Outcomes of Drug-Coated Balloon Angioplasty for Isolated Chronic Occlusion of the Popliteal Artery: A Retrospective Single-Institution Study

PurposeTo assess the 12-month safety and effectiveness of paclitaxel drug-coated balloon (DCB) for the treatment of patients with isolated chronic occlusions in popliteal arteries and evaluate the risk factors of lesion reocclusion.Materials and MethodsFrom January 2018 to December 2019, DCB angioplasty was performed in 54 limbs with isolated chronic popliteal artery occlusion of 48 patients (32 men) with a mean age of 71.5 ± 12.1 (range, 50–97) years, mean occlusive length of 6.3 ± 3.0 (range, 1–15) cm, and mean preoperative ankle-brachial index (ABI) of 0.42 ± 0.12 (range, 0.19–0.58). A total of 18.5% (10/54) of lesions were long-segment occlusions involving the entire popliteal artery from P1 to P3. Twenty seven of 54 limbs presented with critical limb ischemia (CLI) with a mean ABI of 0.33 ± 0.10 (range, 0.19–0.51). The primary endpoint was primary patency rate at 12 months. The secondary endpoints included technical success rate, 1-year secondary patency rate, limb salvage rate, and improvement in clinical symptoms. Univariate Cox regression analysis was used to determine the predictors of lesion reocclusion.ResultsThe technical success rate was 85.2% (46/54), and bailout stenting was performed in 14.8% (8/54) of lesions. The 12-month primary and secondary patency rates by the Kaplan–Meier estimate were 72.6% and 88.3%, respectively. Two thirds of the reocclusions occurred within 6 months after intervention. No 30-day mortality was observed. The limb salvage rate was 100% during a mean follow-up period of 13 months, and all minor amputations occurred in the limbs presented with CLI. The mean ABI increased from 0.42 before the procedure to 0.73 after the procedure. Patients younger than 60 years and the lesions exhibiting long-segment occlusions present as trending risk factors for lesion reocclusion.ConclusionsPaclitaxel DCB angioplasty is safe and effective in managing isolated chronic occlusion of popliteal arteries. Younger patients and long-segment occlusions of the popliteal artery are associated with a relatively higher reocclusion rate after the procedure.     

心脏手术围术期主动脉内球囊反搏的应用

目的 探讨高危心脏病病人围手术期应用主动脉内球囊反搏（IABP）的疗效.方法 分析1998年1月至2002年9月293例应用IABP的围手术期心脏病病人资料.结果 本组治愈179例,死亡114例,总病死率38.91%;其中冠心病病死率35.87%（94/262例）,非冠心病病死率64.52%（20/31例）.术前应用IABP的冠心病者病死率17.24%（5/29例）,明显低于术中和术后开始应用IABP的冠心病者病死率36.47%（62/170例）和42.86%（27/63例）.结论 IABP是一种安全、行之有效的循环辅助方式,术前应积极应用,在高危冠心病病人中可以明显提高治疗效果.     

经皮穿刺气囊二尖瓣成形术的临床应用

本文报告了五例经皮穿刺气囊二尖瓣成形术(PBMV)患者均获成功。对比了他们术前、术后的临床症状、体征、瓣口面积和血液动力学变化。自觉症状100％改善,80％杂音消失,20％减轻。瓣口面积扩大60.17％,肺毛嵌楔压下降44.09％,跨瓣压下降33.88％,肺动脉压下降27.5％。并讨论了手术的适应证、并发症和手术的体会。     

A new approach for acute embolus occlusion of the superior mesenteric artery

Acute embolus occlusion of the superior mesenteric artery (SMA) either demonstrates a poor prognosis, or forces the patients to endure miserable postoperative dietary lives. Recently, we developed a new successful technique which reduced the length of the intestinal segment that had to be removed. The technique was as follows: (1) the distal end of the SMA was ligated to avoid perfusion of the necrotic segment, and (2) a Fogarty balloon catheter was inserted from the distal end of the SMA and then passed proximally to remove any remaining clots. Using the above-described technique on 3 cases from 1992 to 1994, we were thus able to shorten the length of the intestine that had to be removed and thereby greatly improve the patients' postoperative dietary lives.     

Pressure measurements during pelvic floor muscle contractions: The effect of different positions of the vaginal measuring device

The purpose of the present investigation was to assess whether different positions of the vaginal measuring device affect the pressure readings during pelvic floor muscle (PFM) contraction. Twelve women with stress urinary incontinence (SUI) participating in a PFM exercise program, volunteered for the study. The diagnosis of SUI was based on urodynamic investigation and pad test. The mean age of the women was 40.9 years (24–50). The women performed three PFM contractions with a vaginal balloon placed in four different positions: 1) against the vaginal vault and in the posterior fornix, 2) in the proximal upper third of the vagina, 3) with the middle of the balloon 3.5 cm from the introitus vagina and 4) with half of the balloon outside the introitus vagina. The results demonstrated significant differences between recordings from the four vaginal positions: position 1, median pressure 5 cm H₂O; position 2, 9 cm H₂O; position 3, 15 cm H₂O; and position 4, 8 cm H₂O. It is concluded that the position of the vaginal device affects the results. This may be one important factor which could explain the variability of vaginal pressure recordings during PFM contractions. For most women the highest pressure was recorded in position 3. © 1992 Wiley-Liss, Inc.     

头臂干动脉狭窄的经皮经腔球囊导管成形术治疗

本文报告10例12支头臂于动脉狭窄 PTA 结果。锁骨下动脉9支,右无名动脉3支。经球囊导管扩张以后,7支狭窄解除和基本解除,3支改善,其中2支锁骨下动脉窃血消失。狭窄度由87.1%增宽至33.6%,患臂血压由平均12.7/8.5kPa (95.4/64mmHg)升高为17.9/10.6kPa (134.4/80mmHg)。随访4～17个月,1例狭窄复发。全部无并发症。对脑栓塞并发症、适应症、禁忌症等进行了讨论。     

Removal of a Large Common Bile Duct Stone Using Endoscopic Balloon Sphincter Dilation and Extracorporeal Shock Wave Lithotripsy

Abstract: Although endoscopic balloon sphincter dilation (EBSD) appears to be an attractive treatment modality, the rate of bile duct clearance is apparently reduced due to limited enlargement of the bile duct opening when the stones are large and/or numerous. We present the case of an 87-year-old woman who developed an extremely large bile duct stone. To crush the stone sufficiently to allow grasping by a mechanical lithotriptor or a basket catheter with the EBSD procedure, extracorporeal shock wave lithotripsy was performed and the fragments were removed successfully.