Long-term follow-up of Symphony nitinol stents in iliac arteriosclerosis obliterans.

The purpose of this study was to evaluate the long-term results of iliac artery stent placement with use of the symphony stent for the treatment of patients with intermittent claudication. In a prospective study, 31 cases of iliac occlusive arterial disease were treated in 26 patients. Stenoses (n = 27) were treated after failed angioplasty, and occlusions (n = 4) were treated with primary stent placement. Clinical history, clinical stage and the ankle brachial-index (ABI) examination measurement were assessed. The patients were followed up with clinical examination, ABI examination measurement and intravenous angiography. The follow-up period ranged between 9.5 months and 7.5 years (median = 5.9 yr). Data were analyzed using the univariate analysis (Kaplan-Meier method). The mean+/-SD ABI pre-, post-procedure and in the last control was 0.70+/-0.17, 0.97+/-0.15, and 0.96+/-0.20, respectively. Primary patency rates (%) +/- SE were 83+/-7 after 3 years, 75+/-8 after five years, and 67+/-9 after seven years, and secondary patency rates were 93+/-5 after three years, 86+/-7 after five years, and 86+/-7 after seven years. During the first 24 hours, one patient presented occlusion of the treated segment. During follow-up, 9 (29%) patients were admitted to our hospital because of worsening of the symptoms. In this study, the symphony stent has been proven to be a good device to treat lesions in the iliac region but more experience is needed to optimize endovascular treatment in this area. In our experience the treatment of iliac artery occlusive disease with symphony stents can be considered a good option with acceptable patency rates and low morbidity and mortality.

Long-term follow-up of iliac wallstents.

We evaluated the long-term results of the iliac artery stent placement for the treatment of patients with intermittent claudication. From November 1988 to December 1998, 303 legs were treated with metal stents in 259 patients with iliac occlusive arterial disease in a follow-up study approved by the institutional review board. Stenoses (n = 162) were treated after failed angioplasty and occlusions (n = 141) were treated with primary stent placement. According to Fontaine's clinical classification of chronic ischemia, 266 (88%) legs presented stage IIB, 14 (5%) stage III, and 23 (7%) stage IV. In all legs, self-expandable stents (Wallstent) were implanted. The patients were followed up with clinical examination, ankle brachial- index examination measurement and intravenous angiography. The data were analyzed using the univariate analysis (Kaplan-Meier method) and multivariate analysis (Cox proportional model). The primary endpoint of the study was the identification of restenosis or reoclusion of the stenting arterial segment and a secondary endpoint that was an identification of the risk factors of restenosis and reoclusion. The mean +/- SD ankle-brachial index pre-, post-procedure, and in the last control was 0.58 +/- 0.18, 0.90 +/- 0.23, and 0.86 +/- 0.24, respectively. Primary cumulative patency rates were 70% +/- 4 after 5 years, and 65% +/- 5 after 7 years, and secondary patency rates were 92% +/- 2 after 5 years, and 87% +/- 4 after 9 years. Immediate complications in the first 24 hours appeared in 12 (4%) legs, thrombosis in 5 legs, 3 legs presented with distal embolism, 2 thrombi at the access site and pseudo aneurysm and artery rupture in 1 leg. A patient died in the first 24 hours. Within 30 days after the procedure seven complications, 3 thromboses and 4 stenosis appeared. During follow-up, 42 (16%) patients died of other causes. The main causes of death were cardiac disease (39%), cerebrovascular disease (15%), cancer (7%), respiratory diseases (4%), and death due to accidents (2%), and other causes (9%). In 24% of the cases there was insufficient information to assign a principal cause of death. Thirty-six patients (13%) were lost to follow-up. Complications arose in 54 (18%) legs due to occlusion of the treated segment (29%), and stenosis due to intimal hyperplasia (27%). Thirteen patients required surgical treatment. Primary and secondary patency mean time was 80 +/- 3.7 and 102 +/- 2.4 months, respectively. We found no significant relation between patency and the quality of run-off, but a small vessel diameter and the female gender were negative predictive factors for failure (proportional hazards model). The use of stents for treatment of iliac artery occlusive disease may be considered an effective method with a low complication rate and acceptable long-term follow-up results.

Utilidad del gadolinio como medio de contraste en procedimientos terapéuticos endovasculares / Utility of gadolinium as a contrast medium in endovascular therapeutic procedures

Objetivo: Valorar la utilidad del gadolinio asociado al CO2 como medio de contraste angiográfico para la realización de procedimientos terapéuticos endovasculares en pacientes que presentan alteración de la función renal. Material y métodos: Desde enero del 2000 a junio del 2001 se realizaron 10 tratamientos endovasculares usando CO2 y gadolinio como medio de contraste en pacientes con deterioro de la función renal (creatinina > 1,5 mg/ml).Resultados: La dosis media de gadolinio administrada fue 42 ml. En todos los casos las imágenes diagnósticas o terapéuticas fueron satisfactorias. No se detectaron incrementos significativos entre los valores de urea y creatinina previos y los obtenidos a las 24, 48 y 72 horas después del procedimiento. Conclusión: El gadolinio es un medio de contraste útil en combinación con CO2 para la realización de procedimientos terapéuticos endovasculares en pacientes con deterioro de la función renal (AU)

Uso del CO2 como medio de contraste angiográfico en el diagnóstico de hemorragia hepática aguda: a propósito de un caso / Use of CO2 as an angiographic contrast material in the diagnosis of acute hepatic hemorrhage: a case report

La arteriografía selectiva abdominal con contraste yodado es el método de elección para la detección del punto de sangrado en pacientes con hemorragia digestiva aguda en los que los estudios endoscópicos fueron negativos. El CO2 ha sido utilizado con éxito como medio de contraste para la realización de arteriografías abdominales y de miembros inferiores. Presentamos el caso de un paciente con sospecha de sangrado digestivo que se detectó de forma más rápida y precisa usando el CO2, en relación con las arteriografías realizadas con medio de contraste yodado (MCI) (AU)