Assessing drug elution technologies in the superficial femoral artery.

The endovascular management of symptomatic atherosclerotic superficial femoral artery (SFA) disease is challenging and requires consideration of unique anatomical, hemodynamic, and biomechanical factors. The current armamentarium of balloon catheters and flexible nitinol bare metal stents have limited long-term efficacy due to intimal hyperplasia resulting in restenosis. Unfortunately, the remarkably low restenosis rates achieved with drug eluting stents placed in the coronary vasculature has not been replicated in the femoral artery. The reason for this is multifactorial including delivery platforms, drug and dosage selection and trial design flaws. Currently, however, there are several novel therapies and delivery platforms in the development pipeline that have exhibited biologic effectiveness in preclinical and early clinical trials. While these offer promise in improving outcomes following lower extremity intervention, caution is warranted until the safety of these new technologies can be ensured.

Antireflux surgery for patients with end-stage lung disease before and after lung transplantation.

BACKGROUND: Gastroesophageal reflux disease (GERD) is prevalent among patients with end-stage lung disease (ESLD). This disease can lead to microaspiration and may be a risk factor for lung damage before and after transplantation. A fundoplication is the best way to stop reflux, but little is known about the safety of elective antireflux surgery for patients with ESLD. This study aimed to report the safety of laparoscopic fundoplication for patients with ESLD and GERD before or after lung transplantation. METHODS: Between January 1997 and January 2007, 305 patients were listed for lung transplantation, and 189 patients underwent the procedure. In 2003, routine esophageal studies were added to the pretransplantation evaluation. After the authors' initial experience, gastric emptying studies were added as well. RESULTS: A total of 35 patients with GERD or delayed gastric emptying were referred for surgical intervention. A laparoscopic fundoplication was performed for 32 patients (27 total and 5 partial). For three patients, a pyloroplasty also was performed. Two patients had a pyloroplasty without fundoplication. Of the 35 operations, 15 were performed before and 20 after transplantation. Gastric emptying of solids or liquids was delayed in 12 (92%) of 13 posttransplantation studies and 3 (60%) of 5 pretransplantation studies. All operations were completed laparoscopically, and 33 patients recovered uneventfully (94%). The median hospital length of stay was 2 days (range, 1-34 days) for the patients admitted to undergo elective operations. Hospitalization was not prolonged for the three patients who had fundoplications immediately after transplantation. CONCLUSIONS: The results of this study show that laparoscopic antireflux surgery can be performed safely by an experienced multidisciplinary team for selected patients with ESLD before or after lung transplantation, and that gastric emptying is frequently abnormal and should be objectively measured in ESLD patients.