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At least 1,693 records · Page 94Linked to original sources
PubMed1991

Delayed coronary occlusion following primary successful angioplasty: management and outcome.

The treatment of delayed coronary occlusion after primary successful percutaneous transluminal coronary angioplasty (PTCA) is more difficult because surgical standby is often not available. The purpose of this study was to assess the therapeutic approaches and outcome of patients with delayed coronary occlusion from 30 to 180 minutes after successful PTCA. A delayed occlusion occurred in 18 (0.9%) (61 +/- 11 years; male n = 14, female n = 4) out of 2065 consecutive patients after PTCA. In 11 patients the dilated stenoses were located in the left descending artery, while seven patients had the stenosis in the right coronary artery. Twelve patients had unstable or postinfarction angina. The time interval between completion of PTCA and the onset of chest pain was 64 +/- 39 minutes. Immediate i.v. nitroglycerin resulted in no relief of the symptoms in any patient. One patient was operated upon at once, and one was given i.v. thrombolysis resulting in pain relief and reversal of ECG changes. The remaining 16 patients returned initially to the catheterization laboratory, where the occluded vessels were opened by mechanical recanalization. Three of them remained in stable condition. Due to impending reocclusion surgery was necessary in four patients and thrombolysis was performed in nine. After thrombolysis the vessel remained open in four patients. The other five needed bypass surgery on the day of PTCA. Myocardial infarction developed in nine patients (maximal CK 673 +/- 488 units/l). In conclusion, delayed occlusion after successful PTCA is a rare complication occurring primarily in patients with unstable angina. Mechanical recanalization opened the occluded vessel in most patients, and myocardial infarction was prevented in 50%.

Adult↗
PubMedDate not supplied

Palliation of malignant dysphagia using the Nd:YAG laser.

A group of 141 patients with biopsy-proved malignant dysphagia, treated with neodymium YAG laser between April 1985 and November 1988, have been prospectively evaluated. Patients treated since November 1988 have not been included to allow minimum follow-up of 18 months. The success of treatment has been assessed in terms of survival, relief of dysphagia, complications, and length of inpatient stay. One- and two-year survival rates were 12.6% and 3.5%, respectively (mean survival 24.7 weeks). Ninety-two percent of patients were returned to a semisolid diet or better. In 4% recanalization was impossible, and 4% swallowed only liquids despite an adequate channel. Tumor histology, site of tumor, and length of previous treatment had no significant influence on outcome. The presence of metastases significantly influenced survival (p = 0.007). The principal complications were perforation (6.4%) and tracheoesophageal fistula (2.8%). Laser recanalization provides effective palliation for malignant dysphagia.

Adult↗
PubMed1992

Pathological features of the pulmonary artery in Takayasu arteritis.

Little attention has been paid to the pathological features of the pulmonary artery in Takayasu arteritis. Autopsy specimens of 6 cases of this disease were studied. Lesions were found in the aortic arch and its brachiocephalic branches in all cases and in both the aortic arch and thoracoabdominal aorta in 5 cases. The pathohistologic characters of the pulmonary artery were very similar to those of the systemic artery. Stenosis-recanalization, so-called blood vessels-in-blood vessels, of the pulmonary elastic arteries were found in four cases. These lesions were not observed in the systemic arteries, and most of the newly formed channels in them seemed to be branches of bronchial arteries. Luminal obstruction of pulmonary muscular arteries was observed in 4 cases, cellular arteritis of muscular arteries in 2 cases, and angiomatoid dilatation of small blood vessels in 2 cases. Thus in this study we found peculiar stenosis-recanalization lesions of the pulmonary elastic arteries, and also showed that the pulmonary elastic and muscular arteries are frequently involved in Takayasu arteritis. These findings suggest that pulmonary hypertension could influence morbidity and long-term mortality in this disease.

Adult↗
PubMed1989

Laser ablation and the need for intra-arterial imaging.

In 48 patients with severe claudication due to a total obstruction of the femoropopliteal artery, percutaneous recanalization was attempted with a 2.2 mm diameter rounded sapphire contact probe in conjunction with a continuous wave Nd:YAG laser. In eight patients the contact probe laser catheter took a subintimal course that could not be redressed. Laser recanalization needs high-resolution diagnostic information on the complex anatomy of the obstruction. Intra-arterial ultrasound imaging may provide the necessary information to evaluate, monitor or guide novel angioplasty techniques. The design of an ultrasound catheter which combines high-resolution diagnostic imaging with steerability, flexibility and controlled ablation is now the major engineering challenge in interventional cardiology.

Angioplasty, Balloon↗
PubMed1984

Endobronchial laser therapy--differential therapeutic use and clinical value.

Endobronchial laser irradiation was performed on 27 patients with inoperable malignant (n = 23) and benign (n = 4) disease of the bronchial system for the treatment of recurrent pulmonary bleeding and recanalization of centrally obstructed or stenosed airways. The essentially palliative measure led in more than half the patients with hemoptysis to immediate and lasting hemostasis, in all patients with stenosis to complete or partial restoration of airway patency, and in 7 of 11 patients with total obstruction to a radiologically verifiable re-expansion of atelectasis. In the total of 58 laser treatments performed, complications occurred in three cases and were managed by conventional clinical measures. Successful recanalization in patients with pre-existing bronchial obstruction presupposes a short-segment, polypous tumor growth, intact bronchial wall structures, and short occlusion time. In addition to the treatment and prophylaxis of recurrent pulmonary bleeding, the principal use of endobronchial laser treatment in the future will probably concentrate on the palliative therapy of preocclusive stenoses of the trachea and main bronchi.

Adult↗
PubMed1992

Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis.

Acute splenoportal and superior mesenteric venous thrombosis were diagnosed on sonography and computed tomography (CT) in six patients. Sonography demonstrated the presence of echoic material filling the involved vessels in all patients. Precontrast CT scans demonstrated an increased, intra luminal density of the clots in four patients with splenoportal thrombosis. However, in two cases of superior mesenteric venous thrombosis, no hyperdensity was observed within the lumens. Nevertheless, the clots were always visualized as low-density regions in the vessel lumens after bolus injection. Intravenous anticoagulant therapy was started immediately after the diagnosis. All patients were evaluated twice a week with sonography and/or CT until recanalization occurred. The patency of the previously involved vessels was assessed from 6 days to 4 weeks after the acute episode (average time of recanalization: 17 days) without development of collateral pathways. It is concluded that, in the absence of clinical signs of a life-threatening process, a conservative management of acute splanchnic thrombosis can be successfully achieved by (1) early diagnosis, (2) efficacious intravenous anticoagulant therapy, (3) careful imaging follow-up of these patients by sonography and/or CT during the acute phase and, finally, (4) by an extensive search for a hypercoagulable state.

Acenocoumarol↗
PubMed1994

Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access.

To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had central vein obstruction as the cause of severe arm swelling, graft thrombosis, or graft malfunction. All 14 patients had had bilateral temporary subclavian vein dialysis catheters and failed upper extremity arteriovenous access. Seventeen lesions were treated in 14 patients including eight subclavian vein occlusions, six subclavian vein stenoses, two internal jugular vein stenoses, and one superior vena cava stenosis. Twenty-one procedures were performed including 17 percutaneous transluminal balloon angioplasties (PTAs) with stent placement in 13, two axillary to innominate vein bypasses, and two axillary to internal jugular vein bypasses. All patients had resolution of symptoms. Thirteen (76%) PTAs were initially successful but in four (24%) cases it was impossible to recanalize the vein. Eight (47%) PTAs provided functional hemodialysis access for 2 to 9 months, two (12%) restenosed at 3 and 10 months and were successfully redilated, two occluded at 2 and 4 months and were unable to be recanalized, and one failed immediately after a successful PTA. Four PTA failures were followed by venous bypass, which remained patent and provided functional access 7 to 13 months after surgery. Of nine stenotic venous lesions six (67%) were successfully dilated without restenosis, whereas of eight occluded veins only two (25%) were successfully treated without recurrence. Temporary central hemodialysis catheters produce a significant number of symptomatic central vein obstructions in patients with upper extremity arteriovenous access.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1994

Dynamic aspects of glutathione metabolism in obstructive jaundice.

The dynamic aspects of glutathione metabolism during obstructive jaundice were analyzed in rats. Plasma bilirubin levels increased after ligation of the bile duct, with a concomitant increase in hepatorenal glutathione levels. When the bile duct was recanalized, plasma bilirubin levels rapidly decreased, with a concomitant decrease in hepatorenal glutathione levels. The half-life of hepatic glutathione turnover increased markedly after bile duct obstruction, returning to normal after recanalization of the bile duct. Intravenous administration of a loading dose of bilirubin inhibited the biliary secretion of glutathione in a dose-dependent manner. On the other hand, renal glutathione efflux increased markedly after bile duct obstruction. These observations suggest that glutathione status is significantly affected in obstructive jaundice, predominantly due to the inhibition of hepatic secretion by increased bilirubin.

Animals↗
PubMed1997

Impaired coronary circulation in acute myocardial infarction: a dipyridamole-thallium-201 study.

Coronary flow reserve is not fully restored immediately after revascularization of an occluded vessel. The present study examined the coronary flow impairment in patients with acute myocardial infarction (AMI) after successful balloon angioplasty or spontaneous recanalization (without residual epicardial coronary stenosis). Fourteen patients underwent thallium-201 dipyridamole scintigraphy in the acute phase (mean 5.9 days) and in the chronic phase (mean 24. 6 days) after AMI. A 201Tl reinjection study was carried out only in the acute phase of AMI. The fill-in phenomenon was assessed by the %201Tl uptake in the infarct region after 201Tl reinjection, and positive (n=8) and negative (n=6) fill-in groups were distinguished. The %201Tl uptake increased from the acute phase study to the chronic phase study in the positive fill-in group (56.1%+/-4.1% to 74.4%+/-13.6%, P<0.001), whereas it decreased in the negative fill-in group (54.0%+/-10.6% to 43.7%+/-9.9%, P<0.05). The change in %201Tl uptake following reinjection was significantly correlated with the improvement in regional ventricular wall motion in the chronic phase (r=0.85, P<0.001). We conclude that the impaired coronary flow reserve persisted after balloon angioplasty or spontaneous recanalization, which might indicate the presence of "microvascular stunning". The increase in %201Tl uptake predicted the change in ventricular wall motion.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Systemic supply to a pulmonary arteriovenous malformation: potential explanation for recurrence.

A pregnant woman presented with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and a single pulmonary arteriovenous malformation (AVM) that had been embolized 5 years previously. Partly due to pregnancy, recanalization of the aneurysm occurred with subsequent hemoptysis. Despite successful therapeutic reembolization of the afferent pulmonary artery, hemoptysis recurred 5 days later. At this time, recanalization of the pulmonary artery was not demonstrated by pulmonary angiography, but a systemic angiogram revealed a bronchial arterial supply to the pulmonary AVM. A systemic supply should always be sought in cases of recurrent hemoptysis after technically successful embolization of the feeding pulmonary artery.

Adult↗
PubMed1986

Laser angioplasty of arterial stenoses.

To establish the optimal conditions for recanalization of obstructed arteries without damage to vessel walls, an Nd-YAG laser coupled to a 0.2-mm-diameter optical fiber was used on obstructed human cadaver coronary and peripheral arteries and on popliteal arteries in amputated limbs. Vaporization of atheromatous plaques was consistently obtained with energy of 360-600 J and a diluted blood perfusate (3 g/100 ml hemoglobin) at a rate of 30 ml/min. The arterial wall was protected from thermal injury by inserting the optical fiber into an inflated balloon catheter and by cooling the system with the perfusate. Since recanalization of occluded arteries was consistently obtained without damage to the arterial wall or debris and thin and flexible optical fibers were easy to guide in the arteries, percutaneous transluminal Nd-YAG laser angioplasty was used in obstructed femoral and popliteal arteries in 12 patients. The first trials in man with Nd-YAG laser showed the method to be feasible, effective, and at low risk, although further studies are required to improve penetration of the obstruction and increase the diameter tunnel.

Angioplasty, Balloon↗
PubMed1990

Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection.

A technique for recanalization of femoral and popliteal arterial occlusions by intentional subintimal dissection is described. Recanalization with this technique was attempted in 71 occlusions of the femoro-popliteal segment with a mean length of 11.4 cm. Primary technical success was achieved in 54 (76%) cases, with complications occurring in 4 (5.6%). Of 44 successful cases reviewed at a mean follow up of 6 months, 37 (84%) were either asymptomatic or improved. The technique has proved to be an effective method of treating occlusions of the femoral and popliteal arteries with an acceptable complication rate. It may allow successful angioplasty where the standard intraluminal method fails, particularly when reconstructive surgery is the only option.

Aged↗
PubMedDate not supplied

Percutaneous fragmentation of pulmonary emboli in dogs with the impeller-basket catheter.

A new catheter system for rapid percutaneous fragmentation of pulmonary emboli was tested in nine dogs. The system consisted of a high-speed rotating impeller, placed within the center of a self-expandable basket. Preformed radiopaque emboli were introduced via the right external jugular vein. In nine tests in five dogs, a single embolus was launched after the right pulmonary artery had been balloon occluded and the impeller-basket catheter had been positioned into the left pulmonary artery. Seven of nine emboli were completely fragmented, each within less than 10 s. In two tests, performed in two different dogs, the catheter was positioned after complete embolization of the left pulmonary artery. In both cases, the central pulmonary arteries could be fully, and the segmental arteries partly, recanalized. Mobility of the system within the pulmonary arteries was limited. There was no evidence of wall damage at the rotation site of the impeller. Free serum hemoglobin did not increase after treatment. We conclude that the device can be safely operated in the left pulmonary artery system of dogs. It causes no significant hemolysis, and is able to accomplish rapid recanalization of the central arteries. Due to limited steerability, occluded side branches cannot be treated consistently.

Animals↗
PubMedDate not supplied

Distribution and size of particles after dynamic angioplasty in cadaveric arteries with the Kensey catheter system: a comparison with clinical experience.

The distribution and size of atheromatous debris after angioplasty with the Kensey catheter was determined after recanalization of 18 segments of human cadaveric superficial femoral arteries (SFA). The debris produced was studied cytologically and measured semiquantitatively. Nearly 80% of all particles ranged from 5 to 15 microns, approximately the size of red blood cells. More than 20% of all particles exceeded this size and 2% were larger than 100 microns. The use of the Kensey catheter dynamic angioplasty system in the lower extremities contains the risk of embolic complications because more than 20% of all particles are larger than human blood cells. Seven patients with occlusion and 3 with stenoses of the SFA were treated with the Kensey catheter system. Recanalization was successful in all and in 1 case, small emboli in the anterior tibial artery were observed. There was a 50% restenosis/reocclusion rate between 2 weeks and 10 months.

Aged↗
PubMedDate not supplied

The Strecker stent: indications and results in iliac and femoropopliteal arteries.

We have implanted more than 100 Strecker stents in the iliac and femoral arteries. In iliac arteries, follow-up is available from 8 to 48 months (mean 20 months) and in peripheral arteries, from 8 to 32 months (mean 19 months). In iliac and proximal femoral arteries there was a patency rate of 98% (mean 20 months after stent implantation) whereas in peripheral arteries the patency rate was 70.8% (mean 19 months after stent implantation). Besides careful selection of patients, anticoagulation is very important for successful stenting. Because of the excellent results of stents in iliac vessels there is a wide range of good indications, including primary stenting after recanalization of occlusions. In contrast, stent implantation in peripheral vessels should be restricted to special cases such as acute dissection or reocclusion after successful recanalization.

Anticoagulants↗
PubMedDate not supplied

Transjugular intrahepatic portosystemic shunt in portal vein thrombosis: role of the right gastric vein with anomalous insertion.

Transjugular intrahepatic portosystemic shunt (TIPS) was performed in two patients with portal vein thrombosis. In both patients, hepatopetal flow had been maintained by an anomalous insertion of the right gastric vein (RGV) into the portal vein bifurcation and into the left portal branch respectively. In one patient, the main portal trunk could not be recanalized and the RGV was used as an accessory portal vein to place one stent for TIPS. In the other case, access through the partial portal-vein occlusion was gained and three stents were placed from the hepatic vein to the main portal vein distal to the thrombus. In portal vein thrombosis, the aberrant insertion of the RGV into the left or right portal branches may maintain patency of the intrahepatic portal system and, in case of unsuccessful recanalization of the porta, may represent the sole pathway for placing a TIPS.

Collateral Circulation↗
PubMedDate not supplied

Laser angioplasty of peripheral arteries: an epilogue?

This review gives a short overview of the results of 15 years of experimental and clinical work on laser angioplasty. Experimentally, photothermal and photomechanical ablation of plaque could be demonstrated. However, laser angioplasty did not cause reduction of platelet adhesion and intimal hyperplasia. Clinically, the technique of laser angioplasty was continuously improved until the initial recanalization rates and long-term patency rates in femoropopliteal artery occlusions were the same as the success rates of percutaneous transluminal angioplasty (PTA). This was proven by various randomized studies. Currently, laser angioplasty cannot be proposed as a routine procedure because it is an expensive technology. However, laser recanalization and debulking of total occlusions should be further developed, especially in combination with endoluminal graft placement.

Angioplasty, Balloon↗
PubMedDate not supplied

Iatrogenic dissection of the celiac artery and its branches during transcatheter arterial embolization for hepatocellular carcinoma: outcome in 40 patients.

PURPOSE: To study the sequelae of iatrogenic dissection of the celiac axis and its branches in a large patient population. METHODS: We analyzed 40 patients with hepatocellular carcinoma (HCC) whose celiac artery or its branches were dissected during transcatheter arterial embolization (TAE) and underwent follow-up angiography within 2 months. RESULTS: The two most common sites of dissection were the celiac artery in 13 patients (32.5%) and the proper hepatic artery in 11 patients (27.5%). Follow-up angiography revealed complete recanalization in 32.5% (13/40), irregularity and narrowing of the lumen in 40% (16/40), and complete obstruction in 27.5% (11/40). Therefore, 72.5% (29/40) of the dissected arteries recanalized. Pseudoaneurysm formation of the dissected artery was observed in 32.5% (13/40). Subsequent TAE was possible via the dissected arteries in 79% (27/34) of patients in this series. CONCLUSION: Iatrogenic dissection of the celiac and proximal hepatic arteries heals spontaneously in the majority of patients, and in most instances allows subsequent TAE.

Adult↗