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An acute occlusion of the popliteal artery occurred in an 19-year-old football player as a result of a kick into the back of the knee. Twenty months later recanalization was successfully accomplished by percutaneous transluminal catheter dilatation. It is concluded that not only atheromatous but also post-traumatic arterial occlusions can be successfully treated by this method.
Three thrombosed hemodialysis shunts (two polytetrafluorethylene [Goretex] forearm shunts and one Brescia-Cimino shunt) were recanalized by an 8-F oscillational aspiration thrombectomy catheter. The total aspirated blood volume was less than 200 ml in each case. Subsequently, residual wall adherent thrombi were removed by means of a 6-F mesh basket catheter. The mesh basket showed optimal adaptation even to bent vessel or graft segments. The first experience with oscillational aspiration thrombectomy and mesh basket treatment in thrombosed hemodialysis shunts indicate that this technique may serve as a promising alternative to fibrinolysis or surgical shunt declotting.
The results of selective transcervical tubal recanalisation by means of a catheter in 20 patients with tubal occlusions are reported and discussed. The advantages of tubal recanalisation under DSA are stressed. In 18 (90%) of the 20 patients treated, it was possible to recanalize at least one tube. Nine of these 18 women (50%) became pregnant during the period of observation, averaging 12 months. Selective transcervical recanalisation of obstructive tubes is a rapid, reliable, cheap and hardly invasive treatment of sterility, when compared with laparoscopy or laparotomy. In the majority of patients it makes surgery unnecessary.
Between December 1986 and January 1989, 100 patients with chronic occlusions of peripheral arteries were treated with the new technique of low speed rotational angioplasty. This uses a relatively thick, flexible and blunt catheter, which is driven by an electric motor (100 to 200 r.p.m.). The success rate in the superficial femoral and popliteal arteries of the initial intervention for occlusions less than 10 cm was 90%, for occlusions of less than 10 cm, it was 80%. Occlusions on which conventional techniques had failed were successfully recanalized in 65%. Recanalisation was also successful in seven out of 12 patients with occluded iliac arteries. There were no perforations or other serious complications. It is concluded that the new method is particularly effective and safe for recanalisation of chronic vascular occlusions and should also be considered for cases which previously could only be treated surgically.
Between January 1986 and June 1990, recanalization with guide-wire and balloon angioplasty (PTCA) was attempted in 509 patients (416 men, 93 women; mean age 57.5 +/- 9 years) with chronic coronary artery occlusions. The data recorded were analysed to determine the factors which influenced the outcome. The intervention was initially successful in 284 patients (55.8%; circumflex branch: 50%; right coronary artery: 52%; venous bypass graft: 50%; anterior interventricular branch: 64%). The success rate was markedly reduced if (1) the occlusion had persisted for more than 6 months (9.5%; P < 0.001); (2) occlusion had occurred at or after a vessel kink (28.5%; P < 0.001); (3) there had been no vessel "stump" (36%; P < 0.01) and (4) the occlusion was longer than 10 mm (40.7%; P < 0.05). The success-rate was higher if (1) intracoronary anastomoses were absent (61.2%); (2) occlusion had occurred in a straight vessel (62.6%); (3) there had been a vessel stump (64%); (4) the occlusion had persisted for less than 4 weeks (68.5%) and (5) the length of occlusion was < or = 10 mm (75.8%).-These data indicate that the success of PTCA after chronic coronary artery occlusion depended on the site of occlusion, its duration and length, absence of orthograde collaterals and the presence of a vessel stump. Knowing the extent of these factors helps in delineating the indications.
One hundred ninety-five patients have been evaluated for possible laser recanalization (LR). Current laser delivery systems are most appropriate for the treatment of superficial femoral, popliteal, or isolated common iliac artery occlusions, and therefore one half (110) of the patients were initially excluded because of inappropriate disease location. An additional 39 patients were excluded because they showed minimal symptoms or the procedure would have been excessively risky for them. The remaining 46 patients underwent LR for total arterial occlusions, with relief of symptoms and increased ankle brachial indexes in 22 (48%). Of the four patients who could not be surgically reconstructed because of tibial artery occlusion, none was successfully treated. Only one patient required emergency reconstruction for ischemia after LR failure, and no procedures were required for treatment of perforation or bleeding. Successful LR was most likely when isolated lesions less than 15 cm in length, in the common iliac, middle or distal superficial femoral, and above-knee popliteal arteries were treated. Of the 22 patients for whom LR was successful, 11 would have been candidates for standard surgical therapy, six would have been excluded from such therapy by medical or surgical risks, and five had symptoms usually considered too mild to be offered surgery. Thus, at present the impact of LR on the treatment of patients with peripheral vascular disease appears limited.
OBJECTIVE: This study was designed to examine whether mature collecting lymphatics can regenerate in the adult tissue or not. MATERIALS AND METHODS: The X-ray lymphograms were used to detect network of the collecting lymphatics in rabbit hind leg. Regeneration of the lymphatics was observed after surgical removal of the popliteal lymph node or a part of the popliteal afferent lymphatic. Structure and mechanical properties of the lymphatics were also examined by light and electron microscopes and in vitro functional experiments. RESULTS: One week after removal of the lymph node, only an afferent lymphatic and a deposit of the contrast medium at the popliteal region were observed. Four weeks after the removal, the connection of the afferent and efferent lymphatics at the popliteal region, and collateral lymphatics were present in the leg. Further, 4 weeks after 1-mm excisions of a part of the lymphatic, recanalization was observed between the central and peripheral cut ends of the lymphatic but not after 3- and 10-mm excisions. Endothelial cells and smooth muscle cells could be observed by electron microscope, and contractile proteins, and alpha-smooth muscle actin SM1 and SM2 were immunofluorescently detected in both intact and the regenerated lymphatic walls. In both lymphatics, norepinephrine and acetylcholine induced dose-dependent constriction and dilation of the vessels, respectively. CONCLUSION: The present study demonstrated that mature collecting lymphatics are able to regenerate in the adult tissues.
A total of 66 patients with proximal Fallopian tube (113 tubes) obstruction, as diagnosed by both laparoscopy and hysterosalpingogram, were each subjected to a transcervical recanalization procedure sequentially using selective salpingography followed, if necessary, by tubal catheterization with a soft Teflon 2-French catheter and finally, if needed, wire-guide cannulation. Each procedure were terminated once patency had been achieved without recourse to the next technique. Bilateral obstruction was present in 47 patients and unilateral in 19 patients. Patency was achieved in 39 (34.5%) Fallopian tubes by selective salpingography alone, in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wire guide, with 12 (10.6%) tubes remaining obstructed. Pregnancy occurred in 24 (36.4%) patients without recourse to other treatment (mean follow-up, 17 months). Where patency was achieved (59 patients), 19 out of 43 (44.1%) of those treated for bilateral obstruction and five out of 16 (31.3%) of those treated for unilateral obstruction achieved a pregnancy. Pregnancy occurred in six out of 22 patients (27.3%) where selective salpingography was used to produce tubal patency, in 17 out of 30 patients (56.7%) where tubal catheterization was used and in one out of seven (14.3%) where a wire guide was used, which was an ectopic pregnancy. The difference between the ongoing pregnancy rates following tubal catheterization (50.0%) and wire-guide cannulation (0.0%) was significant (P = 0.033). While wire-guide cannulation is the most effective method used to achieve tubal patency, these results indicate that when it is truly necessary, as opposed to electively used by clinicians, the prognosis with regard to pregnancy is poor and alternative therapy such as microsurgery or in-vitro fertilization should be considered early.
Magnetic resonance angiography (MRA) was performed in a thromboembolic stroke model of the rat to characterize intracranial vessel occlusion patterns and to test its predictive power for tissue recovery after recombinant tissue plasminogen activator (rt-PA) treatment. After rt-PA-treated selective middle cerebral artery (MCA) occlusion, full recanalization was observed in two of three animals, whereas additional occlusion of the circle of Willis (CW) resulted in full vascular flow restitution in only one of six rats. Tissue reperfusion markedly lagged the onset of treatment, and the delay correlated with the pattern of vessel occlusion (20 to 23 minutes for selective MCA occlusion vs. 71 to 79 minutes for combined MCA/CW occlusion). In lateral cortex and striatum the apparent diffusion coefficient decreased to 78 +/- 15% of control after embolization, recovered to 80% to 85% after rt-PA treatment of selective MCA occlusion, but further declined to 66% to 69% after combined MCA/CW occlusion. Correspondingly, T2 relaxation time increased to 107% to 118% of control after selective MCA occlusion and to 112% to 124% after combined MCA/CW occlusion in these regions. The present investigation shows that MRA provides valuable information on the severity of thromboembolic stroke and has the power to predict, before the initiation of treatment, the functional tissue outcome after rt-PA-induced thrombolysis.
Thrombosis of the renal artery to a single functioning kidney is a known cause of anuric acute renal failure in atherosclerotic hypertensive patients. In the present report, recovery of renal function rapidly occurred following transluminal recanalization of the occluded artery with a 7F catheter after a 5-week period of anuria. The most interesting feature was that improvement of renal artery permeability was observed following a minimal interventional procedure.
A patient is reported with successful clinical recanalization of a thrombosed saphenous vein interposition graft in the superficial femoral vein after civilian injury. Primary repair of venous injuries may prevent both initial acute venous hypertension as well as the development of chronic venous insufficiency.
An eight-year-old boy received a grade 3 pancreatic injury as a result of a bicycle handlebar accident. Endoscopic retrograde cholangiopancreatography (ERCP) showed a proximal pancreatic duct transection. At laparotomy, a complete transection of the gland and duct was visualized; however, only debridement and external fistulization were performed. Follow-up ERCP performed 3 months postoperatively showed recanalization of the pancreatic duct without further operative intervention. At 1-year follow-up, the patient is pain free and tolerating a regular diet.
Pulmonary arteriovenous malformation (PAVM) results from an anomalous communication between a pulmonary artery and vein and may lead to life-threatening hemoptysis. Pulmonary angiography is the standard diagnostic technique but may be falsely negative in the unusual instance of a thrombosed PAVM. We report a patient with a thrombosed PAVM in which the initial pulmonary angiogram incorrectly suggested pulmonary embolism. A subsequent magnetic resonance (MR) angiogram demonstrated recanalization of the PAVM, thus establishing the true nature of the lesion and leading to appropriate intervention.
I have documented the recanalization of a venous graft placed in the peripheral venous system to replace a severely disrupted peripheral vein. This case demonstrates the feasibility of such a maneuver, where indicated, to preclude large vein ligation or permanent venous obstruction resulting from inappropriate venography.
BACKGROUND: Collaterals provide significant blood supply to the myocardium at risk and the presence of a preserved and adequate collateral network may limit microvascular damage during the occlusion of an epicardial coronary artery. The aim of this study was to evaluate whether thrombolytic therapy (TT) may produce beneficial effects at the level of microvascular circulation in addition to epicardial coronary artery recanalization by using quantitative intracoronary pressure measurement techniques in patients with recent acute myocardial infarction (AMI). MATERIALS AND METHODS: Thirty-six patients who presented with AMI and had preinfarction angina pectoris, more than 60% stenosis and thrombolysis in myocardial infarction (TIMI) grade II flow in the infarct-related artery and who underwent a stent implantation procedure within 10 days of AMI were included in this study. Seventeen of 36 patients had received TT (group 1) and 19 had not received TT due to presence of contraindications or late admission (group 2). Quantitative coronary angiography, TIMI frame count (TFC) assessment and intracoronary pressure measurements were performed before and after stent implantation for all patients. Myocardial fractional flow reserve (FFRmyo) was calculated as the ratio of mean distal coronary pressure to mean aortic pressure. During total occlusion with balloon inflation, distal pressure was recorded as coronary wedge pressure (CWP). Collateral flow index (CFI) was determined by the ratio of simultaneously measured CWP to mean aortic pressure. RESULTS: There were no differences between the two groups with respect to mean per cent stenosis and mean FFRmyo both before and after stent implantation. The mean CWP (25.1 +/- 8.6 mmHg compared with 17.2 +/- 6.2 mmHg, P < 0.01) and CFI (0.24 +/- 0.10 compared with 0.16 +/- 0.11, P < 0.01) were significantly higher and mean post-stent corrected TFC (18.8 +/- 3.7 compared with 22.4 +/- 3.1, P < 0.01) was significantly faster in the group of patients who had received TT compared to those who had not. CONCLUSIONS: We concluded that destruction degree of collateral circulation and distal microvasculature is lower in patients who had received TT, compared to patients who could not be treated with TT. Besides protective effect on collateral vessels, TT provides even more reperfusion and less destruction of the microvasculature.
PURPOSE: To evaluate the authors' preliminary experience with use of endovascular methods to treat inferior vena cava (IVC) thrombosis in patients with IVC filters. MATERIALS AND METHODS: Catheter-directed thrombolysis, balloon maceration, mechanical thrombectomy, and stent placement were used to treat 10 patients with thrombosis of filter-bearing IVCs causing symptoms in 18 limbs. Procedural challenges, technical and clinical success, complications, postprocedural filter status, and postprocedural pulmonary embolism (PE) prophylaxis were monitored. RESULTS: Technical and clinical success were achieved in 15 of 18 (83%) and 14 of 18 symptomatic limbs (78%), respectively. Major bleeding (muscular hematoma) occurred in one patient (10%). Postprocedural PE prophylaxis included anticoagulation (n = 8) and placement of a new filter into a newly placed Wallstent (n = 1). During clinical follow-up, no clinically detectable PE was observed. Data pertaining to late limb status were available at a median of 19 months (range 1-46 months) follow-up in seven patients: three patients were asymptomatic, two patients had ambulatory edema only, one patient had constant mild edema, and one patient had constant severe edema. Postprocedural filter stability was radiographically documented at a median of 255 days (range, 4-1021 d) of follow-up. CONCLUSION: Endovascular recanalization of the occluded IVC is feasible even in the presence of an IVC filter.
Radiofrequency (RF) ablation is becoming established as a method of treatment of small renal neoplasms. Successful RF ablation of a renal arteriovenous malformation (AVM) was performed in a patient who had previously undergone coil embolization and experienced hematuria after the feeding vessels recanalized. The 3.5-cm lesion was successfully treated with RF ablation, resulting in cessation of hematuria. At follow-up, there was no residual enhancement of the AVM on computed tomography and the lesion had decreased in size.
Ejaculatory duct obstruction (EDO) is an uncommon but correctable cause of infertility and male chronic pelvic pain. The condition is thought to be underdiagnosed, but the increased application of noninvasive imaging tools, specifically transrectal ultrasonography (US), has lead to greater recognition of EDO. Moreover, the development of minimally invasive therapies now offers comprehensive evaluation and treatment options with low morbidity for select patient groups. This report describes the technique of transrectal US-guided seminal vesiculography, percutaneous recanalization, and ejaculatory duct balloon dilation for EDO as a treatment for male chronic pelvic pain.