Recanalization of total arterial occlusions with the Kensey dynamic angioplasty catheter

Article Abstract:

The study presents a clinical trial of a new device, the Kensey dynamic angioplasty catheter, which is used to cut-out atherosclerotic accumulation (an accumulation of material blocking arteries) and restore arterial supply. The device uses an oscillating cutting surface at the end of a steel cable. The tip is rotated at a speed of 80,000 RPM by a DC motor, and is lubricated by a physiologic fluid sprayed by an injector device. The effectiveness of this device was evaluated when it was used to treat twelve patients with blockages (occlusion) of leg vessels who could not be treated by traditional techniques because of their poor physical condition. Four of the patients were treated in the operating room and three did well. The fourth patient who had the procedure on both sides of the body had a good restoration of blood flow, but died as a result of a deteriorated general vascular condition. Eight other patients were treated by percutaneous placement of the catheter (via an insertion device through the skin) in the groin or thigh. Although seven patients had a good initial return of blood flow, four experienced an occlusion of their arterial system and required amputation below the knee. One had a serious complication, an embolism (a fragment of a blood clot) and required an above-the-knee amputation. Long-term surveillance of the other three patients who had successful results shows maintenance of the arterial blood flow.

Evaluation, Equipment and supplies, Arterial catheterization, Arterial occlusions, Arterial occlusive diseases

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Infrapopliteal and below-knee popliteal lesions: treatment with sole laser thermal angioplasty

Article Abstract:

The use of a laser instrument to open the bore of arteries in the leg (below the level of the knee) is reported. The technique, laser thermal angioplasty (the rebuilding of a vessel), has only recently been done successfully without the need for a follow-up balloon angioplasty, which involves placing a small balloon in the area of a vascular constriction and expanded to increase the bore of the vessel. In this experiment laser angioplasty was used without the assistance of a balloon to open obstructed arteries below the knee. Laser angioplasty was successful in 14 of 16 cases with documented improvement of blood flow in 70 percent of the patients. Various difficulties existed in three cases which caused the investigators to forego this form of therapy. At six months all patients' vessels remained open at the site of the laser treatment, but two patients had a return of their symptoms. The study demonstrates that this method is appropriate for the treatment of some vessels and compares favorably with the outcome that is obtained by the more conventional balloon angioplasty. The method may be an important advance if long term success is maintained.

Case studies, Popliteal fossa

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Percutaneous excimer-laser and excimer-laser-assisted angioplasty of the lower extremities: results of initial clinical trial

Article Abstract:

Percutaneous laser-assisted angioplasty of the lower extremities has been reported to be an effective technique for vaporizing atheroma, which is fatty degeneration or thickening of the walls of the larger arteries, often occurring as a result of atherosclerosis. This method can be performed with minimal generation of heat or damage to tissue. In clinical trials success was reported in 78 percent of the cases. Complications associated with the technique included four patients who had puncture-site hematomas, which is swelling or blood mass build-up. In follow-up assessment studies, all but one of the patients who were successfully treated became asymptomatic. The complications that the researchers observed during the study were largely procedural and not specifically related to the exciter-laser angioplasty process itself. Nine months after the procedure there was a restenosis rate of 29 percent. Further data on long-term follow-up is needed to completely define the clinical efficacy and relative cost-effectiveness of this approach.

Care and treatment, Atherosclerosis

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