Recanalization of total arterial occlusions with the Kensey dynamic angioplasty catheter

The Kensey dynamic angioplasty catheter is a new device for recanalization of peripheral arterial occlusions. Twelve patients with segmental occlusions who were not considered candidates for conventional bypass surgery because of cardiovascular risk factors were studied. Four of the patients were treated in the operating room. Two had excellent primary results in limb salvage situations, and recanalization of an occluded femoropopliteal bypass graft was successful in another. Bilateral iliac recanalizations in the fourth patient were locally successful but did not prevent the patient's death from advanced ischemic disease. Eight patients were treated percutaneously. Initial recanalization was successful in seven. Four had early reocclusions and required amputation below the knee. One suffered distal embolization after recanalization of a 6-cm popliteal segment and underwent above-the-knee amputation. Long-term follow-up (7-18 months) in the other three patients with successful primary recanalizations has confirmed patency of the recanalized segments.     

Does the Kensey catheter keep a coaxial position inside the arterial lumen?: An in-vitro angioscopic study

Angioscopy was used to evaluate the “self-centering” ability of three Kensey catheters (KC) with different flexibility: one 8Fr “peripheral” and two 5Fr “coronary” (I & II). Angioscopic observations were made inside arteries. 5–18 mm in diameter. There was a good correlation between flexibility and self-centering of the KC [r=0.83, p<0.05]. Increasing the flow rate of rinsing solution from 18 to 60 ml/min prolonged coaxial position from 8.9±3.3 to 36±2.2 sec/min of activation [p<0.001]. A smaller effect on coaxial position was exerted by increasing cam speed from 5.2±0.7 to 19.2±1.6 sec/min (p<0.001). In conclusion, angioscopy showed that the KC has a limited ability to maintain a coaxial position inside the arterial lumen and operators cannot rely on its self-centering property.     

Functional properties of the Kensey arterial recanalization catheter. In vitro investigations

The properties of the Kensey catheter (Cordis Corp., Miami Lakes, FL), a new rotational device for recanalization of arterial occlusions, were studied in vitro. There was no effective centering of the catheter tip in the vessel and no measurable dilatation of the vessel lumen during rotation of the catheter tip. Flow studies confirmed recirculation and repeated exposure of particles at the catheter tip. The vortex induced by the rotating cam disappeared in stenotic segments. The maximum size of the pulverized specimen material was 20 microns for the normal arterial wall, 90 microns for the calcified and atheromatous plaque, and 900 microns for the fresh venous thrombus. For plaque material, an additional reduction of large particles to 30 microns was seen with a decrease in force and an increase in rotation speed. The size of thrombus particles decreased with an increase of rotation speed and the duration of treatment.     

Combined angioplasty with the Kensey catheter and balloon angioplasty in occlusive arterial disease. A preliminary report.

The Kensey dynamic angioplasty catheter is an instrument for mechanical intravascular atherectomy using a rotating cam to recanalize occluded arteries. Twelve dynamic angioplasties were performed in 11 patients. The procedure was followed by an additional balloon dilatation in all cases. A technical success, i.e., a restored lumen, was recorded in 7 patients but only 4 had a functional improvement. No distal embolization or other serious complication occurred. This preliminary report shows that the therapeutic potential with this technique must be further investigated.     

Percutaneous osteoplasty with use of a cement-filled catheter for a pathologic fracture of the humerus

Percutaneous osteoplasty has been used for pathologic fractures of long bones as an adjunct to orthopedic surgery. The present report describes a case of percutaneous osteoplasty with a cement-filled catheter and cement augmentation as the principal therapy to unite a painful pathologic fracture of the humerus. After the procedure, the patient experienced immediate pain relief and improved limb mobility. Percutaneous osteoplasty with this method holds promise as a treatment for pathologic fractures of the humerus that are not amenable to surgical repair.     

Thallium-201 brain tumor imaging: a comparative study with pathologic correlation

In patients with gliomas who were stable or improving, we noted a disparity between clinical status and computed tomography (CT) brain scan results. To elucidate this finding, 29 patients were sequentially scanned with 2.0 mCi of 201Tl (5-30 min), 20 mCi [99mTc]gluceptate (GH) (3-4 hr) and 7-10 mCi 67Ga (48-72 hr). A total of 198 images were obtained. A set of three scans at a midpoint in follow up was selected for analysis. Seven patients who died had neuropathologic data available; brain sections were reconstructed to match radionuclide views without knowledge of image results. In the seven patients with autopsy data, 201Tl offered the most accurate correlation with viable tumor. Gallium-67 gave similar results in patients not receiving steroids. Technetium-99m GH scans could not allow differentiation between tumor, necrosis, and edema. Similarly, the CT scan could not routinely differentiate between fibrotic, nonfibrotic, necrotic, and neoplastic tissue. In the 22 patients without autopsy data, 201Tl scans commonly showed smaller and more focal abnormal uptake when compared with [99mTc]GH and 67Ga scans. Thallium-201 scans more accurately reflect viable tumor burden than other radionuclide studies of primary brain tumors, are minimally affected by concomitant steroid administration, can be performed immediately following tracer administration, and complement the anatomic data obtained from CT scans.     

Effectiveness of a new tunneled catheter in preventing catheter malfunction: a comparative study

PURPOSE: To compare infection and malfunction rates of two different types of antimicrobial-eluting tunneled cuffed catheters (TCCs) for hemodialysis. MATERIALS AND METHODS: The HemoSplit TCC with BioBloc (silver sulfadiazine) coating (n = 100, control group) and the Tal Palindrome Ruby TCC, which has a novel silver antimicrobial sleeve and a spiral-z tip design (n = 100, study group), were compared in this case-controlled study. The main endpoints were TCC infection and malfunction. RESULTS: Primary-assisted TCC patency was significantly reduced with the BioBloc TCC (71% and 61% at 90 and 180 days, respectively) compared with the Palindrome Ruby TCC (94% at 90 and 180 days, P < .0001). Multivariate analysis identified only the BioBloc TCC and common femoral access site as independent predictors of worse patency. The unadjusted relative risk (95% confidence interval) for TCC dysfunction with the BioBloc compared with the Palindrome Ruby was 6.0 (2.33-15.53, P < .001), and the relative risk adjusted for access site was 3.2 (1.71-11.96, P = .002). The infection-free rates of the two TCC types were similar (P = .36). The reintervention-free rate for infection or malfunction was significantly better with the Palindrome Ruby TCC (76% and 58% at 90 and 180 days, respectively) than with the BioBloc TCC (60% and 45% at 90 and 180 days, respectively; P = .03). CONCLUSIONS: The results support the use of the Palindrome Ruby TCC on the basis of the significantly lower thrombosis and reintervention rate; randomized trials are justified to confirm this finding and to evaluate its role in the prevention of TCC infection.     

Percutaneous rotational contact biliary lithotripsy: initial clinical results with the Kensey Nash lithotrite

The percutaneous rotary lithotrite introduces a new concept to fragmentation and percutaneous removal of gallstones. A fluid vortex is generated, pulling calculi into a high-speed blade that fragments stones to predominantly under 500 microns. The results of treating the first 10 patients with this instrument reveal that large stone burdens as well as small stones (2-3 mm) of any composition can be removed if the gallbladder is of sufficient size to accommodate the six-pronged basket. Rotation times of 7-39 minutes were required. Nine of 10 procedures were completed; access was lost in one case. One major complication occurred. At repeat oral cholecystography, the gallbladder was visualized after 3-6 weeks in eight of the nine patients. Ursodeoxycholic acid was administered from 3 to 12 months to five patients with either residual stones or aggregates. The hospital stay ranged from 48 to 72 hours. All patients (except the patient who underwent surgery) resumed light activity in 3-4 days and strenuous activity and full diet within 3 weeks.     

Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study

PURPOSE: To evaluate the feasibility, efficacy, and safety of mechanical thrombectomy of occluded dialysis access with use of a rotating mini-pigtail catheter. MATERIALS AND METHODS: Thrombus was fragmented by mechanical action of the rotating pigtail tip (5-mm diameter), while the guide wire exited a sidehole at the pigtail curvature and served as a fixed rotation axis. Twenty-six procedures were performed in 22 patients (12 men, 10 women; mean age, 55.5 years). Native fistulas were treated in 15 instances, polytetrafluoroethylene (PTFE) grafts were treated in 11 instances. Average occlusion time was 20 hours +/- 13 (range, 5-46 hours), average occlusion length was 25.6 cm +/- 10.1 (range, 6-45 cm). Thrombus fragmentation was followed by balloon angioplasty of underlying stenoses. RESULTS: In all 26 procedures, the dialysis access was successfully declotted with subsequent dialysis using the access (clinical success rate, 100%). Handling of the mini-pigtail catheter was simple and rapid, regardless of whether a graft or a native fistula was treated. Average duration of the intervention was 118 minutes +/- 30. Mean primary patency was 165 days +/- 167. Primary patency rate was 82% at 30 days, 65% at 3 months, and 47% at 6 months. There was no evidence of complications due to the thrombus fragmentation procedure. CONCLUSION: The results suggest that declotting of occluded dialysis grafts and fistulas with the mini-pigtail catheter is as effective and safe as other more established percutaneous therapies. It may serve as an easy-to-handle, low-budget alternative to current thrombectomy devices.     

Fallopian tube recanalization with a catheter system--experience in the use of a balloon catheter

Fallopian tube obstruction is one of the most difficult problems in the treatment of infertility. This report gives the results of a pilot study on the transcervical recanalization of the occlusive fallopian tube. Selective catheterization of the uterine cornu was applied through a balloon catheter, which was wedged at the internal uterine os. In 16 occlusive fallopian tubes of 11 cases, the catheterization procedure was attempted and accomplished with a 87.5% success rate. Recanalization was successful in 75.0% of the affected tubes. Subsequent pregnancy was confirmed in three cases. This convenient technique is safe and effective and it will be accepted as the first choice in the diagnosis and treatment of fallopian tube obstruction.     

血透用临时中心静脉置管相关感染的临床研究

目的探讨血液透析(血透)用临时中心静脉留置导管并发感染的相关因素及临床表现特征,寻求预防感染的有效措施。方法对104例建立中心静脉导管的血透患者进行观察。(1)对不同部位(颈内或锁骨下静脉组及股静脉组)置管的感染发生率进行比较分析。(2)对相同部位不同预防方法感染发生率的比较:从样本中筛取80例经颈内或锁骨下静脉途径的临时性中心静脉置管的患者,前期37例为对照组,采用常规措施预防导管感染;后期43例为试验组,使用抗生素多途径联合给药的试验方法,两组的感染率进行比较。结果 (1)常规预防感染方法的61例临时中心静脉导管中,共发生与静脉导管相关的感染12例(19.6%),股静脉置管感染发生率(29.2%)显著高于颈内及锁骨下静脉(13.5%)(P<0.05);(2)致病菌主要为葡萄球菌属和大肠杆菌属;(3)两组采用不同的预防感染方法感染率分别为13.5%和2.3%,其差异有统计学意义(P<0.05)。结论股静脉置管易发生感染,而抗生素多途径联合用药有助于降低感染率,延长置管后抗生素使用时间可能减少重新置管的几率。     

甲状腺囊性乳头状癌螺旋CT与病理对照研究

目的：通过螺旋CT与病理大体标本的对照研究，探讨甲状腺囊性乳头状癌的CT特征。方法：行术后肿块病理大体标本的多平面照像，然后与相近的病变CT图像相对照，以此来研究甲状腺囊性乳头状癌的CT征象。结果：10例肿物CT表现分为单囊、囊内囊、多囊型三种。单囊表现为一囊性肿物内有实性软组织壁结节，结节内、囊内有斑点状钙化，结节及囊壁均有强化，其囊壁厚薄不均，囊内囊除表现为单囊的征象外，最主要表现为壁结节周围仍有多个小囊与之相连，小囊间有分隔，粗细不均。多囊型表现为多个大小不一的囊融合在一起，其中一个囊内可见实性软组织壁结节及钙化。结论：囊内钙化性壁结节，囊壁厚薄不均，壁结节周围可见多个小囊与之相连，小囊间有分隔，分隔粗细不均是甲状腺囊性乳头状瘤的主要征象。