[The femoral artery: source for a worst case scenario? Possible fatal outcome succeeding the new DRG-system?]. / Die Arteria femoralis: Beispiel für ein Worst-case-Szenario? Sind fatale Entwicklungen im neuen DRG-System implementiert?

Stenoses and occlusions of the femoral artery mainly cause claudication. Their course is often silent and patients notice it by chance or in a medical checkup. Mayor amputations are rare in isolated femoral appearance of PAOD (peripheral arterial occlusive disease). Although conservative treatment is very effective in these patients, there are still a lot of operations performed, mainly bypasses, interventional dilatations or stenting. The examples of some typical courses out of more than 64,000 vascular disease patients treated in the Hochrheinklinik during the last 24 years point out a new possibility taking a wrong way in treatment decisions. The structure of the new German DRGs stimulates to carry out interventions and operations as there is a great enhancement in earnings. These may result not only in a rise of costs but in a higher risk for patients, too.

Intraarterial infusion therapy via a subcutaneous port for limb-threatening ischemia: a pilot study.

PURPOSE: To present the initial results of a new percutaneously implantable catheter port system (PIPS) used for long-term intraarterial infusion therapy in patients with severe ischemic limb disease. METHODS: Ten patients with deep, extended ischemic ulcerations (all 10) and osteomyelitis (6/10) of the foot received intraarterial infusions of prostaglandine E1 and antibiotics, if indicated, via a new port catheter system with the port placed subcutaneously above the groin after percutaneous introduction and the catheter tip placed into the superficial or deep femoral artery. RESULTS: Port implantation and repeated port access were uncomplicated. During the follow-up period (mean 11 months, range 1 week-50 months), port migration, leakage, or infection was not observed. Three catheters thrombosed and were opened by fibrinolysis with recombinant tissue plasminogen activator instilled via the port. Treatment success was achieved in 8 patients: relief from rest pain (8 patients), reduction of ulcer size (4/8), and complete healing (4/8). Limb savage rate was 80%. In 2 patients amputation could not be avoided. CONCLUSION: Selective long-term arterial infusion therapy presents a valuable therapeutic regimen for limb salvage. With the new catheter port system, repeated local intraarterial infusion is safe and simple.

Percutaneously implantable catheter-port system: preliminary technical results.

The function and safety of a percutaneously implantable catheter-port system were studied in 44 patients with different diseases (32 patients with malignant disease, 11 with peripheral arterial disease, and one with recurrent asthmatic attacks). Most patients required repeated local-regional arterial infusion. Infection (two patients) and catheter-related complications (10 patients) were observed during the follow-up period (maximum length of follow-up, 542 days; mean, 177 days). Port migration or leakage did not occur. The data suggest that this new catheter-port system is safe and easy to handle.

[Embolization by the wall components after the PTA of pelvic arterial stenoses]. / Embolisation von Wandbestandteilen nach PTA von Beckenarterienstenosen.

Quality and frequency of embolisation caused by angioplasty of stenoses of iliac arteries were investigated in 50 patients. In 18% emboli were found. They mostly consisted of atheromatous material and were visible by macroscopic view in 10% of the patients. Complications caused by embolisation during angioplasty of iliac artery stenosis however are very rare.

[Catheter dilatation of arteries supplying the brain]. / Katheterdilatation hirnversorgender Arterien.

Stenoses of the extracranial cerebral arteries can be successfully treated with percutaneous transluminal dilatation (PTD). Early and late results of PTD are comparable to those of vascular surgery, but are not accompanied by its morbidity and mortality rates. In 32 patients with subclavian steal syndrome PTD showed a technical success rate of 88% and a clinical cure rate of 72%. The fibrodysplastic carotid artery stenosis is well suited for PTD. These lesions often extend to the skull base causing difficulties for surgical correction. First experiences with PTD of atherosclerotic carotid artery stenosis are promising, but the efficacy of this procedure must be confirmed by a greater number of treated patients. PTD of the vertebral and basilar arteries present new therapeutic possibilities in the management of vertebrobasilar insufficiency demanding further evaluation.

[False aneurysms and bone deterioration (author's transl)]. / Knochenusur bei Aneurysma falsum

Two comparable cases of false aneurysm were studied. The different reaction of the adjacent bone is compared with experimental studies of constant and oscillating pressure effects to the bone.