Percutaneous transluminal angioplasty

Lateral internal sphincterotomy is not redundant in the era of glyceryl trinitrate therapy for chronic anal fissure

Lateral internal sphincterotomy has been the standard treatment for chronic anal fissure, but fissure healing rates of up to 80% with topical glyceryl trinitrate (GTN) treatment have suggested that this operation may become redundant. We evaluated the results of topical treatment of chronic anal fissures with 0.2% GTN for 6 weeks in the outpatient clinical setting, outside the confines of a randomized clinical trial. The role of lateral internal sphincterotomy in the GTN era was also assessed. GTN induced fissure healing in 21 of 49 consecutive patients. Fissures healed spontaneously in 2 patients who discontinued GTN because of headache. Lateral internal sphincterotomy was performed in 26 patients who had persistent symptoms after 6 weeks of GTN therapy. At the 6-week post-sphincterotomy review, all fissures had healed and there were no complications. In this study topical GTN for treatment of chronic anal fissure in the outpatient setting was not as effective as demonstrated in controlled clinical trials. Lateral internal sphincterotomy is still a good therapeutic option, especially in patients not responding to GTN.

Percutaneous arterial recanalization

The current status of new techniques for percutaneous arterial recanalization, including laser, thermal and mechanical angioplasty techniques, is described. The reported results, potential advantages and possible future developments are discussed.

Long-term results of percutaneous transluminal angioplasty: a study of 4750 dilatations and local lyses

During a period of 8 years 4750 percutaneous transluminal angioplasties and local lyses have been performed in the Department of Radiology of the University of Freiburg and the Hochrheinklinik Bad Sackingen. From 1984 to 1987 all patients have been assessed clinically and in 320 cases angiographically. Lesions were localised mainly to the pelvic and the femoro-popliteal regions. The short and long term results have been compared, i.e. 2-8 years after PTA. Patients with occlusive disease from stage IIa to stage IV were treated. Long-term success of PTA (2-8 years after the intervention) reached 85% in stage IIa, 73% in stage IIb, 68% in stage III and 36% in stage IV, when all treated lesions were included.

Intraoperative transluminal balloon dilatation permits simpler safer reconstructive surgery

The clinical and radiological features of seven patients in whom intraoperative transluminal balloon dilatation was used, are described. Indications and advantages of the technique are discussed.

Human percutaneous laser angioplasty. Patient selection criteria and early results

Percutaneous transluminal laser angioplasty is a new method for treating atherosclerotic disease previously not amenable to routine percutaneous transluminal angioplasty techniques. Our results compared favorably with other clinical trials. Patient selection criteria include lesions in the superficial femoral or popliteal system not capable of being treated with routine percutaneous transluminal angioplasty. We think that these lesions include high-grade stenoses or short segmental occlusions. Heavily calcified vessels and long segment occlusions measuring greater than 12 cm in length are probably not amenable to percutaneous transluminal laser angioplasty. The long-term results of this form of therapy for peripheral vascular disease remain unknown.