Arteriogenic impotence: findings in 195 impotent men examined with selective internal pudendal angiography. Young Investigator's Award.

Selective internal pudendal angiography was performed in 195 men (average age, 35.4 years +/- 10.3) who were suspected of having arteriogenic impotence. In the majority of patients, disease was localized to the cavernosal arteries. A previous series that involved older patients had demonstrated significant disease in the hypogastric and internal pudendal arteries. When controlled for trauma, the data revealed no significant difference (X2 test, P greater than .10) in the distribution of hemodynamically significant penile arterial disease. However, in patients who had sustained major pelvic trauma, the common penile artery was frequently hemodynamically compromised. There is a great deal of variation in the origin of the internal pudendal artery. An accessory pudendal artery was demonstrated in 7% of the patients. If a selective internal pudendal artery injection fails to demonstrate the penile arterial anatomy, a less selective injection should be performed. Bilateral injections should always be performed, as unilateral arterial disease was present in 15% of the patients.

Laser angioplasty for limb salvage: observations on early results.

During a 27-month period laser thermal angioplasty (LTA) was attempted in 15 patients who had totally occluded segments of their superficial femoral--popliteal arteries (SFA) with limb-threatening ischemia (rest pain or tissue necrosis). In five patients (33%) laser perforation of the SFA precluded successful angioplasty, and those five patients have been excluded from further analysis. In the remaining 10 patients the prelaser angiogram demonstrated an average SVS/ISCVS runoff score of 7.7 (best possible score, 1; worst possible score, 10). Seven patients (70%) had occlusions of all infrapopliteal arteries. All 10 patients were available for clinical follow-up, and follow-up angiograms were available for eight patients (80%). Clinical failure was defined as recurrence of the clinical signs or symptoms for which the LTA was performed. After 6 months of follow-up clinical failures occurred in nine patients (90%). Four patients had no clinical improvement. Five patients had transient clinical improvement after LTA, and all subsequently had early recurrence of symptoms. The average time from LTA to recurrence of symptoms was 1.7 months. Seven patients had subsequent bypasses or amputations an average of 2.2 months after laser angioplasty. The SFA patency rate by life-table analysis was 25% at 6 months. The single patient with clinical success (at 12 months) had no tibial vessel disease evident on his prelaser angiogram, and he underwent a concomitant inflow procedure at the time of his LTA. We believe that the disappointing results in this small series of patients can be attributed to tibial vessel disease that was not addressed by this technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous laser thermal angioplasty: initial results and 1-year follow-up in 129 femoropopliteal lesions.

Percutaneous peripheral laser thermal angioplasty with a laser-heated metallic-capped fiber was used as an adjunct to conventional balloon angioplasty. Initial angiographic and clinical success was achieved in 99 of 129 (77%) femoropopliteal stenoses and occlusions (21 of 22 [95%] stenoses, 17 of 17 [100%] short [1-3-cm] occlusions, 26 of 37 [70%] medium-length [4-7-cm] occlusions, and 35 of 53 [66%] long [greater than 7 cm] occlusions). There was a 4% frequency of vessel perforation without clinical sequelae and no necessity for emergency bypass surgery. The 1-year cumulative clinical patency was 77% for the 99 lesions with an initial clinical success. In the 21 stenoses and 17 short occlusions, the cumulative clinical patency rates were 95% and 93%, respectively. In the longer occlusions (4-7 cm and greater than 7 cm), the clinical patency rates were 76% and 58%, respectively. The initial angiographic and clinical success, as well as the 1-year cumulative clinical patency, for stenoses and short occlusions after laser-assisted balloon angioplasty may be greater than after conventional balloon angioplasty alone.

Human percutaneous and intraoperative laser thermal angioplasty: initial clinical results as an adjunct to balloon angioplasty.

In this study, the safety and efficacy of percutaneous laser thermal angioplasty as an adjunct to balloon angioplasty were investigated in 13 patients with severe peripheral vascular disease. By means of a novel fiberoptic laser delivery system (Laserprobe) in which argon laser energy is converted to heat in a metallic tip at the end of the fiberoptic fiber, improvement in the angiographic luminal diameter was noted in 14 of 15 femoropopliteal vessels (93%) by delivering 8 to 13 watts of continuous argon laser energy as the Laserprobe was advanced through the lesion. Initial clinical success (indicated by relief of symptoms and increase in Doppler index) for the combined laser and balloon angioplasty procedures was obtained in 12 of 15 vessels (80%), with inadequate balloon dilatation being the limiting factor in three patients. No significant complications of vessel perforation, dissection, pain, spasm, or embolization of debris occurred. Of the 12 patients who had procedures with initial angiographic and clinical success, 10 (83%) were asymptomatic in the initial follow-up period of 1 to 9 months (mean 6 months). Thus, laser thermal angioplasty with a Laserprobe is a safe and effective adjunct to peripheral balloon angioplasty. This technique has the potential to increase the initial success rate of angioplasty for lesions that are difficult or impossible to treat by conventional means. By removing most of the obstructing lesion, this technique may also reduce recurrent stenosis.

Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions.

A metal-tipped laser fibre was used during percutaneous angioplasty of femoral/popliteal or iliac artery occlusions in 56 patients. Primary success was achieved in 50 (89%) of these total occlusions, providing a channel for subsequent balloon dilatation. Before the procedure, 18 lesions had been judged untreatable by conventional angioplasty and four of the six failures were in these. Complications directly attributable to the laser probe were one case of vessel perforation and two cases of entry into vessel walls; these had no sequelae. Other acute complications were a distal thrombosis in a non-heparinised patient, requiring local streptokinase treatment, and two reocclusions and one transient peripheral embolic episode in the first 24 hours. The laser probe technique has potential for increasing the proportion of patients suitable for angioplasty.