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Biomedical subjects

H W Loose

Publications and source records attributed to H W Loose.

17 recordsLinked to original sources
PubMed1998

The management of peripheral arterial aneurysms using percutaneous injection of fibrin adhesive.

Most peripheral arterial aneurysms are pseudoaneurysms and are iatrogenic or related to trauma. They can be treated by several techniques that can be performed by the radiologist, negating the need for surgery. Ultrasound guided compression repair is usually the treatment of choice, but is not always successful. The number of available treatment options reflects the varying site and nature of pseudoaneurysms and perhaps the lack of a consistently reliable method. We have successfully treated 13 patients with peripheral aneurysms (11 femoral, 1 popliteal and 1 posterior tibial aneurysm) using a commercial fibrin tissue adhesive. The method involves percutaneous injection of the adhesive components using ultrasound and screening control, following successful occlusion of the aneurysm neck by angioplasty balloon.

Aneurysm, False↗
PubMed1993

Long-term results of double-balloon percutaneous transluminal angioplasty of the aorta and iliac arteries.

Seventy-nine patients have been treated by double-balloon percutaneous transluminal angioplasty for aortoiliac atherosclerotic lesions within 0.5 cm of the aortic bifurcation. Seven patients had repeated angioplasties, a total of 86 procedures over an 8 year period up to December 1990. The technique is described and its merits discussed. Technically successful dilatation was achieved in 81 cases (94%) and symptomatic relief was obtained in 75 (87%), including 12 of 14 patients with critical ischaemia. Fourteen of 17 occlusions up to 6 cm long and 67 of 69 stenoses were successfully dilated. After an average follow-up of 49 months (median 51 months, range 7-93), only six patients (7%) developed late recurrence of symptoms requiring further treatment. Six patients have died and 12 have been discharged from follow-up. The cumulative success rate beyond 5 years' follow-up was 80%. Complications requiring surgical intervention occurred in four patients (5%). Double-balloon percutaneous transluminal angioplasty was seen to be an effective procedure which produced lasting improvement and is recommended as the first choice treatment for localised stenotic and occlusive disease at the aortic bifurcation.

Adult↗
PubMed1992

Fibromuscular dysplasia of visceral arteries.

The case histories of two patients with combined renal and extra-renal fibromuscular dysplasia are presented. Readers are reminded of this rare but important condition as a cause of obscure abdominal symptoms and abdominal bleeding in the absence of atherosclerotic aortic aneurysm. The aetiology, histology, and management of the condition are discussed.

Adult↗
PubMed1991

Fracturing and stretching of angioplasty balloon catheters under bending with tension.

Eight catheters from five manufacturers have been subjected to tests which combined bending and tension. Three failure mechanisms have been identified. These included separation of the balloon from its proximal attachment to the shaft, fracture of the shaft at its junction with the balloon, and undue ductility of the shaft. It is concluded that good catheter design should ensure that there is no sudden change in stiffness along the length of the catheter, and that the optimum relationship of ductility to stiffness has not yet been defined for catheters. Recommendations relating to these characteristics could be included in the British Standards relating to angioplasty balloon catheters.

Angioplasty, Balloon↗
PubMed1990

Percutaneous transluminal angioplasty of the innominate, subclavian, and axillary arteries.

Percutaneous balloon angioplasty offers an alternative to surgery for the alleviation of symptoms in upper limb arterial disease. This report documents 28 per-femoral dilatation procedures in 27 patients for 33 subclavian, two innominate, and two axillary lesions. Thirty-four stenoses and three occlusions were treated, with multiple dilatations in five patients. Indications for treatment were: arm ischaemia (15 patients); neurological (steal syndrome) symptoms (8); and combined ischaemia plus steal (5). Angioplasty was technically successful in 27 procedures with symptomatic relief in 25 cases up to a mean follow-up of 24 months (median 20 months, range 2-90 months). One patient had successful repeat angioplasty for recurrent ischaemic symptoms after 30 months. Angioplasty improved pulse deficits in all but two patients and reduced arm blood pressure differential to less than 30 mmHg in all but three patients. There were three complications: a femoral artery occlusion and a groin haematoma required surgical intervention and another patient suffered an extension of a contralateral stroke. Percutaneous balloon angioplasty has proved safe and effective. We recommend angioplasty as the first line treatment for ischaemic or neurological symptoms in upper limb vascular disease.

Angioplasty, Balloon↗
PubMed1990

Acquired venous disease of the lower urinary tract.

Thrombosis of the vena cava, femoral veins or iliac veins can result in the formation of large collateral veins in the pelvis and retroperitoneum which are often asymptomatic but which may cause severe bleeding and produce major difficulties in urological management. Such abnormalities are a rare cause of urological symptoms but may be difficult to diagnose unless a high index of suspicion is maintained. Three patients are reported who developed significant urological problems as a consequence of acquired venous disease; the use of ultrasound, venography and CT in the diagnosis of this condition is described.

Adolescent↗
PubMed1988

Common iliac artery occlusion: treatment with pull-through angioplasty.

A technique was developed to traverse an occlusion of the common iliac artery when approach from an ipsilateral puncture has been unsuccessful. The technique involves an antegrade approach to the occlusion and allowed successful passage in seven cases. At 2-year follow-up, only one of the seven occlusions had recurred.

Angioplasty, Balloon↗
PubMed1986

Two-year experience of management of bleeding esophageal varices with a coordinated treatment program based on injection sclerotherapy.

The results of 61 consecutive patients treated for bleeding esophageal varices with a coordinated multidisciplinary protocol are described. The primary form of treatment after vigorous resuscitation was fiberoptic endoscopic injection sclerotherapy under general anesthetic. Thirteen patients failed to be controlled by injection, and eight were able to be treated by percutaneous transhepatic embolization. Those patients who were unable to undergo embolization or whose bleeding did not stop after embolization were controlled by surgery. The overall mortality rate with the 2-year limit was 29 patients (47%); however, only 18 deaths (29%) were related to the hospital admission for bleeding. Only one patient died of continued variceal bleeding. All of the other deaths were from later liver failure or unrelated disease. The results of the study confirmed the high mortality rate in patients with severe liver disease (Child's grade C) undergoing surgical control of bleeding, and it was shown that when control was obtained with injection sclerotherapy and embolization, the 1-year survival rate of a similar group of patients may be as high as 32%.

Anesthesia, General↗
PubMed1983

The os supratrochleare dorsale: a normal variant that may cause symptoms.

Four patients with an os supratrochleare dorsale are presented; three had symptoms that necessitated surgical removal. One patient showed the abnormality in both elbows; three were men and one was a woman. The os supratrochleare dorsale is most likely an accessory bone; however; the location is such that it often becomes traumatized by the olecranon. Posttraumatic pathologic changes with secondary chondrometaplasia of the bone itself occurs as a consequence. Symptomatic patients show posttraumatic changes of the bone, while those without symptoms show a normal trabecular pattern. This condition seems to bear no relation to the supratrochlear septum or to bones in the coronoid fossa.

Adolescent↗
PubMedDate not supplied

Percutaneous ablation of an internal iliac aneurysm using tissue adhesive.

We report the percutaneous injection of tissue adhesive (Tisseal, Immuno, Vienna, Austria) to ablate a 12-cm internal iliac aneurysm. The complex history of this lesion included previous surgery for a ruptured aortic aneurysm, attempted repair of the internal iliac aneurysm, and several embolization procedures. These factors precluded further open repair or transcatheter techniques and dictated the choice of a more direct approach.

Aged↗
PubMedDate not supplied

Percutaneous ablation of peripheral pseudoaneurysms using thrombin: a simple and effective solution.

PURPOSE: To assess the effectiveness of tissue adhesive and thrombin solution in the percutaneous ablation of peripheral artery pseudoaneurysms. METHODS: Twenty-five pseudoaneurysms were treated over a 33-month period; all had failed ultrasound-guided compression. Tissue adhesive or thrombin solution was injected percutaneously, with needle tip position and changes within the aneurysm confirmed with color Doppler ultrasound. In 19 cases we utilized a protective balloon inflated across the aneurysm neck prior to the injection of tissue adhesive and in six cases used thrombin injection alone. Seven patients were anticoagulated. Patients were followed up after the procedure. RESULTS: All 25 aneurysms were treated successfully; two patients required a return visit and there were no immediate complications or peripheral emboli detected. One patient developed a contralateral pseudoaneurysm. CONCLUSIONS: The percutaneous injection of pseudoaneurysms is a safe, atraumatic, and effective treatment for femoral artery pseudoaneurysms in the peripheral circulation. There are significant advantages over ultrasound-guided compression or surgical repair.

Adult↗