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Biomedical subjects

M Lafer

Publications and source records attributed to M Lafer.

At least 19 recordsLinked to original sources
PubMed1996

Carotid artery aneurysm as a rare cause for aspiration pneumonia. A case report.

A now 92-year-old patient presented in 1990 with a massive 6 x 4 x 4 cm aneurysm of the left internal carotid artery which completely occluded the left oro- and nasopharynx. The main complaint of dysphagia was not only a consequence of the narrowed pharynx but was also due to a palsy of the glosso-pharyngeal nerve and caused one to two episodes of aspiration pneumonia per year. The patient could not be operated on because the aneurysm extended to the base of the skull. Remarkably the patient never experienced a cerebral ischemic event and during a follow-up of five years the aneurysm did not increase in size and partial thrombosis of the aneurysm was never detected. Thus conservative management seems feasible, when partial thrombosis of the aneurysm can be ruled by CT-examination.

Aged↗
PubMed1994

Thrombolytic treatment and balloon angioplasty in chronic occlusion of the aortic bifurcation.

OBJECTIVE: To evaluate nonsurgical alternatives in reopening chronically occluded aortic bifurcation. DESIGN: Uncontrolled randomized study. SETTING: University-affiliated referral center for vascular diseases. PATIENTS: Twenty-five of 39 consecutive patients with chronic aortoiliac disease including a totally occluded aortic bifurcation were found to be acceptable candidates for an aortobifemoral prosthetic graft. INTERVENTION: Patients were randomly assigned to receive either streptokinase or urokinase or recombinant tissue-type plasminogen activator (rt-PA). In cases of successful thrombolysis and residual obstructions, subsequent balloon angioplasty was attempted. Prosthetic bypass grafting was done if thrombolytic treatment and balloon angioplasty failed. RESULTS: Complete lysis was achieved in 5 of 25 patients (20%). In 10 (40%) patients, lysis showed residual obstructions, which were reopened mechanically in 8 patients; 2 patients had extra-anatomical bypass grafts. Ten patients (40%) without thrombolysis had surgical aortobifemoral bypass grafts. Overall, recanalization and clinical improvement were achieved in 13 of 25 patients (52%) by thrombolytic therapy and subsequent balloon angioplasty. The recanalization rate did not differ among the different thrombolytic drugs. However, rt-PA therapy resulted in reopening after 4 days of treatment; streptokinase, after 6 days; and urokinase, after 9 days (P < 0.005). No major complications or deaths occurred. CONCLUSION: Thrombolytic treatment followed by balloon angioplasty may help avoid the need for aorto-bifemoral prosthetic bypass grafting in more than 50% of patients with chronic aortoiliac disease.

Adult↗
PubMed1994

Iliac artery stent placement: clinical experience with a nitinol stent.

PURPOSE: To determine the effectiveness of a prototype nitinol stent in the iliac arteries. MATERIALS AND METHODS: Fourteen patients with arteriosclerotic lesions of the iliac arteries (nine stenoses, five occlusions) were treated percutaneously with a prototype nitinol vascular stent (Cragg stent) after unsuccessful percutaneous transluminal angioplasty. RESULTS: In 13 patients available for follow-up, the mean ankle-brachial index (ABI) increased from 0.4 +/- 0.32 (standard deviation) before the procedure to 0.81 +/- 0.27 after the procedure (P < .01). After 6, 12, and 24 months, the mean ABI was 0.97 +/- 0.2, 0.87 +/- 0.15, and 0.89 +/- 0.1, respectively. In two patients, radial stiffness of the stent was too low to completely eliminate a high-grade, calcified stenosis; long-term patency of the vessel, however, was preserved. In all other patients, stent placement achieved good vascular reconstitution. No stent occlusion or restenosis was observed. CONCLUSION: The results with the Cragg stent were similar to those with other commercially available stents. These preliminary results require confirmation with a larger series.

Aged↗
PubMed1993

A simplified procedure for intra-arterial thrombolysis with tissue-type plasminogen activator in peripheral arterial occlusive disease: primary and long-term results.

One-hundred and fifty patients with thrombotic and 60 patients with embolic occlusions of the superficial femoral and/or popliteal artery underwent a simplified IAT (intra-arterial thrombolysis) procedure. Ten mg rt-PA combined with 3000 IU Heparin were infused over 6 h, thereafter the extent of thrombolysis was checked fluoroscopically and the above mentioned treatment course repeated up to four times if necessary. The IAT regimen employed did not involve mechanical recanalization attempts; if complete thrombolysis revealed an underlying stenosis, a PTA (percutaneous transluminal angioplasty) was subsequently performed. IAT resulted in complete recanalization of 88 thrombotic occlusions (59%; 95% confidence interval: 50.8%-66.8%) and of 53 embolic occlusions (88%; 95% confidence interval: 77.1%-94.8% P < 0.001). In a further 33 (22%) thrombotic and four (7%) embolic occlusions IAT reduced the length of the occluded segment. At discharge, 102 (67%) patients with thrombotic and 55 (92%) patients with embolic occlusions were clinically improved. Overall, untoward effects occurred in 60 patients (29%): 47 (22%) were minor. Four patients (2%) suffered a systemic haemorrhage (three gastrointestinal, one macrohaematuria). The cumulative potency rate was significantly higher in patients with embolic occlusions throughout follow-up (82% vs 49% for thrombotic occlusions at 2 years, P < 0.001). Although all amputations were carried out in patients with thrombotic occlusions, follow-up mortality did not differ significantly between patients with embolic and thrombotic occlusions.

Adult↗
PubMed1992

Iliac artery stenting--clinical experience with the Palmaz stent, Wallstent, and Strecker stent.

A total of 82 iliac artery lesions (62 stenoses and 20 occlusions) were treated with 3 different types of endovascular metallic stents (12 lesions with the Palmaz stent, 36 with the Wallstent, and 34 with the Strecker stent). The complication rate was 12%. Occlusion of 2 Wallstents occurred 4 and 12 weeks after stent placement, respectively. Both stents were recanalized by local fibrinolysis. One Strecker stent occluded after 8 months. The observation period was 3 to 26 months (mean 9.7 months). The patency rate with secondary intervention (fibrinolysis) was 100% after 3 and 6 months, and 98% after 9 months. All 3 stent designs turned out to be effective in the treatment of complicated iliac artery occlusive disease.

Adult↗
PubMed1991

[Percutaneous recanalization of pelvic artery occlusions--fibrinolysis, PTA, stents].

In 42 patients with symptomatic chronic iliac artery occlusions with a length of 2-15 cm (mean 4.3 cm), percutaneous recanalization was attempted. The study population was divided into 2 groups: Group I (n = 17) is a retrospective control group, the patients were treated with fibrinolysis (FL) and percutaneous transluminal angioplasty (PTA). In group II (n = 25) the patients were treated according to a prospective protocol including FL, PTA and placement of endovascular self-expandable stents. The recanalization rate for Group I and II together was 83% (35/42). FL was effective in 47%, in 53% the recanalization was performed mechanically only. The patency rate in Group I during a maximum of 69 months was 67%, in Group II, in which residual stenoses were treated with stents, 100% during max. 18 months. Obviously stents help to improve the results after percutaneous recanalization of iliac artery occlusions significantly.

Adult↗