The Simpson atherectomy catheter in the management of complete obstructions

The Simpson atherectomy catheter has been used successfully to recanalise eleven complete occlusions of the iliac and femoropopliteal arteries. Atherectomy and angioplasty were used in combination in 8 cases. Following atherectomy, all patients showed clinical improvement. Distal pulses returned in 7; rest pain and/or claudication disappeared in the other 4. Ischaemic ulcers healed in the 2 affected patients. Overall, ankle-arm indices (AAI) improved by an average of 0.43, with the improvement being greatest (0.55) in patients in whom the lumen was recanalised to within 91-100% of the native luminal diameter. Seven patients have remained with stable AAI values and without change in their clinical status at 18 months follow-up.

Changes in the number of leukocytes and lymphocyte subpopulations induced by exercise in sedentary young people

The influence of physical exercise on the quantification of leukocytes and lymphocyte subpopulations has been studied. These cells were obtained from blood taken from eleven healthy young men and women who follow a sedentary life style, before and after vigorous exercise (running). The results indicate that physical activity increases the number of white blood cells and the concentrations of circulating lymphocytes. The proportion of T-lymphocytes, estimated as rosette forming cells with sheep red blood cells after cold incubation, is constant, whereas a corresponding increase in cells with receptors for C3b or Ig-Fc is also observed. The data indicate that physical activity leads to an irregular intravascular discharge in stored cells.

Use of Gianturco self-expandable stents in the tracheobronchial tree

Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.

Percutaneous atherectomy as an alternative treatment for postangioplasty obstructive intimal flaps

Intimal flaps are commonly seen angiographically after percutaneous balloon angioplasty. Nonobstructive flaps are normally of little clinical significance, but flaps that obstruct blood flow may lead to partial or complete thrombosis. The Simpson atherectomy catheter was used to treat obstructive intimal flaps after angioplasty in four patients. Lumen patency was reestablished in all four cases. The clinical results were excellent, with rest pain and claudication resolved in all four patients and distal pulses reestablished in one. These findings suggest that the Simpson atherectomy catheter can be used to remove large obstructive flaps complicating angioplasty.

Percutaneous transluminal angioplasty as best treatment in stenosis of vascular access for hemodialysis

We show the results of treatment with percutaneous transluminal angioplasty on 38 occasions for vascular access for hemodialysis. Our study includes 22 patients with A-V internal fistulas (Cimino type), 1 autologous saphenous vein shunt and 7 synthetic polytetrafluoro-ethylene shunts. Twenty patients have had a follow-up period over 24 months. Four patients required a second and 2 of them a third transluminal dilatation. Only on two occasions were complications related to the technique. The microscopic findings of the venous wall after percutaneous transluminal angioplasty are shown.

A new technique for introduction of large instruments into the vascular system

A new introducer system for large devices is described, which is easily manufactured from commonly available materials in a hospital environment.

Esophageal strictures: balloon dilation

One hundred seventy transnasal balloon catheter dilation procedures were performed in 35 patients with esophageal strictures to assess the efficacy and safety of the procedure. On the average, five dilations were required per patient. Depending on the cause of the esophageal stricture, success rates for the technique ranged from 67% to 87%, with success defined as the resolution of dysphagia to both fluids and solids. Three complications, all perforations, were seen; one perforation required surgical repair. No procedure-related deaths were identified in this series. Balloon catheter dilation can be safely applied to esophageal strictures from a variety of causes, with a high degree of clinical success.