Use of a puncture needle for recanalization of an occluded right subclavian vein

We report a patient in whom we used a puncture needle to initiate percutaneous recanalization of a chronic occlusion of the junction between the right subclavian vein and the right brachiocephalic vein. Under fluoroscopic guidance, an 18-gauge needle was used to puncture the right subclavian vein. When contrast material injected through the needle confirmed intravascular location, the needle was advanced until it deflected and perforated an occlusion balloon target positioned within the right brachiocephalic vein. This technique may be useful in patients with central venous occlusions that are refractory to traversal using traditional catheter and guidewire techniques.     

Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions

Purpose To determine initial technical results of percutaneous transluminal angioplasty (PTA) and stent procedures in the iliac artery, mean intraarterial pressure gradients were recorded before and after each procedure. Methods We randomly assigned 213 patients with typical intermittent claudication to primary stent placement (n=107) or primary PTA (n=106), with subsequent stenting in the case of a residual mean pressure gradient of >10 mmHg (n=45). Eligibility criteria included angiographic iliac artery stenosis (>50% diameter reduction) and/or a peak systolic velocity ratio >2.5 on duplex examination. Mean intraarterial pressures were simultaneously recorded above and below the lesion, at rest and also durign vasodilatation in the case of a resting gradient ≤10 mmHg. Results Pressure gradients in the primary stent group were 14.9±10.4 mmHg before and 2.9±3.5 mmHg after stenting. Pressure gradients in the primary PTA group were 17.3±11.3 mmHg pre-PTA, 4.2±5.4 mmHg post-PTA, and 2.5±2.8 mmHg after selective stenting. Compared with primary stent placement, PTA plus selective stent placement avoided application of a stent in 63% (86/137) of cases, resulting in a considerable cost saving. Conclusion Technical results of primary stenting and PTA plus selective stenting are similar in terms of residual pressure gradients.     

Non-Operative Revascularisation of Renal Artery Occlusion by Transluminal Angioplasty

A modified transluminal angioplasty technique for treatmentof renal artery occlusion has been developed. From 1980 to 1985,16 consecutive patients with 17 complete main renal artery occlusionsunderwent interventional transfemoral angiography for the purposeof recanalisation. In 12 patients the orifice of the renal arterycould be clearly localised. so an attempt was made. Successfulrevascularisation of the occluded vessel was accomplished inseven patients. In four of these seven, contralateral renalartery stenosis was detected and dilated at the same session. Intact vasculature could be demonstrated distal to the occlusion.In six patients an improvement of renal function was apparentat the end of the dilatation procedure; this was indicated bythe appearance of contrast material in the pelvicalyceal system. The mean serum creatinine fell from 4.6±2.9 to 1.9±0.4mg/dl. Radioisotope studies confirmed improvement of renal functionin the previously occluded kidney in four of four patients.Three patients had acute oliguric renal failure, which was reversiblein two cases following revascularisation. Transluminal angioplastyimproved hypertension in all cases. Mean blood pressure fellfrom 187/110 to l55/88 mmHg. Non-operative renal artery revascularisation can be achievedby transluminal angioplasty techniques and is an alternativeto surgery in patients with increased operative risk.     

Circumferential rupture of an angioplasty balloon with detachment from the shaft: Case report

Rapidly evolving angioplasty balloon techniques need continual evaluation for the type or frequency of balloon-related complications. We recently encountered a case where a new narrow shaft polyethylene terephthalate balloon completely separated from the catheter following circumferential rupture. The balloon was successfully retrieved using grasping forceps and a basket. Patterns of balloon rupture and subsequent management are discussed. Problems of this type were more frequent in the early days of balloon angioplasty, but have since become rare. Close surveillance of new low profile balloons is recommended to determine whether this represents an isolated occurrence or a return to the earlier experience.     

冠状动脉内支架植入术321例分析

目的：评价冠状动脉内支架的临床价值。材料与方法：321例冠心病患者冠状动脉内植入451个支架，植入成功率97．8／，其中79．1％（254例）为B2型以上复杂性病变，因DeNovo及Suboptimal病变植入的支架占56.7％（182／321），Bail－out病变16．5％（53／321），再狭窄病变26.8％（86／321）。结果：28例曾行冠状动脉搭桥水患者的28文静脉移植血管（SVG）内植入49个支架，16例急性心肌梗塞患者接受原发支架植入。多支架植入99例，其中植入3个以上支架者26例。支架类型：Palmaz－schatz支架占69.7％（314个），NIR支架占20．6％（93个），其它支架占9．8％（44个）。多数病例使用高压球囊扩张，住院期间发生急性支架血栓形成6例（1．9％），亚急性支架血栓形成2例，其中1例因心肌梗塞死亡，无严重出血并发症。21例（6.5％）术后2－11个月胸痛复发者支架部位再狭窄，再次PTCA。结论：冠脉内支架是一种安全有效的介入性治疗技术．其扩大了PTCA的适应症，成功率高，并发症低，并减少再狭窄的发生。     

Triple catheter aortoiliac angioplasty in a patient with a horseshoe kidney: Technical note

A method is described for protecting a nonstenotic anomalous artery to the left-lower pole of a horseshoe kidney that originated from a stenotic left common iliac artery. Using a triple catheter technique, injury to this anomalous renal artery was prevented while using “kissing balloons” to dilate bilateral proximal common iliac artery stenoses.     

经自然腔道内镜手术的研究进展

经自然腔道内镜手术（NOTES）是经自然腔道置入软性内镜,通过自然腔道的切口进入体腔的微创手术。目前主要处于动物实验研究阶段,临床主要为个案报道。虽然NOTES的技术和设备在不断完善,但仍存在许多问题亟待解决。本文就NOTES的研究进展作一综述。     

Controlled trial of high-versus low-dose aspirin treatment after percutaneous transluminal angioplasty in patients with peripheral vascular disease

Percutaneous transluminal angioplasty of aortoiliac and femoropopliteal atherosclerotic lesions can provide long-lasting hemodynamic improvement. High-dose aspirin is commonly prescribed as reocclusion prophylaxis, but low doses would be preferable because of fewer adverse effects. We performed a double-blind, randomized, controlled clinical trial in patients with peripheral vascular disease with lesions appropriate for angioplasty. We compared the efficacy and side effects of two doses of aspirin (50 mg vs. 900 mg daily) during a period of 12 months after angioplasty. A total of 359 patients were evaluated: 175 were randomly assigned to treatment with 900 mg aspirin daily and 184 to 50 mg aspirin a day. Thirty-nine patients developed restenosis at the angioplasty site; the cumulative percentage of event-free survival after 1 year (patency rate) was 85% in the 900-mg group and 84% in the 50-mg group. An equivalence test showed the two groups equivalent with respect to restenosis rates (P = 0.003 for an equivalence region of < 10% difference). Nine patients (5%) in the 900-mg group had serious gastrointestinal side effects (peptic ulcer, eight; erosive gastritis requiring transfusion, one) compared to two (peptic ulcer) in the 50-mg group (P = 0.03). The results of our study show that a dose of 50 mg aspirin a day is as effective as one of 900 mg for the prevention of restenoses after lower limb angioplasty, and that severe gastrointestinal side effects are less frequent.Abbreviation PTA percutaneous transluminal angioplasty This work was supported by grants from the Bundesministerium für Forschung and Technologie, Germany Correspondence to: C. Ranke