Safety and efficacy of directional atherectomy for the treatment of in-stent restenosis of the femoropopliteal artery.

AIM: The aim of this study was to evaluate safety and efficacy of directional atherectomy with the Silver HawkTM device as first line treatment for in-stent restenosis of the femoropopliteal artery. METHODS: Over a period of 1.5 years in-stent restenosis of the femoropopliteal artery in 35 lesions (34 legs, 33 patients) was primarily treated with directional atherectomy. Primary endpoint was treatment success (<50% residual stenosis) and the absence of complications. Secondary endpoint was target lesion patency after 3, 6 and 12 month assessed by duplexsonography. RESULTS: Mean patient age was 70 years (SD+/-10). 74 % were claudicants (Rutherford 2-3), 26% had CLI (Ruther-ford (4-5). 45% were diabetics, 82% had a history of arterial hypertension and nicotine abuse. Mean lesion length was 108 mm (SD+/-102 mm). Treatment success with atherectomy alone was achieved in 86% with additional PTA (43%) success increased to 97%. Adjunctive stent implantation was necessary in 11% of the cases. Post interventional ABI increased from 0.54 (+/-0.26) to 0.77 (+/-0.26). The rate of minor complication was 3% (1/34) and the rate of major complication was 18% (6/34), mainly due to distal embolization. Target lesion patency at 3 month was 86.2%, at 6 month 68% and at 12 month 25%. CONCLUSIONS: Although atherectomy of in-stent restenosis as a first line treatment yields a high initial success rate with a low requirement for adjunctive PTA and stent implantation, long term patency rates are low. In our study the theoretical advantage of avoiding barotauma did not result in prevention of recurrent intimal hyperplasia.

Detection of artificial air space opacities with digital radiography: ex vivo study on enhanced latitude post-processing.

PURPOSE: To evaluate in a.-p. digital chest radiograms of an ex vivo system if increased latitude and enhanced image detail contrast (EVP) improve the accuracy of detecting artificial air space opacities in parts of the lung that are superimposed by the diaphragm. MATERIALS AND METHODS: 19 porcine lungs were inflated inside a chest phantom, prepared with 20-50 ml gelatin-stabilized liquid to generate alveolar air space opacities, and examined with direct radiography (3.0 × 2.5 k detector/ 125 kVp/ 4 mAs). 276 a.-p. images with and without EVP of 1.0-3.0 were presented to 6 observers. 8 regions were read for opacities, the reference was defined by CT. Statistics included sensitivity/specificity, interobserver variability, and calculation of Az (area under ROC curve). RESULTS: Behind the diaphragm (opacities in 32/92 regions), the median sensitivity increased from 0.35 without EVP to 0.53-0.56 at EVP 1.5-3.0 (significant in 5/6 observers). The specificity decreased from 0.96 to 0.90 (significant in 6/6), and the Az value and interobserver correlation increased from 0.66 to 0.74 and 0.39 to 0.48, respectively. Above the diaphragm, the median sensitivity for artificial opacities (136/276 regions) increased from 0.71 to 0.77-0.82 with EVP (significant in 4/6 observers). The specificity and Az value decreased from 0.76 to 0.62 and 0.74 to 0.70, respectively, (significant in 3/6). CONCLUSION: In this ex vivo experiment, EVP improved the diagnostic accuracy for artificial air space opacities in the superimposed parts of the lung (area under the ROC curve). Above the diaphragm, the accuracy was not affected due to a tradeoff in sensitivity/specificity.

[Does interventional therapy prolong the patency of hemodialysis fistulas and grafts?]. / Verlängert die radiologisch-interventionelle Therapie die Shuntnutzungsdauer bei hämodialysepflichtigen Patienten?

PURPOSE: To retrospectively evaluate procedural success and patency after endovascular treatment of acute dysfunctional hemodialysis fistulas and grafts in a non-preselected patient cohort. MATERIALS AND METHODS: 185 angiographies of hemodialysis fistulas and grafts on the upper extremities were analyzed for 120 patients (53 male, 67 female; mean-age 63.1 +/- 11.4, range 24 - 91). 70 % (n = 130) were native arteriovenous fistulas, 17 % (n = 31) were prosthetic grafts, and 13 % (n = 24) were non-specific. In total, 278 lesions requiring endovascular treatment were detected. 13 % (n = 35) of the lesions were located in the arterial inflow, 18 % (n = 49) in native arteriovenous anastomoses, 7 % (n = 19) in prosthetic grafts and 62 % (n = 171) in the venous outflow. The primary, secondary and cumulative patency after endovascular treatment was calculated. RESULTS: In 51 % (n = 94) of the cases endovascular treatment could be performed, in 8 % (n = 14) no lesion requiring treatment was detected, and in 42 % (n = 77) intervention was not considered possible. In 45 % (n = 124) of the detected lesions endovascular treatment was successful, in 18 % (n = 51) the intervention failed, and in 37 % (n = 103) intervention was not considered possible. The complication rate was 5 % (n = 10). The primary, secondary, and cumulative patency rates for 50 % of the hemodialysis fistulas and grafts after endovascular treatment were 65, 191, and 370 days, respectively. The results differed significantly from each other with p < 0.05 in the log rank test and log rank trend test. CONCLUSION: Endovascular treatment of acute dysfunctional hemodialysis fistulas and grafts is effective in restoring the patency for hemodialysis.

Suggested Greek translations of expressions in the experimental analysis of behavior.

Greek-English and English-Greek translations of expressions in the experimental analysis of behavior are presented. Included is a short discussion of some of the problems which arose, partly because of the mentalistic nature of Greek science.