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Angioplasty of the subclavian artery
372
ABSTRACTS
We analysed the quality of published data supporting the use oflasers to determine why, in spite of favourable reports, lasers have not found a place in routine angioplasty. Twenty-nine reports of laser angioplasty (1985 1989) published in major English language radiology journals were analysed. 1353 angioplastics were reported (47 per report, some reports duplicated data) using at least 30 individual laser systems. Technical success rates varied from 48-100%. Only three trials reported the use of a guidewire before laser. There were no contemporary controls. Follow up was 0-2 years and life table analyses were seldom used. It was often difficult to determine which vessels were successfully dilated and the nature of the lesions treated (some reports included femoral and iliac artery lesions, stenoses and occlusions). Many reports of laser assisted angioplasty have severe deficiencies and have not made a convincing case for the use of lasers. These deficiencies should be avoided in future assessments of devices introduced into angioplasty practice. TECHNIQUES OF ANGIOPLASTY FOR RENAL TRANSPLANT ARTERIAL STENOSIS R. A. EVANS, S. P. OLLIEE and H. WALTERS
Dulwich Hospital, London Arterial stenosis occurs in 10-15% of transplanted kidneys, and may cause renal impairment and/or hypertension. Percutaneous transluminal angioplasty has become the treatment of choice in recent years. We retrospectively reviewed our experience with this procedure over a 3 year period. Renal impairment in the absence of rejection on biopsy was the indication for angiography in the majority of cases. Doppler ultrasound has recently proved of value in the detection of transplant arterial
stenosis. Eighty-seven procedures were performed on a total of 58 patients (59 transplants). Dilatation was achieved in 57 transplants (96%). Improved techniques which have resulted in a recent high success rate are described. The choice of these is largely dependent on arterial anatomy. There was only one significant complication of anastomotic rupture which occurred in the high risk post-operative period, and was corrected surgically. Angioplasty is a safe and effective technique in the management of problems associated with renal transplant arterial stenosis. ANGIOPLASTY OF THE SUBCLAVIAN ARTERY N. K E N N A N , A. NICHOLSON, W. S H E R I D A N and M. S. R U T T L E Y
difficult. We have studied two new devices which address this problem the Rotacs catheter and the thermoprobe angioplasty catheter in order to evaluate their efficacy. Methods: Eleven patients with potentially difficult or long occlusions of the superficial femoral artery were selected. Following successful traversal of the occlusion, angioplasty was performed. Results: Rotacs was successful in 3/5 and the Thermoprobe in 5/6 patients. In the presence of heavily calcified plaque the Rotacs catheter was deflected leading to failure of the procedure. The Thermoprobe catheter failed to produce a sufficient channel for subsequent anglo, plasty in one patient. Conclusion: Both these devices are an alternative to laser angioplasty but they are cheaper, portable and offer no risk to the operator. The Thermoprobe can vaporize calcific material which would otherwise deflect the Rotacs. However, the Rotacs has the advantage of being steerable as it accepts a 0.035" wire and may be more useful in tortuous vessels. S U P E R I O R VENA CAVA S Y N D R O M E - TREATMENT BY P E R C U T A N E O U S METAL STENT INSERTION A.-M. BELLI and A. P. H E M I N G W A Y
Royal Hallamshire Hospital, Sheffield Superior vena cava syndrome is most often caused by bronchogenic carcinoma extending into the mediastinum. Traditionally it has been treated by aggressive radiotherapy. In some patients response to radiation is poor or the syndrome recurs after maximum-tolerance radiotherapy, due to tumour recurrence, post-radiation fibrosis or superimposed thrombosis. Five patients with bronchogenic carcinoma and SVC syndrome were referred for superior vena cavography with a view to stent insertion. Two were complicated by extensive venous thrombosis and were therefore considered unsuitable. Stents were successfully inserted via the femoral vein in the three cases of uncomplicated SVC obstruction. In all three cases the procedure was well tolerated by the patients with no sideeffects. Insertion of the Gianturco self expanding wire stent (William Cook U K Limited) is technically easy and rapidly performed and provides a simple alternative to radiotherapy with virtually immediate symptomatic relief. Local infusion of thrombolytic agents could extend the indications for stent insertion, but we have not yet performed this. Other indications include SVC stenosis secondary to non-malignant disease, e.g. complications following catheter or pacemaker insertion.
University Hospital of Wales, Cardiff Percutaneous transluminal angioplasty (PTA) is an accepted and widely used technique in the treatment o f coronary and lower limb arterial disease. Its role in subclavian artery stenosis or occlusion has not been so well recognized. We report our experience of subclavian artery angioplasty in 15 consecutive patients over a period of 6 years. The patients, 12 female and 3 male, ranged in age between 35 and 71 years. All had arm claudication, seven had acute hand ischaemia and six had neurological symptoms. Ten patients had significant stenosis, five patients had arterial occlusions. One patient had a right subclavian stenosis. Four of the five patients with occlusion and nine ~of the 10 patients with stenosis underwent successful angioplasty with abolition of the systolic blood pressure difference between the two arms. Eleven patients remain asymptomatic at follow up. in one patient recurrence of symptoms has been shown to be due to further more distal lesions, another has residual mild arm claudication after five years. The single patient with failed dilatation of a stenosis is thought on clinical grounds to have an arteritis. There were no significant complications, no episodes of neurological dysfunction or peripheral embolic events during or after the procedure. All patients with acute digital ischaemia considered to be embolic in origin have remained asymptomatic. In conclusion, we feel that angioplasty is a safe and effective treatment for symptomatic subclavian artery stenosis or occlusion.
USE OF THE ROTACS SYSTEM IN RECANALIZATION OF OCCLUDED CORONARY AND P E R I P H E R A L ARTERIES G. G. HARTNELL, R. P. H. WILDE and J. C. PITTS CRICK
Bristol Royal Infirmary, Bristol Many devices have been evaluated for recanalizing peripheral and coronary arteries. Some are potentially hazardous and others expensive. The Rotacs system (a non-cutting, slow speed rotating device) is promoted as a safe, low cost method for recanalizing occluded vessels which canno[ be crossed with conventional techniques. We report its application to these types of lesions. Rotacs was evaluated in 11 patients (seven with coronary artery occlusions or chronic hard stenoses preventing passage of a dilatation balloon, four with superficial femoral artery occlusions which could not be crossed with a guidewire). In coronary arteries the Rotacs was successful in crossing three total occlusions and one chronic severe stenosis. The Rotacs also crossed three superficial femoral artery occlusions. There were no technique related complications, in particular no evidence of dissection or thrombus formation on the wires. There was one episode of distal embolization in a patient with a chronic occlusion of a dilated right coronary artery which responded to streptokinase infusion. Recanalization was followed by balloon angioplasty in all cases with good symptomatic results. Although experience is currently limited Rotacs appears to be a relatively effective, inexpensive and safe alternative when conventional methods for crossing arterial stenoses or occlusions fail.
ROTACS AND T H E R M O P R O B E ANGIOPLASTY CATHETERS: EXPERIENCE OF NEW M E T H O D S OF CROSSING SUPERFICIAL F E M O R A L ARTERY OCCLUSIONS J. V. COOK, P. I. IGNOTUS, K. A. Y O U N G E R and G. J. H U N T E R
THERAPEUTIC EMBOLIZATION F O R LIFE THREATENING PELVIC HAEMORRHAGE: RESULTS OF EIGHTEEN PROCEDURES S. J. G W Y T H E R and J. MClVOR
St George's Hospital, London
Chafing Cross Hospital, London
Purpose: The crossing of vascular occlusions prior to angioplasty can be
Eighteen embolizatiofi procedures were carried out on 15 patients with
ABSTRACTS
We analysed the quality of published data supporting the use oflasers to determine why, in spite of favourable reports, lasers have not found a place in routine angioplasty. Twenty-nine reports of laser angioplasty (1985 1989) published in major English language radiology journals were analysed. 1353 angioplastics were reported (47 per report, some reports duplicated data) using at least 30 individual laser systems. Technical success rates varied from 48-100%. Only three trials reported the use of a guidewire before laser. There were no contemporary controls. Follow up was 0-2 years and life table analyses were seldom used. It was often difficult to determine which vessels were successfully dilated and the nature of the lesions treated (some reports included femoral and iliac artery lesions, stenoses and occlusions). Many reports of laser assisted angioplasty have severe deficiencies and have not made a convincing case for the use of lasers. These deficiencies should be avoided in future assessments of devices introduced into angioplasty practice. TECHNIQUES OF ANGIOPLASTY FOR RENAL TRANSPLANT ARTERIAL STENOSIS R. A. EVANS, S. P. OLLIEE and H. WALTERS
Dulwich Hospital, London Arterial stenosis occurs in 10-15% of transplanted kidneys, and may cause renal impairment and/or hypertension. Percutaneous transluminal angioplasty has become the treatment of choice in recent years. We retrospectively reviewed our experience with this procedure over a 3 year period. Renal impairment in the absence of rejection on biopsy was the indication for angiography in the majority of cases. Doppler ultrasound has recently proved of value in the detection of transplant arterial
stenosis. Eighty-seven procedures were performed on a total of 58 patients (59 transplants). Dilatation was achieved in 57 transplants (96%). Improved techniques which have resulted in a recent high success rate are described. The choice of these is largely dependent on arterial anatomy. There was only one significant complication of anastomotic rupture which occurred in the high risk post-operative period, and was corrected surgically. Angioplasty is a safe and effective technique in the management of problems associated with renal transplant arterial stenosis. ANGIOPLASTY OF THE SUBCLAVIAN ARTERY N. K E N N A N , A. NICHOLSON, W. S H E R I D A N and M. S. R U T T L E Y
difficult. We have studied two new devices which address this problem the Rotacs catheter and the thermoprobe angioplasty catheter in order to evaluate their efficacy. Methods: Eleven patients with potentially difficult or long occlusions of the superficial femoral artery were selected. Following successful traversal of the occlusion, angioplasty was performed. Results: Rotacs was successful in 3/5 and the Thermoprobe in 5/6 patients. In the presence of heavily calcified plaque the Rotacs catheter was deflected leading to failure of the procedure. The Thermoprobe catheter failed to produce a sufficient channel for subsequent anglo, plasty in one patient. Conclusion: Both these devices are an alternative to laser angioplasty but they are cheaper, portable and offer no risk to the operator. The Thermoprobe can vaporize calcific material which would otherwise deflect the Rotacs. However, the Rotacs has the advantage of being steerable as it accepts a 0.035" wire and may be more useful in tortuous vessels. S U P E R I O R VENA CAVA S Y N D R O M E - TREATMENT BY P E R C U T A N E O U S METAL STENT INSERTION A.-M. BELLI and A. P. H E M I N G W A Y
Royal Hallamshire Hospital, Sheffield Superior vena cava syndrome is most often caused by bronchogenic carcinoma extending into the mediastinum. Traditionally it has been treated by aggressive radiotherapy. In some patients response to radiation is poor or the syndrome recurs after maximum-tolerance radiotherapy, due to tumour recurrence, post-radiation fibrosis or superimposed thrombosis. Five patients with bronchogenic carcinoma and SVC syndrome were referred for superior vena cavography with a view to stent insertion. Two were complicated by extensive venous thrombosis and were therefore considered unsuitable. Stents were successfully inserted via the femoral vein in the three cases of uncomplicated SVC obstruction. In all three cases the procedure was well tolerated by the patients with no sideeffects. Insertion of the Gianturco self expanding wire stent (William Cook U K Limited) is technically easy and rapidly performed and provides a simple alternative to radiotherapy with virtually immediate symptomatic relief. Local infusion of thrombolytic agents could extend the indications for stent insertion, but we have not yet performed this. Other indications include SVC stenosis secondary to non-malignant disease, e.g. complications following catheter or pacemaker insertion.
University Hospital of Wales, Cardiff Percutaneous transluminal angioplasty (PTA) is an accepted and widely used technique in the treatment o f coronary and lower limb arterial disease. Its role in subclavian artery stenosis or occlusion has not been so well recognized. We report our experience of subclavian artery angioplasty in 15 consecutive patients over a period of 6 years. The patients, 12 female and 3 male, ranged in age between 35 and 71 years. All had arm claudication, seven had acute hand ischaemia and six had neurological symptoms. Ten patients had significant stenosis, five patients had arterial occlusions. One patient had a right subclavian stenosis. Four of the five patients with occlusion and nine ~of the 10 patients with stenosis underwent successful angioplasty with abolition of the systolic blood pressure difference between the two arms. Eleven patients remain asymptomatic at follow up. in one patient recurrence of symptoms has been shown to be due to further more distal lesions, another has residual mild arm claudication after five years. The single patient with failed dilatation of a stenosis is thought on clinical grounds to have an arteritis. There were no significant complications, no episodes of neurological dysfunction or peripheral embolic events during or after the procedure. All patients with acute digital ischaemia considered to be embolic in origin have remained asymptomatic. In conclusion, we feel that angioplasty is a safe and effective treatment for symptomatic subclavian artery stenosis or occlusion.
USE OF THE ROTACS SYSTEM IN RECANALIZATION OF OCCLUDED CORONARY AND P E R I P H E R A L ARTERIES G. G. HARTNELL, R. P. H. WILDE and J. C. PITTS CRICK
Bristol Royal Infirmary, Bristol Many devices have been evaluated for recanalizing peripheral and coronary arteries. Some are potentially hazardous and others expensive. The Rotacs system (a non-cutting, slow speed rotating device) is promoted as a safe, low cost method for recanalizing occluded vessels which canno[ be crossed with conventional techniques. We report its application to these types of lesions. Rotacs was evaluated in 11 patients (seven with coronary artery occlusions or chronic hard stenoses preventing passage of a dilatation balloon, four with superficial femoral artery occlusions which could not be crossed with a guidewire). In coronary arteries the Rotacs was successful in crossing three total occlusions and one chronic severe stenosis. The Rotacs also crossed three superficial femoral artery occlusions. There were no technique related complications, in particular no evidence of dissection or thrombus formation on the wires. There was one episode of distal embolization in a patient with a chronic occlusion of a dilated right coronary artery which responded to streptokinase infusion. Recanalization was followed by balloon angioplasty in all cases with good symptomatic results. Although experience is currently limited Rotacs appears to be a relatively effective, inexpensive and safe alternative when conventional methods for crossing arterial stenoses or occlusions fail.
ROTACS AND T H E R M O P R O B E ANGIOPLASTY CATHETERS: EXPERIENCE OF NEW M E T H O D S OF CROSSING SUPERFICIAL F E M O R A L ARTERY OCCLUSIONS J. V. COOK, P. I. IGNOTUS, K. A. Y O U N G E R and G. J. H U N T E R
THERAPEUTIC EMBOLIZATION F O R LIFE THREATENING PELVIC HAEMORRHAGE: RESULTS OF EIGHTEEN PROCEDURES S. J. G W Y T H E R and J. MClVOR
St George's Hospital, London
Chafing Cross Hospital, London
Purpose: The crossing of vascular occlusions prior to angioplasty can be
Eighteen embolizatiofi procedures were carried out on 15 patients with