Friedrich Jm

PTA Plus Stent Implantation Versus PTA Alone for Central Venous Stenoses

From 1990 through 1992, 17 severely stenosed central venous segments were diagnosed in 13 patients. In 9 patients, 11 stenoses were detected during follow-up after trans- femoral venous thrombectomy. The other 6 stenoses occurred in the venous outflow tract of 4 hemodialysis shunts. Six stenoses were treated by percutaneous transvenous angio plasty (PTA) alone, and 11 stenoses by PTA plus stent implantation (PTA+S). For PTA+S, a flexible, self-expanding stent was used. Acute procedure-related complications were not observed. After a median follow-up time of eighteen months (three to thirty-six months), all patients were examined clinically, duplex-sonographically, and angiographically. Following PTA alone (n = 6), there was only 1 excellent result, and 5 patients developed high-grade restenoses. Two of these patients had to be reoperated on, and 1 patient underwent another PTA with stent placement. PTA+S (n = 11) for initial treatment of central venous stenoses gave excellent results in 8 cases, a good result in 1 case, and 2 insufficient results caused by intimal hyperplasia within the stent. These restenoses were successfully treated by another PTA.

Flushable stent-system for internal drainage in occlusive jaundice

The effectiveness of biliary stents may be reduced as a result of obstruction by tumor material, bile salts or detritus. To circumvent this problem we developed a prosthesis system, which allows flushing and repetitive radiological control via a subcutaneous port. Prostheses were implanted in 26 patients presenting with inoperable occlusive lesions of the bile duct. Patency was regularly monitored by checking the bilirubin and alkaline phosphatase levels and using port-cholangiography. Catheter function was easily maintained in 92% of the patients and ended upon malignancy related death. In case of dysfunction, drainage could generally be restored with intensive flushing. This new flushable stent-system was easily implantable, could be exchanged without renewed percutaneous transhepatic puncture and allowed flushing, external drainage, bile probes for bacteriological examinations and follow up cholangiography via the subcutaneous placed port.

Intraoperative Stent Implantation for Venous Anastomotic Stenoses of Hemodialysis Grafts

Ten filiform stenoses and 1 complete occlusion of the venous anastomoses of 11 hemodialysis grafts were diagnosed during operative revision for shunt thrombosis. After Fogarty balloon thrombectomy, the lesions were treated by intraoperative balloon angioplasty and stent implantation (IAS). All grafts could be used for hemodialysis immediately after IAS. The patients could be followed up for six to twelve months. Within 2 stents, restenoses causing rethromboses of the shunts occurred after three and seven months, respectively. In 1 case another intraoperative dilation was successful, and the other was treated by graft prolongation. All other stents were widely patent at the last examination as demonstrated by color duplex sonography. IAS proved an effective alternative to surgical revision of the stenosed anastomosis. It may be applied without difficulty to patients with multiple preceding revisions and provides excellent success rates.