Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty.

Introduction: Retrograde transpopliteal angioplasty (PA) is a potentially useful alternative technique for endovascular treatment of infra-inguinal arterial disease when antegrade transfemoral puncture (FA) is technically not possible or appropriate. This study aimed to investigate the outcomes of PA compared with FA during a 5-year period.

Patients And Methods: A retrospective study was performed to assess 88 PA and 275 FA performed between January 2003 and January 2008.

Subintimal angioplasty for superficial femoral artery occlusion: poor patency in critical ischaemia.

Introduction: Subintimal angioplasty has been proposed for the treatment of long segment occlusive disease and for patients with critical limb ischaemia (CLI) with significant co-morbidity. There is no consensus as to short- and long-term patency. We present our experience with this technique.

Computed tomography-detected abnormalities following conventional abdominal aortic aneurysm (AAA) repair.

Purpose: To determine how time since the operation influences vascular abnormalities following conventional infrarenal abdominal aortic aneurysm (AAA) repair.

Methods: In 47 patients computed tomography was performed 1 to 12 years following the aneurysm repair. Aortic diameters at different levels were measured and other abnormalities recorded.

Early results of retrograde transpopliteal angioplasty of iliofemoral lesions.

Purpose: To assess whether the retrograde transpopliteal approach is a safe, practical and effective alternative to femoral puncture for percutaneous transluminal angioplasty (PTA).

Methods: Forty PTAs in 38 patients were evaluated. Intentional subintimal recanalization was performed in 13 limbs.

Stenting for localised arterial stenoses in the aorto-iliac segment.

Objective: to determine complications and patency following angioplasty (PTA) and stenting of aorto-iliac stenoses.

Setting: District General Hospital in U.K.

Remote superficial femoral artery endarterectomy: medium-term results.

Background: the aim of this study is to determine the medium-term results following successful remote superficial-femoral endarterectomy (RSFE).

Setting: district general hospital in United Kingdom.

Methods: RSFE comprises a single incision over the origin of the superficial femoral artery.

Maintenance of patency following remote superficial femoral artery endarterectomy.

Background: Remote superficial femoral artery endarterectomy (RSFE) is a minimally invasive means of superficial femoral artery revascularisation. It comprises a single groin incision and securing of the distal cut end of atheroma with an intraluminal stent.

Aim: To determine medium-term results of RSFE, with particular reference to costs of maintaining patency.

Iliac occlusions: stenting or crossover grafting? An examination of patency and cost.

Objectives: Percutaneous transluminal angioplasty with stenting is perceived to be a less invasive and cheaper option for the treatment of iliac artery occlusion than surgical reconstruction. We have carried out a prospective observational study of all patients undergoing an iliac stent or femorofemoral crossover graft for iliac artery occlusion to assess the cost effectiveness of the two approaches in a district general hospital.

Methods: Fifty-one patients underwent primary angioplasty with stenting and 87 patients crossover grafting.

Minimally invasive superficial femoral artery endarterectomy: early experience with a modified technique.

Objectives: To describe our experience of a modified technique for carrying out remote endarterectomy for superficial femoral artery occlusive disease.

Methods: A 4-French arterial dilator is inserted using a Smart needle into the popliteal artery below the occlusion. A remote endarterectomy is carried out through an arteriotomy in the proximal superficial femoral artery.

Early experience with stenting for iliac occlusive disease.

Objectives: To review our experience of iliac artery stenting for occlusive disease.

Design: Prospective study of 50 consecutive patients with iliac occlusive disease, November 1993-November 1996. The indications for stenting were complete iliac occlusion (37) restenosis (four), donor site inflow for bypass grafting (four) and difficult stenoses (> 90% and/or > 5 cm) (five).

Cumulative risk of bypass, amputation or death following percutaneous transluminal angioplasty.

Objective: To define cumulative risk of reconstruction, amputation or death following percutaneous transluminal angioplasty (PTA).

Design: Non-randomised observational study.

Patients And Methods: Two hundred and thirty-four PTAs in 212 patients.

Lysis-assisted angioplasty in the treatment of lower-limb arterial thrombosis.

This study examined the results in 30 patients treated with lysis-assisted angioplasty and compared them with the results of 30 patients with simple stenotic disease treated by angioplasty alone. One patient died on the day of treatment with lysis-assisted angioplasty from arterial perforation and haemorrhage. Of the remaining 29 patients 16 (55 per cent) were symptomatically improved and 13 had early reocclusion.

The treatment of upper limb vascular occlusions using intraarterial thrombolysis.

Acute ischaemia of the lower limb is increasingly treated by intraarterial thrombolysis. Four cases are reported in which this technique has been used successfully for treatment of upper limb emboli. The possible indications and potential drawbacks of such treatment are discussed.

An assessment of Gd-DTPA as a CT contrast agent in the renal tract.

Intravenous gadolinium diethylene triamine penta-acetic acid (Gadopentetate dimeglumine, Gd-DTPA) is visualized as a radiographic contrast agent in the renal tract on computed tomography (CT). In this study the CT appearance of this contrast agent within the renal collecting systems of 12 patients is described following a Gd-DTPA enhanced magnetic resonance imaging (MRI) study. The CT appearances are variable and not predictable on the basis of time from injection, age, sex or indices of renal function.

Early results and 1-year follow-up after intra-arterial thrombolysis.

Intra-arterial thrombolysis (IAT) was used as first-line treatment for 100 occlusions causing acute, subacute or chronic ischaemia. Streptokinase was used in 90 cases and tissue plasminogen activator in the remaining ten. Complete lysis, as determined radiologically, was achieved in 55 per cent of cases and partial lysis in 20 per cent.

Consequences of immediate failure of percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty (PTA) is often used for patients who would not previously have been treated, due for example, to their poor general condition or their symptoms being relatively mild. The approximate overall initial success and complication rates are 80% and 10%, respectively. Iliac angioplasties fare rather better than superficial femoral dilatations.

Percutaneous angioplasty in a district general hospital: impact and implications.

Over a 2-year period 147 angioplasties were performed for stenoses or occlusions above or below the inguinal ligament. Most patients had intermittent claudication. The stenosis or occlusion was successfully dilated in 88% of cases.

Double blind comparison of Iomeprol 350 and Iopamidol 340 in intravenous digital subtraction angiography for peripheral vascular disease.

A randomized double blind study was undertaken to compare the diagnostic efficacy and side effects of a new non-ionic contrast medium Iomeprol with a commonly used one--Iopamidol. Visual and densitometric comparison was made of intravenous digital subtraction angiograms performed for peripheral vascular disease. The results show the two media to be similar both in imaging quality and in the incidence of associated side effects.

Low-dose intra-arterial thrombolysis in the treatment of occluded vascular grafts.

As the use of intra-arterial thrombolysis increases, its application to specific areas requires definition. The results of treatment of occluded vascular grafts are presented. Thrombolysis using streptokinase or tissue plasminogen activator was planned in the treatment of 18 occluded vascular grafts (five aortofemoral bifurcation grafts and 13 infrainguinal grafts).

Management of synchronous arterial occlusions using intra-arterial thrombolysis.

Three patients presented with multiple acute arterial occlusions in separate limb vessels. The diagnosis was confirmed by angiography. Each patient was successfully treated by simultaneous infusion of low-dose intra-arterial streptokinase into each occlusion.

Prevalence of abdominal aortic aneurysm in patients with occlusive peripheral vascular disease.

Over a 1-year period, 242 patients with peripheral vascular disease underwent abdominal ultrasonography to detect the presence of an abdominal aortic aneurysm. In 34 (14 per cent) an abdominal aortic aneurysm was found; half of these aneurysms were greater than 4 cm in diameter. In addition, 16 patients had ectatic aortas.

Limitations to the widespread usage of low-dose intra-arterial thrombolysis.

Despite encouraging results, intra-arterial thrombolysis (IAT) has not been readily accepted by British surgeons. In an attempt to clarify the reasons for this we sent a postal questionnaire to surgeons with a vascular interest, asking them to define their present attitude towards IAT. Subsequently, we re-analysed our own clinical data in the light of the answers received.