Percutaneous atherectomy with the Kensey catheter: early and midterm results in femoropopliteal occlusions unsuitable for conventional angioplasty.

Forty-six femoropopliteal occlusions in 44 patients (aged 45-95 years) were recanalized with the percutaneous rotating tip atherectomy catheter completed by balloon dilatation. Thirty-one patients had tight intermittent claudication of the lower limbs, five had resting pain and 10 had skin disorders. The length of the occlusion ranged from 2 to 24 cm. Of 46 procedures, 40 (87%) were immediately successful (increase of mean Doppler systolic ankle-arm index from 0.44 to 0.89) and six (13%) were failures. In two it was impossible to pass through the lesion and in four arterial perforation occurred without any clinical consequences. Of the six failures, five occurred in calcified arteries. Five recanalizations (11%) reoccluded within 48 hours, bringing the total number of early failures to 11. Of these 11 failures, nine were treated by femoropopliteal vein bypass and two by medical treatment only. Two postoperative asymptomatic posterior tibial artery embolisms were treated medically, and one popliteal artery embolism was treated using a Fogarty catheter. At the present time, 25 of 35 primary successes had been followed for six months, and 20 for 12 months with primary patencies 18 of 25 (72%) and 14 of 20 (70%), respectively. If massively calcified lesions are excluded, femoropopliteal recanalization with the percutaneous rotary Kensey atherectomy catheter followed by balloon catheter dilatation is efficacious and reliable with an 80% primary success rate and a 70% patency rate at one year.

[Peripheral arterial recanalization using a Kensey catheter]. / Désobstruction artérielle périphérique par cathéter de Kensey.

Between June 6 1988 and September 30 1989, 46 superficial femoral obliterations in 44 patients were treated by rotary atherectomy, completed by conventional dilatation in 40 patients. The 44 patients (27 males and 17 females), mean age over 66.5 years (45 to 90), presented symptomatic superficial femoral obliterations (17 tight stage, two occlusions, 5 stage III, and 10 stage IV occlusions), with mean length of 9.8 cm (2 to 24 cm). Vascular echography was performed systematically before the procedure, to assess the extent of intraluminal calcification. Moreover, a control venous angiography was performed on the third day. Of the 46 treated arteries, the occlusions which had remained impermeable with a traditional guidewire were traversed successfully and without incident in 40 cases (87%). In case 20, the massively calcified obliteration could not be traversed, and perforation occurred in four cases, but without clinical consequences. In five other cases (11%), precocious reocclusion occurred before the 48th hour. It should be pointed out that, in 2 of these 5 cases, no additional conventional dilatation had been performed at the beginning of the trial. In 35 cases (76%), satisfactory permeability with residual stenosis less than 30% was thus obtained upon discharge from the hospital. For these patients, the lower limb/upper limb Doppler index rose from 0.44 to a mean 0.89 after treatment. 2 embolism were observed: one popliteal treated by embolectomy. The mid term permeability at 6 months is 80% among the 25 primary successes.

[Acute fatal non-occlusive intestinal ischemia during treatment with a cardiotonic glucoside]. / Ischémie intestinale aiguë non occlusive mortelle au cours d'un traitement par glucoside cardiotonique.

After presenting the case of a 70 year old woman who presented a massive mesenteric infarction as a result of non-occlusive intestinal ischaemia ( NOII ), the authors review the principal features of this particular form of intestinal ischaemia. This condition is seen principally in elderly people with a syndrome of low cardiac output, resulting in marked mesenteric vasoconstriction. It is a complication of either severe decompensated heart disease treated with digitaloids or to a state of hypovolaemic or septic shock. The diagnosis of NOII should be suggested by the combination of abdominal signs with a state of shock and/or treated heart disease. The diagnosis is confirmed by selective mesenteric arteriography which reveals a patent but spastic vessel. The treatment is initially medical, consisting of the correction of haemodynamic disturbances and the in situ injection of vasodilator products, which may need to be completed by a surgical operation. However, the prognosis of NOII remains serious, particularly because of the frequent delay in making the diagnosis.