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Biomedical subjects

H Ferral

Publications and source records attributed to H Ferral.

50 records · Page 3Linked to original sources
PubMedDate not supplied

Cragg Endopro System I: early experience. I. Femoral arteries.

PURPOSE: This work describes the early experience with the Cragg Endopro System I. The safety and efficacy of this device in the treatment of atherosclerotic lesions of the femoral arteries are evaluated. MATERIALS AND METHODS: Eleven patients with complex femoral artery lesions were treated. Ten patients presented with femoral artery occlusion and one had a 90% stenosis. All patients had life-style limiting claudication. Associated comorbid states included smoking (n = 10), hypertension (n = 4), hyperlipidemia (n = 5), coronary artery disease (n = 3), and diabetes (n = 1). The stents were dilated to the size of the native artery in the first three patients. The protocol was modified and stents were overdilated by 1 mm in the remaining eight patients. An anticoagulation regimen was used in the first three patients and modified per protocol requirements in the remaining eight. Prophylactics antibiotics were given before the procedure. Follow-up studies included Doppler ultrasound and intravenous and intraarterial digital subtraction angiography. RESULTS: An antegrade femoral approach was used. Stent placement was successful in all patients. The mean lesion length was 9.9 cm (4-18 cm). Mean ankle/brachial index before treatment was 0.65 and increased to 0.87 after treatment. Mean follow-up was 17.2 months, and one patients was lost to follow-up. Complications included sepsis (n = 1), fever (n = 2), severe pain (n = 4), thrombosis (n = 5), and hematoma (n = 2). Stent patency was improved after protocol modifications. Overall primary patency rate was 45% and secondary patency was 56%. CONCLUSION: This early experience with the Cragg Endopro System I shows that recanalization of long femoral occlusions and stent-graft placement is feasible. The primary and secondary patency rates are low and the complication rate is high. Improved patency rates are expected with a more aggressive anticoagulation regimen and stent overdilation.

Aged↗
PubMedDate not supplied

Treatment of chronic iliac artery occlusions with guide wire recanalization and primary stent placement.

PURPOSE: To evaluate the results of primary stent placement without initial thrombolysis in the treatment of iliac occlusions. MATERIALS AND METHODS: During a 3-year period, 61 iliac artery occlusions were treated in 59 patients. The mean length of the occluded segment was 10 cm (range, 4-25 cm). The occluded arteries were treated with primary placement of self-expandable metallic stents. RESULTS: Successful recanalization with primary stent placement was possible in 56 of 61 occlusions (92% technical success rate). Mean Doppler ankle/brachial index increased from 0.51 to 0.90 immediately after treatment and was 0.91 on the last follow-up (P < .05). Primary patency rate at 24 months was 73%, and secondary patency rate was 88%. Procedural complications included distal embolization (n = 4) and an episode of massive intra-abdominal bleeding. Three patients developed a hematoma at the puncture site that did not require additional therapy. Late complications included stent occlusion (n = 9) and significant stenosis related to intimal hyperplasia (n = 1). Mean follow-up period was 29 months (range, 7-55 months). CONCLUSION: Primary stent placement is an effective therapeutic option for iliac artery occlusions.

Aged↗
PubMedDate not supplied

[Transjugular intrahepatic portosystemic shunt (TIPS). Thirteen-year experience].

The transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt that is created by using percutaneous endovascular techniques. TIPS has been employed for the last 13 years mainly for the management of hemorrhagic portal hypertension. The present review addresses important concepts including the accepted indications, contraindications, technical results, clinical results (bleeding control, management of refractory ascites, and other complications of portal hypertension), most important complications, and a brief overview of the most recent research in TIPS.

Ascites↗
PubMedDate not supplied

[Endovascular treatment of arterial occlusive disease of the iliac arteries].

Atherosclerotic disease is one of the most important health problems in the United States and in the entire world. The endovascular techniques for the treatment of peripheral vascular disease have been investigated in recent years. This is a review of the literature of the endovascular techniques used in the treatment of occlusive iliac disease. Angioplasty has showed excellent results in concentric lesions, of less 5 cm of length with a technical success of 96%, primary patency of 90%, 81% and 72% at one, two and three years. The complication rate is 0.5% to 0.8% and the mortality rate is 0.2%. The use of stents has improved the success of arterial recanalization, with a technical success of 97%, and a primary patency of 90%, 84% and 71% at one, two and three years. Major complications appear in less than 1% of the cases. In conclusion the endovascular techniques have been proved to be the treatment of choice for certain selected forms of presentation of atherosclerotic disease in the iliac arteries, specifically short, focal lesions. The results have been excellent with less mortality and morbidity than surgery.

Angioplasty, Balloon↗
PubMedDate not supplied

[Hepatic abscess: image-guided percutaneous drainage. Technique and indications].

Six patients underwent image-guided percutaneous drainage of liver abscesses at the Instituto Nacional de la Nutricion (a tertiary care referral center in Mexico City) in a seven month period. These patients were closely followed in order to evaluate appropriate indications for percutaneous drainage as well as techniques, complications and clinical evolution. Our study group included five males and one female; their mean age was 44.4 years (28-63) and the mean hospitalization time 24.3 days (10-34). We found multiple liver abscesses in three patients, and solitary abscesses in three, two in the left lobe and one in the right lobe. Considering the largest diameter, mean abscess size was 13.7 cm. The most important clinical symptoms were: fever, abdominal pain and malaise, and the most significant laboratory abnormalities were anemia, hypoalbuminemia, leukocytosis and high alkaline phosphatase serum levels. Etiology could be determined in three cases, two were pyogenic abscesses and one amebic. Percutaneous drainage was successful in five out of our six patients (83.3%). Complications included one subcapsular hematoma, without hemodynamic consequences, and one patient with severe upper gastrointestinal tract hemorrhage who required surgery, but we could not entirely demonstrate that the bleeding episode was directly related to the percutaneous drainage.

Adult↗
PubMedDate not supplied

[Electrolyte solution with polyethylene glycol to cleanse the colon for colonoscopy or enema].

The efficacy and safety of an electrolyte-polyethylene glycol solution (SE-PEG) for colonic lavage, was compared with standard bowel preparation (SBP) in a randomized blinded study of volunteers and patients undergoing colonoscopy and barium enema examination. Side effects, biochemical and hematologic changes and quality of examinations were monitored. Colonoscopy and barium enema was scored by colonic segment for type of residual stool and percentage of bowel wall visualized. For colonoscopy and barium enema, preparation with SE-PEG allowed better visualization and produced more optimal exams (8 vs 3; p less than 0.03) and (6 vs 4; p = NS) respectively. We conclude that colonic lavage with SE-PEG is an alternative bowel preparation method and is cheaper, more safe and effective than SBP procedure.

Adult↗
PubMedDate not supplied

[Transjugular portosystemic shunt. The current concepts].

The transjugular intrahepatic portosystemic shunt (TIPS) is an alternative therapeutic approach in the treatment of hemorrhagic portal hypertension. The use of this procedure was established in 1988 and since then, its use has extended impressively. Currently, the accepted indication for TIPS is the variceal bleeding secondary to portal hypertension refractory to medical management or sclerotherapy. In this paper the basic concepts of the TIPS procedure are reviewed, including historical perspective, technical aspects, indications, contraindications and complications.

Contraindications↗
PubMedDate not supplied

Image-guided fine needle aspiration biopsy. One year experience.

An analysis of one year experience with fine needle aspiration biopsies (FNAB) guided by computed tomography or ultrasound was conducted in a tertiary care reference center. We performed 66 procedures, two of them considered insufficient (97% technical success). The overall sensitivity was 90% and the specificity 100%. There were five false negative and no false positive results. The cytological diagnosis was confirmed with core biopsy of surgical specimen (available in 30 patients, 47%), discharge diagnosis and/or clinical evolution. Twenty seven patients had a positive FNAB for malignancy. The complication rate was 12%, all of them considered as minor complications which resolved with conservative management. There was a concordance between FNAB results and final diagnosis in 91.5% of the cases. Fine needle aspiration biopsy is a very useful diagnostic procedure if performed adequately.

Adolescent↗