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At least 397 records · Page 22Linked to original sources
PubMed2006

Percutaneous laser-facilitated thrombectomy: an innovative, easily applied, and effective therapeutic option for recanalization of acute and subacute thrombotic hemodialysis shunt occlusions.

PURPOSE: To report our experience with excimer laser-facilitated recanalization of acute and subacute thrombotic occlusions of hemodialysis shunts. METHODS: Twenty-one patients (16 women; mean age 54+/-19 years, range 31-76) presented with acute and subacute thrombotic occlusions of their hemodialysis shunts (4 Cimino, 17 prosthetic; 18 forearm, 3 upper arm); mean occlusion time was 4.1+/-3 days (range 1-14), and the thrombotic occlusion measured a mean 17.4+/-9 cm (range 5-27). Fresh thrombus was observed in addition to the total shunt occlusion in all cases. All patients were treated initially with a pulsed ultraviolet (308-nm) excimer laser. Eighteen (85.7%) patients received adjunctive local thrombolysis for treatment of residual thrombus. Nineteen (90.5%) patients underwent angioplasty of the underlying anastomotic stenosis. RESULTS: The angiographic occlusion was reduced from 100% to 63%+/-28% after laser treatment and to 36%+/-18% after 1 hour of thrombolytic therapy (20 mg tissue plasminogen activator). TIMI flow increased significantly from grade 0 to 2.7+/-0.5 following laser ablation (p<0.001) and to 3.0+/-0.2 upon completion of the angioplasty procedure (p>0.001 versus baseline). The immediate procedural success was 95.2% (20/21). Detectable thrombotic embolization and laser-related complications were not observed in any case. Primary patency was 85%; 3 patients had abnormal Doppler flow within 6 weeks and underwent reintervention (secondary patency 100%). All successfully treated shunts were usable for further dialysis at the 6-week follow-up. CONCLUSION: Percutaneous excimer laser-facilitated thrombus vaporization is safe and effective for recanalization of acute and subacute thrombotic occlusions of hemodialysis shunts.

Acute Disease↗
PubMed1989

Recanalization of experimental thrombotic arterial occlusion by radiofrequency thermal angioplasty: an angioscopic observation.

The efficacy of radiofrequency (RF) angioplasty for recanalization of arterial thrombosis was assessed angioscopically in five dogs. A thrombus was induced by balloon injury of the left femoral artery. Within two hr, thrombi led to total occlusion of the artery in three dogs, subtotal occlusion in one, and about 70% obstruction in one. A metal-tipped catheter, with a tip size of 2.0 mm x 5.7 mm, was advanced into the thrombus and RF at 13.56 MHz was delivered repeatedly with gradually increased energies. The arterial lumina were recanalized or enlarged in all dogs. The thrombus surface had a shaggy appearance, and were dark (charring), or mixed dark and white in color. There were relatively large variations in the energies required; 140 J in one, 200 J in two and 250 J in two. The present results suggest that thrombotic arterial occlusion, such as acute occlusion complicating balloon angioplasty, can be treated with RF thermal angioplasty. Angioscopy provided detailed information about thrombus surfaces. The variations in required energies indicate the inability to control the thermal effect by energy settings alone. A more sophisticated method such as measurement of tip temperature will be able to overcome this difficulty.

Angioplasty, Balloon↗
PubMed1991

Selective salpingography and fallopian tube recanalization.

Obstruction of the uterine (proximal) end of the fallopian tube is noted on up to 20% of hysterosalpingograms and has a variety of underlying causes. Definitive diagnosis and treatment in the past have required laparoscopy or laparotomy with tubal resection. Selective salpingography and fallopian tube recanalization with fluoroscopically guided catheters has emerged as an improved method both for diagnosis and treatment in these patients. Technical success rates for overcoming the obstruction and visualizing distal tubal anatomy range from 76% to 95%. Pregnancy rates after the procedure vary depending on the patient populations studied; however, early results indicate a greater than 50% intrauterine pregnancy rate by 1 year. The rate of ectopic pregnancy is approximately 10% and that of early tubal reocclusion is less than 30%. Selective salpingography and fallopian tube recanalization is recommended as the first intervention in patients with obstruction of the proximal fallopian tube.

Catheterization↗
PubMed1985

A method to prevent recanalization of the transected bile duct in the rat.

The purpose of this study was to develop a surgical technique for bile duct occlusion in the rat which would prevent restoration of biliary drainage. In three successive series of animals the surgical technique was modified from ligation and transection to ligation and transection with resection and, finally, to ligation and transection with transposition of the distal end behind the stomach-duodenum. In these three groups recanalization was observed in 4 out of 9, 1 out of 9, and 0 out of 19 animals, respectively. Bilirubin levels in plasma monitored in the last group showed that a stable cholestatic jaundice was maintained for at least 6 weeks. The results suggest that transposition of the distal transected end of the bile duct below the stomach-duodenum will effectively reduce the chance of recanalization and thus make study of long-term extrahepatic cholestasis in the rat more practical.

Animals↗
PubMed1992

[A case of complete recanalization in the lower abdominal aorta by intraaortic infusion of a thrombolytic agent].

Intraarterial infusion of thrombolytic agent is useful in the treatment of obstructive arterial diseases in various vessels. However, few studies have shown that this treatment is useful for aortic occlusion. We report the case with complete recanalization in the lower abdominal aorta following intraaortic infusion of a thrombolytic agent. A 59-year-old man was admitted because of weakness and pain in the bilateral lower limbs at rest. Aortography showed complete occlusion of the abdominal aorta proximal to the inferior mesenteric artery. Both external arteries were supplied via rich collaterals. He was treated by intraaortic urokinase infusion of 2,100,000 units. Total recanalization in the abdominal aorta and both common iliac arteries was obtained. Intraaortic infusion of urokinase was shown to be effective treatment of occlusion in the abdominal aorta.

Aorta, Abdominal↗
PubMed1995

Total recanalization of a spontaneously thrombosed arteriovenous malformation. Case report.

The authors describe what they believe to be the first case of an asymptomatic, totally recanalized arteriovenous malformation (AVM) demonstrated by angiography 31 months after complete spontaneous thrombosis. The AVM, which initially became symptomatic with bleeding, had a 2-cm diameter nidus that was located within the inferior aspect of the left frontal lobe and was fed by branches from the left anterior cerebral and anterior ethmoid arteries. A single draining vessel flowed from the nidus into the anterior superior sagittal sinus. The AVM was surgically extirpated after recanalization. The authors stress the necessity for follow-up care for angiographically "cured" AVMs.

Cerebral Angiography↗
PubMedDate not supplied

Carotid artery stenting in a patient with spontaneous recanalization of a proximal internal carotid artery occlusion: a case report.

We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up.

Angioplasty, Balloon↗
PubMed1999

[Recanalization of cerebral cortical venous thrombosis: a case report].

Several clinical cases of sinus thrombosis have been reported, but localized cerebral cortical venous thrombosis is a fairly rare clinical entity. We report a case of a 51-year-old woman who presented with right hemiparesis on admission. CT scan revealed subcortical hemorrhage with perifocal edema in the left front-parietal lobe. A T2W image revealed a large area of hyperintensity indicating edema, and coronal Gd enhanced T1 weighted image showed a reverse-triangle-shaped enhanced lesion. Left carotid angiogram showed cerebral cortical venous thrombosis in the left frontal lobe, but the superior sagittal sinus was not occluded. A month after admission, right hemiparesis had suddenly improved and the patient could walk without any support. Left carotid angiogram showed recanalization of thrombosed cortical veins and CT scan showed disappearance of any low density lesion indicative of edema. It is an important fact that neurological deficit improved quickly a month after onset, and it was suspected that, even without resorting to fibrinolytic therapy, recanalization of thrombosed cerebral veins would still eventually occur. We found the reverse-triangle-shaped enhanced lesion on MRI and we suspected that it was typical finding for cerebral cortical venous thrombosis.

Brain↗
PubMedDate not supplied

A case of Budd-Chiari syndrome successfully treated by transcatheter recanalization of the right hepatic vein and transjugular intrahepatic portosystemic shunt.

A 40-year-old man with Budd-Chiari syndrome due to chronic obstruction of the major hepatic veins was successfully treated by interventional radiologic procedures. Initially, partial splenic embolization was performed to improve thrombocytopenia and coagulopathy of blood. Second, recanalization was done by thrombolic therapy. Finally, the TIPS procedure was carried out through the recanalized right hepatic vein. This resulted in great improvement of Budd-Chiari syndrome, a marked decrease in pressure, and disappearance of gastroesophageal varices on endoscopy.

Adult↗
PubMedDate not supplied

[Selective salpingography and transcervical tubal recanalization: technique, indications, results. Apropos of 53 proceedings].

The aim of the study is to evaluate the efficacy of selective salpingography and fallopian tube recanalization as a diagnostic and therapeutic procedure when proximal tubal obstruction is present. Fifty-three procedures were performed between January 95 and March 98 in the Radiology Department of Hôtel-Dieu de France Hospital, on 53 infertile women aged between 25 and 43 years. Unilateral or bilateral obstruction was documented on hysterosalpingogram or by laparoscopy. The technique consisted of a direct fallopian tube catheterization, under fluoroscopy using an hydrophilic guidewire. Water soluble contrast material was used. Eighty-eight tubes were evaluated (35 with bilateral and 10 with unilateral obstruction, 8 single tubes). Recanalization was possible in 52 cases (97.5%). Twenty-nine patients were followed. Thirteen pregnancies were reported (45%). This pregnancy rate is however increased to 62% if we exclude the cases where other infertility problems coexisted. No complications occurred. Selective salpingography and fallopian tube catheterization is a non invasive successful technique that is extremely useful in the diagnosis and treatment of tubal obstruction in women with infertility problems. It can be performed immediately after an hysterosalpingogram when the fallopian tubes are not opacified.

Adult↗
PubMed2000

ChoICE PT wire for recanalization of chronically occluded coronary arteries: multiple wires in one?

Percutaneous transluminal coronary angioplasty (PTCA) of chronic total occlusions may be technically difficult and the success rate is limited despite increasing operator experience and improvements in PTCA hardware. The number of guidewires required to cross totally occluded lesions is higher than that for stenotic lesions. The ChoICE polymer-tip (PT) wire (Boston Scientific/Scimed, Inc., Maple Grove, Minnesota) is a relatively new stainless-steel core wire with a hydrophilic-coated polyurethane tip. Though never described in the literature, we found that the distal 4 cm of the wire can be cut and reshaped according to the operator's needs. Thus, instead of reshaping a kinked tip or using another new wire, the former being time-consuming and the latter expensive, one can simply cut off the kinked tip and start again with a "new wire." As the tip is resected, the wire becomes progressively more "intermediate-like" and "standard-like." We report our experience with the ChoICE PT wire in 50 consecutive cases of chronic total occlusions. The cumulative crossing success rates were 13/50 (26%) before any resections, 24/50 (48%) after 1 resection, 41/50 (82%) after 2 resections and 42/50 (84%) after 3 resections. There were no perforations, deaths, myocardial infarctions or need for bypass surgery. Our findings suggest that successful recanalization of chronic total occlusions can be achieved with a high success rate using the ChoICE PT wire. A strategy of progressively resecting the more floppy and kinked distal end can provide multiple uses from a single wire, optimizing recanalization success and obviating the need for additional wires.

Adult↗
PubMed2000

Percutaneous recanalization of thrombosed dialysis shunts.

Clotted hemodialysis shunts are a frequent and costly complication encountered in end-stage renal patients undergoing hemodialysis. Treatment strategy is rapidly shifting from surgical thrombectomy to percutaneous recanalization because of the ready availability of the latter technique as well as increased patient comfort. We looked at 99 episodes of thrombosis in hemodialysis shunts, 33 in natural fistulae, treated with several percutaneous techniques of recanalization, all with similar and high success rates, regardless of whether thrombolytics were administered or not.

Angioplasty↗
PubMed2001

Brain single-photon emission CT studies using 99mTc-HMPAO and 99mTc-ECD early after recanalization by local intraarterial thrombolysis in patients with acute embolic middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: The brain distribution of 9mTc-hexamethylpropyleneamine oxime (HMPAO) correlates with regional brain perfusion, whereas 99mTc-ethyl cysteinate dimer (ECD) reflects not only perfusion but also the metabolic status of brain tissue. We compared 99mTc-ECD single-photon emission CT (SPECT) with 99mTc-HMPAO SPECT early after recanalization by local intraarterial thrombolysis (LIT) in patients with acute embolic middle cerebral artery occlusion. We also assessed the predictive value of 99mTc-HMPAO and 99mTc-ECD SPECT for the development of ischemic brain damage. METHODS: 99mTc-HMPAO and consecutive 99mTc-ECD SPECT studies were performed in 15 patients within 3 hours of LIT. The two SPECT studies were obtained independently using a subtraction technique. SPECT evaluation was performed using semiquantitative region-of-interest analysis. Noninfarction, infarction, and hemorrhage were identified by follow-up CT or MR imaging. RESULTS: Forty-five lesions were identified (21 noninfarctions, 19 infarctions, and five hemorrhages). Regardless of 99mTc-HMPAO SPECT findings, lesions showing isoactivity (count rate densities of 0.9 to 1.1 as compared with the contralateral side) on 99mTc-ECD SPECT were salvaged. Lesions with hypoactivity (values < 0.9) on 99mTc-ECD SPECT developed irreversible brain damage. Hemorrhage appeared in lesions with both hyperactivity (values > 1.1) on 99mTc-HMPAO SPECT and hypoactivity on 99mTc-ECD SPECT. CONCLUSION: The brain distribution of 99mTc-ECD in a reperfused area identified by 99mTc-HMPAO SPECT early after recanalization of acute ischemic stroke is dependent on cerebral tissue viability. By combining 99mTc-ECD and 99mTc-HMPAO SPECT, performed within the first few hours of LIT, it is possible to identify patients at risk for hemorrhagic transformation reliably.

Aged↗
PubMed2001

"Wireless" laser recanalization of chronic total coronary occlusions.

Chronic total occlusions in particular, completely obstructed aorto-ostial lesions are among the most challenging targets in interventional cardiology. Excimer laser is a debulking technology for revascularization of complex lesions. Treatment of total occlusions with laser angioplasty can be applied providing that a guidewire traverses the entire length of the occlusion prior to device activation. In many patients with total occlusions, a guidewire is unable to penetrate the target stenosis. This communication presents a new technique termed "wireless" laser recanalization. This approach entails recanalization of a total occlusion with a laser catheter without a leading guidewire.

Adult↗
PubMed2001

Predictors of re-occlusion after successful recanalization of chronic total occlusion.

UNLABELLED: The objective of this study was to highlight the incidence and predictors of re-occlusion after successful recanalization of chronic total coronary occlusions. METHODS AND RESULTS: Following successful recanalization and stent implantation in 716 coronary lesions (665 patients) with chronic total occlusion, four hundred and five (56.6%) lesions (375 patients) underwent repeat angiography within 6 months. Restenosis (> or = 50% lumen narrowing) was observed in 151 (37.3%) lesions; forty-three (10.6%) of these lesions had complete re-occlusion and constituted the study population. In this group, final angiographic minimal lumen diameter (MLD) was 2.6 +/- 0.51 mm and final percent diameter stenosis was 18 +/- 11. Univariate analysis revealed significant correlation between re-occlusion and restenotic lesions, final balloon diameter, final percent diameter stenosis, final angiographic MLD, number of stents per lesion and total stent length. By multivariate analysis, the only independent predictor of re-occlusion was total stent length (OR = 1.46, 95% CI = 1.12-1.82; p = 0.0069). CONCLUSION: Re-occlusion occurs in about 11% of cases after stenting chronic total occlusion. The most important predictor of re-occlusion seems to be stent length.

Aged↗
PubMed1975

Obstruction and normal recanalization of the ureter in the human embryo. Its relation to congenital ureteric obstruction.

In this work, after the study of 45 normal human embryos of 5-55 mm from vertex to coccyx, it is shown that the ureteric ducts, which in the first phases of development are permeable (embryos of 5-13 mm), constantly undergo a process of obstruction and posterior recanalization of their lumen, which takes place when they are from 14 to 22 mm. These processes begin in the middle zone of the ureters and progress proximally and distally until they cover its entire length, for which these ducts, which in embryos of approximately 17 mm in length form solid cords, but in the embryos of 23 mm are totally permeable. This obstructive process is found in relation to atrophy and loss of activity of the mesonephros, while that of recanalization follows the intense longitudinal growth of the ureters in this phase of development. These modifications, which the ureteric lumen normally undergoes during its embryonic development, are of great importance for correct interpretation of the pathogenic mechanism of congenital ureteric strictures and valves.

Cell Differentiation↗
PubMedDate not supplied

[Endoscopic recanalization in treating ureteral obliteration].

For diagnosis of urethral obliteration we have developed a method of complex examination including x-ray and ultrasound investigations, NMR-tomography of the small pelvis and perineum. This method provides maximal significant information about defects in the urethra and adjacent tissues and organs. Endoscopic urethral recanalization was performed in 86 patients with urethral obliteration aged from 7 to 78 years. Good and satisfactory results were achieved in 46 (53.49%) and 34 (39.53%) cases, respectively. Unsatisfactory results were obtained in 6 (6.98%) patients. Two of them had enuresis, 3 developed recurrent obliteration and 1 patient died. He suffered from concurrent cardiovascular disease and died early after surgery of hemorrhage and myocardial infarction. Secondary urethral stricture after endoscopic urethral recanalization was observed in 36 (41.86%) patients. Repeated internal optic urethrotomy and chronic urethral bouginage in combination with medication at the stage of rehabilitation resulted in stabilization of the urethral lumen in 34(94.4%) patients. Serious intraoperative complications arose in 3 (3.49%) patients: perforation of the rectum (1 patient), TUR syndrome (1 patient), prostatic perforation and hemorrhage (1 lethal outcome). The complications were in all the cases explained by erroneous direction of the endoscope movement, obliteration length more than 3 cm and underestimation of the severity of the patient's condition.

Adolescent↗
PubMedDate not supplied

[Intestinal recanalization 16 years after Hartmann's operation].

The authors report a case of a surgical intestinal recanalization after 16 years since a Hartmann's intervention. After some considerations on the results they obtained in similar cases, the Authors call attention on this specific clinical case. They come to the conclusion that a successful surgical recanalization--although the difficult availability of the remaining rectal stump--is possible even if a long period has passed since a Hartmann's intervention was performed. In fact the rectal stump and the sphincter apparatus, even if excluded from the fecal transit for a long while, retain largely their specific functional activities and show a marked ability for an effective sensitive-motor restoration.

Adult↗