Internal iliac artery angioplasty and stenting: an underutilized therapy.

BACKGROUND: Internal iliac artery (IIA) stenosis is a common finding in patients undergoing angiography. In patients with localized thigh and buttock claudication, endovascular treatment of an isolated IIA stenosis may lead to symptomatic improvement. METHODS: We retrospectively reviewed the records of nine patients who underwent IIA intervention for symptomatic thigh/buttock claudication. Patient demographics, angiographic status of both IIAs, and technical success were assessed by chart and angiogram review. Symptom relief was considered a successful outcome. RESULTS: Nine patients underwent unilateral or bilateral IIA angioplasty and/or stenting. There was a 100% technical success rate, and there were no complications. Six patients underwent a bilateral intervention and three underwent unilateral intervention. Fifteen arteries were treated. Seven arteries were treated with angioplasty, two with angioplasty and stenting, and six with primary stenting. Of the nine patients treated, seven had symptomatic relief from their claudication. Mean follow-up was 1 month. CONCLUSION: Percutaneous angioplasty and stenting of the IIA is technically feasible and safe. In patients who present with isolated proximal thigh and buttock claudication, IIA occlusive disease should be considered as an etiology. A majority of patients undergoing intervention report symptomatic improvement. Percutaneous intervention of the IIA has not been reported previously and should be an endovascular treatment option given its low morbidity and success rate. Also, there may be a beneficial role for IIA intervention in those patients undergoing unilateral IIA embolization during the course of endovascular aneurysmorrhaphy.

Verrucous carcinoma of the renal pelvis.

We report a case of a verrucous carcinoma of the renal pelvis after a long history of a renal pelvis stone. Only 1 case of verrucous carcinoma of the renal pelvis has been previously reported, and ours is the first case not associated with a horseshoe kidney.

Vein interposition cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts.

PURPOSE: The modification of the distal anastomosis of polytetrafluoroethylene (PTFE) bypass grafts with vein interposition cuffs (VCs) has been reported to increase graft patency. However, the mechanisms that are responsible for this improved patency are unclear. Because intimal hyperplasia (IH) is a primary cause of prosthetic graft failure, we hypothesized that VCs affect the distal anastomosis by decreasing the IH response of the outflow artery. METHODS: Twenty-three female domestic Yorkshire pigs (mean weight, 35 kg) underwent 42 femoral PTFE bypass grafting procedures. The PTFE bypass grafts were separated into the following three groups according to distal anastomotic configuration: end-to-side anastomoses (ES), VCs, and cuffs constructed with PTFE (PCs). Four femoral arteries from two pigs served as healthy controls. At sacrifice, the grafts were perfusion fixed, and the distal anastomoses harvested at 1 and 4 weeks. The specimens were hemisected and serially sectioned to identify the heel, toe, and mid-anastomotic regions. The sections were cut into 5-microm segments and analyzed for intima and media thickness and area, intima/media area ratio, and the distribution of IH in the vein cuff. The roles of transforming growth factor-beta1 and platelet-derived growth factor-BB in IH development were assessed with immunohistochemistry. RESULTS: IH development was significantly lower at all areas of the anastomosis, with VCs compared with ES and PCs at 4 weeks (P

Patency and limb salvage for polytetrafluoroethylene bypasses with vein interposition cuffs.

Polytetrafluoroethelene (PTFE) is often utilized in patients with limb-threatening ischemia requiring infrainguinal revascularization in the absence of autologous saphenous vein. To increase long-term patency of PTFE grafts, vein interposition cuffs have been recommended as adjunctive procedures. The purpose of this study was to assess the efficacy of vein interposition cuffs on the long-term patency and limb salvage of patients requiring prosthetic bypass grafts for limb-threatening ischemia. Prosthetic bypass grafts with vein interposition cuffs (PTFE/VC) were performed on 56 limbs in 55 patients (32 men, 23 women; mean age of 67 years) from October 1993 to January 1998. Grafts were prospectively evaluated every 3 months for the first 12 months and biannually thereafter with duplex ultrasonography. PTFE/VC and PTFE bypasses at the popliteal level appear to have comparable patencies. However, PTFE/VC appear to offer an improved patency and limb salvage for infrapopliteal bypasses in patients with critical limb ischemia. When infrapopliteal revascularization is required in the absence of autologous saphenous vein, we recommend the use of PTFE with vein interposition cuffs.