Retrograde approach for contralateral iliac and infrainguinal percutaneous transluminal angioplasty: experience in 100 patients

To assess the technical feasibility of percutaneous transluminal angioplasty (PTA) performed by means of a retrograde contralateral approach, 201 PTA procedures performed from January 1989 to August 1990 were retrospectively reviewed. In 100 of these cases, the retrograde femoral artery puncture employed for acquisition of the initial diagnostic arteriogram was also used for angioplasty of 173 contralateral arteries. The overall technical success rate for PTA via the contralateral route was 91% (157 of 173 arteries). Overall success for contralateral suprainguinal disease was 94% (61 of 65) and was as follows for infrainguinal disease: femoral, 88% (68 of 77); popliteal, 90% (18 of 20); graft anastomoses, 100% (five of five); and infrapopliteal, 83% (five of six). There were eight procedure-related complications, including one clinically insignificant distal atheroembolization, two sheared balloon fragments, three arterial thromboses, and two postprocedural amputations. There were no puncture-related complications. PTA can be performed with a contralateral retrograde femoral puncture in a high percentage of patients, even when disease is well below the inguinal ligament.

Extremity osteosarcomas: intraarterial chemotherapy and limb-sparing resection with 2-year follow-up

Twenty-eight consecutive patients with extremity osteosarcoma (24 stage II, four stage III) received their entire preoperative course of chemotherapy intraarterially in order to maximize local drug concentration and tumor shrinkage to facilitate limb-sparing resection. Eighteen tumors were located in the femur, seven in the tibia, two in the humerus, and one in the fibula. Most patients underwent two catheterizations; thus there was a total of 51 procedures. The average duration of each infusion was 10.4 days. There were eight procedure-related complications, but none precluded completion of intraarterial chemotherapy. Limb-sparing surgery was performed on 25 patients. At a mean follow-up of over 2 years, there was one local recurrence. Among limb-salvage patients with stage II disease, 90% (18 of 20) survived and 75% (15 of 20) are disease-free. Compared with patients from previous studies, this technique permits a high percentage of patients with osteosarcoma to undergo limb-sparing resection without compromise of local disease control or survival.