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Biomedical subjects

F J Roth

Publications and source records attributed to F J Roth.

At least 19 recordsLinked to original sources
PubMed1999

[Possibilities and limits of interventional therapy in chronic peripheral arterial occlusive disease].

In the therapy of the chronic peripheral vascular occlusion, angioplasty is rarely used to treat the infra-renal aortic stenosis, whereas the stenosis and the short occlusion of the iliac artery is a classical indication. Primarily, stenoses and occlusions of the iliac artery should be treated with balloon angioplasty exclusively. Only secondarily, when the result of angioplasty was insufficient, e.g. remaining stenosis or dissection, stent implantation is appropriate. Angioplasty is most frequently applied in the obliteration of the femoro-popliteal artery. It can be stated that early- and long-term results are the better, the shorter the occlusion is. Stent implantation in the femoro-popliteal artery should be avoided because of poor results. Only with the intention of limb salvage, when there is no opportunity for surgical treatment, a stent implantation should be considered. In case of recurrent stenoses after stent implantation, angioplasty can be reapplied with great success. The indication for any vascular intervention should be a decision of both, the interventional radiologist and the vascular surgeon, because both kinds of treatment are palliative and not causal. It is the task of the angiologist to do clinical diagnostics and the after-treatment. Quality monitoring is indispensable. It consists of documentation of pre-angioplasty diagnostics and should be able to prove the correct indication for the intervention. The result of the intervention should also be documented by angiography and functional tests. Regular control of the patient after the intervention is necessary for the early recognition of recurrent stenoses.

Angiography↗
PubMed1996

[Coarctation of the abdominal aorta].

HISTORY AND FINDINGS: When a 27-year-old woman went to her general practitioner with symptoms of acute gastroenteritis he noted a paraumbilical murmur on auscultation. There were no symptoms of intermittent claudication or abdominal angina. All peripheral pulses were easily palpable and bilaterally equal, and there were no vascular murmurs. Physical examination and blood pressure (140/70 mm Hg bilaterally) were normal. INVESTIGATIONS: Biochemical tests gave no indication of inflammatory disease. Oscillography showed a brief decrease in amplitude after muscular exertion, predominantly of the thigh. Posterior tibial systolic pressure was 20 mm Hg lower than radial pressure on the right, 25 mm Hg on the left. Colour Doppler sonography demonstrated elongated and looping coarctation of the abdominal aorta. TREATMENT AND COURSE: As the patient had no symptoms only regular follow-up was indicated. There have been no symptoms for 27 months and no progression of the coarctation. CONCLUSION: In young patients with the described symptoms abdominal coarctation should be included in the differential diagnosis.

Acute Disease↗
PubMed1995

[Percutaneous transluminal angioplasty of the deep femoral artery. Retrospective evaluation of early technical and clinical results in 196 cases of catheterization].

AIM: Stenosis of the deep femoral artery with simultaneous occlusion of the superficial femoral artery usually is considered to be a classical indication for vascular surgery. Angioplastic therapy of this vessel is rarely reported. Retrospective analysis of the technical and clinical results following catheter treatment of the deep femoral artery was performed to demonstrate the possibilities of this less invasive method. MATERIAL AND METHOD: 196 angioplasties in 174 patients were performed. 77 patients (39%) suffered from stage II disease according to Fontaine classification (grade I category 2/3 [Rutherford]), 36 (18%) from stage III (grade II category 4) and 75 (38%) from stage IV (grade III category 5). RESULTS: Catheter treatment was successfully performed in 77% (151/196) of the cases. Clinical improvement was seen following 61% (96/196) of the treatments. The complication rate was 3.4% (7/196: thrombosis of the CFA, ascending occlusion of the SFA, occlusion/spasm of the arteria circumflexa femoris lateralis, pulmonary embolism). CONCLUSION: Catheter treatment is a minimal invasive, cost-effective alternative to surgical reconstruction of the deep femoral artery.

Adult↗
PubMed1993

[Color-coded duplex ultrasonography in the diagnosis of renal artery stenosis].

To diagnose possible renal artery stenosis in 120 patients (36 women, 84 men; mean age 57.3 [21-84] years) colour duplex sonography (CDS) of the renal arterial tree was performed before 53 intraarterial angiographies and 67 central venous digital subtraction angiographies. The criterion of stenosis was a maximal flow velocity of > 180 cm/s in the colour duplex sonogram and a diameter reduction of > 50% in the angiogram. CDS demonstrated the renal artery bed in 209 of 247 renal arteries (85%). 84 of the 209 had regional maximal velocities of > 180 cm/s. The sensitivity and specificity of CDS when comparing it with both angiographic methods (in 185 cases that could be evaluated, in 74 of them with abnormal results) were 91 and 88.2%, respectively. Comparing CDS results with those by intraarterial angiography alone (88 cases, with 51 abnormal findings), sensitivity and specificity were 92.1 and 91.8%, respectively. These results demonstrate that CDS can reliably demonstrate flow obstructions in the renal arterial tree and can thus be recommended for the diagnosis of renovascular hypertension.

Aged↗
PubMed1993

[Determination of the length of the occlusion in extremity arteries--color duplex ultrasound versus angiography].

In the management of patients with peripheral arterial occlusive disease the length and location of an arterial occlusion has an impact on the choice of the method of arterial reconstruction, i.e. percutaneous transluminal angioplasty or vascular surgery. The aim of this study was to determine the accuracy of colour-coded Doppler sonography (CDS) compared to conventional contrast arteriography in detecting the length and localisation of an occlusion in peripheral arteries. 100 legs of 94 patients (27 women, 44 to 82 years of age [mean 60.9 years] and 67 men, 21 to 78 years of age [mean 61.3 years]) with clinically suspected artery occlusion were examined prospectively with CDS before angiography and angioplasty. The exact localisation was correctly diagnosed by CDS in 95% with a high correlation (r = 0.95) of occlusion length between both methods. The sensitivity in detecting occlusions was 98% (positive predictive value 98%). It is concluded that colour-coded Doppler sonography can diagnose the length and location of an occlusion in peripheral arteries accurately and therefore can be used as a noninvasive method to select patients for further therapy management.

Adult↗
PubMed1993

Noninvasive assessment of pressure gradients across iliac artery stenoses: duplex and catheter correlative study.

The present study investigates prospectively the validity and accuracy of the simplified Bernoulli equation in the duplex-derived determination of pressure gradients across iliac artery stenoses in patients with occlusive artery disease. In 28 patients (age range, 38 to 76 years; mean, 53 years) with short iliac artery stenoses, we obtained both duplex scan stenotic jet velocity and catheter pressure measurements. Mean and maximum pressure gradients were determined by both methods, as was the peak-to-peak catheter gradient. The correlation between the duplex-determined and nonsimultaneously measured catheter mean pressure gradients was r = 0.77 (standard error of the estimate [SEE] = 5 mm Hg), that between the duplex-derived and catheter-determined maximum pressure gradients was r = 0.80 (SEE = 10 mm Hg), and that between maximum duplex-determined and peak-to-peak catheter gradient was r = 0.76 (SEE = 12 mm Hg). The peak-to-peak catheter gradient was significantly lower than the maximum duplex-derived gradient (46 versus 53 mm Hg, P < 0.05). Duplex-determined mean pressure gradient decreased from 15 +/- 6 to 3 +/- 1 mm Hg after balloon angioplasty of the iliac stenoses. Duplex scan can be used to predict pressure gradients across short iliac artery stenoses, provided that errors caused by angle malcompensation are prevented.

Adult↗
PubMed1993

Accuracy of duplex scanning in the prediction of pressure gradients across peripheral artery stenoses.

The present study investigates the validity and accuracy of the modified Bernoulli equation in the Doppler-derived evaluation of pressure drops across peripheral artery stenoses. Conventional duplex-derived (x) and catheter-measured (y) mean and peak pressure gradients across iliac artery stenoses were determined in 35 iliac arteries of 28 patients. The correlations between both methods were r = 0.84 (n = 35; SEE = 4; y = 0.89x + 2) for the mean and r = 0.86 (n = 27; SEE = 10; y = 0.76x + 11) for the peak pressure gradients. In a second study, color-coded duplex-derived (x) and catheter-measured (y) pressure gradients across iliac artery stenoses were determined in 28 further patients. The correlations were 0.86 (n = 28; SEE = 5; y = 0.98x + 0.5) for the mean and r = 0.83 (n = 18; SEE = 15; y = 0.83x + 4) for the peak pressure gradients. These data show that the modified Bernoulli equation can be applied to predict pressure gradients across iliac artery stenoses in patients with peripheral artery diseases.

Adult↗
PubMed1993

Recanalization of chronic arterial occlusions: low-speed rotational angioplasty. 5 years experience in peripheral and coronary vessels.

Chronic complete occlusions still represent the major technical limitation of percutaneous transluminal angioplasty, both in peripheral and coronary vessels. The clinical use of low-speed rotational angioplasty started in 1986 for the peripheral and in 1987 for the coronary arteries, and has already become part of the clinical routine in several centres. Up to now more than 350 patients with peripheral and 250 patients with coronary occlusions have been treated in Frankfurt; a multicentre questionnaire already contains information about 1,252 patients with peripheral vessel obstructions. In peripheral occlusions the acute success rate was more than 80% if low speed rotational angioplasty was used as the first attempt; after failure of conventional techniques still more than 60% of the vessels could be recanalized successfully. In addition to occlusions of the arteries of the lower limb, indications now may include the iliac artery and the subclavian artery. In each of the patients with chronic coronary occlusions an attempt with conventional techniques had failed before. Following a learning curve, which was also influenced by a better understanding of morphological preconditions, the acute success has now reached 70%. Both in patients with peripheral and those with coronary occlusions the technique turned out to be a safe procedure. Early angiographically documented long-term results in both indications are comparable with conventional balloon techniques. It is concluded that the use of low-speed rotational angioplasty (ROTACS) can improve the results of non-operative invasive treatment, both in peripheral and in coronary arteries.

Angioplasty↗
PubMed1992

[Reopening chronic arterial occlusions].

Chronic complete occlusions still represent the major technical limitation of percutaneous transluminal balloon angioplasty, both in peripheral and coronary vessels. The clinical use of low speed rotational angioplasty (ROTACS) started in 1986 for the peripheral and in 1987 for the coronary vessels, and has already become part of the clinical routine in several centers. Up to now, more than 300 patients with peripheral and more than 200 patients with coronary occlusions were treated in Frankfurt. In peripheral occlusions the acute success rate was more than 80% if used as the first attempt; after failure of conventional techniques still more than 60% of the vessels could be recanalized successfully. In addition to occlusions of the arteries of the lower limbs, the indication now includes the iliac artery and several other indications are under investigation. In each of the patients with chronic coronary occlusions an attempt with conventional techniques had failed before. Following a learning curve, which was also influenced by a better understanding of morphological preconditions, the acute success rate has now reached 70%. Both in patients with peripheral and those with coronary occlusions no deaths occurred. First angiographically documented long-term results in both indications are comparable to conventional balloon angioplasty. It is concluded that the use of low speed rotational angioplasty (ROTACS) can improve the results of nonoperative invasive treatment, both in peripheral and in coronary arteries.

Angiography↗
PubMed1992

[Value of duplex sonography in diagnosis of renal artery stenosis and its value in follow-up after angioplasty (PTA)].

The assessment of the renal arteries is particularly important in the detection of a renovascular cause of the arterial hypertension. The purpose of the present study was twofold: to evaluate the accuracy of duplex scanning in non-invasively diagnosing renal artery stenoses in hypertensive patients, and to determine the results of transluminal angioplasty of renal artery stenoses as assessed by duplex scanning. In 76 patients with arterial hyertension, 170 renal arteries (18 kidneys supplied by two renal arteries) were examined by both duplex scanning and angiography (DSA in intraarterial and intravenous technique, and conventional arteriography). Peak systolic and end-diastolic flow velocity parameters as well as the Pourcelot-index were determined in the proximal renal artery and compared with the indendently performed angiography. In 102 angiographically proven normal renal arteries, mean +/- SD peak systolic and end-diastolic velocity values were 84.7 +/- 13.9 cm/s and 31.2 +/- 7.8 cm/s, respectively, with a Pourcelot-index of 0.66 +/- 0.07. For detecting renal artery stenoses greater than 50%, duplex scanning had a sensitivity of 86%, and a specificity of 83% for a systolic peak velocity of 140 cm/s and more in the renal artery. In 13 patients with 14 stenosed renal arteries, duplex scanning and intraarterial DSA densitometry were performed before and after transluminal angioplasty of the renal artery stenoses. There was fairly good agreement between transstenotic peak systolic velocities and densitometrically determined degrees of stenosis in the renal artery (r = 0.84). These results show that duplex scanning is an accurate noninvasive diagnostic tool in detecting proximal renal artery stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Progress in arterial reconstruction of the upper and lower leg--percutaneous transluminal procedures].

Conventional PTA represents the state of the art method for treating arterial occlusive disease of the leg arteries. Rotational angioplasty is an improvement over conventional PTA in treating long proximal occlusions of the SFA. It can also be used as a second treatment in cases that were primarily unsuccessful with PTA, with an initial success of 59%. Stent implantation is mainly indicated in limb-threatening ischemia. It also permits successful management of an aneurysm as a late and rare complication correlated to PTA. Atherectomy produces better initial success in eccentric stenotic lesions than PTA. It also permits the successful management of obstructive intimal flaps after angioplasty. The new techniques only improve on PTA, if they are used in the differential therapeutic strategy mentioned above.

Angioplasty, Balloon↗
PubMed1992

[Changes in systemic fibrinolysis and blood coagulation parameters in local thrombolysis with tissue plasminogen activator (rt-PA)].

During the local fibrinolysis with rt-PA (2.5 mg/h) systemic plasminogen and alpha 2-antiplasmin activities slightly decrease, but the fibrinolytic system is compensated during the whole treatment. The d-dimer plasma levels increase dependently on the mass of thrombus. Despite the administration of high doses of heparin during the fibrinolysis thrombin is formed, measured as thrombin-antithrombin III complex (TAT).

Blood Coagulation↗
PubMed1991

[Varicosis of the great saphenous vein as a main symptom of iatrogenic arteriovenous fistula].

A 22-year-old man with movement-dependent knee-joint pain was operated on for patellar chondroplasia and meniscal dysplasia after two previous arthroscopic removal of free joint bodies had failed to bring relief. A few months after the operation the same leg had become swollen with signs of venous congestion, long saphenous vein varicosity and traumatic pretibial crural ulcer. The long saphenous vein was partially excised. 18 months after the arthrotomy there was clinical and colour-Doppler evidence of an arteriovenous fistula with false aneurysm in the region of the popliteal artery as cause of the venous congestion. The ulcer healed completely after ligation of the fistula and excision of the false aneurysm. --Arterio-venous fistula should be included in the differential diagnosis as a possible cause of postoperative swelling of a limb.

Adult↗