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Biomedical subjects

E E Starck

Publications and source records attributed to E E Starck.

9 recordsLinked to original sources
PubMed1992

Acute embolic occlusions of the infrainguinal arteries: percutaneous aspiration embolectomy in 102 patients.

Percutaneous aspiration embolectomy (PAE) was performed on acute embolic occlusions of infrainguinal arteries unrelated to percutaneous transluminal angioplasty or chronic atherosclerotic arterial occlusive disease. Of 102 patients, most (62.7% [n = 64]) had limb-threatening ischemia (stages III and IV according to the Fontaine classification); 86.3% (n = 88) had cardiac disease that caused the embolic occlusion. The clinical success rate was 87.3% (n = 89). Major complications occurred in 8.8% (n = 9) of the cases. The 30-day mortality was 3.9% (n = 4). In comparison with Fogarty-catheter embolectomy, PAE has a higher success rate and a lower mortality. PAE has several advantages: It is a simple technique with reduced invasiveness, combines a diagnostic and a therapeutic procedure, enables treatment of tibial and pedal vessels, and can be combined with all other angioplastic methods.

Acute Disease↗
PubMed1991

[Rotation aspiration thromboembolectomy].

Rotating aspiration thromboembolectomy (RAT) was performed in 32 patients (11 women and 21 men; mean age 68 [41-92] years with infrainguinal arterial occlusion, various conventional angioplasty techniques having been unsuccessful. Mean length of occlusion was 19.7 cm (2-47 cm). 17 patients were in stage IIb, 8 in stage III and 7 in stage IV (Fontaine classification). RAT consists of mechanical fragmentation of thrombotic or embolic occlusion material during simultaneous infusion of urokinase, followed by aspiration of the material. Primary success (residual stenosis less than or equal to 50%) was demonstrated by angiography in 31 of 32 patients, while primary clinical success (reduction by at least one Fontaine stage) occurred in 29 patients. These results demonstrate that RAT is a suitable method for the percutaneous intraluminal treatment of long thrombotic or embolic occlusions in which conventional angioplasty techniques have previously failed.

Adult↗
PubMed1986

Percutaneous aspiration thromboembolectomy (PAT): an alternative to surgical balloon techniques for clot retrieval.

Percutaneous aspiration thromboembolectomy (PAT) is an angiographic technique that can be used to remove thromboembolic debris from the distal lower extremity circulation. This procedure employs a specially designed catheter-sheath system, which can be used alone or in combination with balloon angioplasty or thrombolytic drugs (streptokinase 10,000 U/hr or urokinase 100,000 U/hr for 6 hours) to remove thromboembolic material. PAT is best suited for treating iatrogenic emboli resulting from intra-arterial catheterization or balloon angioplasty but can be used as a supplement to Fogarty embolectomy when retained distal clot cannot be retrieved by surgical means and for removal of primary distal emboli of peripheral vascular or cardiac origin. PAT was used in 42 patients with acute threatening limb ischemia. Successful clot retrieval and limb salvage were achieved in 40 of the 42 patients (95%). The major complication was groin hematoma (7 of 42 patients, 17%) and one death occurred as a result of myocardial infarction (2.4%). PAT enhances the therapeutic role of angiography and can be used as an alternative to surgical embolectomy in selected patients.

Aged↗
PubMed1985

Percutaneous aspiration thromboembolectomy.

Percutaneous aspiration thromboembolectomy (PAT) was used as an angioplastic tool to remove from arteries of the lower limbs thromboembolitic material originating from any source. PAT was performed with a custom-designed catheter/sheath system, alone or in combination with balloon dilatation and/or local lytic infusion therapy with streptokinase or urokinase. PAT completed the restoration of blood flow, thus improving the results of the preceding angioplastic interventions. Clinical improvement was high, with 93% success (42 of 45 procedures). Only one below-the-knee amputation occurred, and could not be prevented. No patient became worse because of PAT intervention. The Fogarty catheter technique remains the method of choice for removing emboli within the aorto-iliac region, but in the smaller vessels below the inguinal ligament-especially in the distal superficial femoral, popliteal, and tibial regions--in our experience PAT is superior. This has been substantiated also in studies of laboratory animals, using barium-impregnated emboli.

Aged↗
PubMedDate not supplied

Long-term results of percutaneous aspiration embolectomy.

PURPOSE: To evaluate percutaneous aspiration embolectomy (PAE) as a therapeutic alternative to surgical embolectomy. METHODS: Eighty-five patients underwent 90 PAEs for embolic occlusions below the inguinal ligament between October 1987 and September 1992 in a prospective study with a 96% follow-up. RESULTS: The first PAE was clinically successful in 77 limbs (86%). In eight cases, major amputation was necessary. Eleven of 13 failures were observed in limbs with acutely threatening ischemia, but the success rate was independent of the time interval from embolism to the PAE procedure. The 30-day mortality rate was 3.5%. The cumulative primary patency rate at 1 and 4 years was 68% and 58%, respectively. The limb salvage rate was 88% after 1 year and 86% after 4 years. The patency rate was significantly better and the mortality was significantly lower in patients receiving long-term anticoagulation with coumadin. CONCLUSION: PAE is highly effective in the treatment of embolic occlusions of the lower leg arteries and should be considered as an alternative to Fogarty balloon embolectomy.

Adult↗