONCLUSION: Percutaneous transluminal angioplasty has little immediate risk when lesions are accessible and leads to positive mid-term clinical results in the treatment of intermittent claudication in patients over 70 years of age.

Age Factors↗
PubMed1998

Endovascular management of bleeding iliac artery pseudoaneurysms complicating radiation therapy for pelvic malignancies.

OBJECTIVE: We evaluated arteriographic findings and endovascular treatments of eight patients who had bleeding iliac artery pseudoaneurysms and who had undergone radiation therapy (3000-6500 rad [30-65 Gy]) and surgery for pelvic malignancies. CONCLUSION: Angiography revealed contrast media extravasation in 75% of patients who had bleeding iliac artery pseudoaneurysms and failed to show the source of bleeding in 25%. The patients who had positive findings at angiography were all successfully treated percutaneously, although two patients required additional bypass surgery. Among embolic materials, coils and balloons were safe and efficient, whereas cyanoacrylate was unsafe and led to complications in two of three patients. A covered stent, which was not available for most of our patients, was used in one patient and may be an effective means of treating pseudoaneurysms.

Aneurysm, False↗
PubMed1997

Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser).

A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of recently thrombosed vessels. A total of 52 consecutive patients (42 males and 10 females; mean age 64 +/- 15 years) presenting with acute or subacute occlusion of dialysis shunts (n = 25), peripheral bypass (n = 14) or native arteries (n = 15) were treated with the Hydrolyser (Cordis Europa NV, Roden, The Netherlands). Mean occlusion time was 4 days (range 1-17 days) and mean thrombus length 19 +/- 11 cm. The Hydrolyser was effective and fast in removing thrombus, regardless of the thrombus length. No major complications were reported. The immediate procedure success rates were 82, 100, 87 and 79 % for Brescia Cimino, dialysis shunt, native arteries and bypass grafts, respectively. Adjunctive thrombolysis (applied for persistence of residual thrombus or thrombosed distal vessels too small for hydrolytic thrombectomy) was required in 4 % of thrombotic dialysis shunts, in 20 % of native arteries and in 50 % of bypass graft occlusions. On angiographic controls, distal embolizations were reported only in native arteries (13 %) and bypasses (14 %); all were successfully treated percutaneously, except for one case treated by Fogarty balloon. Cumulative primary patency rates were respectively at 6 months 56, 62, 78 and 65 % for each indication. We conclude from this preliminary clinical study that hydrodynamic thrombectomy with a Hydrolyser is a promising technique to treat acute occlusions. This device can reduce complications as well as the time required to remove large amounts of thrombus and the use of expensive thrombolytic drugs.

Angiography↗
PubMed1997

Experimental bilateral lobar lung transplantation and its application in humans.

BACKGROUND: The critical lack of donor organs from people of small size or children has created great difficulties in transplantation for recipients who are of smaller size. Surgical techniques of organ reduction and partial transplantation may to some extent solve the problem of disparity in organ size, be it liver or lung, and lessen the problem of scarcity of paediatric organs. METHODS: In a series of experiments on dogs the surgical technique of pulmonary partition of a large organ from a grown dog followed by transplantation of lobes, either unilaterally or bilaterally, into a young dog was studied. Two series of experiments were performed in two groups of animals; in group 1 transplantation of a single right lobe (n = 6) or single left lobe (n = 6) from a split adult lung was carried out and in group 2 (n = 10) animals received bilateral lobar transplants from a single split adult lung. The animals were sacrificed at fixed intervals (days 8-120 in group 1, days 7-10 in group 2) and the results of the surgical technique were assessed. RESULTS: Healing of lobar bronchial anastomoses was found to be excellent with no histological evidence of dehiscence or ulceration. There was one bronchial anastomotic stenosis and one arterial thrombosis. Morphological and functional adaptation of the lobes in the thorax was found to be excellent in both groups of animals. The technique has been applied in a clinical setting and the first patient with bilateral lobar lung transplantation followed for 30 months is reported. CONCLUSION: Lung partition and subsequent lobar transplantation, either unilaterally or bilaterally, is associated with satisfactory early results in an animal experimental model. Initial clinical experience in one patient has been successful.

Adult↗
PubMed1996

Aortocaval fistulae: a percutaneous model and treatment with stent grafts in sheep.

BACKGROUND: Treatment of aortocaval fistulae (ACFs) by open surgery is known to be a high-risk procedure. In this experimental study, we developed a percutaneous model of ACF to test a new nonsurgical method of treatment of ACF using endovascular stent grafts. METHODS AND RESULTS: An ACF was created percutaneously in eight sheep. Via a combined venous and arterial femoral approach, angioplasty balloons were inserted to occlude the infrarenal aorta and inferior vena cava (IVC). The IVC was punctured through the lateral aortic wall with a transjugular liver biopsy needle. The fistulous tract was then dilated with an 8-mm angioplasty balloon, and the animal was heparinized. Two weeks later, a 10-mm Cragg-Endopro-Stent was inserted into the aorta at the level of the fistula via a percutaneous femoral approach. ACFs were successfully created in all animals, with rapid dye shunt through the fistula and a 20% increase in cardiac pulsations. Follow-up angiograms at 2 weeks showed a patent ACF, and stent implantation excluded the fistula in every case. Angiographic and pathological examinations up to 6 months demonstrated normal aortic patency and persistent exclusion of the fistulae. CONCLUSIONS: ACFs were effectively treated by endovascular grafting of the aorta. The animal model and the stenting procedures were both performed percutaneously.

Angioplasty, Balloon↗
PubMed1996

Evaluation by electron beam computed tomography of intracardiac masses suspected by transoesophageal echocardiography.

OBJECTIVES: To assess the suitability of electron beam computed tomography (EBT) in evaluating and subsequently managing cardiac masses suspected as a result of examination by transthoracic and transoesophageal cross sectional echocardiography. DESIGN AND PATIENTS: In 76 consecutive patients with suspected cardiac masses, the impact of the EBT examination was analysed by reviewing whether EBT examination altered management by confirming or excluding a mass, whether EBT imaging substantially contributed to decision-making, and lastly whether EBT influenced the decision to operate on the patient. RESULTS: EBT modified the diagnosis or confirmed results which had been questionable with cross sectional echocardiography in 53 cases (70%): these cases included those with anatomical features such as dense calcifications or fatty structures (n = 20), lipomatous lesions (n = 5), equivocal thrombi (n = 5), pericardial masses (n = 5), or hydatid cysts (n = 2). EBT gave information over and above cross sectional echocardiography in all patients with malignant tumours (n = 16) by providing a better delineation of the relation between intracavity masses and normal structures, including the mural site of tumour attachment and tumour extension to the great vessels and the adjacent extracardiac mediastinal structures. EBT provided no additional information over cross sectional echocardiography in the remaining patients (n = 23), particularly in those with myxomas (n = 11) or small valvar lesions (n = 6). EBT only confirmed that the lesion was well demarcated, limited in extent, or not associated with a mass. CONCLUSIONS: EBT has considerable potential for clinical management and surgical planning and may help clinicians to decide against surgery, particularly in patients with unresectable tumours.

Adolescent↗
PubMed1996

Endomyocardial fibrosis: electron-beam CT features.

PURPOSE: To present morphologic and functional electron-beam computed tomographic (CT) features of endomyocardial fibrosis. MATERIALS AND METHODS: Twelve patients with histologic evidence of endomyocardial fibrosis and/or definitive echocardiographic and angiocardiographic findings were examined with electron-beam CT. RESULTS: Endomyocardial fibrosis was depicted as linear calcifications and/or a thin tissue band of low attenuation within the endomyocardium. In right ventricular involvement, CT depicted obliteration of the apex associated with extension along the free wall and/or papillary muscles of the tricuspid valve. In left ventricular involvement, a large amount of endocardial tissue led to severe obliteration within the inflow tract and/or of the apex. At ventricular volume analysis, restrictive patterns of the disease were determined. CONCLUSION: Electron-beam CT allows direct visualization of endomyocardial fibrosis and the resulting volumetric changes and enables distinction of the disease from constrictive pericarditis.

Adolescent↗
PubMed1996

[Acute femoro-popliteal ischemia. New therapeutic approach. Respective role of thrombo-aspiration and in situ thrombolysis].

The purpose of this paper is to describe, based on our experience, the respective place of percutaneous thrombo-aspiration and in situ thrombolysis in acute inferior limb ischemia. Between july 1991 and April 1995, 46 patients presenting with acute arterial occlusion were treated by percutaneous thrombo-aspiration related to arterial emboly (n = 24) or acute in situ thrombosis (n = 22). Most of the occlusions lied in the popliteal and distal leg arteries. Complementary balloon angioplasty of the underlying stenosis was performed in 26 cases (53%). Immediat angiographical success was obtained in 96% of the embolic occlusion and 59% of the in situ thrombosis. Based on this experience, we believe that thrombo-aspiration can be performed to treat a recent acute arterial occlusion (10-20 days) of the terminal part of the superficial femoral artery, with extension distaly to the origin of the leg arteries. This technique is easy to perform and can be proposed as a alternative to the Fogarty catheter in acute short emboli occlusion (length than 15 cm long) on normal or pathologic arteries. Extension of this indication for critical ischemia in patients with no possibility of surgical revascularization, can be proposed using combination of in situ fibrinolysis and thrombo-aspiration with percutaneous angioplasty, at the site or on run off.

Acute Disease↗
PubMed1995

[MRI in cardiology: clinical applications and perspectives].

MRI is an effective tool in the evaluation of cardiovascular diseases. With continued improvements in MR angiography, velocity mapping, myocardial tagging, imaging speed and display, it is anticipated that MRI will play an ever-increasing role in the morphological evaluation of many cardiovascular anomalies. The need for quantification in cardiology has led to the development of a variety of techniques to assess cardiac size and function. In attempting to answer these clinical questions, MRI provides major advantages several: extraordinary flexibility, powerful contrast mechanisms, sensitivity to flow and motion, and freedom from ionizing radiation, contrast agent and acoustic windows. Because of accurate initial results in quantifying cardiac chamber size, global and segmental function, it is likely that MRI methods will play an increasing role in the evaluation of cardiac structure and function. Recently, MRI has emerged as an important tool in the evaluation of great vessel disease, particularly in the evaluation of both congenital and acquired abnormalities of the aorta. Early evidence suggests that magnetic resonance may help in distinguishing constrictive pericarditis from restrictive cardiomyopathy (e.g., amyloid heart disease). Cardiac-MRI lends itself to assessment of intracardiac masses. Spin-echo imaging alone is often sufficient for diagnosis. Cine-MRI has important additive value, however, when a mass lesion shows dynamic motion, or when abnormal flow patterns in conjunction with a mass lesion require evaluation.

Echocardiography↗
PubMed1995

[Drug thrombolysis and mechanical recanalization in recent femoro-popliteal arterial occlusions].

Acute femoro-popliteal occlusions (native arteries or bypass grafts) were treated by medical and surgical treatment. Despite improvement in surgical technique, patient mortality was high and limb loss remained frequent. Percutaneous endoluminal treatment of such lesions is feasible using in situ fibrinolysis and/or thromboaspiration singly or in association with balloon angioplasty. Those techniques are effective and are currently the first intention treatment of many of those acute femoro-popliteal occlusion. The advantages and disadvantages of those techniques are discussed, as well as their respective indications, and particularly their place compared to surgical techniques. New devices such as mechanical thrombectomy may increase effectivity and indications of endovascular treatment however such devices need to be better evaluated.

Arterial Occlusive Diseases↗
PubMed1995

[Isolated stenosing calcified lesions of the aorta].

Two cases of isolated calcified lesions of the aorta are reported. The first observation is that of a 25 years old man suffering from mild intermittent claudication predominant in the left leg. Radiological examination showed a calcified isolated lesion of the infra renal abdominal aorta. The patient underwent surgical treatment (thromboendarteriectomy) and was asymptomatic after 6 months. The second observation concerns a 30 years old man treated for benign thrombocytemia in whom a severe arterial hypertension associated with a thoracic bruit was discovered incidentally. Radiological workup demonstrated a solitary calcified lesion of the descending thoracic aorta. Endarteriectomy was performed and the patient was still asymtomatic at 12 months. A review of the literature as well as physiopathological hypothesis and diagnostic and therapeutic management of these uncommon lesions is proposed.

Adult↗
PubMed1994

[Contribution of the electron beam scanner (Imatron) in aortic pathology].

Electron Beam CT (SFE, Imatron) uses electron beam to generate X rays. This allows the shortest acquisition time today available (50-100 ms). It is the best CT examination for moving structures. In vascular disease arterial wall study is the most important end point, especially in aortic pathology. EBCT is effective in aortic aneurysm, dissection and aortitis diagnosis. It allows a pre-surgical mapping of the lesion and follow-up. We believe that EBCT is superior to other diagnostic mean in the assessment of the ascending aorta and of small arterial lesions.

Aortic Dissection↗
PubMed1994

[Ostial stenosis of the renal arteries: treatment by angioplasty].

In a series of 50 patients (22 females, 28 males); 52 ostial renal artery stenoses were treated by transluminal balloon angioplasty. The mean age of patients was 66 years (range 36-81); mean arterial pressures were 181 mmHg for the systolic pressure and 87 mmHg for the diastolic pressure. The mean level of serum creatinine was 179 mumol/l +/- 128. An immediate success was obtained in 86.5% (residual stenosis of 26%). There were 7.6% of immediate failures and 13.5% of residual stenosis above 50%. Mortality within 1 month was observed in 2 patients. Morbidity included one aortic dissection and 5 cholesterol embolisms. After a mean follow-up of 10 months, 78% of the series were controlled: 66.6% exhibited a residual stenosis below 50%, 25.9% had restenosis and 7.4% had an occlusion of the renal artery. Since patients with ostial renal artery stenosis constitute a high surgical risk group, transluminal balloon angioplasty might be considered as an acceptable and safe alternative treatment.

Adult↗