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PubMed2006

Recurrent rupture of a hypogastric aneurysm caused by spontaneous recanalization of an Amplatzer vascular plug.

A patient with a ruptured hypogastric aneurysm was treated via an endovascular approach with coils in the outflow vessels and an Amplatzer vascular plug (AVP) in the main trunk. After 4 weeks, the patient was readmitted with a recurrence of rupture of the hypogastric aneurysm caused by recanalization of the AVP. Final occlusion of the hypogastric artery was achieved by placement of a stent-graft and additional coils. In consideration of this experience, it is recommended that additional coils or several AVPs be used and early contrast medium-enhanced computed tomography follow-up be performed.

Aged, 80 and over↗
PubMed2005

Spontaneous recanalization of the divided lactiferous duct in the rat.

The objectives of the current study were to test the hypotheses that ductus lactiferous may regenerate after its transection and to develop a reproducible model for future studies. A total of 168 nipples from 14 Wistar female rats were used in this experimental study. This study was conducted in 2 parts. During part 1, the normal anatomy of the lactiferous duct and its histomorphologic features were studied. This group was also used for histologic and morphometric comparison. During part 2, the lactiferous duct was exposed through a vertical incision and was transected by scissors. A small gap was produced by elastic retraction of the surrounding tissue. The authors assessed patency mainly by histologic evaluation. Galactography was performed to collect additional support for the recanalization process. The patency rate of the lactiferous ducts was 66.6%. Luminal narrowing was observed in all specimens. A significant difference did occur in the mean cross-sectional area (P < 0.01) and the wall thickness (P < 0.05) between 2 groups. A computed stereologic image analyzer was used to estimate the mean surface area of a lactiferous duct and the wall thickness.

Animals↗
PubMed2006

Laser recanalization of the subclavian vein.

We report the use of a long wire and introducer as a rail for the laser recanalization of a chronically occluded subclavian vein following extraction of a fractured permanent pacing lead. This allowed new pacing leads to be placed through the previously occluded vessel.

Child↗
PubMed2002

Immediate and long-term outcome of recanalization of chronic total coronary occlusions.

Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was < 30 days (subacute total occlusion [STO]: 25 patients; range 1-30 days) or > 30 days (chronic total occlusion [CTO]: 58 patients; range 3-144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complications, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 +/- 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success.

Aged↗
PubMed1996

Effects of acute percutaneous transluminal recanalization on cerebral embolism.

The effects of percutaneous transluminal recanalization (PTR) on critical hemodynamics of cerebral embolism were studied using stable xenon-enhanced computed tomography in patients within 6 hours after onset. PTR was conducted in 10 cases (PTR group) and not conducted 8 cases (non-PTR group). The development of infarction was followed by CT scan. In the cortical arterial regions, the lowest cerebral blood flow (CBF) value in regions of interests (ROIs) without development of infarction was 12.9 ml/100 g/min in the PTR group and 17.0 ml/100 g/min in the non-PTR group. In ROIs with a cerebrovascular reserve capacity (CRC) less than 0 ml/100 g/min, even with a CBF greater than 12.9 ml/100 g/min, 3 of 4 ROIs underwent cerebral infarction. PTR conducted within 6 hours after onset of cerebral embolism would prevent the cortical regions with a CBF greater than 12.9 ml/100 g/min and with a CRC greater than 0 ml/100 g/min from undergoing cerebral infarction.

Acute Disease↗
PubMed2004

Percutaneous intentional extraluminal recanalization in patients with chronic critical limb ischemia.

PURPOSE: To review percutaneous intentional extraluminal recanalization (PIER) for treatment of patients who are poor candidates for infrainguinal arterial bypass surgery (IABS) and have arterial occlusions and chronic critical limb ischemia (CCLI). MATERIALS AND METHODS: Patients with CCLI who were poor candidates for IABS were candidates for PIER. PIER was performed to create continuous arterial flow to the foot for limb salvage. PIER was attempted in 40 patients (22 men, 18 women; median age, 69 years; age range, 44-87 years). Of these patients, 24 (60%) had diabetes, 17 (42%) had renal disease, and 26 (66%) had coronary artery disease. Wound healing was evaluated at follow-up. Kaplan-Meier curves were constructed to evaluate limb salvage, survival, and amputation-free survival. RESULTS: Fifty procedures were attempted in 44 limbs. Tissue loss was present in 40 (91%) limbs, and rest pain was present in four (9%); technical success occurred in 38 (86%). Thirty-seven (84%) of 44 limbs treated with PIER involved tibial vessels (tibial vessels only, n = 15; tibial and superior femoral artery [SFA] and/or popliteal vessels, n = 22). Sixty-six infrainguinal arterial vessel segments (SFA, n = 29; tibial, n = 37) in 38 limbs (1.7 segments per limb) were successfully treated with PIER. Thirty-five (95%) of 37 tibial occlusions and 24 (83%) of 29 SFA and/or popliteal occlusions were longer than 10 cm. Median run-off scores were 5.3 (range, 3-8) and 6.6 (range, 3-9) for patients with tibial occlusions and SFA and/or popliteal occlusions, respectively, as scored with modified Rutherford weighting of run-off arteries. Median follow-up was 7.8 months (range, 1-24 months). Twelve months after PIER, Kaplan-Meier analysis showed limb salvage rate was 66%, survival rate was 71%, and amputation-free survival rate was 48% in these patients. The 30-day mortality rate was 2.5%. Major complications occurred in four (10%) patients, and minor complications occurred in an additional four (10%). CONCLUSION: PIER is a useful percutaneous technique for limb salvage in patients with CCLI.

Adult↗
PubMed1984

Percutaneous recanalization of an occluded renal artery and delayed ethanol ablation of the kidney resulting in control of hypertension.

An elderly woman presented with severe hypertension related to a renin producing kidney supplied only by collaterals. Recanalization of the artery to this kidney leads to incomplete blood pressure control. Subsequently, percutaneous, selective ethanol infusion ablated the kidney and lead to good control. This two-step approach allowed both evaluation of function and definitive, non-surgical therapy.

Aged↗
PubMed1985

Electrolysis for recanalization of urinary collecting system obstructions: a percutaneous approach.

Nine recent endourologic cases are presented that evidence percutaneous electrolysis and electrocautery as new and safe techniques for incising the urothelium. Electrolysis with balloon dilation was employed to remove stones sequestered behind infundibular and/or diverticular neck stenoses, to correct uretero-pelvic junction (UPJ) stenoses and strictures, and to recanalize a totally obstructed fibrotic UPJ.

Adult↗
PubMed1987

Fallopian tube obstruction: selective salpingography and recanalization. Work in progress.

Seven infertile women, in whom interstitial fallopian tube obstruction (IFTO) was suspected at hysterosalpingography and who were recommended for surgical evaluation and treatment, were treated with catheterization techniques. Selective salpingography with ostial injection demonstrated tubal patency in two patients; direct intratubal salpingography demonstrated patency in another patient. Four patients with a true IFTO underwent fallopian tube recanalization: in the first two, a small soft-tipped guide wire was used, and in the other two, a guide wire and 3-F catheter were used. The suggested catheterization techniques have the potential to make evaluation and treatment of IFTO more efficient, safer, and less expensive than presently used methods.

Adult↗
PubMed1987

Recanalization of obstructed arteries with a flexible, rotating tip catheter.

A flexible, rotating tip catheter (Kensey catheter) was used to recanalize 24 segments of diseased superficial femoral arteries (from cadavers) that were sewn as xenografts into the femoral, carotid, or aorticorenal arteries of 14 dogs. One perforation occurred; there were emboli in some brains and kidneys, the consequences of which remain unknown. No signs of gross neurologic deficits or limb ischemia were seen at 0-11 days.

Angiography↗
PubMed1989

Budd-Chiari syndrome: treatment with percutaneous transhepatic recanalization and dilation.

The authors describe a child with Budd-Chiari syndrome secondary to membranous obstruction of the hepatic veins and a web in the inferior vena cava. Transhepatic catheter venography demonstrated the occlusion, which was recanalized and dilated percutaneously via a transhepatic approach. Hepatomegaly and ascites decreased promptly and the prothrombin time became normal.

Angioplasty, Balloon↗
PubMed1990

Occluded peripheral arteries: clinical utility of argon laser recanalization.

Optically diverged direct argon laser light energy was used prior to conventional balloon angioplasty to recanalize 30 occluded peripheral arteries in 26 patients. Three of five (60%) iliac and 22 of 25 (88%) femoropopliteal lesions ranging in length from 1 to 47 cm (mean, 17.3 cm) were successfully treated, for an overall technical success rate of 83%. In the femoropopliteal system, 13 of 14 (93%) procedures in lesions less than 20 cm and nine of 11 (82%) procedures in lesions greater than 20 cm were treated successfully. No statistically significant differences in success rate based on lesion site, lesion length, degree of lesion calcification, or severity of peripheral vascular disease were found. Major complications were a laser perforation resulting in treatment failure in one case (3%) and a successfully treated distal embolus in another (3%). No reocclusions occurred in the immediate postoperative period. While long-term follow-up will be required to assess continued patency, this system can potentially increase the number of patients amenable to conventional balloon angioplasty and is currently advocated as an alternative to amputation in patients in whom surgical bypass grafting is contraindicated or unfeasible.

Aged↗
PubMed1991

Radiographic fallopian tube recanalization: absorbed ovarian radiation dose.

Absorbed radiation dose to the ovaries during radiographic fallopian tube recanalization was estimated in 29 patients with use of thermoluminescent dosimeters placed in the vaginal fornix. With an average fluoroscopic time of 8.5 minutes +/- 5.5 and an average of 14 +/- 5 105-mm spot radiographs obtained, the average absorbed dose to the ovaries was 8.5 mGy +/- 5.6 (0.85 rad +/- 0.56). Technical guidelines for keeping patient radiation exposure to a minimum during this new interventional procedure are suggested.

Adult↗
PubMed1992

Percutaneous recanalization of a renal artery in aortic dissection.

Chronic renal failure acutely worsened in a patient with a type B aortic dissection. Aortography revealed an occlusion of the left renal artery without renal intimal tear. Percutaneous recanalization, performed with a self-expandable stent, resulted in improvement in the renal function. This technique offers a new therapeutic choice in patients with visceral complications of aortic dissection.

Aortic Dissection↗
PubMed1980

Recanalization of an acutely occluded aortocoronary bypass by intragraft fibrinolysis.

Acute thrombotic occlusion of an aortocoronary bypass graft to the left anterior descending coronary artery (LAD) was successfully dissolved by selective infusion of streptokinase into the graft at 2000 U/min for 1 hour via catheter. There was partial recanalization of the graft and complete filling of the LAD within 15 minutes. After 1 hour of lysis, the graft was completely patent, although high-degree narrowing at the site of the proximal anastomosis was still present. Follow-up angiography 16 days later revealed persistent patency of the graft and disappearance of narrowing at the site of proximal anastomosis. The relatively low total dose of streptokinase (140,000 U) did not result in a systemic hyperlytic state. There were no complications. The technique may prove useful in acute graft occlusion but needs further evaluation.

Acute Disease↗
PubMed1983

Electrocardiographic changes after streptokinase-induced recanalization in patients with acute left anterior descending artery obstruction.

ECG changes were assessed in 15 patients in whom intracoronary streptokinase recanalized a totally occluded left anterior descending artery during acute myocardial infarction. These results were compared retrospectively with those in 22 comparable conventionally treated patients who underwent catheterization during the acute stage of infarction. Before angiography no significant differences were found in the sum of ST elevation (sigma ST increase V1-V6), the sum of R waves (sigma RV1-V6), or the number of Q waves (nQV1-V6) in leads V1 through V6. sigma ST increase V1-V6 was significantly lower in the streptokinase group than in control patients at all times after angiography. sigma RV1-V6 declined and nQV1-V6 increased in both groups during the first 12 hr, but there was no further change in the control group, whereas in the streptokinase group a significant increase in sigma RV1-V6 and decrease in nQV1-V6 followed. There was a significant correlation between long-term electrocardiographic (sigma RV1-V6; nQV1-V6) and angiographic findings (ejection fraction, akinetic segment length). Thus, the Q wave regression and increase in sigma RV1-V6 after streptokinase suggest, in accordance with angiographic findings, that jeopardized myocardium was salvaged by reperfusion.

Aged↗
PubMed1998

Noninvasive in vivo clot dissolution without a thrombolytic drug: recanalization of thrombosed iliofemoral arteries by transcutaneous ultrasound combined with intravenous infusion of microbubbles.

BACKGROUND: Previous in vivo studies have shown that microbubbles not only enhance the effectiveness of thrombolytic agents in the presence of ultrasound but may also augment clot dissolution without thrombolytic drugs. METHODS AND RESULTS: The objective of this study was to examine the efficacy of arterial clot disruption by a noninvasive, nonlytic approach with intravenous administration of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) and transcutaneous delivery of ultrasound alone. Pairs of iliofemoral arteries in 10 rabbits were randomized to receive transcutaneous ultrasound treatment or no ultrasound treatment after an acute artery thrombotic occlusion and intravenous PESDA infusion. Five arteries from 3 additional rabbits served as controls (ultrasound alone). All 10 iliofemoral arteries treated with PESDA + ultrasound were recanalized by angiography after ultrasound treatment. None of the 10 contralateral arteries treated with PESDA alone and none of the 5 arteries treated with ultrasound alone were patent after 1 hour. D-Dimer levels did not change after intravenous PESDA + ultrasound-mediated reperfusion. CONCLUSIONS: In vivo arterial clot dissolution can be achieved with intravenous microbubbles and transcutaneous ultrasound delivery alone. This technique has potential for clinical application in patients with acute arterial and venous thrombotic occlusions.

Animals↗