drsclafani wrote:i am just going to try to use larger balloons, longer and m ore frequent dilatations and fractionated heparin or heparin like material.
So the benefits to this are:
* reducing the rates of restenosis, possibly all the way down to 2% (!) which I would not have thought possible
* avoiding altogether the short-term and long-term problems that may be associated with stent usage
But the risks are:
* a chance of more tears in the vein due to the larger balloons or longer dilations
* as a result of the tearing, a greater risk of clots or vein regrowth to occur, with the ultimate risk being a clot breaking off or a vein growing closed (and this would be what the heparin-like material or fractionated heparin will be working to counter)
Did I miss anything?
Are you less likely to use a cutting balloon if you are now planning to use these larger balloons and longer dilations, because they increase the tearing and a cutting balloon also increases the amount of tearing?
if one dilates progressively, rather than one larger balloon, then the chance of rupture is reduced. Dr. Sinan is not having ruptures. Sometimes small extravasations, but not ruptures.
cutting balloons dont really cut, they indent the vein and they increase the effective pressure generated on the wall. I wil be using cutting balloons as well as other techniques to the same thing nonetheless, i do intend to use cutting aka scoring balloons , anything to improve the effective dilatation.
I just do not like the idea of stents at this point.