A fenestrated covered suprarenal aortic stent.

OBJECTIVE: to address the clinical problem of inadequate neck length of abdominal aortic aneurysms in endoluminal surgery. DESIGN: a covered suprarenal aortic stent was designed with a fenestration to preserve blood flow in a targeted renal artery. METHOD AND MATERIAL: a Dacron-covered stent was accurately cut to size with a fenestration according to pre-imaging studies. RESULTS: the stent was successfully deployed in canine models, preserving the visceral and renal artery of interest. CONCLUSION: by accurately placing a covered stent in the aorta and preserving the blood flow to its branches, it may be possible to extend the indications for endoluminal aortic aneurysm grafting.

Percutaneous transluminal angioplasty of the tibial arteries.

To evaluate the results of percutaneous transluminal angioplasty (PTA) of the tibial vessels, results of 50 procedures performed in 38 patients since 1988 were analysed retrospectively. A total of 73 tibial vessels were treated: 32 anterior tibial arteries, 16 posterior tibial arteries, four peroneal arteries, 12 tibioperoneal trunks and nine trifurcation lesions. Forty-four of 50 PTA procedures were performed in conjunction with interventions in the femoropopliteal arteries and six as isolated procedures. One patient required a femorodistal graft following perforation of the popliteal artery during atherectomy. Distal emboli occurred in two patients and acute thrombosis of both the angioplastied tibial vessels occurred in a third. The technical success rate was 96 per cent. Patients were followed for a mean(s.d.) of 21(13) months. At the latest follow-up, 58 per cent had improved clinically. There were significant improvements in 43 per cent of limb isotope blood flow studies and 52 per cent of ankle:brachial Doppler pressure indices in treated limbs at this time. PTA should be the first treatment option in patients with infrapopliteal arterial disease needing intervention, whenever it is technically feasible.

Coronary angioplasty in high risk patients with percutaneous cardiopulmonary support.

Cardiopulmonary Support (CPS) was employed electively in 13 patients during high risk percutaneous transluminal coronary angioplasty (PTCA) in accordance with a selection criteria, which included at least two of the following; (i) left ventricular ejection fraction of less than 35%, (ii) target vessel(s) supplying more than 50% of the viable myocardium, and (iii) patients refused coronary bypass surgery. The mean age of the patients was 56.8 +/- 10.7 years (range 39-77). PTCA was attempted in a total of 35 lesions in 12 patients; 29 lesions were successfully dilated (technical success rate of 82.9%). On average, 2.7 lesions were attempted in each patient, and 2.2 lesions were successfully dilated per patient. In one patient the procedure was abandoned due to dissection of the iliac artery during cannulation. One patient died of a large pulmonary embolism 72 h after the procedure. All the surviving 11 patients who had successful PTCA on CPS showed symptomatic improvement during a mean follow-up period of 18.5 +/- 4.3 months (range 11 to 24 months). The commonest complication encountered following the CPS-assisted PTCA was local haematoma (nine of 13 patients), but all patients required transfusion due to significant periprocedural blood loss. Our early experience suggests that CPS enhances the safety of undertaking PTCA in high risk patients.

Use of thermal imaging to monitor crural thrombolysis.

Intra-arterial thrombolysis is increasingly being used as the treatment of choice in selected cases of critical limb ischaemia. At present angiography is the established method of monitoring the progress of thrombolysis. We report a case in which thermal imaging was used in conjunction with angiography to monitor the effects of thrombolysis.