A modified form of crossover railroad technique is described for iliac and aortic bifurcation obstructions in which the iliac occlusion is crossed from the opposite side by a guidewire which is brought out through the ipsilateral puncture site. After forming a loop in the abdominal aorta, dilatation with two balloons is performed. This procedure was successfully performed in 2 patients having iliac artery occlusions and aortic bifurcation obstruction.

Angioplasty, Balloon↗

PubMedDate not supplied

Percutaneous transluminal angioplasty in nonspecific aortoarteritis (Takayasu's disease): experience of 16 cases.

Sixteen patients with aortoarteritis underwent percutaneous transluminal angioplasty for dilatation of 19 stenotic arteries. Sites included renal arteries (9), subclavian arteries (5), innominate artery (1), abdominal aorta (2), and descending thoracic aorta (2). Angiographic success was obtained in 14 lesions (74%) and partial success in 1 stenosis. The procedure was unsuccessful in 3 renal and 1 subclavian stenoses (21%). There were three complications. Clinically, there was cure of hypertension in three patients and improvement in six patients who had hypertension. Relief of claudication or return of pulsations was observed in seven patients. There was no evidence of any recurrence in the follow-up period (2-33 months). We conclude that percutaneous transluminal angioplasty is a safe and effective procedure for treating symptomatic stenotic lesions in aortoarteritis.

Adolescent↗

PubMedDate not supplied

Total occlusion of iliac arteries: results of balloon angioplasty.

Fifty-six occluded iliac arteries (mean length 6.1 cm; range 1-17 cm) in 50 patients were treated by percutaneous transluminal angioplasty (PTA) or laser-assisted PTA (bilateral lesions in 6 patients). Twenty-seven patients (54%) were at high risk for surgery. Patients were followed for a maximum period of 72 months (mean 23.12 months; median 20 months). The initial success rate was 78.57% for arteries and 82% for patients. Laser-assisted PTA was attempted in 11 occluded arteries (19.64%) and was successful in 4 arteries (7.14%). Conventional PTA was successful in 71.4% of arteries including all 7 arteries for which laser-assisted PTA failed (76% of patients). PTA was unsuccessful in 12 arteries (21.43%). Urokinase was used before PTA in 1 artery. The effect of PTA was evident clinically by relief of rest pain (66.66%), healing of ulcer (57%), increased claudication distance or no claudication (79%) in limbs, and objectively, by improvement in ankle/arm index (AAI) (an increase of 0.16 to 0.91) and increased exercise tolerance. Continuous improvement in AAI was observed after PTA on follow-up in 9 limbs. One patient died during follow-up. On follow-up, 3 arteries were occluded, 6 showed evidence of stenosis, and 1 showed fusiform dilatation at the PTA site. The long-term results using the life-table method determined a 76% primary patency rate and 81% secondary patency rate for 72 months. The overall patency including failures was 63%. Age of the patients (p = 0.0169) and hypertension (p = 0.0015) significantly affected the long-term patency of the artery but not the initial success. The major complications were arterial rupture in a repeat procedure in 1 artery, axillary artery thrombosis in 1, and distal thromboembolic occlusion during PTA in 4. The long-term patency rates suggest that PTA of totally occluded iliac arteries is a safe and effective procedure and provides a long-term benefit.

Adult↗

PubMedDate not supplied

Occlusion of an aberrant right subclavian artery arising from a Kommerel diverticulum.

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Aortic Diseases↗

PubMedDate not supplied

Percutaneous transluminal angioplasty of the subclavian artery in nonspecific aortoarteritis: results of long-term follow-up.

PURPOSE: The results of percutaneous transluminal angioplasty (PTA) of the subclavian artery in nonspecific aortoarteritis (Takayasu disease) are analyzed. PATIENTS AND METHODS: Twenty-four patients (15 men, nine women; age range, 18-47 years; mean, 37.1 years) with occlusive disease in 26 subclavian arteries, had symptoms due to vertebrobasilar insufficiency, upper limb claudication, or both. Aortography revealed stenosis in 19 arteries and occlusion in seven. The lesions were focal in 14 arteries (< 3 cm) and extensive in 12. Associated lesions involved the brachiocephalic artery in three patients, carotid arteries in five patients, and renal arteries in five patients. RESULTS: Initial technical and clinical success was achieved in 21 of 26 arteries (81%, 17 of 19 stenoses and four of seven occlusions). The maximum follow-up was 82 months (mean, 26 months), during which time restenosis occurred in six arteries, all of which had extensive lesions. The cumulative primary, secondary, and overall patencies were 64%, 82%, and 65%, respectively, as analyzed by means of the life-table method. The cumulative patencies for short- and long-segment lesions were 100% and 50%, respectively (P = .0113). Minor complications were observed in four of 26 procedures (15%) and included vasospasm (three patients) and transient loss of consciousness (one patient). There were no major complications. CONCLUSIONS: PTA is useful for treatment of occlusive disease of the subclavian artery in nonspecific aortoarteritis. The procedure is simple and associated with minimal morbidity. Long-term results are excellent in focal lesions but are less durable in the presence of more extensive disease.

Adolescent↗

PubMedDate not supplied

Recognition of trophoblast HLA class I molecules by decidual NK cell receptors--a review.

During placentation the extravillous trophoblast (EVT) cells migrate through the decidua towards the maternal spiral arteries. The walls of the arteries are then destroyed by trophoblast resulting in an increased blood flow to the fetus. These EVT express HLA-G, HLA-E and HLA-C, an unusual combination of two non-classical and one classical MHC class I molecules. The decidua is infiltrated by distinctive uterine natural killer (NK) cells during the time of trophoblast invasion. These cells express a variety of receptors (CD94/NKG2, KIR and ILT) which are known to recognize HLA class I molecules. There is, therefore, a mechanism for molecular recognition of the placental trophoblast cells. The possible functional consequences of this uterine NK cell-trophoblast interactions are uncertain. One possible result is in an altered NK cell cytokine profile which modulates the invasive proclivity of the EVT. In this way placentation could be controlled.

Decidua↗

PubMedDate not supplied

Vascular access problems in dialysis patients: pathogenesis and strategies for management.

Repetitive hemodialysis was made possible through the development of a chronic means of accessing the circulation. This was accomplished through the use of arteriovenous fistulae or grafts, using autologous veins or synthetic materials. Although the arteriovenous fistula remains the access of choice, synthetic arteriovenous grafts are used in most patients because of problems with late referral to a nephrologist and poor vasculature. This article describes the means of accessing the circulation for hemodialysis, the pathogenesis of access failure through progressive stenosis followed by thrombosis, methods of detecting access dysfunction before thrombosis, and therapeutic options. Although angiographic or surgical intervention remain the mainstays of management, medical treatments to decrease stenosis and delay thrombosis are currently under investigation.

Arteriovenous Shunt, Surgical↗