Intermediate Results of Infrainguinal Percutaneous Transluminal Angioplasty

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.

Intermediate Results of Infrainguinal Percutaneous Transluminal Angioplasty

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.

Retroperitoneal Abscess after Endovascular Repair of Infected Abdominal Aortic Aneurysm

Infected aneurysm of the aorta is a rare but life-threatening condition. The traditional strategy for treating infected aortic aneurysms is open surgical repair with antibiotic therapy. Endovascular repair of infected aortic aneurysms has been performed only sporadically. Case: A 70-year-old man with a history of diabetes who presented with intermittent fever for one month was referred to our institution. Before admission, antibiotic treatment had been already started and on admission, his general condition was not critical. A CT scan showed two saccular aneurysms of the infrarenal abdominal aorta and a retroperitoneal inflammation including hematoma. No microorganism was identified on blood culture. On follow-up CT scan 15 days later, a further increase in aneurysmal diameter was detected and endovascular repair was performed by using Gore Excluder stent graft. The patient was recovered and discharged on hospital day 29. One month after discharge, the patient was readmitted due to chilling and fever. Abdominal CT showed a retroperitoneal abscess around the previously repaired aortic aneurysm. Surgical drainage was performed without reconstruction with extra-anatomical bypass or in situ replacement. Culture from the abscess revealed the growth of Klebsiella pneumoniae. The patient was discharged on postoperative day 31 and continues to be observed.

Retroperitoneal Abscess after Endovascular Repair of Infected Abdominal Aortic Aneurysm

Infected aneurysm of the aorta is a rare but life-threatening condition. The traditional strategy for treating infected aortic aneurysms is open surgical repair with antibiotic therapy. Endovascular repair of infected aortic aneurysms has been performed only sporadically. Case: A 70-year-old man with a history of diabetes who presented with intermittent fever for one month was referred to our institution. Before admission, antibiotic treatment had been already started and on admission, his general condition was not critical. A CT scan showed two saccular aneurysms of the infrarenal abdominal aorta and a retroperitoneal inflammation including hematoma. No microorganism was identified on blood culture. On follow-up CT scan 15 days later, a further increase in aneurysmal diameter was detected and endovascular repair was performed by using Gore Excluder stent graft. The patient was recovered and discharged on hospital day 29. One month after discharge, the patient was readmitted due to chilling and fever. Abdominal CT showed a retroperitoneal abscess around the previously repaired aortic aneurysm. Surgical drainage was performed without reconstruction with extra-anatomical bypass or in situ replacement. Culture from the abscess revealed the growth of Klebsiella pneumoniae. The patient was discharged on postoperative day 31 and continues to be observed.

Cumulative Patency Rate of Percutaneous Transluminal Angioplasty and Stent Placement for Aortoiliac Occlusive Disease

PURPOSE: To evaluate the results of iliac artery angioplasty and stent placement as an option for the treatment of aortoiliac occlusive disease. METHOD: The records of 30 patients (mean age, 65.5 years) who underwent iliac artery angioplasty and/or stent placement were reviewed retrospectively. Presenting symptoms included asymptomatic (6.7%), claudication (73.3%), rest pain (10%), ulceration/tissue loss (3.3%), and blue toe syndrome (6.7%). Follow-up included angioplasty, Doppler ultrasound, and clinical examination. Mean follow-up time was 32 months. RESULT: Forty iliac lesions were treated. Thirty-seven percent of patients had hypertension, 33% had diabetes mellitus, 23% had coronary arterial disease, 6.6% had cerebrovascular disease, 3.3% had hyperlipidemia and 3.3% had renal insufficiency. TASC (Trans Atlantic Inter-Society Consensus) A, B, C and D disease types were 11 (36.7%) patients, 5 (16.7%), 10 (33.3%) and 4 (13.3%). Ipsilateral superficial femoral artery occlusion was present in 6 (20%) patients. Concomitant femoral artery bypass surgery was performed in 10 (33.3%) patients. The cumulative primary patency rates were 83.4%, 71.9% and 64.7% at 1, 2, and 3 years, respectively. CONCLUSION: Iliac artery angioplasty and stent placement is a technically safe and effective treatment modality in patients without ipsilateral superficial femoral artery occlusion.

An Experimental Study for Efficacy of Acetic Acid as a Sclerosing Agent

PURPOSE: To evaluate the efficacy of acetic acid as a sclerosing agent by observation of histologic change in urinary bladder epithelium after the instillation of acetic acid. MATERIALS AND METHODS: Urinary bladder of the rabbit was catheterized with a Foley catheter, and acetic acid of 10%, 20%, 30%, 40% and 50% concentration was instilled for 5 minutes. After evacuation of the acid, the bladder was irrigated three times with normal saline. After two days, gross and histologic examinations of the bladder were performed. RESULTS: A bladder into which10% acetic acid had been instilled revealed a nearly normal epithelium without denudation. In two cases, 20% acetic acid was instilled; one revealed partial denudation of the epithelium and the other revealed complete denudation. Mild to moderate interstitial edema and vascular congestion of the bladder wall were evident in all cases in which acid at a concentration of 30% or more had been instilled. In all cases in which the concentration of acid was greater than 30%, the epithelium was completely denuded. CONCLUSION: An acetic acid concentration of 40% or more is sufficient to completely destroy the epithelium of rabbit urinary bladder, and may be effective as a new sclerosing agent in cases of renal or hepatic cyst.

Experimental Study of Bleeding Control on Liver Biopsy in Rabbit: N-butyl 2-cyanoacrylate(NBCA) injection and RF electrocauterization

PURPOSE: To evaluate the hemostatic effect of N-butyl 2-cyanoacrylate(NBCA) injection and RF electrocauterization of the tract after fine needle biopsy of the liver, and the histopathologic changes of the liver. MATERIALS AND METHODS: Three lobes of rabbit liver were selected and separately punctured four times with 21 gauge biopsy needles. According to the hemostatic procedure on fine needle biopsy, three groups (1, 2, 3) were formed : group 1, in which there was no maneuver for bleeding control, was the control group ; group 2, in which NBCA was injected into the puncture tract while slowly removing the needle ; group 3, in which RF electrocauterization of the tract was carried out. After completely removing the needle, each group was evaluated for amount of bleeding and histologic change. RESULTS: The amount of bleeding was 0.407gm+/-0.245 in group 1,0.028gm+/-0.036 in group 2 and 0.035gm+/-0.028 in group 3. As compared with the control group(group 1), injecting NBCA into the biopsy tract(P=0.0002) and RF electrocauterization of the tract(P=0.0003) significantly reduced the amount of bleeding after liver biopsy. The amount of bleeding was not statistically different between group 2 and 3, however (P=0.58). In Group 1, the tract was fully filled with blood. Group 2 showed NBCA embolized in the biopsy tract, adhering to hepatocytes and mixed with blood; small vessels adjacent to the puncture tract were filled with NBCA. Group 3 showed tissue degeneration, including necrosis of hepatocytes, vacuolation and neutrophil infiltration. CONCLUSION: Injection of NBCA and RF electrocauterization of the tract after puncture of the liver for biopsy efficiently controlled bleeding. In particular, the efficiency of NBCA injection was due to its effect of plugging the tract and causing the embolization of adjacent small vessels. With regard to procedural handling, RF electrocauterization of the tract is superior to injection of NBCA.

Normal Variation of Lumbosacral Thecal Sac on MR

PURPOSE: To evaluate the shape and distal end level of the lumbosacral the cal sac in normal subjects on MR imaging. MATERIALS AND METHODS: One hundred and twelve normal lumbar MRIs were reviewed. The shape and distal endlevel of the lumbosacral thecal sac on T1-weighted midine sagittal image were evaluated. The thecal sac was divided into five types, according to shape and defined as follows : type I(pointed shape) : tapering contour, with rat tail appearance ; type II(ovoid shape) : tapering smoothly, with round end ; type III(round shape) : not tapering, with round end ; type IV(pointed ovoid shape) : ending in papilae ; type V(round pointed shape) : ending in papillae. The levels of the distal end of the thecal sac were also evaluated. RESULTS: Type I was the mostcommon(43/112, 38/4%) and the second most common form was type II(31/112, 27.7%). With regard to the distal end level of the sac, 33 cases were located at the distal one third of the S2 body and 28 were at the middle one third; 16 cases were at the distal one third of the S1 body, and 14 were at the S1-S2 intervertebral disc level. All lumbosacral thecal sacs terminated between the L5-S1 intervertebral body and the distal one third of the S3 body. CONCLUSION: Lumbosacral thecal sacs ended between the L5-S1 intervertebral disc and the S3 spinal body. Most commonly, the sac terminated at the proximal one third of the S2 body. The pointed shape(type I) was most common.