Aim: The intention of the study was to demonstrate that outpatient PTA can be performed without additional risk in comparison with inpatient treatment. Methods: From Jan. 1992 up to May 1994 outpatient percutaneous transluminal angioplasty was performed on 447 subjects suffering from peripheral arterial insufficiency (mostly stage IIb disease, in few cases stage III and IV for limb salvage). 4 weeks after treatment patients were investigated by questionnaire on the following topics: enlightenment on the procedure, postprocedure complications, physical condition and repetition of the PTA in case of recurrence. Results: Immediate technical success was achieved in 407 patients (91%). Complications were recorded in 30 (6.7%) procedures, most of them being minor 22 (4.9%). 8 patients (1.8%) with major complications required hospitalisation. Three of them (0.7%) underwent operation. Catheter treatment was extended by local fibrinolytic therapy in another three cases (0.7%). The questionnaire was returned by 196 patients (44%). 97% found the enlightenment on the procedure adequate. 2% suffered from postprocedure complications. Recurrence was reported in 1%. Clinical improvement was reported in 92%. In case of restenosis or reocclusion 95% would repeat the procedure as outpatient angioplasty. Conclusion: Outpatient PTA can be performed on selected patients on condition that postprocedure care is guaranteed. In our experience there is neither a lower success rate nor a higher complication rate as compared to the inpatient treatment.

AIM:The intention of the study was to demonstrate that outpatient PTA can be performed without additional risk in comparison with inpatient treatment.METHODS:From Jan. 1992 up to May 1994 outpatient percutaneous transluminal angioplasty was performed on 447 subjects suffering from peripheral arterial insufficiency (mostly stage IIb disease, in few cases stage III and IV for limb salvage). 4 weeks after treatment patients were investigated by questionnaire on the following topics: enlightenment on the procedure, post-procedure complications, physical condition and repetition of the PTA in case of recurrence.RESULTS:Immediate technical success was achieved in 407 patients (91%). Complications were recorded in 30 (6.7%) procedures, most of them being minor 22 (4.9%). 8 patients (1.8%) with major complications required hospitalisation. Three of them (0.7%) underwent operation. Catheter treatment was extended by local fibrinolytic therapy in another three cases (0.7%). The questionnaire was returned by 196 patients (44%). 97% found the enlightenment on the procedure adequate. 2% suffered from post-procedure complications. Recurrence was reported in 1%. Clinical improvement was reported in 92%. In case of restenosis or reocclusion 95% would repeat the procedure as outpatient angioplasty.CONCLUSION:Outpatient PTA can be performed on selected patients on condition that post-procedure care is guaranteed. In our experience there is neither a lower success rate nor a higher complication rate as compared to the inpatient treatment.

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.

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.

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.

A prospective, randomised, double-blind study was performed to test the contrast quality, tolerance and safety of ioversol 300 mg/ml (Optiray 300, Mallinckrodt Medical, Inc., St-Louis, USA) versus iohexol 300 mg/ml (Omnipaque 300, Schering AG, Berlin). The study was conducted on 80 patients with peripheral vascular disease, who underwent central venous pelvis-leg angiography. The angiograms in the ioversol group were rated "very good" and "good" in 75.6% of the cases versus 51.3% in the iohexol group. Patient tolerance was nearly identical in both groups. On the 4 point rating scale for pain and heat sensations (1 = none; 4 = severe), the average heat scores were 1.28 for ioversol and 1.44 for iohexol. None of the patients complained of pain when receiving the injection. There were clinically significant changes of blood pressure in 3 patients out of each group and tachycardia in 5 patients in the ioversol group and 9 patients in the iohexol group. Seven out of 80 patients reported mild to moderate side-effects. These were related to the contrast medium in the case of 2 patients in both the ioversol and the iohexol group. All reactions resolved spontaneously or could be controlled by treatment.

Die konventionelle Angioplastie ist der Standard der Katheterbehandlung der unteren Extremität. Die Rotationsangioplastie ist der konventionellen Angioplastie bei der Behandlung des langen prox. Femoralis-Verschlusses überlegen. Die Stent-Implantation der A. femoropoplitea sollte überwiegend im klin. Stadium III/IV vorgenommen werden. Sie erlaubt die Korrektur des Aneurysmas, einer seltenen Spätkomplikation der Angioplastie. Die Atherektomie zeigt bei den exzentrischen Stenosen bessere morphologische Ergebnisse als die Angioplastie. Sie läßt eine primär wegen Intimasegel gescheiterte Angioplastie noch erfolgreich abschließen. Die neuen Techniken bedeuten nur bei differenziertem Einsatz einen Fortschritt der Katheterbehandlung.

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.

The aim of the study was to determine the accuracy of colour--coded Doppler sonography (CDS) compared to angiography in detecting the localisation and length of an occlusion in peripheral arteries. 118 legs of 107 patients with clinical suspected occlusion were examined prospectively with CDS before angiography. In 110 cases both methods identify identical localisations. The sensitivity in detecting occlusions was 97%, the exact localisation was diagnosed by CDS in 95% with a high correlation (r = 0, 96) of length measurements.

75 patients with difficult occlusions in the superficial and popliteal arteries were treated by the "Rotacs" system. This technique is efficient in treating occlusions longer than 10 cm, with an initial success rate of 60.5%. In primary failed conventional angioplasties Rotacs-PTA was successfully employed in 56% as a second intervention. This is considered to be an advance in PTA technique. In stage II disease the PTA results are better than in diseases of the stages III and IV, which agrees with conventional catheter treatment. In the femoropopliteal overlapping segment the initial successful PTA of short, hard, mostly calcified occlusions was only 33%. The complication rate of Rotacs technique compares with that of the conventional methods.

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. - Arteriovenous fistula should be included in the differential diagnosis as a possible cause of postoperative swelling of a limb.

Atherectomy with a Simpson catheter enables a detailed characterization of percutaneously removed human atheromatous plaque material. Cell biological investigations (flow-cytometric analyses, cell type-specific antibodies, immunohistological labelling methods of selected extracellular matrix proteins) are aimed at a comparative characterization of excised material from primary lesions and restenoses to yield further insight into the mechanisms of plaque formation. First results on 17 specimens would like to contribute to a better understanding of the structure and composition of the extracellular matrix and their interaction with cells in atherosclerotic plaques.

Der akute thrombotische Arterienverschluß kompliziert das Bild der chronischen arteriellen Verschlußkrankheit. Im Angiogramm erscheint er als abrupter Gefäßabbruch mit schon ausgebildeten Kollateralgefäßen. Bei seiner Therapie nimmt die lokale niedrig dosierte Fibrinolyse einen festen Platz ein. Sie zeigt die besten Frühergebnisse, wenn sie mit der Aspirationsembolektomie kombiniert wird. Beim akuten Popliteaverschluß und bei der sogenannten dilatierenden Arteriopathie muß im Ultraschall ein Aneurysma ausgeschlossen werden (Kontraindikation), da sonst die Gefahr einer peripheren Embolie mit drastischer Verschlechterung der Durchblutungssituation der Extremität droht.

Acute thrombotic arterial occlusion is a complication of chronic vascular arterial disease. The arteriogram usually reveals a sudden occlusion and the collateral vessels. Treatment with low-dose fibrinolytic therapy is widely accepted. A combination of low-dose fibrinolysis, aspiration embolectomy and angioplasty yields the best primary success rate. In cases of sudden popliteal occlusion and dilating arteriopathy ultrasound sonography should be used to exclude the presence aneurysm which is a contraindication for fibrinolysis. There is a high risk of peripheral embolisation, in the presence of an aneurysm and this may cause severe deterioration of the arterial blood supply.