Regional infusion of urokinase into occluded lower-extremity bypass grafts: long-term clinical results
Article Abstract:
Treatment of diminished arterial flow (claudication) through the thigh, leg and foot (the inferior extremity) is in some cases treated by replacing the affected artery by a graft. Occasionally following the surgery the artery may become sealed off by a blood clot. This study follows the long-term effects of clot removal with a powerful enzyme, urokinase. Earlier studies have focused on the short-term effect of restoring the flow of blood through the vessel rather than long-term maintenance of adequate circulation. In the course of this study 53 patients received a total of 71 treatments with urokinase. The blockage was dissolved in approximately 75 percent of the grafts. Success at dissolving the clot was to some degree dependent on speed of treatment following the blockage, and the position of the graft. Forty-one complications relating to the urokinase treatment were treated either surgically or medically. Twenty-cases of bleeding, some severe, were reported. No statistically significant variables that were predictive of graft success were found. Although the results reported here were poorer than those from others who had reoperated following such consequences, they were in line with the values obtained by others who treated occluded vessels in a more conservative manner. In general the prognosis for patients with obstructions of lower extremity grafts is poor. Patients with grafts below the inguinal (groin) region have a five-year survival of only 48 percent. Although the best results for graft failure in these cases is aggressive treatment prior to obstruction, many cases remain unknown until obstruction is complete. This issue requires further study before a clear pattern of treatment designed for each individual patient is defined.
Publication Name: Radiology
Subject: Health
ISSN: 0033-8419
Year: 1989
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Isolated calf venous thrombosis: diagnosis with compression US
Article Abstract:
Compression ultrasound (US) is an imaging technique used on blood vessels in which images are obtained with high-frequency sound waves while the vessels are compressed so that they are collapsed. This technique is very useful in detecting deep venous thrombosis (DVT), blood clots in veins, in the leg. However, it is not usually performed on the infrapopliteal veins in the calf, and its accuracy in detecting DVT in these veins is not known. Recent studies have shown that DVT in these veins is more important than previously thought. This study examined the effectiveness of compression US in detecting DVT in infrapopliteal veins. Evaluations were made of 45 patients with swelling localized in the calf. Venograms, radiographs of the veins after injecting a contrast agent, were also performed for comparison. Venogram results showed 17 cases of calf vein thrombosis; 13 were DVT, and four of these were located in the superficial calf veins. US detected 15 of the 17 cases, for a sensitivity of 88 percent. US only found 1 of the 27 negative cases to be positive, for a specificity of 96 percent. These results indicate that compression US may be highly useful in diagnosing DVT in calf veins. Further studies are required to confirm these findings. Whether DVT in these veins is clinically significant is still under debate. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Radiology
Subject: Health
ISSN: 0033-8419
Year: 1991
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Simon nitinol inferior vena cava filter: initial clinical experience
Article Abstract:
The Simon nitinol filter is a device which is installed in the main system vein, the vena cava, to prevent blood clots (emboli) from entering the right side of the heart and being pumped into the lungs where the emboli could lodge in the small vessels of the lungs (pulmonary emboli). The use of a vena cava filter system is now accepted as the method of choice for the prevention of pulmonary emboli. The device is inserted through the skin in the groin and has been installed in 103 individuals at 17 participating institutions. The device is currently under clinical investigation and is subject to research control by the FDA. The device is made of a nickel-titanium alloy that when warmed in the body changes from its cold straight shape to a previously imprinted (memory) shape. It is inserted, cooled by a stream of chilled saline, into the vena cava. There it is warmed by the body until it expands to its filter shape and locks into place. All filters that were attempted were successfully inserted, and the device was not associated with difficulties of induction clotting. Only one filter failed in use. The device has proven to be simple, quick to install, and relatively free of significant complications. The Simon nitinol filter is compared to other similar filters.
Publication Name: Radiology
Subject: Health
ISSN: 0033-8419
Year: 1989
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