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At least 397 records · Page 22Linked to original sources
PubMed1994

Performance of indirect embolectomy aided by a new developed flush-suction catheter system. Forty-seven experimental embolectomy procedures in test animals.

Embolectomy by means of the Fogarty catheter is the therapy of choice in the event of acute occlusions of limb arteries. However, less invasive catheter procedures have become established means to perform embolectomies lately. In order to improve the results after using the above mentioned methods, we have developed a new embolectomy procedure. The system applied consists of a flush-suction catheter as well as a high pressure pump. There is a jet-suction unit on the head of the tubular two-lumen catheter to gather thromboembolic material from the circumference of the head, to erode the collected material and evacuate it. The flushing pressure is generated by the pump. For the experimental testing of the system, the flush-suction embolectomy has been performed in 19 pigs after 47 artificial produced extremities embolism. Angiographically and angioscopically it could be proved that even older thrombotic material could be removed completely and without significant trauma of the vessel. At the pathologic investigation of the vessel in which embolectomy had been performed in no case an essential vessel-wall damage could be found. In almost each case the embolic material was removed completely. Only in 5 cases (10.6%) we have distal microembolism. Due to the experimental tests, the system turns out to be reliable as far as the technique is concerned. In addition, in the event of clinical application, the system allows the expectation of a reduction of the time interval between diagnosis and therapy, as well as a percutaneous application.

Angiography↗
PubMed1993

[The evolution of iliac artery surgery: vascular endoprostheses].

The Authors report their experience about vascular endoprostheses in iliac arterial stenoses and thromboses. Results are discussed in relation to technical difficulties and indications. The comparison between classic vascular surgery previously used, and the endovascular procedures recently adopted, leads the Authors to assert the validity of this last technique. However the need of precise indications based on radiological and angioscopic findings is stressed.

Adult↗
PubMedDate not supplied

[Peripheral and coronary angioscopy: its correlation with endovascular procedures].

The efficacy of any method of transluminal angioplasty has been evaluated with angiography, this can show the major anatomic results. Angioscopy can detect by direct observation, the induced changes in the vessel wall morphology after the recanalization method. We studied 5 coronary arteries and 9 peripheral arteries with total occlusion in 7, and the other 7 with more than 75% of obstruction. All of them were evaluated with angiography and angioscopy, before and after the transluminal angioplasty. Eleven of the arteries were treated by transluminal ultrasound angioplasty, we obtained recanalization in 90% of them, in 6 (55%) of this we found angioscopic evidence of dissection in variable degrees. Two cases were treated only with balloon angioplasty, and the angioscopy image was of dissection too. In the only case of laser angioplasty we observed dark brown coloration in the treated lesion suggesting carbonization changes. The initial angiography analysis did not suggest the presence of complication of the atheroma plaque. However in 21% of the cases the angioscopy inspection demonstrated and hemorrhagic dye of the endothelium, and thrombosis in situ in 29%. We no found correlation in angiography and angioscopy aspect in 25% of the cases. Some of the endothelial alterations that can not be detectable by angiography, can be demonstrated by angioscopy, this changes could improve the appreciation of any recanalization method results, that could suggest its possible immediate and late complications.

Angioplasty, Balloon↗
PubMed1993

Secondary dye testing of the lacrimal system.

Using the Olympus PF-22 angioscope to examine the inferior meatus during secondary dye testing of the lacrimal system, I evaluated the efficacy of the secondary dye test to localize partial or functional obstruction of the upper or lower lacrimal excretory system. Secondary dye testing was positive (dye present in the nose) in 12 of 13 lacrimal systems (92%) with functional nasolacrimal duct obstruction, in 7 of 8 (89%) with involutional ectropion, and in 4 of 5 (80%) with facial nerve palsy. Secondary dye testing was negative in the 1 lacrimal system with canalicular stenosis and in 5 of the 6 (83%) with punctal stenosis. Secondary dye testing is helpful in differentiating punctal or canalicular stenosis from functional nasolacrimal duct obstruction; however, it cannot help differentiate ectropion or facial nerve palsy from functional nasolacrimal duct obstruction.

Adult↗
PubMed1993

[Interventional angioscopy].

Since 1987, routine angioscopic examination has been performed in 191 patients undergoing angioplasty, with interventions (196) after a 2 year surveillance period (55). Angioscopy allowed follow up "de visu" of the performance of angioplasty, details of its mechanism to be precise and under dilatation to be carried out. For femoral artery occlusions it allowed treatment "à la carte": conventional dilatation of vegetating atheroma, specific treatment of established thrombi (5) and abstention from therapy of atheroma covered by endothelium (3). It also enabled fresh thrombi complicating a stenosis or at the origin of a thrombus to be detected. The extraction technique employed (15) is described. It facilitated catheterization by directing the probe, enabled avoidance of bypassing of stenosis and flaps and of dissection or false introduction into collaterals (10). Directed biopsy could be carried out in inflammatory arteritis (7). Vegetating atheromatous lesions could be opened and extracted, facilitating subsequent dilatation and allowing an approach to removal of iliac artery obstructions without major risks of complications (13). Finally, after an ineffective dilatation or the presence of a dissection, it assisted making the decision to introduce a stent (9), the tolerance and outcome of these stents are described. Or the 196 patients considered suitable for angioplasty, our therapeutic conduct was modified by angioscopy in 58 cases (29%). Not simply a new diagnostic tool, it plays a role in interventional vascular techniques.

Angioplasty↗
PubMed1993

Arterial intimal flaps: a comparison of primary repair, aspirin, and endovascular excision in an experimental model.

The optimal management for traumatic arterial intimal injuries is unresolved. Three therapeutic options were compared in an experimental model employing a standard intimal flap created in 51 canine superficial femoral arteries. Group 1 (14 arteries) underwent resection with end-to-end repair. Group 2 (19 arteries) received acetylsalicylic acid (ASA) and observation only. Group 3 (21 arteries) underwent endovascular excision of the flap with angioscopic guidance. Control intimal flaps (18 arteries) were created and observed without further intervention. Patency in group 1 (primary repair) and group 2 (ASA) was 100%; the patency in both was significantly (p < 0.05) greater than in the controls, which was 67%. Patency in group 3 (endovascular excision) was 79%. Residual luminal defects were observed in only 8% of the arteries repaired primarily, but in 76% of the aspirin-treated arteries. Residual luminal defects following endovascular excision were present in 53% of the arteries remaining patent. Although resection and primary repair (group 1) provided better results than observation alone (control), addition of ASA (group 2) also sustained patency. However, a high incidence of residual intimal defects occurred, the natural history of which is unknown. While endovascular excision (group 3) may become a feasible alternative, current technology provided inferior patency with frequent residual intimal defects. These results suggest that observation alone supplemented with antiplatelet medication (ASA) may be adequate treatment, but longer follow-up is necessary for confirmation.

Angioscopy↗
PubMed1995

[Interventional radiology: current and future].

The current status and the future development of interventional radiology in Japan were reviewed and discussed. The recent development of interventional radiology has been supported by the technological advances in medical imaging modalities, catheters or other devices. Superselective catheterization and embolization of small vessels have been realized by digital subtraction angiography and microcatheters. Intravascular occlusion with detachable coils is an effective treatment for cerebral aneurysms. Results of balloon angioplasty for arterial occlusive disease have been promoted with the use of vascular stents. Stent-grafts for the treatment of aortic aneurysms are under clinical trials in the western countries. New devices such as specially designed balloons for local drug delivery, angioscopic catheters, intravascular ultrasound and atherectomy catheters are now clinically used. Micromachine technologies will also be applied for new therapeutic catheters. In the field of non-vascular interventional radiology, the use of open-magnet MRI and real-time MR fluoroscopy will be useful in lesion localization, needle tracking and monitoring of treatment such as interstitial laser irradiation, radio frequency tumor ablation or ethanol injection. Interventional radiology will be more widely accepted for the treatment of vascular and non-vascular diseases in the future.

Catheterization↗
PubMed1996

[Clinical experience of laser angioplasty for the peripheral and coronary arterial diseases].

In recent years, laser angioplasty has been widely performed in the world. Since the 1980's we have investigated anigoplasy using Argon laser for patients with peripheral and coronary arterial diseases. This technique aims to open the obstructive arterial lumen. Based on the excellent results of experimental studies, this technique has been clinically applied. Laser angioplasty was carried out in 98 patients with stenotic or occlusive lesions of the peripheral arteries and 10 patients with anginal attack. Argon laser and an optical fiber delivery system with metal tip probe with thermal feedback control system were used for laser angioplasty. This procedure was performed under angioscopic and intravascular ultrasound imaging. Primary clinical success was achieved in 97 (82%) of all 119 lesions, that is, 53 (91%) of 58 in the stenotic lesions and 44 (72%) of 61 in the occlusive lesions. There were no complications required emergency operation. At 95 months of follow-up, the cumulative patency rate was 80% in 83 limbs with primary success. In the 43 stenoses and 40 occlusions, the cumulative patency rare were 87% and 71%, respectively. On the other hand, laser was simultaneously applied at the time of operation for 10 patients with anginal attack in addition to coronary artery bypass grafting. Thus, laser angioplasty was safe and effective to increase the initial success rate for the lesions that were difficult to treat by balloon anigoplasty. Angioscopy and intravascular ultrasound imaging were useful for the observation of the newly recanalized channel by lasing and selection of the recanalization technique, such as laser angioplasty, atherectomy and stent, according to the characterization of the lesions. These results suggested that laser angioplasty might be a useful treatment for patients with chronic peripheral arterial occlusion and improve the long-term patency rate by eliminating restenosis more than conventional balloon angioplasty.

Adult↗
PubMed1996

[Lipid factors and evolution of the atherosclerotic plaque: review of recent trials].

A beneficial impact of lipid-lowering therapy on the incidence of coronary artery disease has been demonstrated in several clinical trials. It has been suggested that lipid lowering therapy not only slows the progression of atherosclerotic lesions, but also promotes its regression. Furthermore, reduced levels of circulating cholesterol (total cholesterol as well as LDL fraction) might decrease plaque volume and growth, restore endothelial function and thus reduce vasomotor tone. The obtained increased plaque stability reduces the risk of disruption and subsequent cardiovascular events. Ongoing ultrasonographic and angioscopic studies will provided further insights into the disease itself and its management.

Controlled Clinical Trials as Topic↗
PubMed1997

[Use of angioscopy in vascular surgery bypass with an in situ approach--first year experience].

Femoropopliteal and femorocrural bypass, managed by "in situ" procedure with the use of angioscope, became a standard surgical method in the treatment of occlusive process in the arteries of lower extremities in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. The capabilities of angioscopy in diagnosis and in surgery are presented, with special emphasis on bypass "in situ" procedure. Technical difficulties encountered in bypass formation and our solutions are described. From December 1993 to December 1994, eleven patients were operated. Common femoral artery was used for proximal anastomosis in four patients. Superficial femoral artery was used in five patients, and profound femoral artery was used in two patients. The third segment of popliteal artery was used for distal anastomosis in five cases. In six cases crural bypass was done. Three of them were on posterior tibial artery, two were on fibular artery and one was on anterior tibial artery. Two out of four or 50% of femoropopliteal bypasses are patent after the first year. One patient died of cardiorespiratory complications in the early postoperative period. Femorocrural bypasses are patent in five out of six patients or 83.3%. Bypass with great saphenous vein "in situ" is the procedure of choice, especially in femorocrural position.

Aged↗
PubMed1997

Surgical reconstruction for deep venous insufficiency.

All patients with significant venous stasis disease should undergo noninvasive evaluation to determine the magnitude, precise location, and etiology of the problem (i.e. obstruction and/or reflux). Patients who fail aggressive medical therapy (compression and skin care) and who have significant symptoms should be considered candidates for surgical correction. The majority of patients screened will have a significant component of superficial venous insufficiency with or without the presence of incompetent perforating veins. In this case we address the superficial and perforating venous systems prior to consideration of deep venous reconstruction. When correction of superficial venous incompetence fails to improve the patient's symptoms, they are then considered for deep venous reconstruction. Patients with primary venous insufficiency are typically good candidates for direct valvuloplasty performed using the open or angioscopic techniques, while patients with damaged (post thrombotic) or absent valves are best managed by vein valve transplantation or segmental transposition. Results for both valvuloplasty and vein valve transplantation demonstrate good intermediate term valvular patency and ulcer healing. It appears that when used as part of a complete treatment protocol addressing superficial, deep, and perforating venous systems, as well as attention to skin care and appropriate compressive therapy that surgical reconstruction for deep venous reflux affords significant benefit to our patients.

Adult↗
PubMed1997

[Coronary angioscopy].

Coronary angioscopy evaluates the composition of the atherosclerotic plaque by direct examination of the arterial wall. The angioscope is fitted with a balloon which prevents assessment of the proximal segment of the vessels. The fibre optic system provides and excellent view of the mid and distal segments of the coronary arteries. The coronary arteries appear smooth and white on angioscopy. The atherosclerotic plaque is a white or yellowish incursion. Unstable plaques are characterised by the presence of thrombus. In unstable angina, thrombus is observed in 64% of cases and in 75% of cases during the first month after myocardial infarction. The colour of the plaque seems to be related to its fragility: the yellow plaque is much more common during myocardial infarction than in unstable angina (75% versus 47% of cases). Finally, after coronary angioplasty restenosis is more commonly white, covered by neo-intimal proliferation. Angioscopy has been shown to be feasible and safe and it is a better method of identifying thrombus. At present, it is a tool for clinical research in coronary thrombosis and interventional cardiology.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Modern trends in the field of the coronary artery surgery: clinical experience of laser application].

In the recent years, laser has been widely utilized in the field of medicine. But, there are few application in the cardiovascular surgery. Since 1980, we have applied lasers in the following three categories in the field of cardiovascular surgery. That is, Group 1: laser angioplasty for occlusive arterial disease, Group 2: laser vascular anastomosis especially for small caliber vessels, Group 3: new myocardial revascularization. Consequently, effects of laser application could be clearly recognized in these fields. On the basis of excellent results of our experimental studies, laser was clinically employed for 135 patients with anginal pain, intermittent claudication or renal failure. Optimal conditions for laser angioplasty were 6 watts in output and 3 sec in irradiation time for each shot. Laser irradiation was carefully repeated according to the grade of atherosclerotic changes. Angioscope was useful for keeping safe procedures. On the other hand, optimal conditions of vascular anastomosis were 20-40 mW in output and 6-12 sec/mm in irradiation time. They consisted of laser angioplasty with 6 cases of intraoperative coronary laser angioplasty in 37 cases, and vascular anastomosis including 8 cases of coronary artery bypass surgery in 97 cases, new myocardial revascularization in one case. These patients are doing well without any complications throughout laser. Our clinical experience of laser application in the cardiovascular surgery are presented.

Adult↗
PubMed1998

[A case report of pulmonary embolectomy using an endoscope for the detection of residual emboli].

A 61-year-old woman was transferred to our hospital because of palpitation, tachypnea and repeated syncopal attack. On admission, sinus tachycardia and hypoxia were noted without deterioration of consciousness. The diagnosis of pulmonary embolism was made by pulmonary angiography and right heart catheterization showing multiple pulmonary emboli and pulmonary hypertension. An emergent pulmonary embolectomy was performed under total cardiopulmonary bypass. Residual emboli of bilateral pulmonary arteries were detected with a fiberoptic choledochoscope and removed carefully with forceps. Pulmonary angioscopic evaluation appears to be safe and useful for direct visual detection of emboli and completion of embolectomy.

Embolectomy↗
PubMed1998

[Percutaneous coronary angioscopy in the diagnosis of cardiac graft coronary disease: comparison with the results of angiography].

Coronary disease in cardiac transplant patients is a major factor in the limitation of long term survival. The aim of this study was to compare the results of angioscopy with those of coronary angiography performed systematically every 18 months in our center. Twenty-nine patients (31 angioscopies) were assessed 38 +/- 21 months after transplantation. The appearance observed by angioscopy were: 1) normal, 2) yellow pigmentation of the arterial surface, 3) elevated plaque < 50%, 4) elevated plaque > or = 50% stenosis. Angiography was: 1) normal, 2) iregularities of the lumen or < 50% stenosis, 3) > or = 50% stenosis. The films were viewed by two independent investigators. Angioscopy was performed on the left anterior descending artery (N = 35), the left circumflex (N = 24) and the right coronary artery (N = 9). One to three arterial segments were examined per vessel (total of 117 segments: average 3.8 segments per patient). Angioscopy was uniterpretable in 13/117 (11%) of cases. Of the 81 (78%) segments considered normal at coronary angiography, only 55 seemed normal at angioscopy (68%). Of the 23 segments considered to be abnormal at coronary angiography, all were also considered to be abnormal at angioscopy. The authors conclude that coronary angioscopy seems to be more sensitive than coronary angiography for the detection of coronary disease due to chronic rejection. Prospective studies are required to determine whether the infra-angiographic angioscopic lesions correspond to earlier stages of coronary disease of the cardiac graft.

Aged↗
PubMed1998

[Progress in diagnosis and treatment of acute coronary syndrome].

Acute coronary syndrome is caused by disruption of a coronary atherosclerotic plaque. It is recognized that the risk of plaque disruption depends more on plaque composition than on plaque size. Therefore, it is important to establish imaging techniques and clinical markers for the identification of vulnerable plaques. Intravascular ultrasound and angioscope may reveal important features of vulnerable plaques. In the near future, optical coherence tomography and intravascular thermography may further improve the characterization of plaques. Systemic markers of inflammation, such as CRP and SAA, may reflect the intensity of inflammation in the atherosclerotic lesion. Clinical observations indicate that plaques may be stabilized by lipid-lowering drugs, anti-oxidants, estrogen and Chlamydia-killing antibiotics. After plaque rupture, new generation antiplatelet and anticoagulant drugs, such as GPIIb/IIIa antagonists and low-molecular heparin, can limit the mural thrombi formation more effectively.

Acute Disease↗
PubMed1998

[Angioscopy associated with renal transplantation].

OBJECTIVES: To evaluate the usefulness of backtable angioscopy of renal allograft previously to kidney transplantation (KT). METHODS: Twenty five allografts from high risk vascular donors have been angioscopically evaluated. Donors were older than 50 years, with severe aortic atheromatosis, polytraumatized, with cardiac arrest or with vascular lesions or anatomic anomalies of the renal vessels. RESULTS: Forty four per cent (11/25) of the grafts showed vascular pathology on angioscopy: subintimal hematoma (2), intimal tear (2), atheroma plaques (2), venous thrombosis (1) and bench microsurgical vascular reconstruction (4). CONCLUSION: Renal allograft angioscopy is useful in selected cases. It allows to evaluate vascular state of the graft and the quality of microsurgical vascular reconstructions.

Angioscopy↗
PubMed1993

Coronary artery rupture and pseudoaneurysm formation resulting from percutaneous coronary angioscopy.

We describe a case in which coronary angioscopy was complicated by inability to deflate the device's occlusion balloon. Rapid over-inflation to rupture the balloon resulted in massive dissection of the artery, pseudoaneurysm formation, and ultimately coronary bypass. While the cause of failure of balloon deflation remains obscure, deliberate over-inflation to cause rupture may be hazardous.

Adult↗