Between August 1978 and July 1983, 93 patients (71 with unilateral and 22 with bilateral isolated carotid siphon stenosis) were identified from a review of 885 consecutive cerebral arteriograms. This yielded 115 cerebral hemispheres at risk. At the time of arteriography, 93 hemispheres were asymptomatic regarding the hemisphere with siphon stenosis (group I), whereas 22 hemispheres in 22 patients had had neurologic events referable to the hemisphere with siphon stenosis (group II). During follow-up (range 1 to 62 months, mean 22.5 months), 64.5% of initially asymptomatic hemispheres remained asymptomatic, 6.5% experienced transient ischemic attacks (TIAs), and 4.3% developed strokes. During the same follow-up period, 63.6% of initially symptomatic hemispheres became asymptomatic, 9.1% had recurrence of TIAs, and 9.1% developed strokes. Sixteen of 71 group I patients (22.5%) and 5 of 22 group II patients (22.7%) died during follow-up. The overall incidence of nonfatal stroke and TIAs was 6.5% and 8.6%, respectively. Myocardial infarction (MI) and stroke accounted for deaths in 6.5% and 4.3% of patients, respectively. There was no significant difference in the incidence of TIA, stroke, or death between group I and group II. The percentage of siphon stenosis in all patients experiencing stroke or TIA (35.4 +/- 14.4%) was not significantly different from that in patients who remained asymptomatic (32.3 +/- 10.6%). Patients with carotid siphon stenosis are at an increased risk of death, stroke, and TIAs compared with the population at large. However, the risk of stroke is less than the risk of stroke in patients with TIAs assumed to be caused by carotid bifurcation disease.(ABSTRACT TRUNCATED AT 250 WORDS)
True tibial artery aneurysms are rare lesions. They may manifest themselves clinically either as a painful leg mass or as evidence of ischemic changes in the foot. Asymptomatic lesions may be found incidentally during arteriography. The need for surgical intervention should be individualized depending on the presentation; the type of surgical intervention is based on coexistent tibial artery anatomy. The present report describes a patient with a true tibial artery aneurysm. Clinical presentation, radiographic findings, and surgical management are described.
Percutaneous transluminal angioplasty (PTA) has provided an alternative method of treatment for occlusive disease of the lower extremities. However, the long-term durability of PTA compared with that of surgical reconstruction has not been adequately evaluated. This study was undertaken to assess the long-term hemodynamic results of PTA. Thirty-four dilatations performed on 28 patients over a 30-month period and followed for 1 to 53 months were reviewed. Twenty-two dilatations were done in the iliac arteries, seven in the superficial femoral, three in the popliteal, one in the peroneal artery, and one at a bypass graft anastomosis. All patients underwent noninvasive measurements of lower extremity segmental pressure prior to dilatation and at scheduled follow-up intervals. Success was defined as an increase in the Doppler-derived segmental lower extremity/brachial index of greater than or equal to 0.15 or normalization of the index (greater than or equal to 0.90), measured at the closest level distal to the site of dilatation. Sixteen of 22 iliac dilatations (72.7%) were initially successful. However, long-term success was maintained in only six (27.6%). Cumulative hemodynamic success for the initially successful iliac dilatations was 28% at 3 years. Seven of 11 (63.6%) dilatations performed on infrainguinal arteries were initially successful; however, only two (18.2%) experienced continued success. Cumulative hemodynamic success for the initially successful infrainguinal dilatations in this group was 35% at 3 years. Although immediate patency and improvement in hemodynamic parameters are similar to comparable surgical procedures, these results demonstrate that PTA is not as durable as conventional surgical procedures.
Eighty-one patients suspected of having cerebrovascular disease had 157 carotid arterial systems studied by both duplex ultrasonography and contrast arteriography to better define the role of carotid duplex scanning in the surgical decision-making process. These studies were reviewed in a blinded fashion in conjunction with history and physical examination data by two surgeons, one operating on only symptomatic lesions, the other operating on both symptomatic and asymptomatic lesions. Results were analyzed to ascertain if there was agreement regarding decisions for carotid endarterectomy based on scan findings compared with decisions based on arteriographic findings. Scans were also compared with arteriograms and data were analyzed by decision matrix analysis. The accuracy of duplex scanning in relation to arteriography was 81% for detection of disease, 90% for the detection of ulceration, 83% for the detection of a critical stenosis, and 99% for the detection of total arterial occlusion. There was agreement between the two studies regarding the need for carotid surgery in 91% and 89% of carotid arteries, according to surgeons A and B, respectively. Regardless of the surgeons' indications for carotid endarterectomy, duplex ultrasonography provides sufficient information for proper surgical decision making in a high percentage of patients. The accuracy of duplex scanning and the risks of contrast arteriography suggest a possible future role for the routine use of duplex ultrasonography with selective utilization of arteriography in the surgical decision-making process in patients being evaluated for cerebrovascular occlusive disease.
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