[Laser versus rotation angioplasty in the recanalization of chronic femoropopliteal arterial occlusions]

Between June 1987 and July 1989 laser angioplasty, and between July 1989 and December 1991 rotation angioplasty was used as the method of choice for the recanalisation of chronic (minimal duration 3 months) arterial occlusions in the femoro-popliteal region. The technical success rate and final results following supplementary balloon dilatation were identical and there was no significant difference between the two groups (laser 87%, rotation 87.7%). For long occlusions (more than 150 mm), the success rate for rotation angioplasty was 60% and significantly higher than for laser angioplasty at 40%. Complication rates for rotation angioplasty were 24.3%, higher than laser angioplasty with 20.3%. This was due to the higher incidence of emboli of 12.1% compared with the laser technique of 7.3%. Cumulative patency rates after two years showed no significant difference (uncorrelated/correlated: laser 53.4%/67.8%; rotation 56.6%/67.5%). Using lytic and aspiration techniques, the higher incidence of embolisation during rotation angioplasty had no adverse effect on final outcome. If both methods are available, it is advisable to treat long occlusions by rotation angioplasty because of the high immediate success rate, whereas short occlusions are best dealt by laser angioplasty because of the lower incidence of embolisation.

[The peripheral macroembolism as a complication of laser angioplasty of the arteries of the extremities--therapy using interventional radiologic measures]

From 1987 to 1989 in the Barmherzige Brüder Hospital in Linz/Austria 160 arteries of extremities were treated with laser-assisted balloon dilatation. During these interventions peripheral macroembolism occurred 8 times. The mean length of the recanalised segment was 8.7 cm and thus longer than average (6.5 cm). All 8 cases were successfully treated by aspiration or aspiration combined with local lysis. No adverse effects on long-term results were noted. In 4 cases an early occlusion of the recanalised segment was diagnosed within 48 hours after laser-assisted angioplasty, three times accompanied by embolism. These emboli, too, were removed by aspiration and lysis. To reduce the risk of embolisation strict rules of indication concerning the age of an occlusion have to be observed and mechanical trauma has to be minimised.

Percutaneous transluminal angioplasty of crural arteries

The authors dilated 103 stenosed crural arteries in 71 patients. Primary success was defined as traversing and reducing the lesion to a residual stenosis of less than 30%. This was achieved in 96% of cases. Complications included one vessel rupture and one occluding intimal flap, which were treated by the vascular surgeon with bypass and venous patch, respectively. One hematoma at the puncture site was treated surgically because of its size. With modern materials such as steerable guide wires and low-profile balloon catheters, dilation of crural arteries has become safe. Until now, the indications for percutaneous transluminal angioplasty (PTA) of crural arteries have been limited to Fontaine stages III and IV disease. The authors believe that the indications for PTA in Fontaine stage IIb disease are justified, especially if intervention improves outflow after a more proximal recanalizing procedure is performed.

[Femoropopliteal laser recanalization--a multicenter study]

Laser-assisted angioplasty was performed in four different hospital centers, following the same treatment protocol and using an Nd-YAG laser with a sapphire-probe catheter. The initial recanalization rate of 259 femoro-popliteal occlusions with a mean length of 7.5 cm was 84%. Dissections or perforations were observed in 10%. An emergency surgical intervention was required in 1.1%. The long-term patency rate of the successfully recanalized arteries was 74% after 2 years. The cumulative cure rate of all 259 patients was 62%.

[Pharmacophlebography with dihydroergotamine]

Insufficient imaging of the deep venous system of the lower limb can be expected in phlebography varying in number with the kind of venous disease. Either too little contrast is achieved or even a pair of deep veins are missed. Studying the effects of dihydroergotamine a shift of blood flow from surface to depth could be proven. In consequence a second phlebography after administering dihydroergotamine led to a decisive contrast enhancement in 85.7% and to the imaging of the missing veins in 75%. A control study without application of a pharmacon did not show these results. Administering 0.5-1.0 mg of dihydroergotamine i.v. (providing no contraindication is present) can improve the diagnostic value of phlebography in problem cases.