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PubMedDate not supplied

Transvaginal fallopian tube catheterization--diagnostic and therapeutic usefulness.

Fifty-two patients with 84 proximal Fallopian tube obstructions underwent Fallopian tube recanalization (FTR). The successful catheterization rate for Fallopian tubal ostia was 100%, and the successful recanalization rate was 64%. After FTR, hysterosalpingography or selective tubography showed no evidence of adhesion (without adhesion) in 31 tubes, perifimbrial adhesion in 17 tubes, hydrosalpinx in six tubes, and intratubal adhesion in 30 tubes (unsuccessful recanalization). Six patients (11%) achieved intrauterine pregnancies and two had extrauterine pregnancies. Follow-up studies in seven patients without adhesion showed patency in one patient and reocclusion in six patients who obtained repatency after a second FTR. Fallopian tube catheterization was useful for the exact diagnosis of Fallopian tube occlusion. The higher incidence of adhesion in patients' background caused the low incidence of pregnancy.

Adult↗
PubMed1993

[Comparison between argon and excimer laser angioplasty in patients with lesions of the femoral and popliteal arteries: clinical and angiography results after 1 year].

The aim of this study was to compare acute and long term results of thermic argon laser versus athermic XeCl-excimer laser for recanalization of femoropopliteal lesions in 43 patients with peripheral vascular disease stage IIb to IV according to Fontaine. The argon laser system was applied in 29 lesions (9 stenoses, 20 occlusions up to 31 cm length) and an excimer laser was used in 28 lesions (10 stenoses, 18 occlusions up to 30 cm length). In all cases balloon dilatation followed laser recanalization to achieve a sufficient primary result (< 25% stenosis rate). Primary success was obtained in 86% with both laser systems. After 1 year 62.5 of the recanalized vessels with excimer laser and 56% with argon laser were still patent. Neither acute nor long term results showed significant differences between both laser systems. Compared to the argon laser, the procedure with the excimer laser was of shorter duration which may be advantageous under routine conditions. After one year, combining the results of both systems, the reocclusion rates of stenoses amounted to 22%, the reocclusion rates of short distance occlusions to 35% and that of long occlusions more than 10 cm length to 71%. With regard to the high reocclusion rate after reopening of long occlusions the laser systems seem to be of advantage, compared to balloon angioplasty mainly in critical stenosis and short occlusions which cannot be passed with the guide-wire.

Angiography↗
PubMed1993

[Deep venous thromboses--established treatment procedures and new trends].

Thrombolysis in deep venous thrombosis is indicated in documented thrombosis of the legs, because, in most cases, it is due to no or minimal collateral flow with bad prognosis. Thrombolysis should not be used regularly in isolated thrombosis of the veins of the lower legs and in subclavian vein thrombosis. The aims in therapy of deep venous thrombosis are reduction of possible complications such as fatal pulmonary embolism, avoidance of progression and recurrence, respectively, and avoidance of a postthrombotic syndrome. In contrast to heparinization, thrombolysis has the advantage of high recanalization rates, but the disadvantage of higher incidence of hemorrhage. With clinically proven dosage regimens of streptokinase and urokinase in our experience, complete recanalization rates are in the range of 30% of primary occluded vessels. According to pivotal and dose-finding studies, the results with tissue plasminogen activator (t-PA) are within the same range. In a different approach, the thrombolytic substances are delivered in a loco-regional type via a vein of the foot. There is some evidence from pivotal clinical trials that the same recanalization rates are obtainable as with streptokinase in ultrahigh dosage. Considering the individual importance and also the epidemiologic and economic value of deep venous thrombosis, there is a need for prospective, randomized trials. Results of clinical studies currently under way will hopefully show the benefit of such new therapeutic strategies.

Heparin↗
PubMed1993

Limitations and pitfalls of laser angioplasty.

Overall, the initial and long-term results of LABA have been disappointing. Poor initial recanalization rates and high restenosis and hemodynamic failure rates have caused investigators to reevaluate the indications for LABA. This reevaluation has resulted in an appropriate limitation of the indications for LABA. At present, LABA is probably indicated only for the treatment of patients with symptomatic, isolated arterial occlusions in whom conventional balloon angioplasty cannot be done because mechanical recanalization using a guidewire is not possible. Other uses of LABA in patients with peripheral vascular disease are discouraged and should be considered experimental. New innovations in technology, including improved arterial imaging techniques and better laser delivery systems, are required before LABA can become a standard therapy for the treatment of patients with peripheral vascular disease. A search for an "ideal" laser wavelength for arterial recanalization is futile until these developments occur. Once these innovations are in use, laser angioplasty may be an important technique in the treatment of peripheral vascular disease. This potentially valuable tool for the vascular surgeon should not be abandoned. Rather, it should be laid aside until it is better developed.

Angioplasty, Balloon, Laser-Assisted↗
PubMed1993

Deep venous insufficiency: the relationship between lysis and subsequent reflux.

PURPOSE: Although venous valvular insufficiency is well recognized as the most important etiologic mechanism in the development of the postthrombotic syndrome, the factors contributing to valve incompetence after deep venous thrombosis remain obscure. METHODS: To establish the relationship between recanalization and valve competence, 113 patients with acute deep venous thrombosis were studied with serial duplex ultrasonography. RESULTS: Median lysis times for segments developing reflux (214 to 474 days) were 2.3 to 7.3 times longer than for corresponding segments not developing reflux (65 to 130 days) for all except the posterior tibial vein. In the posterior tibial vein, median lysis times for those with and without reflux were nearly identical (72 vs 80 days). The median time to onset of reflux was significantly less than the median lysis time in the mid and distal superficial femoral veins and was simultaneous with recanalization in all other segments. CONCLUSIONS: Early recanalization is important in preserving valve integrity for all but the posterior tibial segment. However, the small number of patients with reflux despite early lysis (< 1 month) or without reflux despite relatively late lysis (> 9 to 12 months) suggests that other factors may also contribute to the development of valvular incompetence. These factors may be particularly important in the posterior tibial vein, in which lysis time has little relationship to the ultimate development of reflux.

Adolescent↗
PubMedDate not supplied

Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group.

PURPOSE: 1) To describe the effectiveness and safety of thrombolytic therapy in patients with acute atherothrombotic and embolic stroke and 2) to study the variables of the occlusion site as seen on the angiograms, the CT signs of early ischemia, the hyperdense middle cerebral artery sign (HMCAS), and the size of the infarcts as seen on the 24-hour CT scan. METHODS: Ninety-three of 139 patients with acute stroke were treated with intravenous tissue plasminogen activator (rt-PA). The initial disease and the effects of treatment were assessed with both CT and cerebral angiography. RESULTS: Recanalization of occluded arteries occurred in 32 patients and was more frequent in distal occlusions. In general, patients displaying recanalization tended to develop small infarcts and patients with a HMCAS tended to develop large infarcts. Patients with signs of early ischemia developed large infarcts. The presence of a HMCAS was 100% fic for an occluded artery, but only 27% sensitive. Hemorrhagic transformations occurred in the distribution of the occluded arteries in 32 patients. CONCLUSIONS: Emergency cerebral angiography, which can be carried out relatively safely, adds important information about the nature and extent of the arterial occlusions, and the recanalization efficacy of fibrinolytic therapy for patients with acute stroke. Fibrinolytic therapy can be carried out with a relatively low complication rate that still needs to be correlated with the clinical benefits of the treatment. Fibrinolytic therapy in the doses utilized in this study, is more effective with distal than with proximal carotid territory occlusions.

Acute Disease↗
PubMed1993

[A case of coronary artery embolism associated with combined valvular heart disease].

A 53-year-old-man afflicted with combined valvular heart disease and atrial fibrillation was admitted to our department complaining of chest pain. ST elevation on ECG (II, III, aVF) and elevated CPK value were recognized. He was diagnosed as having acute myocardial infarction, and percutaneous transluminal coronary recanalization was performed immediately. The coronary angiogram showed occlusions at the proximal left branch (#12). But these lesions could not be recanalized by 960000 IU urokinase administration. The cineangiogram after one month revealed perfect recanalization of these occlusions. Mitral stenosis with neovascularity to the left atrium and aortic regurgitation were recognized. We supposed this infarction caused by coronary embolism originated from left atrial thrombi. Acute myocardial infarction associated with mitral stenosis has been reported in fifteen cases previously in Japan, but only three cases revealed coronary occlusion in the acute phase with normal coronary artery in the chronic stage. However, there has been no report, except for this case, demonstrating occlusion in two coronary arteries at the same time. So, our case is the first report of the involvement of two coronary artery occlusions.

Aortic Valve Insufficiency↗
PubMed1995

Molecular basis of fibrinolysis, as relevant for thrombolytic therapy.

The fibrinolytic system comprises an inactive proenzyme, plasminogen, that is converted by plasminogen activators to the active enzyme, plasmin, that degrades fibrin. Two physiological plasminogen activators have been identified: tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA). Plasminogen activation for clot lysis is regulated by specific molecular interactions between tissue-type plasminogen activator (t-PA), plasminogen and fibrin, whereby the lysine-binding sites of the plasminogen molecule play a crucial role by mediating its binding to fibrin, and by controlling the inhibition rate of plasmin by alpha 2-antiplasmin. The recognition that thrombosis within the infarct related coronary artery plays a major role in the pathogenesis of acute myocardial infarction and the observation that early administration of thrombolytic agents results in recanalization of occluded coronary arteries, have provided the basis for the development of thrombolytic therapy in acute myocardial infarction. The elucidation of the biochemical mechanism of fibrin-specific plasminogen activation has fueled the hope that specific and efficacious thrombolytic agents might become available. Comparative studies between the non-fibrin-selective streptokinase and fibrin-selective recombinant t-PA (rt-PA) have shown a difference in efficacy for early coronary artery recanalization, whereas the GUSTO trial has established that clinical benefit in patients with acute myocardial infarction is indeed correlated with the rapidity and frequency of sustained recanalization and that effective thrombolysis requires adequate anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1996

[A case of coronary artery embolism after double valve replacement].

A 69-year-old woman with combined valvular heart disease (mitral regurgitation and aortic regurgitation), ascending aortic aneurysm, and atrial fibrillation underwent double valve replacement (DVR) and, ascending aortic wall plication. The postoperative thrombo-test level was around 20%. The ST elevation on ECG (II, III, aVFm, V4 approximately V6) with chest pain were recognized on the 13 th postoperative day. She was diagnosed as having acute myocardial infarction, and percutaneous transluminal coronary recanalization was performed immediately. The coronary angiogram showed occlusion at the left anterior descending branch (#8). This lesion could be recanalized by 6,000 U plasminogen pro activator (pro-UK) administration. The cineangiogram on the 35th postoperative day, revealed complete recanalization of this occlusion. Several cases of acute myocardial infarction associated with valvular heart diseases has been reported previously in Japan. However, there has been no report, except for this case, demonstrating occlusion in the coronary artery after prosthetic replacement and successful PTCR. So, this case is the first report on that point.

Aged↗
PubMed1996

Preoperative embolization of highly vascular brain tumors: clinical and histopathological findings.

This report concerns the clinical and histopathologic findings in five patients with meningioma and two with hemangioblastoma who underwent embolization with polyvinyl alcohol (PVA) particles before surgery. Angiography revealed loss of tumor stain from the main feeders in all seven patients, with markedly decreased contrast enhancement of computed tomography (CT) and magnetic resonance imaging (MRI) in six of them. Tumor excision was readily accomplished in all instances, with minimal bleeding from the tumor. In the patient operated 1 day after embolization there were almost no necrotic lesions, even though hemorrhage, presumably due to the surgical procedure was noted. Necrotic lesions and island-like residual tumor cells around the vessels were seen in the patient operated two days after embolization. Extended necrotic lesions were noted among patients who underwent surgery at day 4 and thereafter. Revasculization was not found, even in the patient operated one week after embolization. Massive bleeding (due presumably to the surgical procedure, suggesting recanalization) was noted in the tissue of a hemangioblastoma patient who underwent surgery 13 days after embolization, even though tumor excision was easy. In the patient subjected to the surgical procedure 694 days following embolization, the CT and MRI performed 2 months later, revealed contrast enhancement similar to that seen before the operation. Moreover, angiography, done after 5 months, demonstrated tumor stain as had been noted before embolization. The histopathologic examination of this case reveal the presence of extended necrotic lesions, a large number of macrophages that contained PVA particles, and destruction of the walls of the onceoccluded vessels. In addition, there were many blood-filled vessels that had achieved recanalization. These findings suggest that it is desirable to operate within 7 days after embolization, since recanalization occurs during this period, even though PVA particles remain unabsorbed for a long time.

Adult↗
PubMed1996

[Estimation of the length of coronary thrombi and prediction of the result of coronary thrombolytic therapy based on the angiographic findings].

The optimal approach for the treatment of occluded coronary arteries in patients with acute myocardial infarction is still controversial. This study correlated the results of coronary thrombolytic therapy and the clinical course with angiographic findings of infarct related coronary arteries in 111 patients with first attack of acute myocardial infarction and complete coronary occlusion (Thrombolysis in Myocardial Infarction Class 0) of the infarct-related arteries confirmed on coronary angiography followed by thrombolytic therapy within 12 hours after the onset of acute myocardial infarction. The length of the coronary thrombi (proximal thrombi) was estimated by comparing the initial angiographic finding with that obtained approximately 2 weeks later. The shape of the coronary occlusion was classified into two types: occlusion with obscurely stained edge or convex dye outline (type SC), and occlusion with acute cutoff edge or tapered edge (type AT). Although the recanalization rate of thrombolytic therapy was higher and the length of proximal thrombi was shorter in type AT than in type SC, the degree of residual stenosis was greater in the former. Pre- and post-infarction angina were more frequent in type AT. Type SC may indicate a low success rate for thrombolytic therapy and more complications for direct percutaneous transluminal coronary angioplasty (PTCA). However, although direct PTCA may be indicated because of the frequent presence of residual stenosis, the recanalization rate of thrombolytic therapy is high for type AT. The shape of the occlusion of the infarct related artery observed in the coronary angiogram is helpful to decide the optimal recanalization therapy in the acute phase of acute myocardial infarction.

Adult↗
PubMed1996

[A case of acute occlusion of the cervical portion of the right internal carotid artery with successful stepwise vascular dilatation by rescue PTA and deferred PTA].

A case is reported of acute occlusion of the cervical portion of the internal carotid artery, which was recanalized and dilated by steps through rescue percutaneous transluminal angioplasty (PTA) and deferred PTA. A 53-year-old man, complaining of progressive disturbance of consciousness and hemiplegia, was admitted to our department at about 7 hours after onset. CT demonstrated no abnormality. Digital subtraction angiography revealed an occlusion of the right cervical internal carotid artery. After intra-arterial injection of t-PA, a guide wire was able to be passed through the artery. Recanalization of internal carotid artery was performed by rescue PTA with Stealth FS angioplastic balloons of small diameter. Residual stenosis ratio was about 80%. After rescue PTA, his symptoms improved. On the following day, deferred PTA with Stealth FS angioplastic balloons of larger diameter was performed. Stenosis ratio was 30%. After the procedure, his palsy was relieved. DSA in the 3rd week after the PTA revealed that the stenosis ratio had changed from 30% to 13%. Rescue PTA is very effective for prompt recanalization. Stepwise vascular dilatation by rescue PTA with small balloons followed by deferred PTA can improve symptoms and prevent fatal hemorrhagic infarction. This method is especially useful for high risk patients of cervical internal carotid artery occlusion.

Acute Disease↗
PubMed1997

On the relationship between changes in the deep veins evaluated by duplex sonography and the postthrombotic syndrome 12 years after deep vein thrombosis.

In a prospective study we performed color duplex ultrasonography to evaluate patency and valvular function of previous thrombosed veins 12 years after the acute thrombosis. Normal clinical findings were found in 64% of the patients, mild postthrombotic skin changes in 28%, and marked trophic changes in 5%; only 1 venous ulcer occurred. In 39 patients, 114 initially thrombosed vein segments were evaluated. Thirty-seven of 72 proximal segments were completely recanalized (23 with valvular incompetence) and 21 segments exhibited partial recanalization (19 with valvular incompetence). Superficial femoral vein segments were completely occluded in 19%, however, excellent collateralization was provided via the deep femoral vein. Thromboses of the posterior tibial vein demonstrated a high rate of recanalization with development of valvular incompetence in 52%. Whereas obstruction and valvular incompetence as single factors led to a postthrombotic leg in 8.5% and 33%, respectively, the most frequent cause for the development of the postthrombotic syndrome was the combination of reflux plus obstruction in the deep veins (50%). Compression therapy with elastic compression stockings is recommended for at least 5 years after the acute thrombosis.

Adult↗
PubMed1997

Postoperative combined radiohyperthermia in Astler-Coller stages B2 and C distal rectal cancer.

Pelvic perineal recurrence rate is the major therapeutic problem after curative surgery of extraperithoneal rectal cancer, after lower anterior resection as well as abdomino-perineal resection: local failure rate is high, particularly for stages B2-C. Radiotherapy alone or in combination with chemotherapy proved to be an useful adjunct to surgery. Postoperative radiotherapy, with 40 to 50 Gy doses, has shown local improvement, but causing intestinal damaging. There is now evidence that hyperthermia enthances radiation effects, by killing radioresistant acid tumor cells. In order to give high postoperative radiation doses, without intestinal damage, and to kill acid tumor cells by hyperthermia, we developed a device, able both to displace intestinal loops and to produce combined hyperthermia. From 1993 to 1995, four patients with Astler-Coller stages B2 (2 patients), C1 (1 patient) and C2 (1 patient) distal cancer, were operated by Hartmann's procedure and treated with postoperative radio-hyperthermia with our device. Overall radiation dose delivered in the pelvic area was of 65 Gy, associated with three heating sessions at 43 degrees C for 30 minutes. Pelvic infection occurred in one patient; all pelvic byopsies were negative and no bowel damage was found. Three patients underwent recanalization, one had anasthomotic leackage. The C1 and C2 stage patients died from hepatic metastasis, 18 and 11 months after recanalization; one B2 stage patient is still under treatment and the other is alive and disease free 13 months after recanalization. Our technique allows to give high postoperative radiation doses, without small intestine damage, and to give a good hyperthermia for better control of local failure.

Adenocarcinoma↗
PubMed1995

[The long-term efficacy of fibrinolytic treatment in the acute phase of a myocardial infarct. A comparison with a control group].

BACKGROUND: The follow-up of patients with an acute myocardial infarction treated with fibrinolysis and that of patients treated with conventional therapy was analyzed. PATIENTS AND METHODS: The study cohort included: 1) 214 patients with a first acute infarction of < or = 4 hours and with < or = 70 years of age who participated in a randomized study comparing the effects of streptokinase (SK, n: 110) vs conventional treatment (control, n: 104), and 2) a total of 361 patients with a myocardial infarction of < or = 6 hours and < or = 75 years old treated with fibrinolytic agents. RESULTS: In-hospital mortality in the randomized study was 11% for the control group and 7% for the SK group, and 8.8% for the rest of patients treated with fibrinolysis. Mortality during follow-up in the randomized study (7.0 +/- 1.5 years) was 10.7% for the SK group and 19.3% for the control group. Ejection fraction was significantly lower in non survivors than in survivors (36.7% vs 50.8%, (p < 0.0001) and among patients with an ejection fraction < 50%, follow-up mortality was significantly lower in those with a complete recanalization (TIMI 3) than in those with an absent or incomplete recanalization (TIMI 0-2) (98% vs 22%). Follow-up mortality for the rest of patients treated with fibrinolysis (2.6 +/- 1.6 years) was 9%. CONCLUSIONS: 1) The reduction of in-hospital mortality by fibrinolysis appears to increase in the long-term follow-up, and 2) the long-term survival seems to be related not only to the left ventricular function but also to the extent of angiographic recanalization.

Chi-Square Distribution↗
PubMed1997

[Vasitis nodosa].

OBJECTIVE: To describe a case of vasitis nodosum causing spontaneous recanalization of the vas deferens. METHODS: Herein we describe a patient who had undergone vasectomy 9 years earlier. A nodule in the vas deferens arising from granulomatous reaction had progressed to vasitis nodosum, causing spontaneous recanalization of the vas deferens. RESULTS: Vasitis nodosum may be more frequent than it is considered to be although clinical problems rarely arise. CONCLUSION: Confusion may arise in distinguishing the histological features of vasitis nodosum from those of adenocarcinomatous neoplasia. Although rarely, its growth may cause recanalization of the vas deferens in vasectomized patients.

Adult↗
PubMed1998

Guglielmi detachable coil embolization for unruptured aneurysms in nonsurgical candidates: a cost-effectiveness exploration.

PURPOSE: We calculated the incremental cost-utility ratio for Guglielmi detachable coil (GDC) embolization versus no therapy for unruptured intracranial aneurysms considered inappropriate for surgical clipping procedures. METHODS: Decision tree and Markov analyses that employ cohort simulation were applied to determine the incremental cost-utility ratio of GDC embolization versus no therapy for unruptured cerebral aneurysms. Clinical values required as input data were estimated from the literature for the following variables: relative frequencies of complete aneurysmal occlusion, partial aneurysmal occlusion, and attempted coiling (no coils detached); morbidity and mortality of GDC embolization; frequency, morbidity, and mortality of spontaneous aneurysmal rupture in untreated and GDC-embolized aneurysms; annual rate of recanalization of GDC-embolized aneurysms; quality of life when knowingly living with untreated or GDG-embolized aneurysms and of living with fixed neurologic deficit; costs of GDC embolization, spontaneous aneurysmal rupture, stroke, and rehabilitation; and discount rate. Cost-utility ratios below $50000 per quality-adjusted life year saved were considered acceptable. Sensitivity analyses were performed for all relevant input variables. RESULTS: Baseline input values resulted in acceptable cost-utility ratios for GDC embolization of unruptured intracranial aneurysms. These ratios remained within acceptable limits across wide ranges of various input parameters. Cost-effectiveness was markedly affected by the natural course of unruptured, untreated aneurysms; rates of spontaneous rupture greater than 2% per year resulted in favorable cost-utility ratios that were relatively unaffected by variation in GDC efficacy, while rates of rupture less than 1% per year resulted in unfavorable ratios that were highly dependent on GDC efficacy. Many of the GDC efficacy indexes, such as rate of failed coiling, early recanalization, and progressive aneurysmal thrombosis, have mild effects on the cost-utility ratios. GDC complication rate as well as life expectancy had moderate effects on the analysis. The influence of late aneurysmal recanalization was mild unless high rates of rupture for partially coiled aneurysms were applied. Suboptimal clip placement resulting from the presence of GDC coils within a ruptured aneurysm had no demonstrable consequence on cost-utility ratios. CONCLUSIONS: The single most influential variable determining the cost-effectiveness of GDC embolization in our analysis was the natural course of untreated aneurysms. Other important variables included GDC-related morbidity and life expectancy at the time of GDC embolization.

Cost-Benefit Analysis↗
PubMed1998

Clinical determinants of ultrasound-guided sclerotherapy outcome. Part I: The effects of age, gender, and vein size.

BACKGROUND: Ablation of the incompetent saphenous vein may be accomplished by either surgical extirpation or ultrasound-guided sclerotherapy (UGS). Clinical guidelines for the selection of suitable candidates for UGS have yet to be established for this relatively new procedure. OBJECTIVE: To assess the effects of age, gender, and vein size on the outcome of UGS. METHODS: UGS was performed on 116 Class C2-6EPASPR limbs with duplex-confirmed saphenofemoral junctional incompetence using 1-mL injectate volumes of 3% sodium tetradecyl sulphate (STS) (15-mL maximum) and Class II compression. Treatment endpoint was persistent vasospasm observed on duplex imaging, with clinical and duplex ultrasound follow-up at 2 weeks, 6 months, and annually for 2 years. RESULTS: Statistical testing showed that only vein size affected recanalization. Age, gender, and vein size all affected the dosage required to achieve vasospasm, but not the clinical recurrence rate. Vein size was larger in males and correlated with age. CONCLUSIONS: Larger doses of STS are required to induce vasospasm in older patients, males, and those with larger veins. Regardless of gender and age, larger veins are more likely to recanalize, but are not necessarily associated with clinical recurrence. Although older patients and males tend to have larger veins, their recanalization rates are similar to younger patients and females when sufficiently higher STS doses are used to induce vasospasm. Ambulatory patients of all ages and either gender may be good candidates for UGS if vasospasm is used as the treatment endpoint. Contrary to prevailing opinion, large vein caliber is not an absolute contraindication for UGS.

Adult↗