[Catheterization therapy of thromboembolic arterial occlusions of the lower extremities]. / Katetrizacní lécba trombembolických uzáveru tepen dolních koncetin.

Thromboembolic occlusions of peripheral arteries may threaten the vitality of extremities and sometimes patients life. Till recently the main therapeutic method was Fogarty surgical thromboembolectomy. A less invasive procedure is systemic (intravenous) and local (intraarterial) thrombolysis. All these method have, however, certain disadvantages. A new approach to the treatment for acute and subacute occlusions of peripheral arteries represents catheter thromboembolectomy, which involves the following: a) Aspiration of thromboembolic material--percutaneous thrombembolextraction (PTEE), b) Local infiltration thrombolysis where the catheter penetrates through the occlusion while simultaneously administering a fibrinolytic agent, c) PTA of residual stenosis in case of thrombotic occlusion. A combination of these methods of treatment for thromboembolic occlusions of peripheral arteries is very effective and enables to use a small amount of thrombolytic agent. The thrombosis and the underlying atherosclerotic stenosis are resolved during the same session.

[Results of radionuclide ventriculography and correlation with echocardiography and angiography]. / Výsledky radionuklidové ventrikulografie v korelaci s echokardiografií a angiografií.

In a group of 24 patients with coronary artery diseases, correlations of left ventricle end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV), and ejection fraction (EF) measurement results were assessed. Compared results were obtained with radiological angiography (RTG), echocardiography (USG), and radionuclide ventriculography (RNVG). In RNVG, the left ventricle volume was calculated using a geometrical method (GEO), a sample method with measurement of left ventricle position depth from a scintigraphic image (VZ1), and a sample method with assessment of left ventricle position depth from body height and body weight (VZ2). Interpersonal variability of RNVG evaluation was assessed simultaneously. Compared with RTG, the best correlation of EDV measurement was attained with GEO (r = 0.83) and VZ2 (r = 0.82). These methods correlate best also in ESV measurement (r = 0.91). The best correlation of EF values was obtained with USG, while r = 0.85 when using GEO and VZ2. A very low correlation was found in SV (r values from 0.39 to 0.50). The studied methods usually overestimate low values and underestimate higher values. To the EF value of 50 per cent corresponds in USG the value 48 per cent, in GEO and VZ2 the value 42 per cent. The values of EDV, ESV, and SV obtained with USG and RNVG correlate well with RTG, while the values of SV are, due to a low correlation, practically useless. Interpersonal variability of RNVG methods evaluation is minimal. (Tab. 6, Ref. 30.)

Percutaneous laser angioplasty with a pulsed Nd:YAG laser. Initial clinical experience and early follow-up.

Percutaneous laser-assisted balloon angioplasty with a pulsed Nd:YAG laser coupled to sapphire tipped optical fibers was used for the treatment of 22 patients presenting with 30 chronic occlusions of peripheral arteries (mean length 11 cm) during 25 sessions. The procedure was completed by balloon dilatation in 67%. Successful recanalization was achieved in 92%, clinically the procedure was successful in 68% with mean ABPI increase from 0.43 +/- 0.13 to 0.79 +/- 0.21. In 8 cases complications occurred. Two reocclusions were treated by streptokinase infusion, and 2 procedures were repeated 2 months later, one patient was referred to elective bypass surgery, and 3 patients were treated conservatively. Six patients were followed-up for more than 6 months. In 1 patient claudication of 400 m reappeared. These results are encouraging and it is likely that this method could become an important adjunct to balloon angioplasty.

[Percutaneous recanalization of the femoral artery using a laser]. / Perkutánní rekanalizace femorální tepny laserem.

The authors performed, in the period from February to May 1989 seven recanalization interventions on occlusions of femoral artery with a laser angioplasty. In six cases the dilatation of the formed primary canal was made by subsequent balloon angioplasty. In all patients the intervention was followed by a significant clinical improvement and increased doppler index. No significant clinical complications occurred during the interventions.