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Biomedical subjects

S Tyagi

Publications and source records attributed to S Tyagi.

118 records · Page 7Linked to original sources
PubMedDate not supplied

Laser assisted balloon angioplasty in lower extremity occlusive disease.

Percutaneous transluminal laser angioplasty was used as an adjunct to balloon angioplasty in 36 occluded lower extremity artery segments in 32 patients. Indications for intervention were severe claudication in 25 (78.1%) and rest pain or gangrene in 7 (21.9%) patients. Neodymium-yttrium-aluminium-garnet laser heated probe was used to recanalize the iliac artery in 19, femoral artery in 9, both iliac and femoral arteries in 2, and popliteal and tibial arteries in 2 patients. Patients with successful laser recanalization underwent balloon angioplasty to further widen the lumen. Initial angiographic success was achieved in 28 (87.5%) patients with recanalization of 32 (88.9%) of 36 occlusions. Three patients had extra-axial catheter/guide wire passage and 1 patient had acute thrombosis of the recanalized artery which was successfully reperfused by thrombolytic therapy. At discharge the Doppler ankle-arm pressure index had increased from 0.46 +/- 0.15 to 0.84 +/- 0.12 (p < 0.001) in 29 patients with recanalized arteries. There was marked clinical improvement in these patients. On 6-47 (mean = 23.4 +/- 7.5) months follow up of 28 successfully treated patients 26 (92.9%) showed sustained clinical improvement. Thus laser assisted balloon angioplasty appears to be a safe and useful adjunct in recanalization of lower extremity occlusive disease.

Adult↗
PubMedDate not supplied

Percutaneous rotational atherectomy in peripheral vascular disease for lesions unsuitable for balloon angioplasty.

Percutaneous rotational atherectomy (Rotablator), a high speed (> 140,000 RPM) rotational burr was used to relieve 90-99 percent obstruction in 3 superficial femoral and 2 axillary arteries. These patients had severe claudication in respective extremities. In 4 patients, the lesion was considered to be unsuitable for balloon angioplasty and one patient underwent rotational atherectomy after failure to cross the lesion with balloon catheter. The burr size used ranged from 1.5 to 2.5 mm. After rotablation, the stenosis was reduced from 94.6 +/- 4.5 percent to 42 +/- 8.4 percent. The residual narrowing was further reduced by adjunctive balloon angioplasty to 14 +/- 5.5 percent (p < 0.001). Except for hemoglobinuria in one patient, there were no complications. All patients had good distal pulsations and were relieved of their claudication. On follow-up of 5-18 months, there has been no restenosis. Thus, our preliminary experience suggests that rotational atherectomy is safe and produces gratifying results in patients with peripheral vascular disease having lesions unsuitable for primary balloon angioplasty.

Aged↗
PubMedDate not supplied

A decade of subclavian angioplasty: aortoarteritis versus atherosclerosis.

The therapeutic outcome of percutaneous transluminal angioplasty (PTA) for subclavian steno-occlusive disease performed over the last 10 years was assessed in 60 consecutive patients of aortoarteritis (n = 35) and atherosclerosis (n = 25). Sixty lesions were stenotic and 6 short segment total occlusions. Twenty-five lesions were prevertebral and 41 postvertebral. PTA was successful in 56 (primary success rate 93.3%) stenotic lesions and 3 (50%) total occlusions. In comparison to atherosclerosis, patients with aortoarteritis were younger (27.7 +/- 9.1 versus 54.7 +/- 10.7 years; p < 0.001), more often female (75% versus 20%; p < 0.001), gangrene was uncommon (0% versus 16%; p < 0.05) and diffuse involvement was more often seen (42.9% versus 4.0%; p < 0.001). The luminal diameter stenosis was similar before PTA (88.6 +/- 9.7% versus 89.0 +/- 9.1%; p = NS); however, aortoarteritis group had more residual stenosis (15.7 +/- 12.5% versus 8.3 +/- 9.6%; p < 0.05) after PTA. Higher balloon inflation pressure was required to dilate the lesions of aortoarteritis (9.9 +/- 4.6 versus 5.5 +/- 1.0 atm; p < 0.001). Three (5%) patients had complications which could be effectively managed nonsurgically. There were no neurological sequelae, even in PTA of prevertebral lesions. On clinical follow-up over a period of 4-120 (43.7 +/- 29.6) months in 45 of the 60 (75%) patients, higher restenosis rate (20.8% versus 4.8%; p = NS) was observed in aortoarteritis group, particularly in those patients with diffuse arterial narrowing. These lesions could be effectively redilated. Successful PTA resulted in marked improvement in symptoms on long-term follow-up. In conclusion, subclavian PTA is safe and can be as effectively performed in aortoarteritis as in atherosclerosis with good long-term results.

Adolescent↗
PubMedDate not supplied

Anaesthetic management of patients undergoing surgery for tachyarrhythmias. Initial experience with 16 patients.

Sixteen patients suffering from various cardiac arrhythmias were treated surgically. Intraoperative computerised electrophysiologic mapping was used in 14. Thirteen patients were suffering from Wolff-Parkinson-White syndrome. They underwent surgical division or cryoablation of accessory pathways. Two patients who had rheumatic mitral stenosis with left atrial clot underwent "Maze III" procedure with open mitral commissurotomy and clot removal. One patient with paroxysmal refractory ventricular tachycardia and a left ventricular aneurysm had an aneurysmectomy with subendocardial resection of the arrhythmic focus. All antiarrhythmic medications were discontinued preoperatively. Morphine was the principal anaesthetic agent, supplemented with halothane. Muscle relaxation was provided with pancuronium bromide. The various problems encountered included hypotension and arrhythmia during placement of epicardial band array for mapping (4 patients), ventricular tachycardia during internal jugular vein cannulation (1 patient) and continuance of delta wave after cryoablation in 2 patients. Halothane may have interfered with electrophysiologic mapping and accurate localization of accessory pathway leading to persistence of delta wave. The choice of anaesthetic agents should be guided by the electrophysiologic effects and potential influence of these agents on the accessory pathways.

Adult↗