Peripheral atherectomy: experimental results with a new device

The size of present rotational atherectomy devices is limited in part by a tendency to produce vessel torsion. The authors designed and investigated a large-bore rotational atherectomy device for peripheral atherectomy in a single pass without significant torsion. A plaque was retrieved from 36 of 40 cadaveric iliac arteries. The mean plaque size was 8.4 x 3.9 mm, and the average number retrieved per artery was two. Thirty of 34 severely calcified arteries were treated successfully. Effluent study revealed no distal embolization; however, six perforations and four dissections occurred. Preliminary results suggest that a cutting surface with a relatively large diameter can be designed to be effective without producing vessel torsion. Changes in future designs will include added flexibility and expandable cutting surfaces to enhance safety and minimize entry diameter.     

Peripheral arterial occlusions: a 6-year experience with local low-dose thrombolytic therapy

Early and long-term results of treatment with local low-dose thrombolysis in 554 patients with 564 peripheral arterial occlusions are reported. Of 92 embolic occlusions present for 2 months or more, 59 (64.1%) were recanalized with a cumulative patency of 89.5% after 5 years. Of 472 thrombotic occlusions present for up to 6 months and more, 254 (53.8%) were successfully treated with a cumulative patency of 58.8% after 5 years. The hospital mortality and amputation rate were 1.6% and 1.95%, respectively. The average age of the patients was 69.1 years and more than half of those treated had stage III or IV disease. A 6-year experience with local low-dose thrombolytic therapy has completely confirmed its efficacy and has led to improvements in technique, which are described. The doses of streptokinase and urokinase needed for a successful result have been substantially reduced and the duration of treatment shortened. The number of complications has also been reduced. Differential therapeutic considerations compared to vascular surgery are mentioned. The results should motivate a reconsideration of the diagnostic and therapeutic measures to be used in the treatment of peripheral arterial occlusions.     

Infrainguinal directional atherectomy: Long-term follow-up and comparison with percutaneous transluminal angioplasty

Purpose To assess the long-term results of directional atherectomy (DA) for femoropopliteal artery atherosclerotic lesions and to compare the results to those previously reported for percutaneous transluminal balloon angioplasty (PTA).Materials and Methods Eighty-four percutaneous DA procedures performed on 75 patients between July 1988 and August 1992 were retrospectively reviewed and evaluated for technical and initial clinical success. Long-term patency was assessed with a combination of ankle-brachial index measurements and angiography.Results Initial technical success was achieved in 77 of 84 procedures (92%). Follow-up of 72 patients was obtained, including 74 of the 84 (88%) DA procedures with a mean follow-up of 17.4 months (range 1–48 months). Primary patency was 78% at 1 year and 57% at 2 years. Patients with diabetes, complete luminal occlusion, or limb salvage situations had significantly lower patency.Conclusions Femoropopliteal artery DA can be performed safely with a high technical and initial clinical success. Long-term patency is improved when compared with published series for PTA. With this improvement in mind, DA may have a place in the treatment of focal infrainguinal stenoses.     

Peripheral artery atherectomy: description of technique and report of initial results

Percutaneous transluminal atherectomy has been developed for treatment of peripheral artery stenoses. The atherectomy catheter is inserted through a sheath, and the resection window of the catheter is positioned adjacent to the vascular stenosis. The balloon is inflated, and the motor-driven cutting blade advanced. The balloon is then deflated, the catheter withdrawn, and the atheromatous material, which resembles the resected material of an endarterectomy, removed from the catheter. This process is repeated until the resection provides an adequate lumen. To date, 12 arterial lesions (three common iliac, two external iliac, four superficial femoral, and three popliteal artery) in ten patients have been resected with excellent angiographic results. The conditions of seven patients who underwent atherectomy for relief from claudication were improved by the criteria of ankle/arm ratios and/or claudication distance. Three patients successfully underwent atherectomy for limb salvage. More data on long-term patency and restenosis rates are needed before the ultimate role of atherectomy in the management of peripheral artery disease can be determined.     

Management of inferior pancreaticoduodenal artery aneurysms: A 4-year,single center experience

Inferior pancreaticoduodenal artery aneurysms are uncommon visceral artery aneurysms usually difficult to resect, and, if untreated, have a propensity to rupture with catastrophic results. We reviewed the clinical and treatment records of four patients encountered in our institution within the last 4 years. Three patients presented as bleeding emergencies from single aneurysms and were successfully treated by transcatheter embolization using coaxial technique and a variety of embolic agents. One nonemergent, asymptomatic patient had surgical resection of two inferior pancreaticoduodenal artery aneurysms due to unfavorable anatomy for embolization. Embolization therapy appears to be the treatment of choice in the emergency setting. Patients with unsuitable anatomy for embolization may still re quire surgical intervention.     

SilverHawk斑块切除系统治疗下肢动脉硬化闭塞症的初步临床应用

目的 评价SilverHawk直接斑块切除术治疗下肢动脉硬化闭塞症(ASO)的临床疗效及安全性.方法 应用SilverHawk斑块切除系统治疗7例ASO患者,管腔闭塞或狭窄≥80%,病变长度1.8～14.5 cm.临床表现(Fontaine分类):Ⅱb级4例、Ⅲ级1例、Ⅳ级2例.踝肱指数(ABI)0.28~0.65.术后随访观察疗效,观察指标包括临床症状、彩色超声或CTA检测管腔通畅情况.随访和观察指标用中位数表示,统计方法 用两样本的Kolmogorov-Smirnov检验.结果 7例患者的7个闭塞病变均经腔内开通成功(残余狭窄<30%).临床症状均消失或明显改善;Fontaine分类:Ⅰ级6例、Ⅱ a级1例.ABI为0.82～1.18,与术前比较差异有统计学意义(P=0.002).随访1~6个月,ABI仍为0.75～1.14,与术后比较差异无统计学意义(P=0.938),Fontaine分类同术后.结论 SiLverHawk直接斑块切除术是治疗下肢动脉硬化闭塞症的一种安全有效的新方法.

Abstract：

Objective To evaluate the clinical efficiency and seeurity of SilverHawk directional atherectomy device in treating arteriosclerosis obliterans of lower extremity.Methods Seyen patients with lower extremity ischemia were treated with SilverHawk directional atherectomy.The lesions length varied from 1.8 to 14.5 cm.Clinical symptoms(Fontaine classification)included 4 cases of grade Ⅱ b,1 case of grade Ⅲ,2 cases of grade Ⅳ.The ABI varied from 0.28 to 0.65.Patency was evaluated with color duplex sonography or CTA besides clinical examination during follow-up.Results Seven occlusive lesions were recanalizated successfully.The technical success(residual stenosis<30%)rate was 100%. Clinical symptoms were obviously improved or disappeared.The ABI varied from 0.82 to 1.18(P=0.002),and Fontaine classification included 6 cases of Ⅰ:1 case of Ⅱ a.Patency rate was 100%and the ABI varied from 0.75 to 1.14(P=0.938).Fontaine classifications keep consistent l-6 nonths after operation.Conclusion SilverHawk drectional atherectomy Was a safe and effective way for treatment of lower arteriosclerosis obliteran.     

斑块旋切术联合药物涂层球囊治疗股腘动脉病变的应用研究

目的：探讨TurboHawk斑块旋切导管(DA)联合紫杉醇药物涂层球囊(PCB)治疗下肢股腘动脉（FPA）狭窄及闭塞性病变的疗效及安全性。 方法：选取2016年9月-2017年8月我院收治的17例下肢动脉硬化闭塞症患者,男11例,女6例,平均年龄（73.2±7.5）岁,14例（82%）患肢Rutherford分级>4级,表现为患肢严重缺血,靶病变为股腘动脉,接受了DA联合PCB的腔内治疗方案。术前、术后常规双联抗血小板治疗,术后3、6、12个月复查患肢踝肱指数（ABI）、彩色超声或CTA随访。 结果：17例患者接受了上述治疗方案,平均病变长度为（286.1±69.4）mm,全部靶病变血管再通成功,1例顽固性狭窄行支架补救,技术成功率为94.1%（16/17）,8例术前已有足趾坏死者接受截趾术,均经治疗创面完全愈合且不影响行走。术后即刻患肢缺血症状改善,Rutherford分级明显下降,差异均有统计学意义,术后ABI比术前明显提高（0.99±0.10 vs. 0.30±0.19,t=15.31,P<0.05）。随访3~14个月,平均（7.4±3.8）个月,全部患者下肢缺血症状无复发,保肢率为100%;随访期间未见明显需手术干预的复发狭窄,一期管腔通畅率为100%。住院及随访期间无严重手术相关并发症。 结论：DA联合PCB治疗下肢股腘动脉病变是安全有效的,近期通畅率高。     

冠状动脉旋磨术在高危钙化病变中应用的单中心经验

目的 总结冠状动脉旋磨术在高危冠状动脉钙化病变中应用的经验,分析该技术治疗高危钙化病变患者的安全性及近、远期预后.方法 回顾分析2010年1月至2014年12月接受冠状动脉旋磨术结合支架植入术治疗患者130例,其中符合高危复杂钙化病变患者23例.分析术前术后冠状动脉DSA造影资料及临床信息,评估介入术并发症和主要心脑血管不良事件发生率.结果 23例患者26处钙化病变均接受冠状动脉旋磨术,其中15处(57.7％)、7处(26.9％)、4处(15.4％)病变分别以初始直径1.25 mm、1.5 mm、1.75 mm磨头开始旋磨.23处病变(88.5％)成功旋磨并顺利植入支架,即刻效果满意,无并发症;3处(11.5％)病变未植入支架,原因分别为血管太细、血管穿孔和支架内再狭窄,仅作旋磨术.术中发生冠状动脉夹层1处(3.8％),支架植入后边支闭塞2处(7.7％),血管穿孔1处(3.8％),无复流2处(7.7％)及支架内残余狭窄1例(3.8％).住院期间无死亡事件发生,发生支架植入术后心肌梗死3例(13.0％),对比剂肾病2例(8.7％).术后1年随访发现5例(21.7％)心绞痛症状再发,其中2例经造影证实与支架内再狭窄有关.21例获随访4～60个月,平均(25.5±10.7)个月,结果4例病死,2例再行血管重建术.结论 冠状动脉旋磨术治疗高危钙化病变安全、有效,术中根据病变特点遵循“磨头更小、推进更慢、分段旋磨”的原则,手术成功率高,并发症发生率低,术后主要心脑血管不良事件发生率低.     

Mammographic-pathologic correlation of apocrine metaplasia diagnosed using vacuum-assisted stereotactic core-needle biopsy: our 4-year experience

OBJECTIVE: To determine whether focal apocrine metaplasia of the breast has distinctive mammographic characteristics, we evaluated apocrine metaplasia diagnosed by vacuum-assisted stereotactic core-needle biopsy and correlated mammographic imaging and histopathologic findings. MATERIALS AND METHODS: We retrospectively reviewed our institutional database for records of all vacuum-assisted stereotactic core-needle biopsies performed during a 4-year period. Five hundred thirty-eight lesions were biopsied, of which 302 (56%) were benign. Apocrine metaplasia was diagnosed in 37 lesions. In 11 of these 37 lesions, apocrine metaplasia made up more than 50% of the lesion sampled. RESULTS: On mammography, eight cases (73%) appeared as new or increasing calcifications, and three cases (27%) appeared as new or enlarging equal-density masses (0.6-1.2 cm). Calcifications were heterogeneous in five lesions (63%), amorphous in two (25%), and punctate in one (12%); one heterogeneous cluster of calcifications (12%) also contained milk of calcium. The pattern of calcification distribution was clustered in five lesions (63%), multiple clusters in two (25%), and linear in one (12%). Two masses (67%) were lobular, and one (33%) was round. Two borders (67%) were microlobulated, and one (33%) was circumscribed. CONCLUSION: Apocrine metaplasia is a benign condition commonly associated with other fibrocystic changes. Lesions composed of more than 50% focal apocrine metaplasia are relatively uncommon. A new or enlarging lobular, microlobulated mass or heterogeneous calcification cluster may represent apocrine metaplasia. Because no distinguishing mammographic features are present to require follow-up by imaging, needle biopsy is required for definitive diagnosis.     

Endoluminal repair of peripheral arterial aneurysms: 4-year experience with the cragg endopro system I

PURPOSE: To assess the efficiency and long-term patency of the Cragg EndoPro System I in patients with peripheral arterial aneurysms. MATERIALS AND METHODS: In 10 patients, 13 stent-grafts were used to treat 15 arterial aneurysms. Aneurysms were located in the common iliac (n = 4), superficial femoral (n = 4), popliteal (n = 3), and subclavian arteries (n = 2), and in a femoropopliteal bypass-graft (n = 2). Follow-up ranged between 2 and 46 months (mean, 36 months). Examination included clinical status, color-coded duplex sonography, computed tomography angiography, and intra-arterial digital subtraction angiography (DSA). RESULTS: Technical success was achieved in all patients. Primary patency was four of four in iliac vessels and three of nine in non-iliac vessels; secondary patency in noniliac vessels was four of nine. Repairs included one local lysis, four percutaneous transluminal angioplasties, one surgical thrombectomy, and one bypass surgery. Stent wire disintegration was detected in one of four iliac stent-grafts and in seven of nine noniliac stent-grafts. In noniliac grafts, significant stenoses occurred in three of nine; occlusion occurred in five of nine. One complication at the iliac level was a vessel wall penetration at the proximal stent edge, with development of a new aneurysmal formation. No late endoleaks were found. CONCLUSION: Exclusion of peripheral arterial aneurysms with stent-grafts is feasible. Long-term results are excellent in iliac vessels. Mechanical weakness of the stent assembly and frequent re-stenoses or occlusions are significant drawbacks in noniliac vessels with low patency rates.     

药物涂层球囊联合斑块旋切术治疗股浅动脉支架内再闭塞

【摘要】 目的 评价药物涂层球囊（DCB）联合TurboHawk定向斑块旋切术（DA）治疗股浅动脉支架内再闭塞的近中期效果。 方法 回顾性分析2016年8月至2018年8月在郑州大学第五附属医院接受血管内治疗的36例股浅动脉支架内再闭塞患者临床资料。其中19例接受DCB联合DA治疗,17例接受普通球囊血管成形术（POBA）联合DA治疗。对比两组近中期临床疗效。结果 两组患者手术均获成功,平均随访（11.28±1.63）（9～15）个月。DCB＋DA组术后6个月靶血管一期通畅率与POBA＋DA组差异无统计学意义［94.7%（18/19）对82.4%（14/17）,P＞0.05］,术后12个月一期通畅率高于POBA＋DA组［89.5%（17/19）对64.7%（11/17）,P=0.029］。两组患者术后6个月最小管腔直径（MLD）差异无统计学意义（P＞0.05）。术后12个月DCB＋DA组患者MLD显著高于POBA＋DA组（P=0.029）,远期管腔丢失（LLL）显著低于POBA＋DA组（P=0.018）。 结论 DCB联合DA治疗股浅动脉支架内再闭塞具有较好的近中期效果。     

Pneumatic reduction of intussusception: 5-year experience.

Pneumatic reduction of 246 intussusceptions was attempted in 219 patients over a 5-year period. The mean age of the patients was 15.4 months. Successful reduction was achieved in 199 cases (80.9%). Bowel perforation occurred in seven cases (2.8%), requiring needle decompression of tension pneumoperitoneum in one case. Recurrence of intussusception occurred in 27 cases (11%). The mean fluoroscopy time was 3.5 minutes +/- 0.2 in successful reductions and 9.3 minutes +/- 0.9 in failed reductions (P less than .001). Logistic regression analysis helped identify four independent predictors of failure, as follows: (a) ileoileocolic intussusception (P less than .001), (b) long duration of symptoms (P less than .001), (c) rectal bleeding (P less than .01), and (d) failed reduction with barium at another institution (P less than .05). Predictors of bowel perforation were a younger age (P less than .05) and long duration of symptoms (P less than .05). Surgery was performed in 48 cases (19.5%), 16 of which required bowel resection. Transmural necrosis of bowel wall was found in nine specimens. The most important predictor of outcome in this series was a long duration of symptoms. Pneumatic reduction is a useful substitute for barium in the management of pediatric intussusception.     

Radiopaque abdominal foreign bodies introduced by the enteral route. 4-year experience

The aim of this work has been the comparison between the results found in literature and our experience with the introduction of radiopaque foreign bodies by enteral way into the abdomen. The kind of our patients, most of whom were in jail, the sufficient number of cases and the particularity of some of them have convinced us of the soundness of our experience and have persuaded us to briefly report it, with our observations and conclusions. The first thing we want to point out, on the basis of our study, is that the degree of radiopacity of a foreign body is more important than its dimensions as far as its visibility at X-ray examination is concerned. Another conclusive point we want to stress is that surgery is often needed to remove foreign bodies introduced by rectum, while most patients who ingest foreign bodies do not need surgery and expel what they have ingested, without complications, by rectal way.     

Endovascular treatment of femoropopliteal stenoses/occlusions with a SilverHawk directional atherectomy device: immediate results and 12-month follow-up

Purpose

This paper reports our immediate and 12-month follow-up results in the treatment of arterial stenoses/occlusions of the femoropopliteal region with the use of the SilverHawk directional atherectomy device (EV3, USA).

Materials and methods

In an 18-month period, we treated 18 patients (13 men, five women, age range 39–81 years) with the SilverHawk directional atherectomy device. Inclusion criteria were symptomatic femoropopliteal stenosis/insufficiency, nonresponsiveness to medical therapy, and Rutherford categories 3–5. Exclusion criteria were based on the preliminary colour Doppler ultrasound (US) assessment and were plaque with a calcified component >50% and inadequate upstream and/or downstream vascular bed. Patients with severe vascular impairment, classified as TransAtlantic Inter-Society Consensus (TASC) D, were also excluded.

Results

The procedure was successfully completed in all cases, with evident recanalisation and sufficient wall remodelling. No major complication was observed. At assessment immediately after the procedure and over the following days, an improvement in clinical symptoms and in the Rutherford scale was observed. Follow-up at 2 and 12 months identified one case of distal reocclusion subsequently treated with amputation, and two cases of restenosis (primary patency 79%) successfully treated with a repeat procedure (secondary patency 96%).

Conclusions

The SilverHawk directional atherectomy device proved to be an effective and safe tool in all our patients treated for femoropopliteal stenosis/occlusion, with a significant improvement in both imaging findings and clinical signs and symptoms.     

Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela.

OBJECTIVE: The purpose of this study was to evaluate the use of sonographically guided directional vacuum-assisted biopsy in the histologic diagnosis of breast lesions. MATERIALS AND METHODS: Eighty-eight lesions in 83 women underwent sonographically guided 11-gauge directional vacuum-assisted breast biopsy during a 26-month period. Biopsies were performed using high-resolution sonography equipment with a 7.5-MHz transducer, obtaining a median of 17 specimens per lesion. Imaging studies, medical records, and histologic findings were reviewed. RESULTS: Median patient age was 48 years (range, 25-78 years). Median lesion size was 1.2 cm (range, 0.4-2.5 cm). Twenty-four (27.3%) of 88 lesions were palpable. The median time required to perform biopsy was 17 min (range, 10-40 min). Complete removal of the lesion seen at sonography occurred in 78 (88.6%) of 88 lesions and was significantly more frequent in lesions measuring 1.5 cm or less than in larger lesions (68/71 = 95.8% vs 10/17 = 58.8%,p < 0.0003). A surgical procedure was spared in 79 (95.2%) of 83 women. In 36 lesions with imaging and clinical follow-up after sonographically guided biopsy with benign findings (range, 4-24 months; median, 11.3 months), we found no evidence of cancer or scarring in the breast. CONCLUSION: In our small series, sonographically guided directional vacuum-assisted biopsy was a fast and accurate method for breast diagnosis. This technique resulted in complete removal of 95.8% of lesions shown at sonography measuring 1.5 cm or less and spared a surgical procedure in 95.2% of women. Further work is necessary to refine indications, evaluate cost-effectiveness, and assess long-term outcome.     

SilverHawk~(TM)斑块切除系统在治疗下肢动脉硬化闭塞症中的临床应用

目的探讨Silver HawkTM直接斑块切除术治疗下肢动脉硬化闭塞症(ASO)的临床疗效及其安全性。方法应用Silver HawkTM斑块切除系统累计治疗32例ASO患者,临床表现(Fontaine分类):Ⅱa级2例,Ⅱb级18例,Ⅲ级8例,Ⅳ级4例。踝肱指数(ABI)为0.18~0.67,平均(0.46±0.05)。术后对临床症状以及管腔通畅情况进行随访。结果 32个闭塞病变均经腔内开通成功,技术成功率为100%(残余狭窄<30%),临床症状均消失或明显改善;Fontaine分类:I级以上26例,Ⅱa级6例。术后患肢ABI为0.76~1.16,平均(0.92±0.07),与术前比较差异有统计学意义(P<0.05)。术后随访1~12个月,ABI为0.73~1.16,平均(0.89±0.06);与术后即刻比较,差异无统计学意义(P>0.05)。结论 Silver HawkTM直接斑块切除术是治疗下肢动脉硬化闭塞症的一种安全有效的新方法。