Final report of the European multi-center registry using the Duett vascular sealing device.

Duett, a novel vascular sealing device, was first clinically used in July 1997. A European multi-center registry was established to evaluate the safety and procedural success of the Duett sealing device in a broad range of patients undergoing diagnostic or interventional endovascular procedures. At 25 European sites 1587 patients were enrolled. All patients (> or = 18 years) must have given informed consent for the use of the sealing device after a diagnostic and/or interventional endovascular procedure performed via a femoral arterial approach. Standard length (< or = 10 cm) 5 to 9 F introducer sheaths had to be used. An ACT of < or = 400 s, and any approved GP IIb/IIIa platelet receptor antagonist was permitted. Successful deployment could be achieved in 96.2% (1526/1587 patients) with complete hemostasis within 2 to 5 minutes in over 95% of the patients. The complication-free rate was 96.4%. Arterial occlusions were rare (4 patients) and successfully treated with surgical repair in 1 and with thrombolysis in 3 patients. Pseudoaneurysms occurred in 34 patients, the majority (30/34) were successfully treated with ultrasound-guided compression or resolved spontaneously. The total rate of major complications was 2.6% (41/1587). The final results of the European registry demonstrate that the Duett sealing device can be used with a high procedural success following diagnostic and interventional endovascular procedures. The incidence of major complications is low and comparable to all other approved vascular closure devices and manual compression. CE-mark certification was approved at the end of 1998.

Iodixanol in cardioangiography in patients with coronary artery disease. Tolerability, cardiac and renal effects.

Iodixanol is a new nonionic, dimeric contrast medium. With the addition of 18 mmol/l Na+ and 0.3 mmol/l Ca++ to iodixanol 320 mg I/ml a plasma-isotonic solution was obtained. The purpose was to evaluate the suitability of iodixanol for use in cardioangiography by determining the diagnostic efficacy, patient tolerability, and cardiac and renal side-effects. Initially, 14 patients with coronary artery disease were examined using iodixanol. A double-blind, randomized study was then performed in 72 patients, comparing iodixanol and iohexol. Serum and urine were sampled before the examination, and one and 2 days after. The diagnostic information was good and the number of adverse events low with iodixanol. The patients reported significantly less of a sensation of warmth following injection of iodixanol than iohexol. Our results also indicate that iodixanol 320 mg I/ml influences renal function to a lesser degree than does iohexol 350 mg I/ml. We therefore conclude that isotonic iodixanol is a safe contrast medium for use in cardioangiography.

[Arteria gastroepiploica dextra in coronary surgery. Complete revascularization in angina pectoris]. / Arteria gastroepiploica dextra i koronarkirurgi. Komplett arterialisering ved angina pectoris.

We have used the right gastroepiploic artery as a viable jump graft to the distal right coronary artery in two patients. The first patient was a 37 year-old man with recurrent angina after coronary bypass surgery with three vein grafts eight years previously. The second patient was a man aged 45 with angina in New York Heart Association Class III to IV. In both cases coronary angiography revealed severe triple vessel disease with multiple proximal and distal occlusions or stenosis. Both internal mammary arteries were also used in the two patients to revascularize the LAD and circumflex systems. Thus, a complete revascularization was achieved by use of only viable arteries as conduits. Both patients recovered well and were free from angina. At present only the first patient has had a postoperative angiogram, which showed good patency of the gastroepiploic artery jump graft. If the long-term patency of this type of graft is similar to that of the internal mammary arteries, it is another suitable arterial conduit for revascularization of the ischemic myocardium.

Morbid obesity treated with gastric partitioning and gastrogastrostomy.

Between April 1981 and July 1983, 30 patients were operated on for morbid obesity with gastric partitioning and a gastrogastrostomy (GP). The patients were checked 3, 6, 9, 12, and 24 months postoperatively. Radiological investigations were performed on the 5th postoperative day and after 2-32 months. All patients lost weight postoperatively, ranging from 14 to 45 kg after 9 months, but thereafter a slight increase in weight was noted. The weight loss was not correlated with radiologically measured stoma size or volume of the upper gastric pouch. Thus, in contrast studies combined with Gastroluft (sodium bicarbonate, tartaric acid, and dimethicone), pouch distention does not yield prognostic information on anticipated weight loss. More reliable methods for measuring stoma and pouch size are needed, but other factors like patient motivation and a careful postoperative follow-up study with dietetic advice are probably more important for a satisfactory outcome.