Color Doppler imaging of the ophthalmic artery blood flow spectra of patients who have had a transient ischemic attack. Correlations with generalized iris transluminance and pseudoexfoliation syndrome.

PURPOSE: To study the interrelations among pseudoexfoliation syndrome (PXS), abnormal iris transluminance, and ophthalmic artery blood flow in a controlled study. METHODS: Ultrasonographic examination using color Doppler imaging (CDI) was performed on the ophthalmic arteries of 46 unselected patients (92 eyes) who have had at least one transient ischemic attack (TIA) and on 32 healthy subjects (64 eyes). The authors recorded the peak systolic and end diastolic velocities and determined the resistivity indices. Iris transillumination photographs were evaluated by two ophthalmologists in a blind trial to show the presence of abnormal iris transluminance of these eyes. Biomicroscopic examination was performed to show the presence of PXS. RESULTS: The frequency of abnormal iris transluminance in the whole group of patients who had had a TIA and in control subjects was 63% and 28%, respectively (P < 0.05). Pseudoexfoliation syndrome was found in 41% of the right eyes and in 43% of the left eyes in the group of patients who had had a TIA. The difference between the resistivity indices for the ophthalmic arteries of patients who had had a TIA with positive iris transluminance and healthy subjects without transluminance was statistically significant (P < 0.05, Student's t test). Pseudoexfoliation syndrome was detectable in 55.6% of the right eyes and in 61.5% of the left eyes of patients who had had a TIA with abnormal iris transluminance. CONCLUSION: The exceptionally high frequency of PXS in the eyes of patients who had had a TIA with positive iris transluminance suggests pathologic changes in the blood supply of PXS eyes. High values of resistivity indices for the ophthalmic arteries of these eyes suggest that disturbances in the ciliary circulation may be the possible cause of these changes.

Femoropopliteal angioplasty in patients with claudication: primary and secondary patency in 140 limbs with 1-3-year follow-up.

PURPOSE: To determine the usefulness of percutaneous transluminal angioplasty in the femoropopliteal arteries in patients with claudication. MATERIALS AND METHODS: In a prospective study of 106 claudicants (71 men and 35 women, aged 41-90 years [mean, 67 years]), a total of 208 lesions in 140 limbs were treated. The patients were followed up for 12-36 months. The patency rates were based on determination of the ankle-brachial index. RESULTS: The hemodynamic success rate for all the treated limbs was 89%, 99% for femoropopliteal stenoses (n = 71) and 80% for femoropopliteal occlusions (n = 69). In multiple logistic regression analysis, a smaller number of diseased vessels (one to two vs three to seven) and milder lesion severity (stenosis vs occlusion) correlated favorably with early success. Survival analysis with the Kaplan-Meier method according to established criteria revealed 1-, 2-, and 3-year primary patency rates of 47% (27 of 57 limbs), 41% (14 of 34 limbs), and 43% (three of seven limbs), respectively. CONCLUSION: In selected cases, good primary success and acceptable long-term results can be achieved with femoropopliteal angioplasty in claudicants.

Chronic critical lower-limb ischemia: prospective trial of angioplasty with 1-36 months follow-up.

To determine the utility of percutaneous transluminal angioplasty (PTA) in the treatment of chronic critical lower-limb ischemia, a prospective study of 103 consecutive patients (117 limbs) was performed. Patients underwent PTA for a total of 209 lesions in the iliac (n = 4), femoropopliteal (n = 121), and infrapopliteal (n = 84) arteries and were followed up for 1-36 months (mean, 12 months). The primary technical success rate was 92% for stenosis and 80% for occlusion. Survival analysis with the Kaplan-Meier method revealed 1-, 2-, and 3-year limb salvage rates of 56%, 49%, and 49%, respectively. The following factors correlated favorably with limb salvage in Cox multiple regression analyses: a small number of diseased lower-limb vessels (one to five vs six to eight) and treated lesions per limb (one or two vs three to five), achieved peripheral runoff (one to three patent calf vessels vs none), and an occlusion as the successfully treated target lesion (instead of stenosis).