ABSTRACT
Mesenteric angina is a difficult diagnosis and surgical treatment carries a significant morbidity and mortality. In patients with stenotic mesenteric vascular disease angioplasty offers an alternative method of treatment. In six patients who underwent mesenteric angioplasty relief of symptoms was achieved in five. Recurrence of symptoms associated with recurrent stenosis occurred in two patients and was remedied by re-dilation in one. Mesenteric angioplasty is a safe alternative to surgical revascularisation for mesenteric stenosis causing chronic intestinal ischaemia.
Subject(s)
Angioplasty, Balloon , Intestines/blood supply , Ischemia/therapy , Mesenteric Vascular Occlusion/therapy , Aged , Female , Humans , Ischemia/diagnostic imaging , Male , Mesenteric Arteries/diagnostic imaging , Mesenteric Vascular Occlusion/diagnostic imaging , Middle Aged , RadiographyABSTRACT
Non-invasive follow-up of 94 femoro-distal reconstructions has identified 14 graft related stenoses (4 proximal anastomotic, 4 intragraft and 7 distal anastomotic). Stenoses treated by percutaneous transluminal angioplasty (PTA) recurred by 6 months. Stenoses treated by surgical revision remained satisfactory with a mean follow-up of 13 months. In this series, formal surgical revision appears to be superior to PTA for the treatment of graft stenoses.
Subject(s)
Angioplasty, Balloon , Femoral Artery/surgery , Graft Occlusion, Vascular/therapy , Leg/blood supply , Popliteal Artery/surgery , Aged , Arterial Occlusive Diseases/surgery , Humans , Recurrence , ReoperationSubject(s)
Angioplasty, Balloon/methods , Graft Occlusion, Vascular/therapy , Ultrasonography , Aged , Aged, 80 and over , Humans , MaleABSTRACT
B mode ultrasound was used to assess and map the long saphenous vein in 20 limbs prior to femorodistal bypass. The assessment was compared with operative findings. Eighteen of 19 adequate veins and 8 of 9 anatomical abnormalities or major divisions were correctly identified. B mode ultrasound allows accurate marking of the vein, facilitating dissection, alerts the surgeon to possible difficulties and is an ideal non-invasive technique for preoperative assessment of the long saphenous vein.
Subject(s)
Saphenous Vein/anatomy & histology , Ultrasonography , Aged , Aged, 80 and over , Female , Femoral Artery/surgery , Humans , Male , Middle Aged , Saphenous Vein/abnormalities , Saphenous Vein/transplantationABSTRACT
Duplex scanning and ankle brachial pressure indices have been used to objectively assess 94 femoro-distal bypass grafts 4-8 weeks postoperatively. Twenty grafts were occluded. Of the 74 patent grafts, three distinct groups could be identified on the basis of the non-invasive examination. Group 1. Patent grafts with no evidence of haemodynamically significant disease. Group 2. Patent grafts with localised disease. Group 3. Patent: haemodynamically failed grafts. Ankle brachial pressure indices alone could not differentiate between occluded grafts and grafts that were patent: haemodynamically failed (group 3), or adequately separate between grafts in groups 1 and 2. Duplex scanning when combined with pressure indices identified patent grafts "at risk" due to the presence of haemodynamically significant disease. Life table analysis demonstrated appreciable differences in event free survival between group 1 grafts and "at risk" grafts (groups 2 and 3). Duplex scanning is ideal for regular postoperative surveillance and complements the use of ankle brachial pressure indices in the follow-up of femoro-distal grafts.
Subject(s)
Blood Vessel Prosthesis , Femoral Artery/surgery , Graft Occlusion, Vascular/diagnosis , Leg/blood supply , Ultrasonography , Actuarial Analysis , Aged , Ankle/blood supply , Blood Pressure , Female , Humans , Male , Postoperative Care , Prospective StudiesABSTRACT
Fifty-eight grafts have been assessed using duplex scanning and ankle brachial pressure indices. This assessment is compared with the findings by angiography. Eighteen grafts were occluded and 40 patent. Duplex scanning defined graft status with a greater accuracy than pressure indices. Pressure indices alone would not differentiate "satisfactory" grafts from those with localised, haemodynamically significant disease. Only 55% of those grafts with localised stenoses demonstrated a fall of greater than 0.2 in ankle brachial pressure index after exercise. When the information obtained using pressure indices and duplex scanning was combined non-invasive assessment had a sensitivity of 86% and specificity of 94% for detection of localised, haemodynamically significant disease in patent grafts. Haemodynamically significant disease, as defined by angiography, can be detected and localised with duplex scanning complementing the use of pressure indices in graft assessment.
