Femoropopliteal In-stent Restenosis Repair: Midterm Outcomes After Paclitaxel Eluting Balloon Use (PLAISIR Trial).

OBJECTIVE: The aim was to assess 18 month outcomes of the paclitaxel eluting balloon (PEB) in patients with femoropopliteal (FP) in-stent restenosis (ISR). METHODS: In a national prospective and multicentre cohort study, symptomatic patients with femoropopliteal in-stent restenosis were included from January 2012 to June 2013. Patients were treated by paclitaxel eluting balloon angioplasty (In Pact Admiral, Medtronic, Santa Rosa, CA, USA). Clinical and duplex scan follow-up evaluations were performed at 1, 3, 6, 9, 12, and 18 months. The primary endpoint was freedom from target lesion revascularisation (TLR) at 12 months. Secondary endpoints were major adverse cardiovascular events (MACE), Target extremity revascularisation (TER), primary and secondary sustained clinical improvement, recurrent restenosis rate, primary and secondary patency, quality of life assessed by EQ-5D questionnaire, technical success, clinical success, and length of stay RESULTS: A total of 53 patients were enrolled. After a blinded review, 10 patients were defined as protocol violation because restenosis occurred more than 2 years after stent implantation. Procedures were performed in 55 limbs, 48 (87%) for claudication and 7 (13%) for critical limb ischaemia. The mean diameter and length of PEB were 6 ± 0.57 mm and 86 mm ± 32 mm, follow-up was 17 months (range 1-19). At 1 year, the survival rate was 96 ± 2.7% and freedom from TLR and TER were 90.2 ± 4.2% and 85 ± 5%, respectively. Sustained primary and secondary clinical improvements were 78.6 ± 5.7% and 92.0 ± 3.8%, respectively. At 1 year, the primary patency rate was 83.7 ± 5.0%. Prior to the procedure, the mean EQ-5D score was 66 ± 14 and 74 ± 16 at 1 year (p = .10). Two patients died during follow-up; one patient died 33 days after the procedure because of limb ischaemia. CONCLUSION: PEB for the treatment of FP ISR is associated with a low rate of re-interventions and restenosis. Clinical improvement is maintained at 18 months.

The role of polyester patch angioplasty in carotid endarterectomy: a multicenter study.

The objectives of this study were to examine the morphology, restenosis, dilatation, and possible complications of polyester collagen impregnated carotid patches. Between March 1994 and January 1995, 207 patients (56 females and 151 males) undergoing 221 carotid endarterectomies (CE) with a collagen-impregnated knitted polyester patch were enrolled in a European prospective multicenter study. Patches were used for arteries deemed to be smaller than usual by visual inspection. General anesthesia was used in 201 procedures (91%), and a shunt was used in 76 procedures (34.4%). One hundred fourteen CE (51.6%) were checked by a perioperative arteriography or angioscopy. The diameter of the internal carotid artery (ICA) and carotid bulb (CB) were measured by duplex scan both preoperatively and every 6 months during follow-up. The main end point was carotid occlusion or restenosis, defined as a stenosis of 50% or more according to NASCET criteria. Carotid polyester-impregnated patches appear to be reliable. The patch was easy to cut and suture, and hemostasis was obtained immediately. No rupture occurred. However, the higher restenosis rate in women may restrict the use of polyester patch to men.

The LGM Vena-Tech caval filter: results of a multicenter study.

Caval filters have proved essential to the progress being made in the prevention of recurrent pulmonary embolism. A prospective multicenter study was conducted to evaluate the efficacy and possible complications relating to the LGM Vena-Tech percutaneous caval filter, which has been used in Europe since 1989. A total of 222 patients who had undergone LGM Vena-Tech filter placement between September 1989 and December 1991 were included in this study. Two hundred twenty caval filters were positioned via the percutaneous route: 154 of them via the jugular or subclavian vein and 66 via the femoral vein. Two filters could not be implanted. The in-hospital mortality rate was 1.7% (four patients), which included one patient who died of intraoperative recurrent pulmonary embolism. Mean follow-up was 15 months. Forty-one patients died during follow-up (actuarial survival 65.4% +/- 6% at 30 months). There were five cases of recurrent pulmonary embolism (cumulative freedom from pulmonary embolism 93.2% +/- 3.8% at 30 months). Ten patients had thrombosis of the inferior vena cava (actuarial caval patency 94% +/- 3.6% at 30 months). Eight filters (3.6%) migrated over distances that were less than the height of one vertebra. Shifting did not lead to any cases of thrombosis or recurrent pulmonary embolism. Ten filters tilted between 15 and 25 degrees in relation to the inferior vena cava axis. Recurrent pulmonary embolism never occurred concurrently with filter tilting. The LGM Vena-Tech caval filter ensures satisfactory prevention of pulmonary embolism with a low rate of complications. However, because its long-term fate is not known, its use should be restricted to cases in which heparin treatment has failed or is contraindicated.

[Acute acalculous gallbladder disease in children: acute cholecystitis or acute gallbladder distension (author's transl)]. / Pathologie vésiculaire aiguë non lithiasique de l'enfant: cholécystite aiguë ou distension vésiculaire aiguë (à propos de 2 cas).

Acute acalculous gallbladder disease is rarely encountered in children. Two observations permit a review of its clinical, diagnostic, and therapeutic aspects. Acute acalculous cholecystitis and acute gallbladder distension present clinically in a similar fashion, although, in the latter the fever is usually absent and there is a history of episodic pain. The pathogenesis of these affections remains uncertain but generalized infection and anomalies of the cystic duct seem to be favoring circumstances. The diagnosis, rarely initially made, could be confirmed by oral cholecystography showing an non visualized gallbladder. Surgery is necessary in order to confirme or refute the diagnosis. The therapeutic approach can be either the simple drainage of the gallbladder or a cholecystectomy. Due to the risk of allowing a cervicocystic obstacle persist, it seems that a cholecystectomy, which is well tolerated by the child, would be preferable.