[Peripheral pulsed laser angioplasty--4-year clinical experience]. / Periphere gepulste Laserangioplastie--Erfahrungen nach 4jährigem klinischen Einsatz.

In 134 patients, 21 iliac, 91 femoropopliteal and 22 crural arterial occlusions were treated by percutaneous laser-assisted angioplasty and in 32 patients femoropopliteal occlusions by conventional balloon angioplasty. Laser angioplasty could be performed in 126 patients following initial guide wire recanalisation using 9.7 and 4.5-F multifiber catheters, respectively. In 72 patients a 308-nm excimer laser and in 54 patients a 504-nm pulsed day laser was used. Luminal opening by laser angioplasty was obtained in 102 of 126 (81%) procedures (9 incomplete catheter passages, 15 persistent occlusions). 95% of iliac, 90% of femoropopliteal and 77% of crural recanalizations including supplemental balloon dilatations (n = 105) and stent implantations (n = 24) succeeded technically. Clinical success rates at 1 (2) years after angioplasty were 95% (89%) for iliac, 66% (63%) for femoropopliteal and 57% (50%) for crural treatments. Technical and clinical results of laser-assisted femoropopliteal recanalizations showed no significant differences in comparison to the results of conventional balloon angioplasty. The use of pulsed lasers for the treatment of peripheral arterial occlusive disease would require further technical improvements.

[Twiddler-Syndrome in a subpectoral implanted unipolar cardioverter-defibrillator]. / Twiddler-Syndrom bei einem subpektoral implantierten unipolaren Cardioverter-Defibrillator.

Twiddler's syndrome is a rare complication in patients with pacemakers. We report this very rare syndrome in a patient with pectoral implanted unipolar cardioverter defibrillator. This syndrome was detected because the patient presented in the 3 month routine visit an exitblock with an increased pacing impedance. The defibrillation threshold remained unchanged. The chest x-ray revealed an inferolaterally migrated generator with a multiply rotated lead. The intraoperative exploration showed a generator which was rotated nine-fold around its longitudinal axis with a multiple twisted unipolar lead. The lead was substituted and the aggregate fixed with a suture to the underlying muscle fascia. An atrophy of the pectoralis muscle was found in this patient which previously resulted from a long hospital stay. This atrophy was identified as a possible risk factor for the development of Twiddler's syndrome. This report illustrates that Twiddler's syndrome, a rare complication in patients with pectoral ICD, may become a significant problem in these patients as it is for pacemaker patients but with more serious possible consequences.