ABSTRACT
Redo femoropopliteal bypass surgery is associated with increased morbidity and related to a poorer outcome than primary procedures. Endografts might provide an alternative, avoiding dissection of a previously operated groin. Patients treated with a polytetrafluoroethylene-covered stents for superficial femoral artery occlusive disease between February 2009 and September 2011 were prospectively gathered. Demographics, clinical status, procedural aspects, and follow-up were retrieved. Seventy-four patients were included of which 5 (7%) were treated before with a femoropopliteal bypass. Indication for intervention was Rutherford category 3 in all patients and the median ankle-brachial index (ABI) was 0.68. Technical success was achieved in all cases. The postoperative course was uneventful in all and the ABI increased to 0.95. After a follow-up period of 18 months, 4 of 5 endografts remained patent. The use of endografts after failed femoropopliteal bypass surgery is feasible and safe and could be used to avoid or minimize a difficult and hazardous dissection of a previously operated area.
Subject(s)
Blood Vessel Prosthesis Implantation , Endovascular Procedures , Femoral Artery/surgery , Peripheral Arterial Disease/surgery , Popliteal Artery/surgery , Vascular Surgical Procedures , Aged , Ankle Brachial Index , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Constriction, Pathologic , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Female , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Limb Salvage , Male , Middle Aged , Netherlands , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Polytetrafluoroethylene , Popliteal Artery/diagnostic imaging , Popliteal Artery/physiopathology , Prospective Studies , Prosthesis Design , Radiography , Reoperation , Stents , Time Factors , Treatment Failure , Vascular Patency , Vascular Surgical Procedures/adverse effectsABSTRACT
Paired and matched CT scans, one before and one after IV injection of contrast material, from 30 spinal CT studies were presented in a blind fashion to six observers with varying degrees of radiologic experience. The observers were asked to indicate which section of each pair gave the best delineation of intraspinal soft tissues. Seventy-five percent of the verdicts indicated the postcontrast image was superior in this respect, but the six observers were unanimous on this in only 50% of the cases. At a follow-up viewing of the same cases several weeks later, some 20% of the verdicts were changed. Experience in interpreting spinal CT scans did not prove to influence rating performance or improve intraobserver consistency. In summary, contrast material, in the dosage and injection mode used by us, appeared to be the most important factor in improving scan interpretation.
Subject(s)
Contrast Media/administration & dosage , Injections, Intravenous , Spine/diagnostic imaging , Tomography, X-Ray Computed , HumansABSTRACT
Contrast-enhanced CT can be useful in differentiating between recurrent disk herniation and scar formation after disk surgery. Thirty such CT studies were assessed retrospectively to determine the utility of CT attenuation measurements in identifying intraspinal pathology. Measured values of intraspinal tissues, but also of "reference" materials such as CSF, blood, and muscle tissue, showed large individual variations; and enhancement patterns for recurrent herniation and scar formation were not specific. The chief value of contrast administration may lie in the clearer definition that is gained of various structures within the postoperative spine.
