EFFECTS OF ULTRASOUND ENERGY ON FEMORAL A RTERIAL-OCCLUSION ANGIOGRAPHIC AND ANGIOSCOPIC RESULTS

Ultrasonic energy has been shown to be able to disrupt atherosclerotic plaques and thrombi- The authors used an ultrasonic angioplastic tech nique developed by the group in 10 patients with a femoral arterial oc clusion. The ultrasonic angioplasty was attempted before surgical bypa ss using a 130 cm long titanium guide wire with a 0.8 mm diameter and a round distal tip measuring 2 or 2.5 mm. Angiographic and angioscopic examinations were performed before and after the procedure in 9 patie nts. It was not possible to perform the angioplasty in 1 patient. Angi oscopy showed that the proximal part of the occlusion consisted of ath eromatous material in 3 cases and of thrombus in 6 cases. Angiography showed complete restoration of flow in 4 cases ; distal flow was very slow in 4 cases and no distal run-off was observed in 1 case- Angiosco py showed residual stenosis at the site of entry in only 1 case. In 3 cases, the artery had no significant residual stenosis. In the other 5 patients residual stenosis was present and angioscopy showed persiste nce of strands of fibrin and small thrombi. These results show that ul trasonic angioplasty was capable of recanalising an occlusion in 9 out of 10 patients with partial or total disruption of thrombi. At the pr esent stage of development of this system, balloon angioplasty would b e an essential complement in most cases in order to obtain normal flow without significant residual stenosis. The manoeuvrability of the gui de wire and the relatively small size of the round distal tip explain why not all the thrombi could be treated. When these problems are solv ed, ultrasonic angioplasty could become a useful tool because of its m echanical effects and its ability to disrupt clots.