Percutaneous aspiration thromboembolectomy (PAT) was used as an angioplastic tool to remove from arteries of the lower limbs thromboembolitic material originating from any source. PAT was performed with a custom-designed catheter/sheath system, alone or in combination with balloon dilatation and/or local lytic infusion therapy with streptokinase or urokinase. PAT completed the restoration of blood flow, thus improving the results of the preceding angioplastic interventions. Clinical improvement was high, with 93% success (42 of 45 procedures). Only one below-the-knee amputation occurred, and could not be prevented. No patient became worse because of PAT intervention. The Fogarty catheter technique remains the method of choice for removing emboli within the aorto-iliac region, but in the smaller vessels below the inguinal ligament-especially in the distal superficial femoral, popliteal, and tibial regions--in our experience PAT is superior. This has been substantiated also in studies of laboratory animals, using barium-impregnated emboli.

Percutaneous aspiration embolectomy (PAE) was performed on acute embolic occlusions of infrainguinal arteries unrelated to percutaneous transluminal angioplasty or chronic atherosclerotic arterial occlusive disease. Of 102 patients, most (62.7% [n = 64]) had limb-threatening ischemia (stages III and IV according to the Fontaine classification); 86.3% (n = 88) had cardiac disease that caused the embolic occlusion. The clinical success rate was 87.3% (n = 89). Major complications occurred in 8.8% (n = 9) of the cases. The 30-day mortality was 3.9% (n = 4). In comparison with Fogarty-catheter embolectomy, PAE has a higher success rate and a lower mortality. PAE has several advantages: It is a simple technique with reduced invasiveness, combines a diagnostic and a therapeutic procedure, enables treatment of tibial and pedal vessels, and can be combined with all other angioplastic methods.

We have performed 84 balloon dilatations in 40 patients who had esophageal strictures. Of these patients, 31 who had benign diseases improved, and the procedure proved to be safe, reliable, and easy to perform; in 77% of these patients, only one or two dilatations were necessary. In 10 patients who had previously undergone treatment with bougienage, the symptom-free interval of 9.3 months following balloon dilatation is four times longer than that experienced following bougienage. In patients who have malignant disease, though the symptom-free intervals are short, the procedure can be repeated easily and is accepted well by patients so that palliation can be achieved. Since only readily controlled transverse forces act in the balloon therapy, rupture is virtually eliminated, while the use of a flexible angiographic guidewire to traverse the strictures practically excludes perforation. Balloon dilatation offers distinct advantages compared with bougienage for the treatment of esophageal strictures.

PAE is highly effective in the treatment of embolic occlusions of the lower leg arteries and should be considered as an alternative to Fogarty balloon embolectomy.

Treatment of esophageal stenosis by large diameter balloon catheters offers significant advantages over bouginage. Catheter dilating force is confined to the affected segment and can be controlled by the patient's reaction. Perforation is practically excluded by the use of fluoroscopy, contrast media, flexible angiographic guidewires, and better control over the time and forces of dilation. Wider, more lasting dilation can be achieved. Forty-one dilations were done on 21 patients with this new procedure without complications and with improved relapse-free intervals.

Clinical indications are essentially those guidelines observed by moderately aggressive vascular surgeons. By using a combination of several angioplastic techniques specifically tailored to the type of occlusive material, we gain time and primary success with fewer complications. In more escalated treatments with stents, in 21% we achieve a primary clinical success rate until hospital discharge of 97% in the iliac region, 95% in the femoropopliteal region, and 89.9% in tibial angioplasty without stenting. Long‐term results decrease with luminal width and the degree of changes by the underlying atherosclerotic disease. Less invasiveness and low complication rates favor PTA over vascular surgery.

Biliary metal stents are thought to offer improved long-term palliation of malignant biliary obstruction due to a lower incidence of migration and clogging. Placement of these stents is technically more complicated than that of plastic endoprostheses and requires two experienced physicians. We report the incidence and reasons for apparent malfunction of expandable metal stent deployment (Wallstents and Strecker stents). In 116 applications of 82 Wallstents (endoscopic approach: n = 33, transhepatic approach: n = 49), we observed 19 cases of stent malfunction due to technical problems of stent delivery. In 13 cases (15.8%), the restraining membrane of the Wallstent could not be retracted sufficiently to deliver the stent. There were 6 (17.6%) failures in 34 cases of Strecker stent deployment. In 3 cases, we noted difficult balloon removal, including avulsion of the balloon catheter shaft within the endoscope during attempted balloon removal in one case. In one case, the Strecker stent could only be released partially, requiring subsequent endoscopic extraction. In two patients, only partial expansion of one end of the Strecker stent could be achieved. Given the significant malfunction rate of expandable metal stents during stent delivery, further improvements in the delivery system of the metal stents are required.

We sought to determine whether the application of a self-expanding metal stent enables palliation of malignant dysphagia with minimal risk. The results of pilot studies from two centers are reported. We treated 8 inoperable patients with a 14 mm self-expanding metal stent (Wallstent). The stent was applied without general anesthesia under mild i.v. sedation. The procedure was successful in all cases. No side effects were noted. In one patient, tumor ingrowth through the meshes of the stent occurred. This patient was additionally treated with a percutaneous gastrostomy. One patient experienced tumor overgrowth of the proximal end, necessitating laser treatment. Three patients were still alive after three months. The mean number of cumulative endoscopic interventions per patient was 2.2 (SD: +/- 2; median 2). The mean observation time was 10.7 weeks +/- 2 (median 12). Dysphagia was graded from 0 (normal swallowing) to 4 (inability to swallow saliva). Dysphagia was significantly (p less than 0.0005) reduced from grade 3.1 (SD: +/- 0.35) to 0.5 (SD: +/- 0.5) immediately after stenting. 62.5% of the patients were able to manage a virtually normal diet (in one of these patients dysphagia recurred six weeks after stent placement due to tumor ingrowth). Six patients (75%) were able to ingest all necessary calories orally. The application of a 14 mm self-expanding metal stent in cases of inoperable malignant esophageal obstruction seems to offer safe and effective palliation of malignant dysphagia.