Ultrasound-accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience.

Purpose: To evaluate the success of lysis and clinical outcomes in patients treated with ultrasound (US)-accelerated thrombolysis for deep vein thrombosis (DVT).

Materials And Methods: Forty-seven patients with 53 cases of DVT were treated with US-accelerated thrombolysis at eight centers in the United States. Sixty percent of the occlusions were in the lower extremity, 36% were in the upper extremity, and 4% were hepatic.

Ultrasound-enhanced Thrombolysis.

Purpose: To report a single-center clinical experience with ultrasound-enhanced thrombolysis in the treatment of both arterial and venous thromboses.

Methods: From January 2005 to June 2006, 33 patients (23 men; age range 39-90 years) with 36 occlusions were treated using ultrasound-enhanced thrombolytic therapy for acute and chronic arterial and venous occlusions. After diagnostic angiography, the occlusions were crossed with an appropriately sized Lysus infusion catheter for infusion of urokinase (80,000-120,000 IU/h).

Waligraft endoprosthesis for the percutaneous treatment of femoral and popliteal artery aneurysms.

Purpose: To evaluate the safety and efficacy of the Wallgraft Endoprosthesis for the treatment of femoropopliteal artery aneurysms.

Methods: From October 1997 to April 2000, 17 patients (13 men; mean age 73.5 +/- 7.

Percutaneous transluminal angioplasty of supra-aortic vessels.

Purpose: To retrospectively review the techniques and results of percutaneous transluminal angioplasty (PTA) in the supra-aortic vessels.

Methods: Over a 5-year period, 112 patients underwent percutaneous treatment of 151 lesions in the innominate, subclavian, carotid, and vertebral arteries. The percutaneous technique included standard retrograde femoral artery access in the majority of patients with balloon dilation of the lesion site.

Rotational atherectomy with a new device: initial clinical experience.

The Bard Atherectomy Catheter is a new rotational atherectomy device that consists of a flexible, hollow, thin-walled cutting catheter that, while rotated at 1,500 revolutions per minute, is advanced across the lesion over a special spiral guidewire system. We report the initial clinical experience with this device in 20 peripheral lesions in ten patients. The majority of patients were treated for limb salvage.

Thrombolysis and angioplasty of chronic iliac artery occlusions.

The role of percutaneous angioplasty in the management of chronic iliac artery occlusions is controversial. This article reviews 7 years of experience in treating patients with complete chronic iliac artery occlusions (n = 99) by using thrombolysis and angioplasty. Patients were not excluded due to age or length of the lesion, or severity of underlying peripheral vascular disease.

PTA and thrombolysis in leg salvage.

Purpose: The goals of any treatment for ischemic vascular disease are to relieve pain, allow wound healing, and regain/maintain ambulatory abilities. To determine if endovascular therapy could accomplish these goals in patients with limbs at risk, we undertook a retrospective analysis of the results of percutaneous transluminal angioplasty (PTA) and thrombolysis in leg salvage.

Methods: Over an 8-year period ending in 1993, 327 patients (209 males, 118 females) with limb-threatening ischemia (defined as one or more of the following: ischemic rest pain, ischemic ulceration, or gangrene) in 361 limbs were seen.

Limb salvage: thrombolysoangioplasty as an alternative to amputation.

Objective: This 5-year retrospective study evaluates the results of thrombolysoangioplasty (TLA) used as an alternative to major amputation in patients with severely debilitating, lower extremity, peripheral vascular disease. All patients in this study were originally designated for major amputation to treat their ischemic symptoms after all other surgical options were exhausted.

Materials And Methods: Twenty-one limbs in 20 patients with complete occlusions of the superficial femoral, popliteal and at least 2 of the 3 major branches below the popliteal trifurcation were attempted for thrombolysoangioplasty for limb salvage.

Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy.

Angioplasty of the brachiocephalic vessels has been utilized in the treatment of stenotic/occlusive lesions for the past twelve years. The guidelines for use of PTA therapy versus surgery, however, have not been well defined. Multiple pathologies and morphologies for the various lesions have been described.

Real-time intravascular ultrasound imaging in humans.

The capability of obtaining cross-sectional, high resolution images of arteries with the use of ultrasound catheters has recently been demonstrated in animal studies. In this study the in vivo feasibility of intravascular ultrasound imaging in humans was evaluated. In 26 patients who had undergone diagnostic cardiac catheterization or iliofemoral arteriography, 1 of 3 different models of 20-MHz ultrasound catheters was advanced retrograde, into the iliac arteries and aorta or anterograde into the femoral arteries and real-time cross-sectional images of the arteries were obtained in all.

Peripheral laser-assisted balloon angioplasty. Initial multicenter experience in 219 peripheral arteries.

In this multicenter clinical series of peripheral laser-assisted balloon angioplasty with an argon laser-heated, metallic-capped fiberoptic, angiographic and clinical success was achieved in a total of 155 (71%) of 219 attempted lesions. When the anatomy of the lesion was subjectively categorized by the angiographer into those considered possible or impossible to treat by conventional balloon angioplasty, clinical success was achieved in 116 (78%) of 149 lesions considered possible to treat with balloon angioplasty (39 [95%] of 41 stenoses and 77 [71%] of 108 occlusions). More importantly, clinical success was achieved in 39 (56%) of 70 lesions considered impossible to treat by conventional means.

Percutaneous transluminal angioplasty for treatment of subclavian steal.

Twenty-two patients with subclavian steal were treated with percutaneous transluminal angioplasty (PTA). Fifteen had unilateral stenosis of the subclavian artery, one had severe stenosis on the left and total occlusion on the right, five had total subclavian occlusion on the left, and one had total occlusion of the innominate artery. All subclavian stenoses as well as the occluded innominate artery were successfully dilated, resulting in correction of subclavian steal; however, attempts to recanalize the totally occluded subclavian arteries failed.

Percutaneous transluminal angioplasty of the brachiocephalic arteries.

Percutaneous transluminal angioplasty was used to treat atherosclerotic lesions in 22 brachiocephalic arteries in 20 patients during a 2 1/2 year period. Seven subclavian, 13 vertebral, one external carotid, and one common carotid arteries were involved. Nineteen arteries were successfully dilated, but dilatation of two vertebral arteries and attempted recanalization of one subclavian artery failed.

Percutaneous transluminal angioplasty as a complement to surgery.

Transluminal angioplasty, a nonsurgical treatment for atherosclerotic occlusive disease, was performed on 56 arteries in 45 patients in conjunction with reconstructive vascular surgery. Twelve patients were treated presurgically, 12 patients were treated postsurgically, and 21 patients were treated intraoperatively. Some arteries were dilated to increase arterial inflow to the graft or to improve the distal runoff.

Percutaneous transluminal angioplasty of the vertebral arteries.

Dilatation of stenosis at the origin of the vertebral artery, using a Grüntzig balloon catheter, was attempted in 5 selected patients and was successful in 4. Two patients had isolated vertebral artery disease without significant carotid occlusive disease, while the other 3 also had ulcerated carotid plaques. All patients had classical vertebral basilar insufficiency and were being considered for reconstructive surgery; however, dilatation alleviated the symptoms and made surgery unnecessary.

Percutaneous transluminal angioplasty of the iliac arteries: 66 experiences.

Sixty-six iliac arteries in 45 patients, 25 male and 20 female, were treated with percutaneous transluminal angioplasty (PTA) for atherosclerotic occlusive disease. Of 103 lesions dilated, 51 were in common iliac and 51 in external iliac arteries. While iliac artery disease was the primary lesion in 18 patients, eight of whom had total occlusion, 27 patients had additional femoropopliteal disease.

Percutaneous transluminal angioplasty of the deep femoral artery.

Successful dilatation and recanalization of the severely stenotic or completely occluded deep femoral arteries in twelve patients is presented. This nonsurgical procedure is effective, less traumatic, and less time-consuming than surgical endarterectomy.

Percutaneous transluminal angioplasty and case selection.

The application of percutaneous transluminal angioplasty (PTA) in the treatment of arteriosclerotic occlusive disease is relatively new in the United States. To ascertain more data on case selection, procedure, and success rate, the authors evaluated 100 consecutive patients as possible candidates for treatment with PTA. Patients were divided into five groups on the basis of procedural acceptability.