Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.     

Relief of buttock claudication by percutaneous recanalization of an occluded superior gluteal artery

We report a case of a woman presenting with right severe buttock claudication and normal neurological and osteoarticular examination, in whom a guidewire recanalization and percutaneous transluminal angioplasty (PTA) of an occluded right superior gluteal artery (SGA) has provided relief of her symptoms. To our knowledge, this is the first report of percutaneous recanalization of the SGA. PTA can be considered the treatment of choice for buttock claudication caused by SGA stenosis or occlusion.     

Anatomy of the thoracic aorta: Magnetic resonance imaging and interpretation of flow phenomena

The authors present the results of magnetic resonance imaging (MRI) in the investigation of the anatomy of the thoracic aorta in a group of eight volunteers and in one patient with presumptive Takayasu's disease but with normal aorta. Transaxial, coronal, sagittal and oblique slices were made and the morphologic results are presented. Major flow phenomena are also discussed and some examples given.     

Transluminal angioplasty of failing infrainguinal arterial by-pass grafts: Initial and long-term results in 13 patients

Thirteen stenotic infrainguinal arterial bypasses (12 venous, 1 Gore-tex graft) were treated by transluminal angioplasty, either percutaneously (10 patients) or surgically (3 patients). Eleven procedures were immediately successful (two at the proximal portions of femoropopliteal grafts, six near the distal anastomoses, and three at the distal parts of femoroinfrapopliteal grafts) and dilated stenoses are still patent with a mean duration of 24 months in all patients except 2 who died during the follow-up period. The calculated cumulative patency rate is 85% at 36 months. Two procedures were followed by immediate disruption near the distal end of anin situ saphenous bypass graft where balloon inflation was performed. These required immediate surgical repair. Dilatation of the distal ends ofin situ saphenous femoropopliteal bypasses may not be as safe as in other locations.     

Percutaneous transulnar artery approach for diagnostic and therapeutic coronary intervention

While the transradial approach is now a well-established alternative to the conventional femoral approach for cardiac catheterization, the ulnar artery is rarely used. The objective of this prospective study was to evaluate the feasibility and safety of transulnar catheterization for routine diagnostic and therapeutic coronary interventions. Among 210 consecutive patients referred for diagnostic coronary angiography and or angioplasty and screened for appropriateness of the ulnar approach, 172 (172 of 210, 82%) underwent attempted ulnar artery catheterization, which was successful in 158 (158 of 172, 91%). The 173 procedures successfully performed via the ulnar approach included 122 diagnostic coronary angiographies, 38 coronary angiographies followed by angioplasty, and 13 elective angioplasties. Access site complications consisted of one case each of silent ulnar artery thrombosis, pseudoaneurysm, and hematoma due to ulnar artery wall rupture during an unsuccessful catheterization attempt. No cardiac or systemic complications were recorded. The transulnar approach appears feasible and safe for routine coronary diagnostic and therapeutic interventions.     

Localized dilatation of the bronchi. A misunderstood etiology of coronaro-bronchial fistula

The authors report the case of a coronary to bronchial artery anastomosis secondary to focal bronchiectasis. The diagnosis was made after finding large retroatrial vessels on coronary arteriography. A pulmonary steal syndrome, frequently reported in this condition in the literature, was not present in that particular case. The diagnosis of a coronary to bronchial artery anastomosis should alert the physician to possible underlying cardiac disease (Tetralogy of Fallot, supravalvular aortic stenosis, severe coronary artery disease). A bronchopulmonary etiology (chronic obstructive airways disease, multiple bullae, bronchiectasis) is less commonly found as the presentation is often atypical.     

Prevertebral lesions of the subclavian artery: long-term results of reconstructive surgery and percutaneous angioplasty

Short and long-term results were compared after reconstructive surgery and percutaneous transluminal angioplasty (PTA) of aortic arch trunks and subclavian arteries in 2 groups of patients (10 after dilatation and 12 after surgery). The technique used for treatment was selected as a function of distribution of lesions, their number and their appearance. Gruntzig's method was applied for PTA, while surgery consisted of either reimplantation of subclavian arteries into the main carotid artery or prosthetic by-pass procedures. Immediate and long-term (mean: 14 months) review examinations were by Doppler velocimetry and digital subtraction angiography. Thromboembolic complications secondary to PTA were not observed and there were no cases of recurrence of stenosis in the 10 patients after follow up for 13 months. Complications after surgery were one case of recurrence of stenosis requiring a repeat operation after 20 months, one case of thrombosis of carotid-axillary shunt after 19 months and one case of repeat surgery for lymphorrhea. Long-term results were very good in this series of 12 patients. It is difficult to compare results of the two techniques, patients treated by surgery having multiple lesions requiring combined procedures, and the number of cases treated being too low. However, PTA appears to be effective therapy for localized, non-ulcerated stenosis, and surgery for long or ulcerated stenosis, complete thrombosis and multiple lesions of aortic arch trunks justifying associated procedures.