Subject(s)
Embolization, Therapeutic/methods , Postpartum Hemorrhage/therapy , Acute Disease , Adult , Female , Humans , Pregnancy , Treatment OutcomeABSTRACT
Arteriovenous malformations (AVM) are rare vascular lesions that can present with a myriad of clinical presentations. In our institutions, initial workup consists of a clinical exam, color Doppler imaging, and magnetic resonance imaging. After the initial noninvasive workup, arteriography, at times closed system venography, and ethanol endovascular repair of the AVM is performed under general anesthesia. Depending on the size of the lesion, additional Swan-Ganz line and arterial line monitoring are performed. Patients are usually observed overnight and uneventfully discharged the following day if no complication occurs. Patients are followed at periodic intervals despite cure of their lesion. Long-term follow-up is essential in AVM management.
Subject(s)
Arteriovenous Malformations/therapy , Embolization, Therapeutic/methods , Ethanol/administration & dosage , Arteriovenous Malformations/diagnosis , Catheterization, Peripheral/methods , Diagnostic Imaging , Follow-Up Studies , Humans , Recurrence , Treatment OutcomeABSTRACT
PURPOSE: The clinical efficacy of 44 successful conventional and laser-assisted recanalizations of the femoropopliteal artery was assessed in a noncomparative study by the life-table method. METHODS: Laser-assisted angioplasty using continuous laser and a sapphire probe was performed to achieve primary recanalization in femoral artery occlusions when conventional guidewire recanalization had already failed. Nineteen of the patients underwent a conventional recanalization (PTA; mean length of occlusion 4.4 +/- 4.1 cm), and 25 underwent percutaneous laser-assisted angioplasty (PLA; mean length of occlusion 10.1 +/- 6.7 cm). RESULTS: There was no statistical relation between the preprocedure Fontaine classification and the success rate in the PTA cases (p = 0.25), whereas there was a statistical relation in the PLA cases: The success rate in patients preprocedurally classified as Fontaine II was better than in those classified as Fontaine III/IV (p = 0.05). After a 3-year follow-up the patency rate in the patients with the PTA recanalizations was 37% and that in those with the PLA procedure was 53%. This difference was not statistically significant (p = 0.47). CONCLUSION: It is concluded that the laser should remain an investigational device.
Subject(s)
Angioplasty, Balloon, Laser-Assisted , Femoral Artery , Popliteal Artery , Angioplasty, Balloon , Angioplasty, Balloon, Laser-Assisted/adverse effects , Arterial Occlusive Diseases/surgery , Arterial Occlusive Diseases/therapy , Follow-Up Studies , Humans , Life Tables , Prospective Studies , Recurrence , Vascular PatencyABSTRACT
Recanalization of 75 femoropopliteal arterial occlusions was attempted with either conventional percutaneous transluminal angioplasty (n = 28; mean occlusion length, 5.5 cm) or percutaneous laser-assisted angioplasty (PLA) (n = 47; mean occlusion length, 11.6 cm). Conventional recanalization was technically successful in 21 patients (mean occlusion length, 4.4 cm +/- 3.9) and was a technical failure in seven (mean occlusion length, 8.7 cm +/- 6.2). The technical outcome was a function of the length of the occlusion (P = .04). The PLA procedure, performed with a laser with a sapphire probe, was a technical success in 32 patients (mean length, 10.7 cm +/- 6.5) and a technical failure in 15 (mean length, 13.6 cm +/- 8.2). With PLA, the length of the occlusion did not determine the technical (P = .20) or clinical (P = .12) outcome. In patients with gangrene, PLA of occlusions longer than 5 cm failed clinically (P = .02). This PLA method appeared to be safe and allowed passage through occlusions longer than 10 cm.
