Thrombolysis combined with angioplasty for failed femorodistal arterial grafts.

This study examines the long-term clinical success and complications of thrombolysis-angioplasty (TLA) of failed arterial grafts performed in 17 patients (group 1) and matched with 21 patients (groups 2) who had intra-arterial thrombolysis (IAT) followed by graft revision. TLA consists of alternating thrombolysis with percutaneous transluminal angioplasty (PTA) in the treatment of occlusive arterial disease. Failed grafts consisted of 21 vein grafts, 6 ovine collagen grafts, 6 polytetrafluorethylene (PTFE) prostheses, 3 human umbilical veins and 2 polyurethane vascular grafts. All bypasses were below the knee, of which 13 were to the tibial level. Thrombolytic agents used were urokinase in 21 cases, tissue plasminogen activator in 13 cases and streptokinase in 4 cases. Following successful thrombolysis, PTA was performed with a 3 mm to 5 mm balloon catheters. Nine tandem lesions were corrected. In all 24 stenoses were treated: 14 anastomotic stenoses, 4 graft strictures and 5 peripheral stenotic lesions. The combined cumulative patency rate of both groups was 36% (SE 10.8%) at 3 years. The initial technical success rate in group 1 was 70% (12 of 17 grafts). The cumulative patency rate, as revealed by life-table analysis, was 35.6% (SE 10.2%) at one year and 21.3% (SE 9.6%) at 2 years. In all, 10 grafts failed at follow-up and in 6 of these cases secondary intervention was unsuccessful. Mid-graft and isolated lesions responded better than did anastomotic and tandem lesions. In group 2 the cumulative patency rate was 60.4% (SE 5.7%) at one year and 50.3% (SE 12.9%) at 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined iliac transluminal angioplasty and femoropopliteal reconstruction for multilevel arterial occlusive disease.

Patients with multilevel arterial disease represent a challenging problem. A retrospective review of 46 consecutive femoropopliteal reconstructions combined with iliac balloon angioplasty was performed. Twenty-five procedures were below-knee and 21 to the above-knee popliteal artery segment. Mean follow-up was 26.8 months (range 4 to 84). There were 2 peroperative deaths and 3 serious complications (10.9%). In the late follow-up 4 significant restenoses and 1 reocclusion occurred for a patency rate of 81% for the inflow procedure at 5 years. Primary and secondary patency rate of combined procedures at 5 years was 61% and 76% respectively. The 5-year limb salvage rate was 93%. The mortality rate, morbidity rate and cumulative patency were not significantly different from a group of 38 patients who underwent 43 aortofemoral bypasses combined with femoropopliteal revascularization. In the latter group, the frequent incidence of anastomotic aneurysm (9.2%) was the main detrimental factor observed at follow-up. The authors conclude that femoropopliteal reconstruction combined with iliac angioplasty is effective for managing patients with multilevel disease. The possibility of intraoperative digital subtraction angioplasty and the use of no-profile co-axial balloon catheter design in the latter years of this study has improved our results.

Günther vena caval filter: clinical appraisal.

The mechanical stability of the Günther filter, caval patency, and complications related to filter placement were evaluated in 33 patients. Indications for placement included recurrent pulmonary embolism despite anticoagulation (n = 24) and contraindication to anticoagulation (n = 5). Four filters were placed prior to pulmonary lysis. Filters were positioned via the transfemoral route in 31 patients and via the transjugular route in two. Placement was complicated by pneumothorax in one case and faulty filter position in another. Patients were followed up for 52 months (mean, 12.1 months). Four patients died of nonembolic complications; three patients were lost to follow-up. Among the remaining 26 patients, caudal migration (3-6 cm) occurred in 19 (73%), cephalic migration into the atrium occurred in one, the inferior vena cava occluded in five, and struts perforated the caval wall in five. Pulmonary embolism recurred in one patient. In 11 cases, thrombus caught inside the basket was revealed with computed tomography; in one case a 7-cm floating thrombus was observed. The authors conclude that use of the Günther filter cannot be recommended because of the high prevalence of complications.

Distal popliteal and tibioperoneal transluminal angioplasty: long-term follow-up.

The long-term efficacy of percutaneous transluminal angioplasty (PTA) for treatment of occlusive lesions involving arteries below the knee was evaluated in 168 consecutive patients. The procedure was preceded by intraarterial thrombolysis in 33 patients with failing femorodistal grafts. Indications were disabling claudication in 40 cases (24%), acute ischemia in 18 (11%), rest pain in 49 (29%), and tissue necrosis in 61 (36%). Angioplasty of tandem femoral and/or iliac lesions was performed in 58 cases (34.5%). Major complications were observed in 19 patients (11.3%) and minor complications in 12 others. Five patients died within 30 days (3%). Mean follow-up was 26.1 months (range, 4-72 months). Major amputation was required in 26 cases (15%). The cumulative clinical success at 3 years was 83% for a single stenosis, 76% for multilevel lesions, 44% following lytic therapy, 36% for segmental occlusions, and 14% for anastomotic stenoses. Infrapopliteal PTA is useful in selected patients. Factors associated with poor long-term patency include a single patent tibial artery (P = .039), acute ischemia (P = .03), anastomotic stenosis (P = .01), and, possibly, complete occlusion prior to treatment (P = .091).

[Percutaneous transluminal angioplasty in the region of the renal artery--indications, technic and results]. / Perkutane transluminale Angioplastie (PTA) im Bereich der Arteria renalis--Indikation, Technik und Ergebnisse.

The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes.

[Percutaneous transluminal sclerotherapy of the spermatic vein in idiopathic varicocele]. / Die perkutane transluminale Sklerosierung der Vena spermatica bei idiopathischr Varikozele.

Percutaneous sclerotherapy of the spermatic vein has become a very efficacious and safe treatment and is also a real alternative to surgery.

[Transcatheter therapy in the icterus patient: extracorporeal drainage--endoprosthesis]. / Transkathetertherapie beim ikterischen Patienten: extrakorporale Drainage--Endoprothese.

Percutaneous transhepatic cholangiography, as well as the therapeutic possibility of extracorporeal biliary tract drainage and insertion of an endoprosthesis are discussed in this paper. The results are presented of 19 patients treated by extracorporeal drainage and of 12 patients treated by insertion of an endoprosthesis, with a successful outcome in each group. The clinical parameters, the reduction in bilirubin values after treatment and improvement in the patient's condition and general well-being are discussed.

[Percutaneous transluminal vasodilatation. Long-term results and report on experiences with a new system of catheters: transaxillary technic]. / Perkutane transluminale Gefässdilatation. Langzeitergebnisse und Erfahrungsbericht mit einem neuen Kathetersystem: transaxilläre Technik.

A report is given on the result of 567 transluminal vasodilatations, some of which have been followed up for more than five years. The results of conventional techniques were compared with a new catheter technique. The complication rate with the newly-adopted system is much lower than with conventional ones, while the reocclusion rate is only about 10%, which is about half of the figure obtained in the period up to July 1981 when the new technique was introduced.

[Pelvic lipomatosis--its appearance on radiography and computed tomography (author's transl)]. / Die Beckenlipomatose im Röntgenbild und in der Computertomographie.

Case report on a case of pelvic lipomatosis, the 21. case published in the world literature. The typical radiographic findings, such as deformity of the urinary bladder and the abnormal course of the sigma, were seen. Computed tomography confirms the diagnosis.

[Intra-arterial infusion treatment in lung neoplasms]. / Intraarterielle Infusionsbehandlung von Lungentumoren.

Intraarterial infusionstherapy was performed with cytostatic agents (10 patients) and proteolytic enzymes (4 patients) in 14 selected cases with malignant lung tumours. Diagnosis was in 8 patients small cell carcinoma, in 3 patients adenocarcinoma, in 2 patients squamous cell carcinoma of the lung and in 1 patient leiomyosarcoma of the lung (relapse). Infusions were performed in 8 cases through the A. bronchialis, in 5 through the A. pulmonalis and in 1 patient through the A. thoracica interna. After single infusions of cytostatic agents via the A. bronchialis, remissions of varying extents, were found in 5 out of 8 patients. Repeated infusions with enzymes (1-5 series) through the A. pulmonalis lead in 2 out of 4 cases to slight remissions with a duration of 5 and 12 months, respectively. Possibilities and limiting factors of this therapeutic modality are demonstrated by recent observations.