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At least 505 records · Page 28Linked to original sources
PubMed1997

Recanalization of total coronary occlusions using a laser guidewire (the European TOTAL Surveillance Study).

The success rates of coronary angioplasty for the treatment of chronic total occlusions are less favorable than for coronary stenosis. Therefore, a new laser guidewire (LW) was designed to facilitate the crossing of chronic total occlusions. We report on the results of a European multicenter surveillance study, evaluating the laser guidewire performance. Between May 1994 and July 1996, 345 patients (age 59 +/- 10 years, 291 men) with chronic total occlusions were enrolled in 28 European centers. The median age of occlusion was 29 weeks (range 2 to 884), the occlusion length 19 +/- 10 mm. LW recanalization was successful in 205 patients (59%/). LW perforation occurred in 73 patients (21%), with hemodynamic consequences in 4 (1%). There were no deaths, emergency coronary artery bypass graft surgery, or Q-wave myocardial infarctions. In a multivariate regression analysis an occlusion age of <40 weeks (p = 0.001, RR = 1.34) and an occlusion length <30 mm (p = 0.01, RR = 1.59) were independent predictors of success. Results indicate that the LW is an effective and safe tool in the treatment of chronic total occlusion refractory to conventional guidewires.

Chronic Disease↗
PubMed1982

Endoscopic recanalization of a portoenterostomy.

Sudden cessation of bile flow occurred in an infant with biliary atresia following successful portoenterostomy. Bile flow was re-established by an endoscopic recanalization procedure, and has been sustained during 1 yr of follow-up.

Bile Ducts↗
PubMed1991

Obstruction and recanalization of the ureter during embryonic development.

Major controversies still exist regarding the terminology, the etiology and the pathogenesis of congenital obstructive diseases of the ureter. To try to provide some additional information to this controversial subject, a comparative study of ureteral development in rat and human embryos, using light and electron microscopy, has been performed. During fetal development we observed and demonstrated the existence of obstructive phenomena, both at the level of the ureterovesical junction (Chwalla's membrane) and along the ureter. At the end of the embryonic period, the ureter undergoes a physiologic recanalization process.

Animals↗
PubMed1998

Percutaneous intentional extraluminal (subintimal) recanalization: how to do it yourself.

A new and simple technique to treat long superficial femoral artery occlusions is explained step by step. Both authors have extensive experience with this technique of percutaneous intentional extraluminal (subintimal) recanalization and this paper is based on their personal experience. Technical considerations, indications, pitfalls, possible complications and results are discussed.

Angioplasty, Balloon↗
PubMed1998

Percutaneous intentional extraluminal (subintimal) recanalization of crural arteries.

Patients with critical limb ischaemia (CLI) often have occlusive disease of the crural arteries. Therefore attempts at treating CLI by minimally invasive means has to be directed towards recanalization of occluded crural arteries. Subintimal angioplasty of long occlusions of the crural arteries is safe and effective and is therefore an excellent alternative to reconstructive surgery in patients who are frequently elderly and frail. It is also relatively cheap when compared to bypass surgery.

Aged↗
PubMed2002

Coronary recanalization in anterior myocardial infarction: the open perforator hypothesis.

OBJECTIVE: Patent perforators, noninvasively imaged by transthoracic color-Doppler echocardiography, may reflect adequate reperfusion in anterior myocardial infarction (MI). BACKGROUND: The Thrombolysis In Myocardial Infarction (TIMI) classification may not fully reflect adequate myocardial reperfusion in MI. METHODS: We studied 61 patients with anterior MI undergoing thrombolysis (n = 28), primary stenting (n = 20), or neither one (n = 13). High-resolution color-Doppler ultrasound was used to image the left anterior descending coronary artery (LAD) and perforators in four segments of the anterior-apical wall and to build a new recanalization score (RS). The TIMI flow was assessed by angiography. Wall motion score index (WMSI), ejection fraction (EF), end-diastolic volume index, and end-systolic volume index (ESVI) were measured by echocardiography at baseline and at three-month follow-up. Linear regression equations, considering RS or TIMI flow as independent variables, were compared among these functional recovery parameters. A multivariate linear model, predicting percent changes of WMSI, EF, or ESVI, was used to investigate the contribution of several clinical covariates along with RS and TIMI flow. RESULTS: Sensitivity, specificity, and diagnostic accuracy of color-Doppler ultrasound in detecting LAD patency were 86%, 98%, and 97%, respectively. Mean and peak flow velocities discriminated (0.004 < p < 0.008) TIMI flow but not RS. Regression equations showed that RS discriminated better than TIMI flow recovery of ventricular function (p < 0.012). The RS was the best single multivariate predictor (p < 0.0001) of percent changes in WMSI, EF, and ESVI. CONCLUSIONS: Transthoracic color-Doppler ultrasound detects an open LAD after MI. Perforators reflect adequate myocardial reperfusion and are early noninvasive markers of myocardial viability.

Aged↗
PubMed1996

Coronary recanalization by elective angioplasty prevents ventricular dilation after anterior myocardial infarction.

OBJECTIVES: In a prospective study we evaluated whether late recanalization of the left anterior descending coronary artery (LAD) affects ventricular volume and function after anterior myocardial infarction. BACKGROUND: Persistent coronary occlusion after anterior myocardial infarction leads to ventricular dilation and heart failure. METHODS: We studied 73 consecutive patients with acute anterior myocardial infarction as a first cardiac event; all had an isolated lesion or occlusion of the proximal LAD. Six patients died before hospital discharge. The 67 survivors were classified into two groups: group I (patent LAD and good distal flow, n = 40) and group II (LAD occlusion or subocclusion, n = 27). The 20 patients in group I who had significant residual stenosis and all patients in group II underwent elective percutaneous transluminal coronary angioplasty (PTCA) within 18 days of myocardial infarction. The procedure was successful in 17 patients in group I (group IB) and in 16 patients in group II (group IIA): in the remaining 11 patients of group II, patency could not be reestablished (group IIB). Left ventricular volumes, ejection fraction and a dysfunction score were measured by echocardiography on admission, before PTCA, at discharge and after 3 and 6 months. RESULTS: Although cumulative ST segment elevation was similar in groups I and II, ejection fraction and dysfunction score were significantly worse in group II. However, ventricular function and volumes progressively improved in group IIA, whereas group IIB exhibited progressive deterioration of function (dysfunction score [mean +/- SD] increased from 21 +/- 6 to 25 +/- 8, p < 0.05; ejection fraction decreased from 43 +/- 10% to 37 +/- 11%, p < 0.05); and end-systolic volume increased from 34 +/- 10 to 72 +/- 28 ml/m2, p < 0.05). Patients in group IIB also had worse effort tolerance, higher heart rate at rest, lower blood pressure and significantly greater prevalence of chronic heart failure. CONCLUSIONS: Delayed PTCA of an occluded LAD can frequently restore vessel patency. Success appears to be associated with better ventricular function and a lack of chronic dilation. Large randomized studies are warranted to evaluate the effect of delayed PTCA on late mortality.

Adult↗
PubMed1998

Time dependence of left ventricular recovery after delayed recanalization of an occluded infarct-related coronary artery: findings of a pilot study.

OBJECTIVES: We sought to test the hypothesis that late recanalization of infarct-related coronary arteries (IRAs) improves long-term left ventricular (LV) function. BACKGROUND: Reperfusion within 24 h of an acute myocardial infarction (MI) has been shown to improve myocardial healing and to reduce infarct expansion. Uncontrolled data suggest that there may be a time window of several weeks for such an effect. METHODS: Sixteen asymptomatic patients 10 +/- 4 days after a first Q wave anterior wall MI with persistent left anterior descending coronary artery occlusion and infarct-zone akinesia were randomized to immediate (2 weeks) or delayed (3 months) angioplasty. Repeat catheterization and cardiac magnetic resonance imaging (MRI) were performed after 3 and 12 months. RESULTS: Angiography 3 months after MI revealed that LV ejection fraction (LVEF) had increased ([mean +/- SD] 54.4 +/- 4.3% vs. 63.9 +/- 7.4%, p < 0.01) as a result of improved regional function (p < 0.01) and LV end-systolic volume had decreased (p < 0.002), whereas LV end-diastolic volume remained unchanged. With delayed angioplasty, LVEF, infarct zone wall motion and LV volumes did not improve. Cardiac MRI at baseline and at 3 and 12 months confirmed these findings and extended them up to 1 year, indicating that delayed angioplasty could no longer improve LV function because of marked LV dilation (p < 0.01). Immediate angioplasty had a high success rate, but restenosis (50%) was accompanied by new severe angina as a clinical indicator of salvaged myocardium, which did not occur after delayed angioplasty. CONCLUSIONS: This pilot study in selected patients supports the hypothesis that myocardial viability persists ("hibernation") for 2 to 3 weeks but not for 3 months after MI, during which time it may be worthwhile to restore blood flow to a large myocardial territory, even in asymptomatic patients, to improve long-term LV function.

Adult↗
PubMed2003

Treatment of limb-threatening ischemia with percutaneous intentional extraluminal recanalization: a preliminary evaluation.

OBJECTIVE: We assessed the technical success, safety, and short-term effectiveness of percutaneous intentional extraluminal recanalization (PIER) in patients with limb-threatening ischemia and no autologous vein or with a major contraindication to surgery. METHODS: From 1999 through 2002, 25 patients with femoropopliteal occlusion and rest pain or tissue loss underwent PIER. Thirteen patients had undergone one or more failed bypass surgeries in the treated lower extremity, and no patient had suitable vein for bypass grafting. In four patients the ejection fraction was less than 15%; four patients had severe nonreconstructable coronary artery disease; and two patients with metastatic cancer refused amputation. All patients underwent subintimal wire placement, followed by percutaneous transluminal angioplasty and intracoil stent placement. Occlusions ranged in length from 6 to 18 cm, and 1 to 10 stents were placed. Technical success required no residual stenosis greater than 30% on arteriography, velocity ratio less than 1.5 on duplex ultrasound scanning, and improvement in ankle-brachial index of 0.15 or greater. Follow-up duplex scanning was performed every 3 months. RESULTS: Initial success was obtained in 23 of 25 patients (92%), with ankle-brachial index improvement of.31 to.54. All successful procedures resulted in symptomatic improvement. Mean follow-up was 13.3 months (range, 4-30 months). During follow-up, 10 patients died and 2 arteries demonstrated recurrent occlusion. With life table analysis, success rate was 92% at 12 months. Of the 4 patients in whom the procedure failed, 3 required major amputation and symptoms persisted in one. Complications occurred after two procedures, one myocardial infarction and one groin hematoma. CONCLUSIONS: PIER is technically possible in patients with femoropopliteal occlusion, and the procedure is associated with a low complication rate. Most procedures provide at least short-term clinical success and have enabled successful wound healing and pain relief in patients without other effective options. Further studies and longer follow-up are required to determine long-term success and the role of PIER in treatment of femoropopliteal occlusion.

Aged↗
PubMed1991

Recanalization of an occluded aortoiliac bypass graft with Palmaz stents.

Four tandem Palmaz balloon-expandable vascular stents were used to recanalize the completely occluded limb of an aortoiliac bypass graft after failure of thrombolysis and conventional angioplasty. The resting peak-systolic pressure gradient across the occluded limb was reduced from 68 to 13 mm Hg. The patient's rest pain resolved, and the ankle-brachial index rose from 0.54 to 0.78. No embolization or stent-related complications occurred. The graft remains patent as determined with noninvasive studies obtained 8 months later.

Anastomosis, Surgical↗
PubMedDate not supplied

Admixture of heparin with urokinase to decrease thrombolysis time and urokinase dose in polytetrafluoroethylene dialysis graft recanalization.

PURPOSE: To determine whether the addition of heparin to urokinase during dialysis graft thrombolysis can lower urokinase dose and shorten procedure time. PATIENTS AND METHODS: Patients who underwent dialysis graft thrombolysis during an 18-month period were studied retrospectively. Twenty patients were treated with urokinase alone, and 19 patients were treated with urokinase and heparin. Thrombolysis was performed in the angiography suite by using a crossed-catheter technique. Urokinase was administered directly into the thrombus. In patients receiving heparin, 5,000 IU was added directly to the initial urokinase solution. RESULTS: In patients who received urokinase alone, an average of 750,000 U of urokinase was used, and the average procedure time was 2 hours 42 minutes. When heparin was added, an average of 435,000 U of urokinase was used, and the average procedure time was 2 hours. CONCLUSION: The addition of heparin to urokinase can decrease both urokinase dose and thrombolysis time in the recanalization of dialysis grafts.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Treatment of chronic iliac artery occlusions with guide wire recanalization and primary stent placement.

PURPOSE: To evaluate the results of primary stent placement without initial thrombolysis in the treatment of iliac occlusions. MATERIALS AND METHODS: During a 3-year period, 61 iliac artery occlusions were treated in 59 patients. The mean length of the occluded segment was 10 cm (range, 4-25 cm). The occluded arteries were treated with primary placement of self-expandable metallic stents. RESULTS: Successful recanalization with primary stent placement was possible in 56 of 61 occlusions (92% technical success rate). Mean Doppler ankle/brachial index increased from 0.51 to 0.90 immediately after treatment and was 0.91 on the last follow-up (P < .05). Primary patency rate at 24 months was 73%, and secondary patency rate was 88%. Procedural complications included distal embolization (n = 4) and an episode of massive intra-abdominal bleeding. Three patients developed a hematoma at the puncture site that did not require additional therapy. Late complications included stent occlusion (n = 9) and significant stenosis related to intimal hyperplasia (n = 1). Mean follow-up period was 29 months (range, 7-55 months). CONCLUSION: Primary stent placement is an effective therapeutic option for iliac artery occlusions.

Aged↗
PubMed1999

Symptomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstruction with endovascular stents.

PURPOSE: To evaluate the safety and efficacy of portal reconstruction in patients with symptomatic spleno-mesenteric-portal venous thrombosis. MATERIALS AND METHODS: Portal reconstruction was attempted in 21 patients (seven women, 14 men; mean age, 53.6 years +/- 15.2) with chronic thrombosis of the portal vein alone (n = 8), splenic vein alone (n = 3), or portal, mesenteric, and splenic veins (n = 10). Indications for the procedure were bleeding varices (n = 15), ascites (n = 2), hypersplenism (n = 2), and enteropathy (n = 2). Sixteen procedures were started transhepatically and of these seven were converted to a transjugular intrahepatic portosystemic shunt (TIPS) after successful recanalization of the thrombosed vein. In six patients reconstructions were performed using an intrahepatic portal vein as outflow. Five procedures were performed primarily as TIPS. Wallstents dilated to 7-10 mm were used for reconstruction. The mean follow-up period was 15.2 months +/- 15.9. RESULTS: Technical success of portal reconstruction was 85.7% (18 of 21). Thirty-day mortality was 14.3% (three of 21) but was not procedural related. The cumulative rates of survival, primary patency, and palliation at 43 months of follow-up were 61.2% +/- 13.5%, 63.5% +/- 15.3%, and 31.7% +/- 15.7%, respectively. Secondary patency was 79.1% +/- 13.8%. The only predictor of mortality was the presence of liver disease (P = .001, Cox regression). CONCLUSION: Portal reconstruction is a safe and effective treatment option for patients with symptomatic chronic portal thrombosis. Liver disease predisposes to a higher mortality.

Aged↗
PubMed2001

The use of transducer-tipped ultrasound catheter for recanalization of thrombotic arterial occlusions.

Ultrasound energy is currently being used and intensively investigated for recanalization of thrombotically occluded arteries. The ultrasonic energy is mainly applied either by a transcutaneous approach or by a percutaneous approach through a catheter with an external ultrasound transducer. Catheter-delivered transducer-tipped ultrasound thrombolysis is a new and innovative method. In this article we summarize the current available data on the use of this new type of catheter and discuss future directions and clinical applications.

Animals↗
PubMed2001

Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt.

A frequent complication in patients with end-stage liver disease is portal vein thrombosis (PVT). Although PVT is not considered an absolute contraindication to orthotopic liver transplantation (OLT), more complex surgery is required and patients have more postoperative complications and greater mortality rates. We describe 2 patients who experienced complete PVT either while waiting for liver transplantation or during the workup, resulting in acute deterioration of liver function. Recanalization of the portal vein was successfully performed in both patients using transjugular intrahepatic portosystemic stent shunt (TIPS), and patency was maintained by the addition of anticoagulation therapy. They subsequently underwent successful OLTs and remain well. In conclusion, we believe that TIPS placement can be performed safely in patients with recent PVT, ensuring the patency of the portal vein until OLT.

Budd-Chiari Syndrome↗
PubMed1978

[Percutaneous transluminal recanalization in a patient with arterial occlusive disease and multiple injuries (author's transl)].

A case of a 66 year old patient with multiple injuries is reported. A combination of conventional trauma treatment and percutaneous transluminal angioplasty (PTR) of a segmented superficial femoral artery occlusion prevented leg amputation. When the patient died 8 weeks later from trauma sequelae the successful recanalization was demonstrated in histopathology investigation. It is concluded that PTR is an ideal accessory to the present therapeutic spectrum in vascular surgery.

Accidents, Traffic↗