Fallopian tube recanalization in an unrestricted patient population.

PURPOSE: To review the effectiveness of fallopian tube recanalization (FTR) when performed without restriction based on history or tubal condition. MATERIALS AND METHODS: From October 1989 to July 1992 in 37 consecutive women, aged 22-44 years (mean, 35 years), 42 FTRs were performed (five patients each underwent two FTRs). Water-soluble contrast material and selective ostial salpingography and/or microcatheter technique were used exclusively. Eighty tubes were evaluated, since four patients had previously undergone unilateral salpingectomy. Sixty-three tubes (79%) were occluded at the outset of the procedure. RESULTS: Complete recanalization was achieved in 45 of 63 (71%) occlusions. Adhesions were present in 25 of 80 (31%) tubes, salpingitis isthmica nodosa in 12 (15%), and hydrosalpinx in nine (11%). The 42 procedures resulted in 14 (33%) conceptions, nine (64%) of which involved pathologic tubes. Eleven intrauterine pregnancies resulted in five spontaneous first-trimester abortions, five full-term deliveries, and one continuing pregnancy. CONCLUSION: Favorable conception and live birth rates can be achieved with FTR, despite a high prevalence of tubal disease.

Intraarterial chemotherapy with limb-sparing resection of large soft-tissue sarcomas of the extremities.

Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.

Palmaz vascular stent: initial clinical experience.

The safety and efficacy of the Palmaz balloon-expandable vascular stent and its effect on the results of percutaneous transluminal angioplasty (PTA) were assessed in a prospective study. Technical success was achieved in the placement of 34 of 35 stents (97%) in 27 common and external iliac artery lesions in 19 patients (23 limbs) who presented with disabling claudication, rest pain, or gangrene. Stent placement improved the angiographic results achieved by PTA alone in all 19 patients. Seventeen of 23 limbs (74%) had significant (greater than 20%) elevation of the ankle-arm index after combined angioplasty and stent placement, including nine limbs with occlusive outflow lesions. All 10 patients with continuous runoff distal to the stent and one patient with discontinuous runoff had resolution of their symptoms, remaining unchanged at a mean follow-up time of 6 months. There were three complications: One significantly altered the patient's hospital course, but none detracted from the achieved stent result. Stent placement is effective and does not significantly increase the complication rate of conventional iliac PTA. The current delivery system, however, may limit its utility.