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Little Witch Goes to School (Step-Into-Reading, Step 3)
by: Deborah Hautzig
Department of Radiology, Clarkson Hospital, Omaha, NE 68105.
Palmaz balloon-expandable intraluminal stents (BEISs) were used to treat vena caval and adjacent central venous obstructions that failed to respond to conventional balloon angioplasty. An initial series included seven patients: five had superior vena cava (SVC) syndrome due to a malignant neoplasm and/or radiation therapy, one had dialysis access-related stenosis of the subclavian vein, and one had inferior vena cava (IVC) and bilateral common iliac vein obstruction due to abdominopelvic radiation therapy for Hodgkin disease. Treatment produced clinical benefit in all seven patients. Patency was achieved with stents placed across stenoses of the SVC, IVC, and brachiocephalic and subclavian veins. One stent placed in a left common iliac vein was oval and was shown to be occluded on a follow-up computed tomographic scan, suggesting that compression between the right common iliac artery and the spine was responsible. Although caution is recommended in placement at possible compression sites, BEISs can be used to treat obstructions of the vena cava and major central veins.
Department of Surgery, Indiana University Medical Center, Indianapolis 46202.
Since 1987, we have used the Palmaz expandable intraluminal stent in 22 selected cases of iliac artery stenosis in 14 men and six women with a mean age of 63 years for claudication (9), graft salvage (5), rest pain (4), and tissue loss (2). Morphologic criteria included severe percutaneous balloon angioplasty-induced dissection (6), long or multiple stenoses or occlusions (5), post-percutaneous balloon angioplasty elastic recoil (4), location of stenosis (4), and restenosis following percutaneous balloon angioplasty (3). Twenty-two limbs were treated with 61 stents. The mean pressure gradient across the lesion fell from 31 +/- 15 to 1.1 +/- 2.4 mmHg after stenting. The mean ankle/brachial systolic pressure index improved from 0.59 +/- 0.31 to 0.83 +/- 0.25 after stenting. The mean follow-up is 11.4 months, with a mean ankle/brachial index at their most recent follow-up of 0.88 +/- 0.19. Symptomatically, 11 extremities are normal and five limbs are improved. Three patients have died and two have required bypass grafts for iliac occlusive disease. In this early experience, the Palmaz intraluminal stent appears to be valuable for the management of post-percutaneous balloon angioplasty restenosis, elastic recoil, and percutaneous balloon angioplasty-induced dissection, although it is not without complications.