Percutaneous transluminal angioplasty with drug-eluting balloons for salvage of infrainguinal bypass grafts.

PURPOSE: To evaluate the safety and feasibility of using drug-eluting balloons (DEBs) in the treatment of infrainguinal bypass graft stenoses. METHODS: A nonrandomized prospective study evaluated the feasibility of DEB treatment for intragraft/anastomotic stenoses arising >1 month after infrainguinal bypass grafting; stenoses due to graft/technical problems (e.g., vein torsion) were excluded, as were failed grafts that could not be successfully recanalized with catheter-directed thrombolysis. Between February 2010 and February 2012, 41 patients (35 men; mean age 71 years, range 46-87) were treated with DEBs for 63 anastomotic/intragraft stenoses in vein or prosthetic grafts. Follow-up was performed with duplex ultrasonography. The primary endpoint at 12 months was graft occlusion or >50% restenosis at the DEB treatment site. RESULTS: DEB treatment was technically successful in 61 (96.8%) of the 63 lesions with no complications other than one instance of vasospasm; one totally occluded segment and one restenosis were treated surgically. The mean follow-up was 16.7 months (range 3-24). The estimated cumulative target site primary and secondary patency rates at 6 months were 91% and 96%, respectively, and 70% and 90%, respectively, at both 12 and 18 months (no restenoses after 12 months). The estimated mean durations of primary and secondary treatment site patency were 20.3 and 22.7 months, respectively (p=0.033). At 6 and 12/18 months, the cumulative rates were 96% and 90%, respectively, for graft patency and 98% and 93% for freedom from amputation. CONCLUSION: DEBs proved to be a feasible, safe, and effective treatment for vein and prosthetic bypass graft stenoses, with excellent technical success and acceptable short and midterm patency.

Intraoperative embolization with poloxamer 407 during surgical resection of a carotid body tumor.

Surgical excision is the preferred definitive treatment for carotid body tumors, although postoperative morbidity rate as quoted in the literature is rather high. Morbidity includes cranial nerve dysfunction, stroke, and the majority severe blood loss. Embolization of the feeding branches of the external carotid artery can be performed a few days prior to surgery with the intention to decrease blood loss during operation, facilitate surgical resection, and reduce operating time and morbidity. The special risk of embolization is migration into the intracranial circulation. Poloxamer 407, a reverse-thermal polymer, is a nontoxic compound that is a viscous liquid at room temperatures but instantly changes to a firm water-soluble gel when warmed to body temperature. It dissolves spontaneously or can be dissolved at will by cooling. We describe an intraoperative technique for complete devascularization of carotid body tumor by using an intraarterial temporary occlusion technique with a poloxamer 407.