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.
Percutaneous aspiration-thromboembolectomy is a simple method for removal of thrombo-embolic material of diverse origin. It is highly effective with small material outlay. As a third angioplasty method it has considerably improved the success rates of balloon dilatation and local lysis treatment with urokinase or streptokinase. The procedure was used alone or in combination on 71 occasions involving 69 limbs in 66 patients. An angiographically demonstrable success was seen in 96% and clinical improvement in 91.6%. Local lysis treatment with streptokinase or urokinase was shortened, less hazardous and, because of removal of non-lysable material, more successful. Embolectomy with the Fogarty catheter remains the method of choice for treating emboli arising from the heart in vessels of the aorto-iliac system. For smaller vessels below the inguinal ligament, however, we consider the new, lesser invasive method to be an alternative to vessel surgery.
A total of 92 dilatations using the balloon-catheter were carried out in 46 patients with oesophageal strictures. Of these 73 were in 36 patients having a benign primary disease, predominantly stenoses following anastomotic operations or with stenoses resulting from reflux oesophagitis. The average relapse-free period after balloon-catheter dilatation was 6.3 times greater than with bougienage. Balloon-catheter dilatation has proved to be a simple and safe procedure that can be applied inexpensively in an outpatient department. It has now become the method of choice in our hospital for the non-operative treatment of strictures of the oesophagus.
The new imaging method digital subtraction angiography (DSA) permits intravenous arteriography. 1259 patients were thus investigated over one year. The lower extremities comprised 21,4% of assessment areas. 120 investigations in 95 patients were based on an indication of percutaneous transluminal angioplasty (PTA). DSA can be used before and after the PTA. The small extent of invasiveness and the shortening of in-patient admission are particular advantages preoperatively. These advantages, in addition to the possibility of out-patient evaluation, are also true for DSA in comparison to the conventional arteriography. Thus the combination of both methods has been found to be very suitable.
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