CLINICAL RESULTS AND COST EFFECTIVENESS OF RADIOFREQUENCY AND CYANOACRYLATE COMPARED WITH TRADITIONAL STRIPPING FOR TREATING VARICOSE VEINS

BACKGROUND

Disease of the venous system is an underappreciated public health problem. Minimally invasive treatments based on radiofrequency ablation (RFA) or cyano-acrylate adhesive ablation (CA) have almost entirely replaced surgical stripping (SS) of the great and small saphenous veins.

OBJECTIVE

The purpose of this study is to compare the outcome 3 years after SS, RFA, or CA by assessing complications and reintervention and performing a cost-effectiveness analysis.

METHODS

Between February 2016 and February 2019, all consecutive patients with symptomatic varicose veins from the Vascular Department of two hospitals who were treated with SS, RFA or CA were included in the study. The clinical outcomes were measured by quality-adjusted life years (QALYs), complications and reintervention. A comparison with conservative treatment was also performed. A detailed resource use was recorded for each procedure. All costs were normalized to May 2020 US dollars and euros. Analysis of the data was by treatment received. All statistical tests were two-sided, and the significance level was set at 5%. Two perspectives of the analysis were considered: the social perspective and that of the Spanish Public Health System (SPHS). The time horizon was 3 years. No discount rate was applied.

RESULTS

A total of 233 patients were enrolled in this study: 90 SS (38.6%), 93 RFA (39.9%), and 50 CA (21.5%). There were 11 complications in the SS group (12.2%) vs. 3 (3.3%) with RFA and 3 (6%) with CA (p = 0.06). There were no cases of reinterventions. The median loss of workdays was 15 days for SS (IQR 10-30), 0 days for RFA (IQR 0-6), and 0 for CA (IQR 0-1) groups, respectively (p < 0.001). The median level of satisfaction for SS was 9 (IQR 8-10), 10 for RFA (IQR 9-10), and also 10 for CA (IQR 9-10) (p < 0.001). The QALYs was 2.6 years for all three procedures. The medians overall cost is €852/US$926 for SS, €1002/US$1089 for RFA and €1228.3/US$1335 for CA. The total cost per QALY is 323 €/QALY (351US$/QALY) for SS; 380 €/QALY (413US$/QALY) for RFA and 467 €/QALY (508US$/QALY) for CA. Indirect cost was measured by workdays lost cost for each patient, for SS was €1527 (US$1660) (IQR 1018-3054); 0€ (IQR 0- 611) for RFA and 0€ (IQR 0-102) for CA (p < 0.001).

CONCLUSIONS

All three techniques were cost effective (procedures are recommended with an incremental cost-effectiveness ratio under 30,000€/QALY). From the SPHS perspective, when considering only health care costs, the most cost-effective technique was SS. From the social perspective, including the opportunity cost of medical leave, CA was the most cost-effective technique, saving €1600 per patient, a cost that more than compensates for the savings of SS in direct healthcare costs.

Erythrocyte concentrations of chromium, copper, manganese, molybdenum, selenium and zinc in subjects with different physical training levels

Background

The aim of the present study was to determine changes occurring in the erythrocyte concentrations of chromium (Cr), copper (Cu), manganese (Mn), molybdenum (Mo), selenium (Se) and zinc (Zn) in male subjects with different training levels living in the same region (Spain).

Methods

Thirty sedentary subjects (24.34 ± 3.02 years) formed the control group (CG); 24 moderately trained (4–7 h/week) subjects (23.53 ± 1.85 years) formed the group with a moderate degree of training (MTG) and 22 professional cyclists (23.29 ± 2.73 years), who performed more than 20 h/week of training, formed the high-level training group (HTG). Erythrocyte samples were collected from all subjects in fasting conditions, washed and frozen at − 80 °C until analysis. Erythrocyte analysis of trace elements was performed by inductively coupled plasma mass spectrometry (ICP-MS).

Results

The results showed that there was a statistically significant lower erythrocyte concentration of Cu, Mn, Mo and Zn in the MTG and HTG than CG. Se was only significantly lower in HTG than CG. The correlation analysis indicates that this change was correlated with training in the case of Cu, Mn, Se and Zn. All results are expressed in μg/g Hb.

Conclusions

We can conclude that physical training produces a decrease in erythrocyte concentrations of Cu, Mn, Se and Zn, which can cause a decrement in athletes’ performance given the importance of these elements. For this reason, erythrocyte monitoring during the season would seem to be advisable to avoid negative effects on performance.

Influence of an exercise until exhaustion in serum and urinary concentrations of toxic minerals among professional athletes, a preliminary approach

The aim of the present survey was to determine differences in the serum and urinary concentrations of several toxic trace elements (As, Be, Cd, Cs and Pb) between long distance runners and non-sportsmen living in the same area of Extremadura (Spain) in basal conditions as well as after the performance of a maximal effort test until exhaustion. 21 Spanish national long-distance runners were recruited before the start of their training season and 26 untrained students. All of them had similar ages. The effort test consisted in running on a treadmill incrementally in stages, until exhaustion. Serum and urine analysis of trace metals was performed by inductively coupled plasma mass spectrometry (ICP-MS). In the statistics the urine and blood basal concentrations was analyzed first using Student t test. Then the differences between the pre and post-test values were analyzed using Wilcoxon test. The serum concentrations of Be (p < 0.001), Cd (p < 0.01), Cs (p < 0.001) and Pb (p < 0.001) were higher in the athletes than the control groups in basal conditions. In relation to the exercise, the results showed that there were lower serum concentrations of Be, Cd and Pb after the test, but without statistically significance, in both groups. Cs (p < 0.001) concentrations were statistically lower after the exercise tests in both groups, but if the parameters were corrected in relation to hematocrit and hemoglobin concentrations the differences were significant only among the athletes. In urine, the concentrations of Be (p < 0.001) and Cd (p < 0.01) were higher among athletes than among controls, being the opposite case for urinary Pb values. In relation to the exercise-induced effect of the test, the results showed that among controls only Cd values were modified, but if creatinine corrections are applied this difference does not reach statistical significance. However, sportsmen suffered a diminution in Be values, that can be observed only if urine values are corrected. Also, an increase in Cd, both in corrected and normal values, was observed, fact that occurred also in the case of Cs, but only if urinary values are corrected. It can be concluded that an incremental exercise to exhaustion among elite athletes of long distance modalities can produce changes in serum and urinary concentrations of toxic trace elements which may reflect an adaptive mechanism to prevent toxicity, and which could be an interesting outcome for physicians in the treatment and prevention of toxic situations.

Comparison of urine toxic metals concentrations in athletes and in sedentary subjects living in the same area of Extremadura (Spain)

Cadmium (Cd), tungsten (W), tellurium (Te), beryllium (Be), and lead (Pb), are non-essential metals pervasive in the human environment. Studies on athletes during training periods compared to non-training control subjects, indicate increased loss of minerals through sweat and urine. The aim of this study was to compare the level of these trace elements, determined by inductively coupled plasma mass spectrometry (ICP-MS) in urine samples, between athletes and age-matched sedentary subjects living in the same geographical area, although anthropometric and cardiovascular measurements showed that athletes have significantly (P ≤ 0.001) lower BMI, body fat and heart rate, whereas the muscle and bone percentage was significantly (P ≤ 0.001) higher than in sedentary subjects. The validity of the methodology was checked by the biological certified reference material. Trace element analysis concentrations, expressed in μg/mg creatinine, of five toxic elements in urine from athletes (n = 21) versus sedentary subjects, (n = 26) were as follows: Cd (0.123 ± 0.075 vs. 0.069 ± 0.041, P ≤ 0.05); W (0.082 ± 0.053 vs. < limit of detection); Te (0.244 ± 0.193 vs. 0.066 ± 0.045, P ≤ 0.001), Be (0.536 ± 0.244 vs. 0.066 ± 0.035, P ≤ 0.001); Pb (0.938 ± 0.664 vs. 2.162 ± 1.444 P ≤ 0.001). With the exception of Pb, urine toxic metal concentrations from athletes were higher than from sedentary subjects. This fact suggests that physical activity counteracts, at least in part, the cumulative effect of toxic environment by increasing the urine excretion of toxic metals in trained people.

Effects of aerobic exercise on urinary estrogens and progestagens in pre and postmenopausal women

The purpose of this study was to elucidate the effect of 6 months of aerobic exercise on urinary excretion of female steroid hormones in pre and postmenopausal women and to check the basal values of urinary steroid. To this end, 20 premenopausal (age 45.56 ± 4.06 years) and 20 postmenopausal (age 52.27 ± 3.80 years) women, all sedentary, were studied before and after a supervised 6-month exercise training program (at 60-70% of maximal heart rate, 60 min/day, 3 days/week), based on aerobic dance. The exercise included standing on one leg, squatting, walking, and touching their heels. Before and after the program, anthropometric data and VO(2max) were measured and urine samples were collected and analyzed by gas chromatography/mass spectrometry (GC/Q-MS). Both, pre and postmenopausal women, improved their VO(2max) after the aerobic exercise program. Regarding the urinary steroids, on the one hand, important differences were observed between urinary estrogens and progestagens in pre and postmenopausal women in basal values. Estrone (P < 0.05), pregnanediol (P < 0.01), pregnanetriol (P < 0.05), and estriol (P < 0.01) levels were lower in postmenopausal women than in premenopausal women. On the other hand, the aerobic exercise program did not affect postmenopausal women in the same way as premenopausal women. After the exercise program, no changes in urinary steroid levels were observed in premenopausal women. However, the aerobic exercise program caused an increase in urinary excretion of pregnanediol (P < 0.05) and pregnanetriol (P < 0.05) in postmenopausal women.

Endovascular treatment for pseudoaneurysms after surgical correction of aortic coarctation

Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coarctation, which were treated by endovascular means.

Carotid artery stenting without angioplasty and cerebral protection: a single-center experience with up to 7 years' follow-up

BACKGROUND AND PURPOSE

The use of cerebral protection during CAS in the treatment of carotid artery disease is matter of controversy. The purpose of this study was to evaluate the outcome of CASWBAP in a large cohort of patients, with ≤7 years' follow-up.

MATERIALS AND METHODS

Two hundred thirty-six patients with 255 symptomatic carotid stenoses and/or with high-risk-morphology plaques of >50% and asymptomatic plaques of >70% were prospectively identified. Patients underwent neurologic and carotid US examination before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Plain films of the neck were obtained immediately after the procedure and then at 1 and 3 months.

RESULTS

Technical success was achieved in 253/255 (99%) patients. Primary stent placement was successful in 248/253 (98%) patients. Neurologic periprocedural complications within 30 days included 1 (0.4%) nondisabling stroke, 1 (0.4%) disabling stroke, 11 (4.3%) TIAs, and 1 (0.4%) death. The mean duration of follow-up was 23 ± 1.4 months (range, 3-84 months). During the follow-up period, there were 9 additional deaths (7 unrelated to the carotid disease and 2 stroke-related) and 2 strokes (in other vascular territories). The degree of stenosis decreased from a mean of 82% before the procedure to a mean of 30% immediately after. During follow-up, 38 (14.8%) angioplasties were performed due to restenosis in 19 (7.4%) patients, lack of stent expansion in 14 (5.4%), or both in 5 (1.9%).

CONCLUSIONS

CASWBAP is effective and safe with a low incidence of periprocedural complications, providing satisfactory long-term clinical results.

The effect of high level tennis matches on urine steroid profiles in professional tennis players

AIM

Modern day, tennis matches are characterized by shorter and more intense efforts with players enduring great physical and psychological stress. The aim of this study was to evaluate acute changes in the urinary steroid profile of elite tennis players following professional tournament matches.

METHODS

Eight professional male tennis players participated in this study. Urine samples were collected before and after tennis matches corresponding to the quarter finals of the Spanish Tennis Masters.

RESULTS

After the match, there was a significant fall (P<0.05) in testosterone, androsterone, etiocholanolone, and dehydroepiandrosterone (DHEA). Cortisone increased whereas tetrahydrocortisone (THE) decreased. The anabolic/catabolic hormone ratio also decreased, although only the fall in total suprarenal androgen (TSA)/total corticosteroid (TC) and DHEA/(THE+THF) ratios had a significant decrease (P<0.05).

CONCLUSION

These results indicate that a professional tennis match modifies the urine steroid profiles of players, increasing corticosteroid and decreasing androgen excretion in urine, suggesting an important adrenal activation.

Primary stenting immediatly after surgery in occluded anastomoses of aortoaortic tube graft: a case report

The conventional elective open procedures for abdominal aortic aneurysm repair are reliable and yield durable results. The aortoaortic tube graft has the lowest morbidity incidence when compared with different techniques. Albeit infrequent, thrombosis can be present in the first 30 days. Its treatment consists in thrombectomy and anastomosis evaluation, but with an increase in morbidity, especially in patients with urgent reintervention. This is a case report of a patient with aortoaortic tube graft, who present critical left limb ischemia immediately after surgical procedure. Angiography showed complete occlusion of left common iliac artery, affecting the distal graft anastomosis. The occlusion was resolved with endovascular treatment, and a noncovered, self-expanding, nitinol stent was deployed (primary stenting) covering the distal bypass anastomosis, with no complications and complete lower limb perfusion recovery. One month later, the patient was still asymptomatic, with distal pulse palpable and ankle-brachial index 1.

Effect of different exercise intensities on oxidative stress markers and antioxidant response in trained cyclists

Traditionally, physical activity has been associated with beneficial effects on the organism. However, exercise has been shown to increase the production of reactive oxygen species (ROS) to a point that can exceed antioxidant defences, causing oxidative stress. Characteristics of exercise such as the intensity or duration seem to be associated with oxidative damage. The aim of this study was to evaluate the effect of exercise of two different cycling intensities on oxidative stress and antioxidant response in trained males. Twenty male trained cyclists participated in this study. The maximal exercise test consisted of an incremental cycling test until voluntary exhaustion, and the submaximal test was a steady state at 75% VO(2max) for 30 min on a cycloergometer. In maximal exercise test (16+/-4 min of cycling), the results showed an increase in malondialdehyde (MDA) from 40.6+/-2.0 to 45.4+/- 18.4 microM (p<0.05) in plasma and from 0.21+/-0.10 to 0.23+/-0.12 micromol/g Hb (P<0.05) in erythrocytes, also vitamin C increased in plasma from 3.80+/-1.60 to 5.20+/-2.16 mg/mL (P<0.05) and it decreased from 130.5+/-34.7 to 83.4+/-30.0 mg/g hemoglobin (P<0.05) in erythrocytes, whereas there were no changes in vitamin E concentrations. In submaximal exercise, no significant differences were obtained in MDA, vitamin C or vitamin E. In conclusion, short time of high intensity cycling leads to oxidative stress increasing plasma and decreasing erythrocyte vitamin C levels.

Salvage of a subacute failure in femoral dialysis loop graft using stent covering the arterial and venous anastomosis

Endovascular treatment can be considered the first line therapy in the majority of dysfunctioning arteriovenous fistula. However, when early thrombosis of the arteriovenous access occurs, surgical treatment is recommended. In these cases, technical problems are the most frequent cause of the malfunction. We report a case of a subacute thrombosis of an arteriovenous fistula, femoral artery to femoral vein looped ePTFE with venous anastomosis occlusion and subocclusion lesion at the arterial anastomosis. Both anastomoses were treated using self-expandable stents, and no other intervention was necessary until the one-year follow-up for maintain patency.

Evaluation of urinary steroid profile in highly trained cyclists

AIM

A regular and intense physical exercise significantly modifies hormonal metabolism and there are many reports of a change in urine steroid levels accompanying the practice of sport. The aim of this study was to compare the urinary steroid profile between highly trained cyclists and untrained subjects.

METHODS

Urine levels of testosterone (T), epitestosterone (Epit), androstenedione, dehydroepiandrosterone (DHEA), androsterone (A), etiocholanolone (E), beta-estradiol (E2), estrone (E1) and the most abundant urine metabolites of cortisol and cortisone, tetrahydrocortisone (THE) and tetrahydrocortisol (THF) were determined by gas chromatography-mass spectrometry in urine samples from a group of professional cyclists (n=15) submitted to maximum level training for several years and compared with urine samples from sedentary subjects (n=15). The relationships between T/Epit, A+E/ THE, A+E/ THF, DHEA/THE and DHEA/THF were also studied.

RESULTS

Cyclists showed lower urine levels of T, A, E and E2 and higher urine levels of androstenedione and E1 than sedentary individuals. A+E/THE and A+E/ THF ratios were higher in sedentary subjects than in cyclists.

CONCLUSION

We conclude that cyclists showed a urinary steroid profile different from sedentary individuals, probably due to an adaptation to regular and intense physical training .

Carotid stenting without use of balloon angioplasty and distal protection devices: preliminary experience in 100 cases

BACKGROUND AND PURPOSE

A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices.

MATERIALS AND METHODS

Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals.

RESULTS

Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10-36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after.

CONCLUSIONS

In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

Treatment of innominate arterial stenosis with self-expanding stent: long-term follow-up

We report our experience with the use of a self-expanding stent in the treatment of a severe innominate artery stenosis resulting in right upper limb ischemia. A 45-year-old woman was admitted for right upper limb ischemia, asymmetry of the carotid pulse and the lack of pulse in the right upper extremity. The patient had a history of chain smoking, hypertension, hypercholesterolemia, and acute myocardial infarction one year ago. She was diagnosed of the innominate artery stenosis by angiography one year ago at another hospital. At the time of admission her blood pressure was normal in the left arm and absent in the right upper limb. Arteriography showed a severe stenosis subocclusion of the innominate artery with an inverse flow of the ipsilateral vertebral artery. As the patient was not considered to be a surgical candidate due to instable angina, stent placement was indicated. After placement through an axillary approach an angiogram showed a patent right subclavian artery without residual stenosis. Angiographic follow-up showed a patent innominate arterial lumen two years after the procedure. The patient continued to be asymptomatic during six years follow-up. Blood pressure remained normal in both upper extremities, without any ischemic signs. Our experience indicates that placement of an endovascular stent is an effective therapeutic option in selected patients with symptomatic stenosis in the innominate artery when a surgical treatment is contraindicated.

Menopause-induced changes in lipid fractions and total fatty acids in plasma

The purpose of the present work was to evaluate the changes induced by the menopause in plasma lipids and total fatty acids.

METHODS

35 post-menopausal and 25 non-postmenopausal women were included in the study. Plasma triglycerides (TG), total cholesterol (TC) and HDL-C concentrations were detemined enzymatically. Plasma fatty acids were determined by capillary gas chromatography.

RESULTS

Total cholesterol was higher (p < 0.05) in the postmenopausal women (6.18 +/- 0.77 mmol/l vs. 5.21 +/- 0.85 mmol/l). No significant changes were observed, however, in TG, HDL-C or LDL-C. The study of plasma fatty acids showed the post-menopausal women to have raised levels (p < 0.05) of stearic acid (C18:0), oleic acid (C18:1), and decrease of arachidonic acid (C20:4). Also noteworthy was the significant decrease (p < 0.001) of the desaturation index D5 (3.82 +/- 1.75) in the post-menopausal women. The SHBG level was lower (p <0.001) in the post-menopausal women (55.98 +/- 20nmol/l) than in the non-menopausal women (68.36 +/- 30 nmol/l). Multivariate analysis revealed correlation between menopause and SHBG (r = -0.3904, p < 0.05), D5 (r = -0.500, p < 0.001), TC (r = 0.3137, p <0.05), stearic acid (r = 03564, p < 0.05) and oleic acid (r = 0.2954, p < 0.05).

CONCLUSION

In post-menopausal women, as well as higher total cholesterol, the alterations in plasma fatty acids may constitute an important risk factor for cardiovascular diseases.

Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites

BACKGROUND

Some cirrhotic patients with tense ascites who undergo paracentesis develop a circulatory dysfunction syndrome, manifested by an increase in plasma renin activity. Recently, a significant inverse correlation between postparacentesis changes in plasma renin activity and systemic vascular resistance has been demonstrated in these patients, suggesting that peripheral arterial vasodilatation could be responsible for this circulatory dysfunction, but the mechanisms by which tense ascites removal induces such changes are unknown

AIM

To investigate the role of a decrease in intra-abdominal pressure (IAP) in the development of early postparacentesis haemodynamic changes

METHODS

Eleven cirrhotic patients with tense ascites received a large volume paracentesis. A specially designed pneumatic girdle was used to compress the abdomen to avoid a decrease in IAP during ascites removal. Haemodynamic studies were performed before paracentesis, one hour after ascites flow stopped, and 30 minutes after pneumatic girdle deflation

RESULTS

When IAP was maintained at its original level, no haemodynamic changes were observed, despite large volume paracentesis. However, a significant decrease in systemic vascular resistance was seen immediately after pneumatic girdle deflation

CONCLUSIONS

Early haemodynamic changes after paracentesis are avoided if IAP is maintained at its original level. The abrupt decrease in IAP could be the trigger for the development of the initial haemodynamic changes that eventually produce postparacentesis circulatory dysfunction.

Endovascular repair of abdominal aortic aneurysm in a renal transplant patient

A 65-year-old man presented with an asymptomatic infrarenal abdominal aortic aneurysm of 6 cm in transverse diameter. Five years before he received a cadaveric renal transplant. The patient also had the following risk factors and associated diseases: arterial hypertension, coronary artery disease, previous myocardial infarction, coronary angioplasty and stent, ileal resection secondary to Chron disease, hepatopathy, hyperlipidemia and hepato-renal cystic disease. The ASA classification was III, IV. Considering previous abdominal operations and risk factors, we decided to repair the aneurysm with a minimal aggression. The aneurysm was successfully approached by an endovascular route implanting a 22x10 bifurcated aorto-iliac endovascular prosthesis. The patient died 13 months later after being diagnosed of enterocolitis by cytomegalovirus complicated with sepsis and lung infection. We consider this less invasive modality of treatment a valid and useful alternative in this high-risk group of patients.

Implantation of a composite bifurcated cryopreserved aorto-iliac-femoral homograft in a patient with Candida albicans endocarditis

A 35 year old woman, cocaine addict, suffered Candida albicans aortic valve endocarditis complicated with embolisation of infected vegetations in the distal abdominal aorta. She underwent successful staged aortic valve replacement followed by transaortic and transfemoral thrombectomy. One month later an arteriogram disclosed partial occlusion of the left iliac artery, bilateral aneurysmal degeneration of both iliac arteries and right iliac artery-right iliac vein fistula. She was operated again, performing re-laparotomy and re-exploration. A composite bifurcated cryopreserved homograft was implanted end-to-side between the infrarenal abdominal aorta, right external iliac artery and left common femoral artery. The right iliac artery-iliac vein fistula was obliterated with suture. The patient had an uneventful recovery but a relapsing arterio-venous fistula was diagnosed by arteriography. Three months later she underwent percutaneous transluminal closure of the reopened fistula. At present, 17 months after the implantation of the homograft, the patient is symptom-free, on antifungal agents and with arteriographic and clinical evidence of a well-functioning arterial homograft.

Recanalization of thrombosed superficial femoral arteries with a hydraulic thrombectomy catheter in a canine model

OBJECTIVE

This experiment was conducted to evaluate efficacy and safety of the Oasis thrombectomy catheter on arterial thrombosis in dogs.

MATERIALS AND METHODS

Thrombosis was induced in 18 femoral arteries of nine mongrel dogs. Recanalization of the thrombosed femoral artery was performed using a thrombectomy catheter 7-10 days after thrombus induction. Pre- and postprocedural arterial status was documented by angiography. After mechanical thrombectomy, the animals were sacrificed and the femoral arteries were harvested and examined macro- and microscopically. Additionally, in vitro fragmentation was carried out to determine particle size and distribution from the recovered effluent.

RESULTS

Subacute thrombosis was successfully created in 15 femoral arteries. Full recanalization was achieved in 80% (12/15) of the thrombosed femoral arteries without any residual thrombus. No significant downstream embolization was documented angiographically. Endothelial denudation was observed in all the treated arteries along with occasional disruption of the internal elastic lamina. No medial injury was seen. Ninety-eight percent of thrombus was liquefied, defined as particles smaller than 15 microm, by the catheter. Particles larger than 400 microm represented 0.27% of the original clot weight.

CONCLUSION

Occluded femoral arteries with 7- to 10-day-old thrombus can be efficiently recanalized with the Oasis catheter in dogs without any significant complication. This thrombectomy catheter appears to be highly effective and safe and requires no sophisticated equipment. Blood loss was our major concern regarding use of this catheter but can be minimized by strictly controlling activation time and restricting the inflow into the vascular segment being treated.

Diagnosis and percutaneous treatment of gastrointestinal hemorrhage. Long-term experience

OBJECTIVE

to report our experience in the diagnosis and treatment of gastrointestinal hemorrhage.

METHOD

from April 1987 to April 1997, 196 patients with gastrointestinal hemorrhage (134 men and 62 women) were studied. 165 (84%) were diagnosed as presenting upper gastrointestinal hemorrhage, and 31 (16%) presented lower gastrointestinal hemorrhage. The patients were studied with endoscopy and arteriography, and embolization was prescribed in 131 (67%). Patients with bleeding from esophageal varices were excluded from this study.

RESULTS

a bleeding point was identified angiographically in 33% (n = 65) patients. 131 (67%) patients were treated with therapeutic embolization, which was successful in 89% (n = 116) patients. The bleeding was resolved in 80% (n = 93) of the patients. Complications included arterial spasm (n = 12), pain (n = 24), coil migration (n = 8), allergic reaction (n = 2) and celiac trunk dissection (n = 2). During follow-up 16 patients presented rebleeding that stopped after reembolization in 9 cases, whereas in 7 cases surgery was needed.

CONCLUSIONS

in our experience, diagnostic angiography and percutaneous therapeutic embolization are effective, less aggressive methods that lead to few complications. Both methods have become indispensable tools in managing patients with gastrointestinal hemorrhage that does not respond to conservative therapy. Even in patients with no evidence of angiographic bleeding, embolization in selected patients is successful.