Recanalization of chronic arterial occlusions: low-speed rotational angioplasty. 5 years experience in peripheral and coronary vessels.

Chronic complete occlusions still represent the major technical limitation of percutaneous transluminal angioplasty, both in peripheral and coronary vessels. The clinical use of low-speed rotational angioplasty started in 1986 for the peripheral and in 1987 for the coronary arteries, and has already become part of the clinical routine in several centres. Up to now more than 350 patients with peripheral and 250 patients with coronary occlusions have been treated in Frankfurt; a multicentre questionnaire already contains information about 1,252 patients with peripheral vessel obstructions.

[Antibiotic concentrations after intravenous and retrograde intravenous injections].

In patients with peripheral arterial occlusive disease, it is difficult to attain an adequate antibiotic concentration in poorly perfused infected lesions. The antibiotic concentrations prevailing in the ulcer secretion with the different routes of administration were investigated in 7 patients. The patients received 1 g of cefotaxim on consecutive days: intravenously on the first day, intraarterially on the second day and by retrograde venous injection on the third day.

[Behavior of post-occlusion systolic blood pressure after long duration blockade. Effect of induced hypertension].

A suprasystolic blockade (300 mm Hg) was applied for 50 to 60 min to the thigh of the affected leg with a blood pressure cuff in 13 patients with occlusions of the femoral artery. Afterwards, the pre-postocclusive systolic pressure difference was clearly less in most patients than before the compression manoeuvre. This reduction of the systolic pressure gradient, which was greatest in the first hour and slowly decreased in subsequent days, is likely to be based on a dilatation of the collateral arteries.

[Effect of transient therapeutic occlusion on some hemodynamic parameters and walking distance].

The effect of a one hour lasting occlusion was studied by recording the ankle/arm pressure ratios at rest and during post-occlusive reactive hyperemia 30 min, 1 day, 3 days and 7 days after the procedure. Both parameters improved, reaching a maximum on the 7th day at which time the changes became statistically significant. Finally, a standardized walking distance test yielded a highly significant improvement when determined on the 7th day (mean increase in walking distance: 69%).

[Gingko biloba extract EGb 761 and pentoxifylline in intermittent claudication. Secondary analysis of the clinical effectiveness].

Clinical trials on the efficacy of EGb 761 and pentoxifylline are summarized in the context of their methods and results and compared with each other. All placebo-controlled, randomized and double-blind studies with the major target objective of "pain-free walking distance" were selected. The pentoxifylline studies were adopted from a survey of the existing literature in the English language, which has been brought up to date via DIMDI research.

[Spontaneous course of peripheral, stenosing arteriosclerosis and the effect of catheter interventions].

Peripheral obliterating arteriosclerosis tends to progress. If it was previously a mainly unilateral disease, similar alterations on the opposite side are to be expected in the near future. This applies in particular to the most frequent incidence, occlusion of the femoral artery, which only rarely remains unilateral.

[Antibiotic treatment for diabetic foot. Advantages of intravenous regional route as alternative for systemic route].

Diabetic angiopathy prevents adequate access of antibiotic agents to septic areas of the diabetic foot. We treated 22 such patients with antibiotics infused through a superficial vein associated to tourniquet occlusion of the limb (Group A). A control group of 47 patients, similar in age, sex and severity of diabetes received conventional systemic therapy (Group B).

[Which therapeutic measures ensure good long-term results in arterial occlusive disease?].

The lumen-opening methods reconstructive operation, angioplasty and thrombolysis achieve their best long-term results in the region of the large iliofemoral arteries. After elimination of occlusions in arteries situated more peripherally, reobliterations are more frequent and not uncommonly associated with a deterioration in the course of the disease. Of the conservative measures, long-term benefit is to be expected primarily from continuous training.

[Concentration of cefotaxime in the exudate from ischemic ulcer after systemic and regional administration].

We evaluated the concentration of cefotaxime in the exudate from ischemic leg ulcers in 9 subjects with severe obstructive arterial disease. The administration of the drug was either systemic (1 g in 250 ml of saline given in 30 min) or regional at a vein of the foot while a tourniquet was applied at the level of the thigh during 30 min. Hygroscopic discs were used to collect samples of ulcer exudate at hourly intervals for 4 hr.

[Long-term arterial blockade and retrograde venous perfusion in peripheral arterial occlusive diseases].

The method of longterm artificial arterial blockade in patients with peripheral arterial occlusive disease (PAOD) opens new therapeutic possibilities. However, it is yet not clear if and how the suspected dilation of collateral arteries can be therapeutically used. The retrograde venous perfusion permits the transport of active substances in high concentrations into ischemic areas.

[Duplex ultrasound studies of the deep femoral artery].

In case of occlusion of the superficial femoral artery (SFA), the deep femoral artery (DFA) supplies the entire lower extremity. Not infrequently, the SFA occlusion is associated with stenosis of the origin of the DFA. The angiographic study of the origin of DFA is often unsatisfactory.

Doppler ophthalmic blood pressure measurement in the hemodynamic evaluation of occlusive carotid artery disease.

In 102 patients with angiographically proven occlusive carotid artery disease of 60-100% diameter reduction, Doppler ophthalmic artery pressure and blood flow direction were recorded by the recently developed ophthalmomanometry-Doppler technique. Among these 102 patients, 50 presented with complete carotid artery occlusions and 52 with carotid artery diameter stenoses of greater than or equal to 60%. Mean +/- SD Doppler ophthalmic artery pressure was 69 +/- 15 mm Hg ipsilateral to the occlusion and 86 +/- 18 mm Hg ipsilateral to a stenosis of the carotid artery (p less than 0.

[Doppler-ophthalmomanometry in patients with obstruction of the carotid arteries].

A novel noninvasive method to determine simultaneously ophthalmic artery pressure (OAP) and flow direction based on Doppler ultrasound principles is presented: ophthalmomanometry-Doppler (OMD). Studies performed on 25 angiographically proven normal subjects with direct recording of the internal carotid artery pressure (ICP) and indirect determination of the brachial artery pressure (BAP) demonstrated that OAP values assessed by the OMD device are highly correlated with simultaneous ipsilateral intraarterial systolic ICP measurements (r = 0.95, n = 10) and with simultaneous recordings of the BAP (r = 0.

[Rotation angioplasty--clinical experiences in 83 patients with chronic arterial vascular occlusion].

Chronic, total vascular occlusion represents the limit for use of balloon dilatation. Occlusions of the superficial femoral artery and popliteal artery of more than 10 cm in length have a low recanalization rate of 50 to 60% with conventional angioplasty. In iliac artery occlusions, in addition to a high rate of complications, the recanalization rate is only about 30 to 40%.

Results of low speed rotational angioplasty for chronic peripheral occlusions.

After experimental investigation using postmortem human arteries, 19 patients with chronic peripheral artery occlusions were treated with a new angioplasty technique between December 1986 and October 1987. In 17 patients the superficial femoral artery and in 2 patients the popliteal artery were completely occluded. The length of the occlusions ranged between 5 and 25 cm (mean 11).

Historical aspects on the development of angiology in Germany.

Clinical angiology is mainly concerned with vessels and disorders of circulation which can be detected and appraised with clinical methods. The arteries and veins of the limbs as well as the major extracranial arteries supplying the brain are primarily involved. The consequences of a peripheral arterial disease were initially recognized as being due to disorders of blood flow only in their most severe forms.

[Significance of the ejection fraction at rest and by stress using radionuclide ventriculography for the prognosis of myocardial infarct patients--comparison with other study methods].

We examined 221 patients with postmyocardial infarctions 8 weeks after MI using radionuclide ventriculography (RNVA) at rest (EFR) and during supine submaximal exercise (delta EF). Mortality rates were evaluated 2 1/2 and 3 1/2 years later by interviewing patients and/or their homephysicians. Sixteen patients were dead (6.

Hemodynamic assessment of the iliac disease by proximal thigh pressure and Doppler femoral flow velocity.

In 22 normal and 51 limbs with arterial occlusive disease, upper thigh blood pressure at rest and after the knee exercise, Doppler flow velocity tracing at the common femoral artery, and the mean femoral velocity tracing during the postischemic reactive hyperemia were investigated. These results were compared with angiographic findings, and the diagnostic value for assessing the iliac disease was discussed. Measurement of the upper thigh pressure after the knee exercise enables prediction of the significant stenosis of the iliac artery.

Clinical significance of Doppler velocity and blood pressure measurements in peripheral arterial occlusive disease.

In 20 normals and 50 limbs with arterial occlusive disease, Doppler flow velocity and blood pressure in different levels of the leg were determined at rest and during reactive hyperemia. While blood pressure measurement at the ankle and flow velocity analysis at the posterior tibial artery were of use in the diagnosis of arterial occlusion, recording the mean femoral flow velocity during reactive hyperemia showed less diagnostic value. Ankle blood pressure was determined after two different exercises--knee exercise and ankle exercise.