Fifty patients whose surgical approach violated the arterial geniculate circulation to the patella were evaluated to determine the subsequent effect on patella viability. Comparative postoperative radionuclide scans in 100 knees, 50 control and 50 surgical, revealed an avascular insult in only 7 knees (14%). It appears that the intratendinous circulation described by Björkström and Goldie protects the patella from an avascular insult in the presence of geniculate arterial disruption.
The primary concerns in the development of a laser catheter for intravascular use are the potential hazards of vessel wall perforation and distal embolization. We present evidence, using technetium 99-labeled thrombi in two rabbit aortas and one human cadaver coronary artery, that distal embolization does not occur after argon laser recanalization. Also, no vessel wall perforation was observed during recanalization of 15 thrombosed rabbit aortas and 1 inferior vena cava, used because of their extremely thin walls. Laser recanalization of three peripheral arteries with atherosclerotic plaque obstruction, in amputated human legs, showed no evidence of vessel wall perforation. The incidence of vessel wall perforation can be minimized by preferential use of the argon laser, strict maintainance of a coaxial relationship between the laser catheter and the vessel, and exercising care during the actual lasing process. Distal embolization does not appear to be an important consideration.
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