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Title: Laser radiation in the treatment of prosthetic graft stenosis. A preliminary study of prosthesis damage by laser energy

Abstract

Transluminal laser recanalization is potentially an important new treatment of anastomotic intimal hyperplasia. However, currently used grafts or sutures may be damaged by laser radiation at power and energy levels required for plaque removal. To investigate this problem, two commonly used grafts (Dacron and polytetrafluoroethylene (PTFE)) and two types of vascular suture (polypropylene and PTFE) were exposed to argon laser radiation in vitro. Dacron and PTFE grafts recovered from amputations were also studied to determine whether graft healing affected graft resistance to laser damage. Power and energy levels required to perforate atherosclerotic superficial femoral arteries were determined for comparison. PTFE grafts were significantly (1.5 to 7 times) more resistant to perforation by laser energy than atherosclerotic arteries under all conditions. In contrast, Dacron grafts perforated at power and energy levels one half to one third of that required for vaporization of atherosclerotic plaque. PTFE sutures remained intact at power and energy levels above the levels that perforated atherosclerotic arteries, whereas polypropylene sutures were destroyed by very low levels of power and energy (0.5 joules at 0.5 watts). Because of the variable levels of power and energy that damage different types of prosthetic grafts and sutures, laser angioplasty should only bemore » investigated clinically as a therapy for anastomotic intimal hyperplasia when PTFE grafts and sutures are present.« less

Authors:
; ;
Publication Date:
Research Org.:
Univ. of Florida, Gainesville
OSTI Identifier:
5955962
Resource Type:
Journal Article
Resource Relation:
Journal Name: J. Vasc. Surg.; (United States); Journal Volume: 6:3
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; 62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD VESSELS; GRAFTS; LASER RADIATION; BIOLOGICAL EFFECTS; IN VITRO; LASERS; POLYTETRAFLUOROETHYLENE; SURGERY; VASCULAR DISEASES; BODY; CARDIOVASCULAR SYSTEM; DISEASES; ELECTROMAGNETIC RADIATION; FLUORINATED ALIPHATIC HYDROCARBONS; HALOGENATED ALIPHATIC HYDROCARBONS; MEDICINE; ORGANIC COMPOUNDS; ORGANIC FLUORINE COMPOUNDS; ORGANIC HALOGEN COMPOUNDS; ORGANIC POLYMERS; ORGANS; POLYETHYLENES; POLYMERS; POLYOLEFINS; RADIATIONS; TRANSPLANTS; 560400* - Other Environmental Pollutant Effects; 550600 - Medicine

Citation Formats

Seeger, J.M., Abela, G.S., and Klingman, N. Laser radiation in the treatment of prosthetic graft stenosis. A preliminary study of prosthesis damage by laser energy. United States: N. p., 1987. Web. doi:10.1067/mva.1987.avs0060221.
Seeger, J.M., Abela, G.S., & Klingman, N. Laser radiation in the treatment of prosthetic graft stenosis. A preliminary study of prosthesis damage by laser energy. United States. doi:10.1067/mva.1987.avs0060221.
Seeger, J.M., Abela, G.S., and Klingman, N. 1987. "Laser radiation in the treatment of prosthetic graft stenosis. A preliminary study of prosthesis damage by laser energy". United States. doi:10.1067/mva.1987.avs0060221.
@article{osti_5955962,
title = {Laser radiation in the treatment of prosthetic graft stenosis. A preliminary study of prosthesis damage by laser energy},
author = {Seeger, J.M. and Abela, G.S. and Klingman, N.},
abstractNote = {Transluminal laser recanalization is potentially an important new treatment of anastomotic intimal hyperplasia. However, currently used grafts or sutures may be damaged by laser radiation at power and energy levels required for plaque removal. To investigate this problem, two commonly used grafts (Dacron and polytetrafluoroethylene (PTFE)) and two types of vascular suture (polypropylene and PTFE) were exposed to argon laser radiation in vitro. Dacron and PTFE grafts recovered from amputations were also studied to determine whether graft healing affected graft resistance to laser damage. Power and energy levels required to perforate atherosclerotic superficial femoral arteries were determined for comparison. PTFE grafts were significantly (1.5 to 7 times) more resistant to perforation by laser energy than atherosclerotic arteries under all conditions. In contrast, Dacron grafts perforated at power and energy levels one half to one third of that required for vaporization of atherosclerotic plaque. PTFE sutures remained intact at power and energy levels above the levels that perforated atherosclerotic arteries, whereas polypropylene sutures were destroyed by very low levels of power and energy (0.5 joules at 0.5 watts). Because of the variable levels of power and energy that damage different types of prosthetic grafts and sutures, laser angioplasty should only be investigated clinically as a therapy for anastomotic intimal hyperplasia when PTFE grafts and sutures are present.},
doi = {10.1067/mva.1987.avs0060221},
journal = {J. Vasc. Surg.; (United States)},
number = ,
volume = 6:3,
place = {United States},
year = 1987,
month = 9
}
  • An unsolved problem in colon and rectal surgery involves the treatment of locally invasive primary and recurrent rectal cancer. An approach is described that uses intracavitary iridium-192 sources in combination with a pelvic displacement prosthesis to augment external beam radiation doses to sites of residual disease identified at surgery. This approach should permit administration of tumoricidal doses of radiation to positive surgical margins minimizing radiation toxicity to the small bowel. The radiation source and all prosthetic materials are removed at the bedside within 2 weeks of surgery, ensuring accurate radiation dosimetry, minimizing infectious complications, and sparing the patient the needmore » for full high-dose pelvic irradiation.« less
  • Liver transplantation preserving the retrohepatic inferior vena cava, the so-called piggyback technique, is becoming more frequently used because it avoids caval cross-clamping during the anhepatic phase of surgery. However, hepatic venous outflow blockade causing ascites seems to be less infrequent after piggyback than with cavo-caval anastomosis. We report a 62-year-old patient who underwent liver transplantation using the piggyback technique and developed a stenosis in the anastomosis between the hepatic veins and the inferior vena cava leading to severe postoperative ascites. Ascites was unresponsive to diuretic therapy and was associated with renal function impairment. Since the etiology of the stenosis wasmore » mechanical (torsion), percutaneous transluminal angioplasty was unsuccessful. Finally, an autoexpandable prosthesis was placed across the anastomosis resulting in rapid and permanent (3 years of follow-up) resolution of ascites.« less
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  • Megavoltage photon intensity-modulated radiation therapy (IMRT) is typically used in the treatment of prostate cancer at our institution. Approximately 1% to 2% of patients with prostate cancer have hip prostheses. The presence of the prosthesis usually complicates the planning process because of dose perturbation around the prosthesis, radiation attenuation through the prosthesis, and the introduction of computed tomography artifacts in the planning volume. In addition, hip prostheses are typically made of materials of high atomic number, which add uncertainty to the dosimetry of the prostate and critical organs in the planning volume. When the prosthesis is bilateral, treatment planning ismore » further complicated because only a limited number of beam angles can be used to avoid the prostheses. In this case study, we will report the observed advantages of using noncoplanar beams in the delivery of IMRT to a prostate cancer patient with bilateral hip prostheses. The treatment was planned for 75.6 Gy using a 7-field coplanar approach and a noncoplanar arrangement, with all fields avoiding entrance though the prostheses. Our results indicate that, compared with the coplanar plan, the noncoplanar plan delivers the prescribed dose to the target with a slightly better conformality and sparing of rectal tissue versus the coplanar plan.« less