Mechanical revascularization of occluded iliac arteries with use of self-expandable endoprostheses

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is a technique used to treat narrowing and blockages in blood vessels. It involves inserting a balloon into the obstructed area by means of a catheter and inflating the balloon to open up the vessel. PTA is used to treat such blockages in the iliac arteries, which supply the pelvis and legs with blood. It is often used in conjunction with thrombolytic agents, which help dissolve blood clots, because early studies found that PTA alone was not highly effective in treating these problems. Vascular endoprostheses - artificial devices placed in the vessels t keep them open - are also used to treat narrowed vessels. This study examined the effectiveness in treating occlusions in iliac arteries of using self-expanding endoprostheses, or stents, after PTA and without using any thrombolytic therapy. Treatment and outcome were studied in 68 patients requiring treatment for occluded iliac arteries. Results showed PTA and stent placement was successful in 48 of 68 patients. The success rate improved over time, with an initial success rate of 56 percent in the beginning of the study increasing to 81 percent in the latter stages. All 48 patients having successful PTA showed clinical improvements. Reocclusions occurred in two patients within two months of treatment. Long-term follow-up averaging 8.3 months revealed no further reocclusions in the other patients. No major complications from PTA occurred. Two main findings emerged from the study. The first is that initial success rates for PTA tend to improve greatly with time as a result of experience. Secondly, using self-expanding endoprostheses improves the long-term effectiveness of PTA without the need for thrombolytic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Transluminal angioplasty, Balloon angioplasty, Arteries, Arterial stenosis

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Iliac and femoral artery stenoses and occlusions: treatment with intravascular stents

Article Abstract:

Atherosclerotic stenosis and occlusion (narrowing) of arteries is usually caused by the accumulation of plaque along the inside of the blood vessel walls and results in impaired blood flow. Flexible, self-expanding, metallic intravascular stents were used to treat 45 patients with atherosclerotic stenoses and occlusions of the iliac and superficial femoral arteries (which are located within the lower pelvis) to provide support to the vessels and improve blood flow in the lower extremities. Of this group, 37 patients received stents following inadequate balloon angioplasty (surgical removal of plaque from interior blood vessel walls). While several types of stents are available, researchers favorably report the use of the Wallstent because of its flexibility and ease of insertion. The Wallstent molds and affixes itself to the vessel wall and may also be used with tortuous (twisting) vessels. The development of clots (thrombi) is a complication associated with the use of stents and prior to insertion antithrombotic therapy should be initiated. At one year follow-up evaluation 40 of the 45 patients had patent vessels with stents in place. Two patients had developed thrombi; increased thickening of the vessel had caused stenosis of the stent in three patients and stent occlusion in one patient. Intravascular stents seem to be most useful to improve patency of the iliac and superficial femoral arteries after angioplasty, and to relieve stenosis in the presence of ulcerative plaques. Stents may also prove to be a valuable means of reducing complications following balloon angioplasty. Long-term evaluation of this technique and its effects on blood flow is needed before it becomes widespread.

Research, Physiological aspects, Arteriosclerosis, Blood vessels, Stent (Surgery), Stents, Angioplasty, Femoral artery

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Urinary bladder neoplasms: evaluation with contrast-enhanced MR imaging

Article Abstract:

The most common cancer of the urinary tract is carcinoma of the bladder. To plan appropriate treatment for bladder tumors it is necessary to identify the stage of the tumor. Computed tomography has been used for this purpose but is considered to be only 32 to 64 percent accurate. Magnetic resonance (MR) imaging without the use of intravenously administered contrast medium has provided only slight improvement in tumor staging. To examine the urinary tract of 48 patients with bladder neoplasms (abnormal tissue growth) researchers used MR imaging enhanced by the contrast agent gadolinium diethylene-triaminepentaacetic acid (Gd-DTPA) which produced an improved MR image. Gd-DTPA was valuable in detecting small bladder tumors and in differentiating between dead (necrotic) and living (vital) tissue within large tumors. Obtaining images before and after administering Gd-DTPA is advised.

Usage, Magnetic resonance imaging, Contrast media, Contrast media (Chemicals), Gadolinium, Urinary organs, Urinary tract, Bladder cancer

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