Zalman Rubinstein

Percutaneous transluminal angioplasty. A suggested method for analysis of clinical, arteriographic, and hemodynamic factors affecting the results of treatment.

Sixty-nine percutaneous transluminal angioplasties (PTAs) were performed in the iliac and the femoral arteries of 54 patients. The main factors that might affect the results were reviewed: associated diseases, severity of ischemic symptoms, location and type of lesions (stenosis or occlusion and their length), and presence of disease distal to the site dilated. The vascular status of the patients in our series was more severe than in most others. Improvement at follow-up (average 15 months) was maintained in 74% of 66 radiographically successful PTAs. Poor runoff was the only factor found to affect the outcome deleteriously. Intra-arterial pressure measurements performed during the procedure and vascular laboratory studies were most valuable in assessing immediate and long-term results. Wide variations in results of PTA published in the literature are due to differences in methods of selection, evaluation, and reporting. A plea is made for future presentations of PTA series in an analyzable and comparable way, including and correlating all relevant variables as in the model suggested by the present study.

Vascular Lesions Associated with Impotence in Diabetic and Nondiabetic Arterial Occlusive Disease

Translumbar aortographies performed in 91 patients for limiting leg ischemia were reviewed, and stenosis was graded by points from one (normal vessel) to five (complete occlusion) for each vessel. Of 62 nondiabetic patients, 18 (29 per cent) were impotent, while of 29 diabetics, 17 (58.6 per cent) were impotent (p < 0.01). Significantly greater stenosis (p < 0.005) was found in the internal pudendal arteries of impotent patients when compared statistically with potent patients. This was true for the group as a whole, for diabetics and nondiabetics, and for patients over 50 years old both with and without diabetes. There was no significant difference in the extent of stenosis of the iliac arteries (common and internal) between potent and impotent patients. There was also no significant difference in the pattern of stenosis between diabetic and nondiabetic patients in the group as a whole and also in the potent and impotent subgroups analyzed separately. Neither diminished femoral pulses nor aortographic evidence of external iliac and common femoral arterial stenosis correlated significantly with impotence. These observations indicate that vascular lesions are as important in diabetics as in nondiabetics in the genesis of impotence. Clinical implications regarding diagnostic investigations and treatment are discussed.

Hepatic infarction and gallbladder necrosis complicating arterial embolization for bleeding duodenal ulcer

SummaryA case of severe duodenal hemorrhage in a septic renal allograft recipient is presented in which successful occlusion of the gastroduodenal artery by Gelfoam emboli also resulted in severe hepatic infarction and gallbladder necrosis. These complications were caused by reflux of emboli from the gastroduodenal artery into the distal branches of the hepatic artery.

Percutaneous removal of intravascular foreign bodies.

Catheter and guidewire fragments left remaining in the cardiovascular system induce a high incidence of morbidity. Percutaneous removal of these fragments was attempted in 13 patients, with complete success in 10, partial success in two, and the fragment was extraluminal in one patient.Technique of foreign body removal and problems encountered are discussed.

Distribution and symmetry of arteriosclerotic lesions of the lower extremities: an arteriographic study of 200 limbs.

Lower-extremity arteriograms of 100 candidates for vascular surgery were reviewed. All the arteries in the 200 limbs were visualized and graded as normal, irregular, stenotic, or occluded. The occurrence of hemodynamically significant disease (stenosis or occlusion) was markedly different in various arteries: iliac—37%, common femoral—9%, superficial femoral—58%, deep femoral—19%, popliteal—17.5%, tibialis anterior—27.5%, tibialis posterior—28.5%, and peroneal—16.5%. A remarkable symmetry was observed between the two lower limbs. In 53–76% of contralateral vessels the arteriographic picture was identical. When one degree of difference in arteriosclerotic involvement was allowed, the symmetry increased to 80–96%.

Preoperative angiography and embolization of large pelvic tumors

Pelvic tumors are often large and difficult to excise with appropriate surgical margins due to their size, proximity to neurovascular structures, and major intraoperative bleeding. The purpose of this study is to evaluate the yield of preoperative angiography and embolization so as to facilitate achievement of good surgical results.

Importance of the falciform ligament, ligamentum teres and splenic hilus in the spread of malignancy as demonstrated by computed tomography

Computed tomographic detection of significantly large (greater than 1.5 cm) transcoelomic secondary malignant serosal deposits is discussed. Attention is drawn to the importance of the falciform ligament, ligamentum teres, and splenic hilus as sites of secondary deposits. An anatomical explanation is presented for the detection of these findings on computed tomography.

Takayasu arteritis in Israel — update

Takayasu disease in our Israeli series consists of 56 patients, and has been detected only in Sephardic and oriental Jews as well as in Arabs and Bedouin. Suspicion of Takayasu disease should be raised whenever renal artery stenosis and involvement of the aorta and its branches occur in patients from oriental origin.

Food as a cause of small intestinal obstruction. A report of five cases without previous gastric surgery.

The clinical and roentgenographic findings in five patients with small intestinal obstruction caused by food impaction are presented. None had undergone previous gastric surgery. While the clinical features are those of small intestinal obstruction, an upper gastrointestinal study may demonstrate the exact site and nature of the obstruction.

Use of Oral Converting Enzyme Inhibitor, Captopril for Lateralizing Renal Venous Renin Activity

Captopril was administered prior to renal vein renin sampling in an attempt to select patients amenable to surgical treatment for renin dependent hypertension. Renal venous blood for plasma renin activity was taken only after captopril stimulation. Sampling from the antecubital vein before and after this provocation showed a marked rise in renin, thereby confirming the efficacy of the test. Elimination of the initial selective renal vein sampling shortens the catheterization period without affecting the accuracy and dependability of the procedure.