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A 70 years-old man, with acute myocardial infarction, was submitted to successfull percutaneous transluminal coronary angioplasty of the left main stem coronary artery, following recanalization of that artery.
Thrombosis of the straight and transverse sinuses associated with a large hemorrhagic venous infarct developed in an infant with large chronic subdural fluid collections after drainage of the subdurals. CT and MR studies obtained before and after the onset of venous sinus thrombosis showed interval widening of a segment of the posterior falx between the vein of Galen and the superior sagittal sinus. MR angiography confirmed a recanalized falcine sinus.
Long-term results of recanalization of the esophagus by orthograde bouginage through the guide and by endoprosthesis post-burn strictures were evaluated in 105 patients. The application of these methods enabled in 81% of patients to achieve steadfast restoration of esophageal continuity, sufficient enough for adequate feeding. Orthograde bouginage of the esophagus through the guide showed to be effective in 45.5% patients with strictures up to 100 mm length and over 6 mm in diameter, the end of the bouge being not more than 1.5 kg. Endoprosthetic procedure provided to achieve restoration of esophageal continuity in 95% of patients.
The combination of vascular operative procedures and transluminal recanalization with a Dotter-catheter is recommended. According to own results this has been proven to be very successful, especially in old patients or in patients in a reduced physical state. The main advantage is a shorter duration of the surgical procedures and a reduction of the operative stress situation compared to other surgical methods. For the application of the Dotter-technique, however, it is necessary to observe the indications carefully.
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Patients with obstructing cancers are ineligible for preoperative chemotherapy and radiation unless they undergo surgical diversion. Endoscopic laser therapy (ELT) may provide an alternative to colostomy for these patients. We retrospectively reviewed all patients with distal sigmoid and rectal carcinomas who underwent ELT from January 1988 through April 1990. The majority of patients were referred for palliation of advanced disease. Thirty-seven patients underwent 123 ELT sessions (median, 2.5; range, one to 18). In 84% of patients, patency was maintained during a median follow-up of 31.5 weeks (range, one to 123). Morbidity and mortality were 2.5% (3/123) and 5% (1/37), respectively. Sixty-two percent had radiotherapy, chemotherapy, and/or surgery concurrent with ELT. Endoscopic laser therapy can safely and effectively reestablish and maintain luminal patency in patients with obstructing distal cancers. In addition, ELT can enable the administration of preoperative adjuvant radiotherapy and chemotherapy.
Two babies with duct-dependent cyanotic congenital heart disease were palliated with modified Blalock-Taussig shunts. One patient was diagnosed to have tetralogy of Fallot, and the other patient, tricuspid atresia type Ia. Early postoperative arterial oxygen saturations dropped significantly due to shunt thrombosis. Both patients were successfully treated with angioplasty and stent implantation.
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Palliative treatment of upper gastrointestinal tract obstruction was undertaken by endoscopic laser therapy in 6 patients with carcinoma of the oesophagus or stomach. All had dysphagia for solids on admission and were considered unsuitable for surgery or radiotherapy. Three were in sites unsuitable for placement of an endoscopic prosthesis. The tumours occluded up to 90 per cent of the lumen (2 squamous and 4 adenocarcinomas). Treatment was carried out under direct vision, the laser wave guide being passed through the biopsy channel of a standard endoscope. Superficial tumour vaporized immediately using energies of 2-10 000 J per session, whereas deeper layers sloughed over the succeeding 2-3 days. Two to six treatments were required to relieve dysphagia and there were no major complications. Quantitative barium studies before and after treatment showed a significant increase in luminal diameter. These patients could eat solid food after treatment and all were able to go home.
Chronic total occlusions remain a challenge to interventionalists due to failure of crossing or perforation by strong wires. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through occlusions that could not be crossed by conventional guidewires.
We describe a case in which a discrete atretic segment of the right pulmonary artery (due to a Blalock-Taussig shunt) was reconstructed using a new radiofrequency system, balloon dilation, and stent implantation in an 18-month-old patient. The shunt was coil-occluded. The technique and applications of this novel approach are discussed.
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Subclavian artery lesion that is associated with low complication rate could be treated by percutaneous intervention effectively. However, the success of endovascular therapy for occlusive lesion may be limited by failure to cross with a guidewire. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through subclavian artery occlusion that could not be crossed by conventional guidewires.
A technique for transcatheter "reconstruction" of a completely occluded left pulmonary artery using radiofrequency perforation with subsequent balloon dilation and stent implantation is reported in a 7-year-old child. It is shown that transcatheter radiofrequency perforation can still be effective years after the occlusion of a vessel.