RESUMEN
PURPOSE: To evaluate a continuous-infusion protocol for peripheral arterial thrombolysis using tenecteplase (TNK), with regard to the technique, dosing, infusion times, and clinical outcomes. METHODS: Between November 1999 and July 2002, 48 patients (30 men; mean age 68.5+/-11.9 years) presented with acute limb ischemia (ALI) owing to iliofemoral arterial thrombosis, which was treated with continuous TNK infusion (either 0.50 mg/h [n=22, group A] or 0.25 mg/h [n=26, group B]). All patients received periprocedural heparin (500 U/h) and peri and postprocedural tirofiban for 6 to 12 hours. Follow-up included ankle-brachial index and duplex ultrasound at baseline, 1 month, and 6 months. The variables retrospectively analyzed included total infusion time, total TNK dose, fibrinogen analysis, clinical and thrombolysis outcomes, and complications. RESULTS: The overall clinical procedural success was 95.8%. Complete (>95%) lysis was observed in 35 (73%) patients; overall mean infusion time was 7.5 hours, and overall mean TNK dose was 4.8 mg. No deaths, intracranial bleeding, or embolic events occurred in either group. Of the 8 (16.7%) complications, 5 (10.4%) were major: 1 femoral repair (group A), 2 >5-cm nonsurgical hematomas (1 in each group), and 2 gastrointestinal hemorrhages (1 in each group). The 3 (6.3%) minor complications were minor hematomas (2 in group A and 1 in group B). The 30-day and 14-month mean limb salvage rates were 95.8% (46/ 48) and 89.6% (43/48), respectively. CONCLUSIONS: Continuous TNK infusion (0.25-0.50 mg/h) is a safe and feasible treatment for continuous pharmacological thrombolysis in ALI, potentially offering decreased infusion times and bleeding complications, as well as improved outcomes.
Asunto(s)
Fibrinolíticos/administración & dosificación , Isquemia/tratamiento farmacológico , Pierna/irrigación sanguínea , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/administración & dosificación , Tirosina/análogos & derivados , Anciano , Quimioterapia Combinada , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Isquemia/etiología , Masculino , Persona de Mediana Edad , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Estudios Retrospectivos , Tenecteplasa , Trombosis/complicaciones , Trombosis/tratamiento farmacológico , Tirofibán , Resultado del Tratamiento , Tirosina/administración & dosificaciónRESUMEN
PURPOSE: To report the technique of carotid endarterectomy (CEA) combined with retrograde balloon angioplasty and stenting of proximal "tandem" lesions in the supra-aortic trunk. TECHNIQUE: Intraoperative techniques in 34 patients with 23 left common carotid artery (CCA) and 11 innominate artery lesions included general anesthesia, low-dose dextran, prosthetic patching, selective shunting, 8-F sheath entry into the native CCA before the CEA, manual CCA sizing, and balloon-expandable stent placement after predilation. The technique has a high procedural success rate (97%) and appears durable. Over a mean 34-month follow-up, 2 >70% ostial CCA restenoses were found at 24 months. CONCLUSIONS: Intraoperative innominate or left CCA balloon angioplasty/stenting combined with carotid endarterectomy is safe, effective, and durable.
Asunto(s)
Angioplastia de Balón/instrumentación , Tronco Braquiocefálico/cirugía , Arteria Carótida Común/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/instrumentación , Complicaciones Posoperatorias/diagnóstico por imagen , Stents , Angiografía , Tronco Braquiocefálico/diagnóstico por imagen , Arteria Carótida Común/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Terapia Combinada , Estudios de Seguimiento , Humanos , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Endovascular exclusion with covered stents is an alternative to surgical repair of iliac artery aneurysms (IAAs). We report a case where covered stent implantation failed to exclude an IAA, as demonstrated by persistent endoleak. The aneurysm was successfully excluded with a bifurcated aortoiliac endograft. This option should be considered for endovascular treatment of IAAs.
Asunto(s)
Implantación de Prótesis Vascular , Aneurisma Ilíaco/cirugía , Anciano , Anciano de 80 o más Años , Prótesis Vascular , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Arteria Ilíaca/cirugía , Masculino , Stents , Tomografía Computarizada por Rayos XRESUMEN
We report a new approach to preoperative vascular exclusion of a carotid body tumor. Before surgery, covered stents were placed in the external carotid artery, resulting in vascular exclusion of the tumor. Subsequent surgical excision was uneventful, with operative blood loss less than 200 mL and no neurologic complications postoperatively. This technique deserves further consideration as a reasonable alternative to conventional embolization.