bluuebunny/crossref_metadata_2025 huggingface dataset:
Visceral Artery Aneurysms: A Single Center Experience
Authors: Grego F. G. , Lepidi S. , Ragazzi R. , Iurilli V. , Stramanà R. , Deriu G. P.
Published: September 2022

Background

Splanchnic artery areurysm is a rare but clinically relevant disease, showing a high mortality rate in emergency surgery. Reports on splanchnic aneurysms are rare and often anecdotal. The aim of this study is to discuss data obtained from 16 patients in a single vascular surgery center.

Materials and methods

Between January 1987 and December 2000. 16 patients underwent surgery for splanchnic artery aneurysms. In 13 patients the localization was single (in two associated with an infrarenal abdominal aortic aneurysm) and in 3 patients multiple. The arteries involved were: splenic (8). hepatic (4). celiac (3), superior mesenteric (3), ileocolic (2), and pancreatoduodenal (1). 13 patients were asymptomatic and 3 presentee with abdominal pain. All patients underwent CT scan, and abdominal aortic and selective visceral artery angiography. Before surgery, all patients underwent cerebral MR or cerebral CT scan. 13 patients underwent open vascular surgery; 3 patients (2 splenic and 1 hepatic) underwent endovascular procedure (angioembolization). Histological examination of the aneurysmal wall was obtained in 14 patients. Ultrasound examination was performed after 6 months, then yearly. 14 patients underwent abdominal CT scan during the long-term follow-up.

Results

Perioperative mortality was absent. 12 cases were classified as displastic, with minor or major secondary atherosclerotic changes, and in many cases severe caseations. 2 cases were classified as atherosclerotic. Cerebral MR did not show any cases of intracerebral displastric aneurismal disease. One patient was lost at follow-up after 9 years. One patient showed a recurrence at 6 years (superior mesenteric artery): the patient underwent a new surgical procedure and died 20 days after surgery for intestinal infarction. All abdominal follow-up CT scans show good results of the vascular reconstruction and escluded other new visceral or aortic aneurysms.

Conclusions

Visceral artery aneurysms are an uncommon form of abdominal vascular disease showing a high postoperative mortality rate in emergencies. Surgery, and in selected cases, endovascular treatment, can successfully manage splanchnic artery aneurysms with few complications and low recurrence.
Undiagnosed Aberrant Right Subclavian Artery: Pitfall in Aortic Arch Surgery
Authors: Bednarkiewicz Marek , Bruschweiler Ivan , Christenson Jan T.
Published: September 2022

Selected cerebral perfusion as brain protection via right subclavian artery during aortic arch aneurysm repair adds safety, but may be jeopardized by aortic arch anomalies not readily recognized preoperatively. We describe a case of transverse aortic arch aneurysm repair where an undiagnosed aberrant right subclavian artery was cannulated for selective brain protection.
The Fontan-Operation: From Intra- to Extracardiac Procedure
Authors: Kuroczynski W. , Kampmann C. , Choi Y. -H. , Pruefer D. , Singelmann J. , Huth R. , Schmid F. -X. , Heinemann M. , Oelert H.
Published: September 2022

Purpose

For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation.

Methods

From January 1995 until April 2002. 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an Intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed.

Principal findings

There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, or to 90.5% without fenestration respectively. In patients with fenestration procedure, the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation.

Conclusions

Modified Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the benefits of less surgical injury and a higher intraoperative flexibility.
Off-Pump Coronary Surgery: Surgical Strategy for the High-Risk Patient
Authors: Van Belleghem Y. , Caes F. , Maene L. , Van Overbeke H. , Moerman A. , Van Nooten G.
Published: September 2022

Objective

In a retrospective study, we compared two groups of consecutive patients operated by the same team during the year 2000 for coronary artery disease with the use of extracorporeal circulation (group 1, n = 230) or on the beating heart using the Octopus II plus stabiliser (group 2. n = 228). High-risk patients were identified by a EuroSCORE plus 6. EuroSCORE definitions and predicted risk models were utilized to compare the variables of the groups.

Methods

There were no significant differences between the preoperative variables of the groups in age, gender, left ventricular function, diabetes and peripheral vascular and renal disease as is indicated by the Euroscore (resp. 4.7/5.1 p = 0.107). Calcification of the ascending aorta and chronic obstructive lung disease were statistically significant more prevalent in the beating heart group. No differences in preoperative variables in the high-risk patients group (Euroscore 8.5/8.1 p = 0.356) except for calcification of the ascending aorta.

Results

All patients underwent a full revascularisation through a midline sternotomy. Significant more distal anastomoses were performed in group 1 (3.7 per patient (1–6)) with regard to group 2 (2.9 per patient (1–6)). Anesthesia, postoperative treatment and follow up were equal for both groups. A significant lower incidence of atrial fibrillation ( p = 0.010), shorter ICU stay ( p = 0.031) and renal insufficiency ( p=0.033) was reported in group 2. In the low risk group, we could not diagnose any difference between the two groups, except for atrial fibrillation. The benefits of the beating heart surgery however were more pronounced in the high-risk patient as is indicated by a significant reduction of the ICU stay by 1 day (3.5d/2.5d ( p = 0.028)), better preservation of the renal function ( p = 0.017) and a significant reduction of the length of hospital stay by more than two days ( p= 0.040). A lower incidence of atrial fibrillation, however not significant.

Conclusion

In our experience, beating heart surgery is a safe alternative for conventional coronary heart surgery. High-risk patients do benefit most from this technique. It became our first choice in the elderly patient and patients presenting with higher co-morbidities.
Amputation for Acute Ischaemia is Associated with Increased Comorbidity and Higher Amputation Level
Authors: Campbell W. B. , Marriott S. , Eve R. , Mapson E. , Sexton S. , Thompson J. F.
Published: September 2022

Background:

There is some evidence that the early outcome of major amputation is worse after failed thromboembolectomy, but the risk factors and results of amputation done for acute ischaemia have never been compared with those for chronic ischaemia in a large series of patients.

Method:

Retrospective review of 30 day outcome for all 322 primary amputations done for arterial disease during 1992–8. There were 286 patients (163 male; median age 76 years) who had 270 amputations for chronic ischaemia and 52 for acute ischaemia.

Results:

The acute group had higher prevalences of cardiac disease (48% versus 29%— p<0.02), limiting pulmonary disease (27% versus 13%— p<0.02) and ASA grades 4 and 5 (27% versus 14%— p<0.05). Amputation below the knee was less common after acute ischaemia (31% versus 60%— p<0.001). There were trends towards more revisions (19% versus 11%) and higher mortality (25% versus 19%) in the acute group but neither reached statistical significance.

Conclusion:

Patients having major amputations for acute ischaemia have higher levels of pre-existing comorbidity than those with chronic ischaemia and are twice as likely to require amputation above the knee. They should be managed as a particularly high risk group.
Surgical Treatment of Ventricular Septal Defect Complicating Acute Myocardial Infarction. Experience of a North Italian Referral Hospital
Authors: Cerin G. , Donato M. Di , Dimulescu D. , Montericcio V. , Menicanti L , Frigiola A. , De Ambroggi L.
Published: September 2022

The purpose of our study was to evaluate the clinical outcome of postinfarction ventricular septal defect (VSD) of patients referred to our institution for surgical treatment, by assessing the role of several operative, pre- and post-operative variables on mortality.

The medical records of 58 consecutive patients (mean age 73±7 years), operated on after 14±12 days from the acute myocardial infarction were retrospectively reviewed and the data were analyzed. Associated procedures were left ventricular reconstruction in 13 patients and aortocoronary bypass grafting in 47 (81%).

The overall operative, in-hospital mortality rate was 52% (75% in patients operated on within the first week and 16% if time from infarct to surgery was >3 weeks). Time from AMI to surgery and time from hospital admission to operation were significantly shorter in nonsurvivors ( p=0.003 and 0.012, respectively). Other pre-operative variables significantly associated with mortality were: cardiogenic shock, pulmonary pressure, VSD diameter.

In conclusion, time from AMI to operation appears to be a very important prognostic factor. However, size of VSD and hemodynamic conditions significantly influence the mortality. Moreover, concomitant procedures of revascularization can be safely performed, when required, as actually occurs in most cases.
Epidural Analgesia in Patients with Chronic Obstructive Pulmonary Disease Undergoing Transperitoneal Abdominal Aortic Aneurysmorraphy — A Multi-Institutional Analysis
Authors: Bush R. L. , Lin P. H. , Reddy P. P. , Chen C. , Weiss V. J. , Guinn G. , Lumsden A. B.
Published: September 2022

Introduction:

Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop pulmonary morbidity following major abdominal surgery. The purpose of this study was to examine the utility of epidural analgesia in patients with COPD who underwent elective transperitoneal abdominal aortic aneurysm (AAA) repair.

Methods:

During a 7-year period, all patients diagnosed with COPD undergoing elective AAA repair ( n=425) from three hospitals were reviewed. Inclusion criteria were an FEV1/FVC ratio <75% and/or a PaCO2>45 mmHg. Clinical outcomes were compared between those who received epidural analgesia (epidural group) and those who did not (control group). Primary endpoints measured were duration of intubation, ICU stay, hospital days. and pulmonary complications.

Results:

Strict inclusion criteria were met by 131 patients, which included 86 patients in the epidural group and 45 patients in the control group. When comparing the epidural vs. control group, the mean AAA size was 6.3±0.9 cm vs. 6.0±1.5 cm (NS), FEV1 was 57.2±24.7% vs. 49.0±10.3% (NS), and the mean FFV1/FVC ratio was 52.0±11.4% vs. 50.6±6.7% (NS), respectively. The epidural group had a significantly lower incidence of post-operative ventilator dependency and ICU stay ( p<0.05), as well as a decreased trend in pulmonary complications when compared to the control group. The overall hospital stay remained similar between the two groups. The relative risk of developing a pulmonary complication in the absence of epidural analgesia was 2.3

Conclusions:

Perioperative epidural analgesia is beneficial in patients with COPD undergoing AAA repair by reducing both the post-operative ventilator duration and ICU stay. Epidural analgesia should be considered in all COPD patients undergoing elective transperitoneal AAA repair.
Reduced Jugular Venous Oxygen Saturation during Rewarming from Deep Hypothermic Circulatory Arrest: Cerebral Overextraction?
Authors: Kiziltan H. T. , Baltali M. , Koca D. , Oner S. , Sener M. , Tasdelen A.
Published: September 2022

Deep hypothermic circulatory arrest may impair cerebral cellular functions, and physiological parameters following circulatory arrest may deviate from the normal. The intention of this study was to monitor jugular venous oxygen saturation during cardiopulmonary bypass before and after deep hypothermic circulatory arrest. Jugular venous oxygen saturation were obtained on 18 patients by using a retrograde jugular vein catheter during replacement of the ascending aorta. Indications for operations were ascending aortic dilatation ( n = 15) and acute aortic dissection ( n = 3). Hypothermic cardiopulmonary bypass (233 ± 60 min), cardioplegic arrest (105 ± 37 min) and circulatory arrest (22 ± 7 min) were utilized during the operations. Jugular venous oxygen saturation increased during hypothermia and decreased during rewarming. Compared with cooling, jugular venous oxygen saturation during the initial part of rewarming were significantly lower (87 ± 5% vs. 97 ± 1%, 89 ± 4% vs. 95 ± 2%, 81 ± 4% vs. 87 ± 5% at 16, 20 and 24°C respectively, p < 0.05). One patient required reexploration because of bleeding. All patients were found neurologically normal before being discharged from the hospital (mean 14 ± 7 days). In conclusion, jugular venous oxygen saturation is inversely related to the body temperature in patients undergoing hypothermic cardiopulmonary bypass. Significantly decreased jugular venous oxygen saturation during the initial part of rewarming may signify an increased cerebral extraction of oxygen.
EuroSCORE Overestimates the Cardiac Operative Risk
Authors: Karabulut H. , Toraman F. , Alhan C. , Çamur G. , Evrenkaya S. , Daǧdelen S. , Tarcan S.
Published: September 2022

Introduction:

It was the purpose of our study to assess the validity of EuroSCORE (European system for cardiac operative risk evaluation) in our patient population.

Materials and Methods:

Between March 1999 and August 2001, information on risk factors and mortality was collected for 1123 consecutive adult patients undergoing heart surgery with cardiopulmonary bypass. EuroSCORE was used for risk stratification. Mean age ± standard deviation was 58.6 ± 10.9 and 29.1% of the patients were female. The area under the receiver operating characteristic (ROC) curve was calculated as an index for the predictive value of the scoring system.

Results:

The area under the ROC curve was 0.824 for all patients and 0.828 for the isolated CABG subgroup which shows an excellent predictive ability. When the scoring system was applied in low, medium, and high risk groups, there was no overlap between 95% confidence intervals of observed and expected mortality in all three groups both for the isolated CABG cases and for all patients. Decreased left ventricular ejection fraction, emergent operation, and preoperative unstable angina requiring i.v. nitrate treatment were significant predictive variables for early mortality.

Conclusion:

EuroSCORE is a simple and objective system for predicting the risk of heart surgery. The predictive power of the EuroSCORE is excellent, however it seems that mortally is considerably overestimated by this score.
Eversion Carotid Endarterectomy: A Technical Alternative that may Obviate Patch Closure in Women
Authors: Darling R. Clement , Mehta Manish , Roddy Sean P. , Paty Philip S. K. , Kreienberg Paul B. , Ozsvath Kathleen J. , Chang Benjamin B. , Shah Dhiraj M.
Published: September 2022

Purpose:

Recurrent carotid stenosis following standard longitudinal carotid endarterectomy (s-CEA), with and without patch angioplasty, effects the durability of the procedure and can lead to reintervention. The purpose of this study is to evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) in women.

Methods:

The records of all patients undergoing elective carotid endarterectomy (CEA) for symptomatic and asymptomatic high-grade carotid stenosis over a 5-year period from July 1994 to June 1999 were reviewed. Eversion endarterectomy was performed preferentially under regional anesthesia in awake patients. Postoperatively, patients were routinely evaluated by duplex scans at 3 months, 6 months, 12 months, and yearly thereafter. Hemodynamically significant restenosis (>70%) via duplex scans was confirmed by standard or magnetic resonance angiography. Student's t-test and Chi square analysis were used to assess statistical significance and assumed for P < 0.05.

Results:

Over this 5-year period, 3429 eversion carotid endarterectomies were done for symptomatic (female: 375, male: 573) and asymptomatic (female: 1091, male: 1390) high grade carotid stenosis. In the postoperative period 18 (0.9%) male and 12 (0.8%) female patients developed a permanent stroke ( P = NS). Operative mortality was 0.6% ( n = 12) in males and 0.5% ( n = 8) in females ( P= NS). Cranial nerve injuries, wound infections, and neck hematoma occurred in 7 (0.4%), 2 (0.1%), and 26 (1.3%) male and in 3 (0.2%), 3 (0.2%), and 15 (1.0%) female patients, respectively. Recurrent carotid stenosis greater than 70% via duplex scan (PSV >125 cm/s and EDV >100 cm/s) developed in 12 (1.0%) males and 15 (1.5%) females ( P= NS).

Conclusion:

The eversion technique for CEA requires both the transection and anastomosis of the internal carotid artery at the carotid bulb, and appears to result in a low incidence of restenosis in women. This is a straightforward technique and obviates the need for primary closure of distal smaller caliber internal carotid artery that can lead to narrowing, and the use of patch closure that has its attendant risks.
Repair of Coarctation of the Aorta in Adults and Hypertension
Authors: Özyazicioǧlu Ahmet , Ateş Azman , Yekeler İbrahim , Balci Ahmet Yavuz , Bozkurt Engin
Published: September 2022

The aim of this study is to determine if surgical repair of coarctation in adults improves systemic hypertension.

The charts of 23 consecutive patients (age range 13–36 years, mean 23.6 ± 7) who underwent repair of aortic coarctation at the Atatürk University, Aziziye Hospital, between 1986 and 2000 were reviewed. There were 16 (70%) men and seven (30%) women. All patients had preoperative hypertension. Systolic blood pressure (BP) ranged between 150 and 200 mmHg. with a mean of 176 ± 15 mmHg. Peak systolic gradient across the coarctation was 52 ± 20 mmHg (range from 30 to 112 mmHg).

There were no early or late deaths. Mean systolic BP values at the first postoperative evaluation were 176 ± 15 mmHg (p < 0.001 from preoperative values). Exercise testing revealed hypertensive response to exercise in three of 10 patients who had borderline hypertension at rest and without medication.

Repair of coarctation of aorta even in adults is safe and improves systemic hypertension. To identify patients with potential hypertension, exercise testing should be performed. Impaired arterial dilatation may be an important contributor to exercise-related hypertension and late morbidity or mortality.
Results of Endoaneurysmorrhaphy: Does the Location of the Aneurysm Matter?
Authors: Bechtel J. F. Matthias , Tölg Ralph , Robinson Derek R. , Graf Bernhardt , Richardt Gert , Kraatz Ernst G. , Sievers Hans-Hinrich , Bartels Claus
Published: September 2022

Endoaneurysmorrhaphy is mostly performed on anterior-septal left ventricular (LV) aneurysms. It may also be applied to posterior aneurysms, which is technically more challenging. Whether the surgical risk is the same, irrespective of the location of the aneurysm, has not been studied before. We reviewed our experience with 158 patients (62 ± 9 years, 72% male) undergoing endoaneurysmorrhaphy. Eleven patients (7%) had posterior LV aneurysms. Perioperative mortality was 5.7%. Of all preoperative and surgical variables tested, the presence of a posterior LV aneurysm ( p = 0.017), concomitant mitral valve surgery ( p = 0.008) and duration of extracorporal circulation ( p = 0.001) were significantly associated with higher perioperative mortality. However, patients with posterior LV aneurysms had more severe heart failure ( p = 0.0061) and a higher LV end diastolic volume index (138 ± 38 vs. 102 ± 41 ml/kg body weight; p = 0.040) than patients with antero-septal LV aneurysms. Further studies are needed to determine whether the location of the aneurysm is a risk factor for mortality irrespective of the clinical presentation.
Polyester vs. Bovine Pericardial Patching during Carotid Endarterectomy: Early Neurologic Events and Incidence of Restenosis
Authors: Neuhauser Beate , Oldenburg W. Andrew
Published: September 2022

Purpose

The aim of this report was to compare polyester vs. bovine pericardial patching during CEA with regards to the incidence of early neurologic events and recurrent stenosis.

Patients and methods

One hundred and twenty-five consecutive patients with high grade symptomatic (14%) or asymptomatic (86%) carotid artery stenosis (>70%) who underwent 139 CEAs by a single surgeon between January 1997 and April 2001 were retrospectively reviewed. Patients were assessed postoperatively clinically and with routine follow-up duplex scanning. Recurrent stenosis was defined as a narrowing in the common or internal carotid artery of more than 50% by duplex ultrasound examination.

Results

From January 1997 to May 1999, a polyester patch was routinely used in 81 (58%) patients, while between June 1999 and April 2001, a bovine pericardium patch was exclusively used in 59 (42%) patients. There were no ipsilateral postoperative TIAs or strokes in either group. The combined 30-day mortality rate for both groups was 0.8%. One patient in the polyester patch group died from cardiopulmonary complications 10 days after discharge. The length of follow-up in the bovine pericardial patch group was 3–28 months (mean 12 months), while in the polyester patch group was 1–50 months (mean 24.5 month). One patient developed a carotid pseudoaneurysm of the suture line in the bovine pericardium patch group caused by a local infection after previous neck dissection and radiation. The incidence of recurrent stenosis was two patients (4%) in the bovine pericardium group as opposed to six patients (7.6%) in the polyester patch group.

Conclusion

Although this is a preliminary report, it is concluded that bovine pericardium provides excellent perioperative results and is at least comparable to polyester patching in terms of safety. Our study with short term follow up suggests that bovine pericardium patching during carotid endarterectomy may have a lower restenosis rate compared to knitted polyester patching. Clear superiority of bovine pericardium as a patch material awaits a prospective randomised study with long-term follow-up.
Inferior Mesenteric and Hypogastric Artery Reconstruction to Prevent Colonic Ischaemia following Abdominal Aortic Aneurysmectomy
Authors: Shigematsu H. , Nunokawa M. , Hatakeyama T. , Aramoto H. , Ohshiro H. , Kobayashi I. , Yasuhara H. , Muto T. , Morioka Y.
Published: September 2022

In 179 patients receiving prosthetic grafts for abdominal aortic aneurysmectomy, an attempt was made to preserve or restore continuity of at least two vessels, including the patent inferior mesenteric artery (IMA) and bilateral hypogastric arteries (HGAs), so as to prevent colorectal ischaemia. Adjunctive reconstruction of the IMA and/or HGAs was performed in 60 patients; a total of 40 HGAs and 31 IMAs were reconstructed. The hospital mortality rates of patients with elective and ruptured aneurysm repair were 3.9 and 22% respectively. There were no deaths related to colorectal ischaemia. The mean(s.d.) IMA stump blood pressure was 66(18) mmHg and the mean(s.d.) IMA stump pressure index (the ratio of mean peak systolic IMA pressure to mean systolic systemic pressure) was 0.58(0.15). The IMA was revascularized in all patients whose stump pressure was <40 mmHg and whose index was <0.4. Postoperative angiography revealed a 94% patency rate for the IMA and 92% for the HGAs. Colorectal ischaemia did not develop in any patient in whom aneurysmectomy was performed electively or in any who had colonoscopy because of watery diarrhoea after surgery. These results indicate the significance of adjunctive reconstruction of the IMA and HGA during abdominal aortic aneurysmectomy.
Upper-Extremity Deep Venous Thrombosis: Analysis of 52 Cases
Authors: Burihan E. , de Figueiredo L. F. Poli , Francisco J. , Miranda F.
Published: September 2022

In a review of 52 cases of deep venous thrombosis (DVT) of the upper extremity, the predisposing factors, clinical manifestations, topography of thrombosis, treatment employed, presence of complications, and evolution of the disease were investigated. In all patients, clinical manifestations were confirmed by bilateral phlebography and superior cavography. Thirty-five (67%) of the patients were male; the mean age was 45.4 years. Clinical manifestations were edema in 51 patients (98%), dilated collateral circulation in 37 (71%), and pain in 33 (63%). One patient presented with pulmonary embolism and another with phlegmasia cerulea dolens-like signs in an extremity. The right axillosubclavian segment was involved in 23 patients (44%), the left in 17 (33%), and both left and right segments associated with DVT of the superior vena cava in 11 (21%). One patient had left and right axillosubclavian thrombosis without superior vena cava involvement. The main predisposing factors identified were central venous catheterization in 15 patients (29%) and extrinsic compression, caused mainly by cancer, in 15 (29%). There were three cases of DVT related to effort and three to thoracic outlet syndrome. The majority of patients were treated with systemic heparin therapy followed by oral anticoagulation. During a follow-up of 6 months, nine patients died, one from pulmonary embolism; 21 patients (40%) were symptom-free, 11 (21%) had minimal edema, and seven (13%) had symptomless edema. Four patients (8%) were lost to follow-up. The overall incidence of pulmonary embolism was 4%. It is concluded that DVT of the upper extremity is a multifactorial disease that may lead to severe complications, such as chronic obstructive edema, superior vena cava syndrome, and pulmonary embolism.
Association of Intra-Abdominal Pathologies and Vascular Anomalies with Infrarenal Aortic Aneurysm: A Computed Tomographic Study
Authors: Matano R. , Gennaro M. , Mohan C. , Ascer E.
Published: September 2022

The prevalence of potentially significant intra-abdominal pathologies or vascular anomalies in candidates for infrarenal aortic aneurysm repair remains unclear. This study retrospectively reviewed 130 consecutive patients with aortic aneurysms (4.5–10.0 cm in largest diameter) who had undergone contrast-enhanced abdominal computed tomography. The overall incidence of potentially significant pathologies was 31.5%. Gallstones were detected in 25 patients (19.2%). adrenal masses in six (4.6%), pancreatic tumors in two (1.5%), renal stones in two (1.5%), liver metastases in one (0.8%), retroperitoneal lymphoma in one (0.8%) and left gastric artery aneurysm in one (0.8%). Other pathologies included renal cysts in 42 patients (32.3%), colonic diverticulosis in nine (6.9%) and hepatic cysts in three (2.3%). Major vascular anomalies were encountered in only three of the 130 patients (2.3%) and these included two with a left-sided inferior vena cava and one case of retroaortic left renal vein. This study emphasizes the high incidence of potentially significant intra-abdominal pathologies and the low incidence of major vascular anomalies associated with infrarenal aortic aneurysm. The impact of such findings on the management of aortic aneurysms is discussed.
Comparison of Reversed and in Situ Saphenous Vein Grafts for Infragenicular Bypass: Experience of Two Surgeons
Authors: Sasajima T. , Kubo Y. , Kokubo M. , Izumi Y. , Inaba M.
Published: September 2022

A series of 241 consecutive autogenous vein bypasses for chronic lower-limb ischaemia performed by two surgeons since 1980 was reviewed. After 1985, in situ vein bypass was employed preferentially and was compared with reversed vein bypass. The two groups of patients had similar risk factors, indications and outflow. Of the 241 bypasses, 157 were to the below-knee popliteal artery and 84 to infrapopliteal arteries. The utilization rates of a single ipsilateral saphenous vein were 57.5% for reversed and 71.9% for in situ vein bypass. However, in situ vein bypass was impossible in 43 procedures and these were changed to the reversed operation with contralateral vein. The primary 5-year patency rates of reversed and in situ vein bypass grafts to the popliteal artery were 82.5 versus 74.5%, and the primary 4-year patency rates for infrapopliteal bypass 68.5 versus 80.0%. The respective secondary patency rates were 94.2 versus 92.1% and 85.7 versus 91.1%. The main cause of graft failure was vein graft stenosis (reversed vein bypass, 13.0%; in situ, 11.1%), which usually occurred in the first 2 years after surgery. Of 23 grafts revised for stenosis. 21 were salvaged and restenosis rarely occurred. Both reversed and in situ vein bypass grafts were equally effective, but careful surveillance for 2 years and aggressive revision were extremely important after either type of reconstruction.
Pseudoaneurysm of the Tibioperoneal Trunk
Authors: Şener E. , Bayazit M. , Göl M. K. , Saritaş A. , Taşdemir O. , Bayazit K.
Published: September 2022

A young woman with an iatrogenic coagulation defect related to a mechanical mitral valve prosthesis developed a pseudoaneurysm of the tibioperoneal trunk after a minor blunt injury. The importance of minor blunt trauma in such cases and the surgical approach are reviewed.
New Expandable Access Sheath for Endovascular Visualization and Repair
Authors: Criado F. J. , Fogarty T. J. , Patten P.
Published: September 2022

Catheter-based endovascular techniques are becoming increasingly important. Access to the vascular lumen is the single most critical common step to all these interventions. This report describes the concept of, and initial clinical experience with, a new expandable access sheath for endovascular therapy.
Arteriovenous Fistula between the Right Internal Mammary Artery and the Subclavian Vein: Percutaneous Closure with Detachable Balloon-Catheter Embolization
Authors: Moura R. , Uflacker R. , Yoshida W. B. , Rollo H. A. , Lastoria S. , Maffei F. H. Abreo
Published: September 2022

A case of iatrogenic fistula from the right internal mammary artery to the subclavian vein following subclavian vein catheterization is reported. The patient had undergone percutaneous Intracath catheterization of the subclavian vein to treat hypovolemic shock during the surgical treatment of ectopic pregnancy. She had remained symptom-free for 7 years and then started to complain of effort dyspnea. The patient was found to have a thrill and a bruit at the subclavian region, and arteriography demonstrated a fistula between the right internal mammary artery and the subclavian vein. The fistula was successfully closed by embolization with a percutaneous detachable balloon catheter.
Femoral Arteriovenous Fistula following Cardiac Catheterization: An Anatomic Explanation
Authors: Sidawy A. N. , Neville R. F. , Adib H. , Curry K. M.
Published: September 2022

The exact etiology of femoral iatrogenic arteriovenous fistula (AVF) following cardiac catheterization is not known. The most common explanation is simultaneous placement of arterial and venous catheters for left and right heart catheterization. Using a strict protocol for groin examination before and after cardiac catheterization, seven patients were found to have a groin thrill and/or bruit as a result of AVF after catheterization in the period from July 1986 to December 1990; one patient had two fistulas, making a total of eight. During the same period, a total of 2609 cardiac catheterizations were performed using the Seldinger technique; the incidence of AVF after the procedure was thus 0.22%. Arteriography was used to confirm the presence of the fistulas and identify their exact location. All eight lesions originated below the bifurcation of the common femoral artery (CFA). Three originated at the superficial femoral artery (SFA) and five at the profunda femoris artery (PFA). In the patient with two fistulas, one originated at the SFA and one at the PFA. The veins involved were the superficial femoral (SFV) in two AVFs and the profunda femoris (PFV) or its lateral circumflex branch in six. The fact that all eight fistulas originated below the bifurcation of the CFA points to a possible anatomic explanation for the formation of iatrogenic AVF. The CFA and common femoral vein (CFV) are located side by side, which makes it difficult to puncture both with one stick Below the bifurcation, the PFV crosses laterally behind the proximal SFA and then lies in a posterior location to the PFA. In addition, the SFV moves laterally behind the SFA to rest posterior to it. A through-and-through puncture of the SFA or PFA can cause direct communication between these arteries and the SFV or PFV, leading to formation of an AVF. Puncturing the CFA or CFV above their bifurcations will lead to a marked decrease in the incidence of AVF following cardiac catheterization.
Hypothermic Ventricular Fibrillation with Pulsatile Coronary Perfusion during Repair of Ventricular Septal Perforation following Infarction
Authors: Kitamura S. , Kawachi K. , Mizuguchi K. , Hamada Y. , Taniguchi S. , Fukutomi M. , Niwaya K.
Published: September 2022

Emergency or urgent surgery for ventricular septal perforation (VSP) following acute myocardial infarction still carries a high operative mortality rate. Hypothermic fibrillatory arrest studies without aortic cross-clamping and using continuous pulsatile coronary flow were performed to improve this result. Of 19 patients suffering from VSP. 12 underwent hypothermic (mean(s.d.) blood temperature 23.5(1.7)°C) ventricular fibrillation with concomitant pulsatile systemic and continuous coronary perfusion (group 1), and seven underwent deep hypothermic cardioplegic ischaemic arrest with systemic pulsatile perfusion alone (group 2). The two groups were comparable in terms of age, sex. location of infarction, number of coronary arteries involved, interval between infarction and surgery, and preoperative maximum enzyme levels and haemodynamics. Pulsatile flow with a mean(s.d.) pulse pressure of 48(13)mmHg was produced by an intra-aortic balloon pumping device in both groups. Operative exposure In the two groups was comparable. In group 1. mean(s.d.) cardiac output in the early postoperative period (within 3 h of procedure) was significantly higher than in group 2 (4.2(0.9) versus 2.6(0.7)Imin−1 m−2, P<0.01). The 30-day operative mortality rate was significantly lower in group 1 (8% (80% confidence interval 1–29%)) than in group 2 (57% (80% confidence interval 28–83%)) ( P<0.05). On the basis of these results, hypothermic fibrillatory arrest with continuous pulsatile coronary perfusion can be recommended for myocardial protection during surgery for VSP associated with severe heart failure or cardiogenic shock.
Direct Atrioventricular versus Atriopulmonary Connection: A Comparative Experimental Study
Authors: Fantidis P. , Ruiz M. A. Fernández , Castejón R. , Jarabo R. Madero , Zurdo G. Cordovilla
Published: September 2022

A study of 31 dogs, divided into two groups, was conducted to compare direct atrioventricular with atriopulmonary connection using a valved conduit to treat tricuspid atresia. The first group ( n= 9) acted as controls. In the second group ( n = 22), an experimental model was established for direct atrioventricular connection that could be converted to atriopulmonary connection. In subgroup A ( n = 11), the blood from the right atrium (RA) was conducted to a haemodynamically effective residual right ventricle (RV), whereas in subgroup B ( n = 11) the blood was conducted from the RA to an ineffective residual RV. There were haemodynamic advantages of atrioventricular connection in subgroup A. No such differences were found between the two surgical techniques in subgroup B. In both subgroups, light external compression of the pulmonary artery produced a profound deterioration in the haemodynamic state. The technique of direct atrioventricular connection does not appear to offer any advantages as a method of atriopulmonary bypass.
Modified Fontan Procedure for Complex Congenital Heart Disease
Authors: Hsieh M.-J. , Lin P. J. , Chang C.-H. , Chang J.-P. , Chu J.-J. , Su W.-J.
Published: September 2022

The Fontan procedure is frequently used for correction of complex congenital heart disease, but the postoperative morbidity and mortality rates are still high. The results in 35 consecutive patients who underwent the Fontan procedure from January 1980 to June 1991 are reviewed. The patients comprised 26 boys and nine girls aged from 1.7 to 14.8 (mean 6.8) years. The underlying diseases were univentricular heart (19 patients), tricuspid atresia (eight), complete atrioventricular canal (three patients, two of whom had straddling atrioventricular valve) and other conditions (five). Valved conduits were implanted in four patients and non-valved in 15. Direct right atrium-pulmonary artery anastomosis was performed in 16 patients. The overall hospital mortality rate was 23% (eight patients); in the final year of the review it was 11%. Follow-up of the survivors ranged from 1 to 120 (mean 25) months. All except two patients attained New York Heart Association functional class I or II. Three patients underwent reoperation for atrioventricular valve regurgitation and conduit stenosis with good results. It is concluded that the Fontan procedure is a good palliative operation for complex congenital heart disease.
Coronary Steal Syndrome
Authors: Gayá J. , Prego A. Del Río , Guilleuma J. , Vela P. , Arribas A. , Parra J. J. López , Del Bosque V. Paredero
Published: September 2022

A patient who suffered recurrent myocardial ischaemia and cerebrovascular symptoms 56 months after a quadruple coronary bypass is reported. Three coronary arteries had been bypassed using reversed saphenous vein and the other using the left internal mammary artery (IMA). Coronary angiography demonstrated patency of all bypasses but the presence of an obstruction of the left subclavian artery proximal to the origin of the left IMA, with angiographic criteria of the steal syndrome. The patient's symptoms were relieved by bypass from the left common carotid artery to the distal left subclavian artery. The pathophysiology, diagnosis, prevention and treatment of coronary steal syndrome are discussed.
Open Heart Surgery under Total Extracorporeal Circulation in a Patient with Advanced Glaucoma
Authors: Ohtake H. , Misaki T. , Matsunaga Y. , Tubota M. , Watanabe Y. , Shirao Y.
Published: September 2022

A patient with Wolff-Parkinson—White syndrome and severe glaucoma underwent division of the accessory pathway under total extracorporeal circulation (ECC). During ECC, systolic systemic pressure was maintained at 60–80mmHg. Arterial pressure in the optic nerve terminal is reported to be half to one-third of systemic arterial pressure and approximates 20 mmHg during ECC. In the case presented, intraocular pressure was maintained below 15 mmHg throughout ECC. Postoperative examination of the patient revealed no change in visual acuity. During ECC, intraocular pressure may exceed the ocular bottom pressure, placing the optic nerve at risk of ischaemia. In cases where optic nerve ischaemia from ECC is likely, preoperative examination by an ophthalmologist is needed.
Arteritis: Experience in Jeddah, Saudi Arabia
Authors: Al Zahrani H. A.
Published: September 2022

Inflammation of the arteries is a difficult condition to diagnose and treat. Eighteen consecutive patients (16 men, two women) with arteritis treated in the vascular surgery department of King Fahad Hospital. Jeddah. Saudi Arabia, over a period of 3 years were reviewed to define the local pattern of the disease. The mean age of the group was 29.2 (range 18–50) years. Buerger's disease was diagnosed in 11 patients and considered to be the most common type of arteritis. Other types of arteritis identified were: non-specific (four patients), infective (one), irradiation (one) and vasculitis secondary to scleroderma (one). The most common finding was severe lower-limb ischaemia from infrapopliteal occlusion. Arteriography carried out in 16 patients showed either occlusion or stenosis of the affected artery. In one patient an associated renal aneurysm was detected. All patients were advised to stop smoking and unilateral or bilateral lumbar sympathectomy undertaken in those with Buerger's disease. By adopting this policy limb salvage was achieved in nine of the 11 patients with Buerger's disease. In addition to these measures, corticosteroids were prescribed for selected cases of arteritis.
Angioscope-Assisted Endovascular Occlusion of Venous Tributaries: Preclinical Studies
Authors: Rosenthal D. , Herring M. B. , McCready R. A. , Levy A. M.
Published: September 2022

The feasibility of angioscope-assisted occlusion of venous tributaries from within a vein using a steerable ‘shaped-memory’ nickel-titanium (nitinol) alloy catheter and occlusion coils was evaluated. An initial series of tests was designed to establish the necessary pressure (275 p.s.i., 1897.5kPa), time (1.5s) and volume (2.5 ml normal saline) requirements for hydraulic delivery of platinum occlusion coils from the nitinol catheter through a 3-Fr tracking catheter. In a second series, 25 side branches of the saphenous vein in 11 amputated limbs were visualized angioscopically and cannulated with the nitinol catheter under angioscopic and fluoroscopic surveillance to determine whether the catheter tip could be positioned and coils deployed. In a third series of studies, ten canine femoral vein tributaries were successfully cannulated with an 8-Fr nitinol catheter and 19 occlusion coils delivered under angioscopic surveillance. Fluoroscopy verified coil placement and all embolized venous tributaries were thrombosed. An ideal approach for femoropopliteal in situ saphenous vein bypass would allow the surgeon to divide saphenous vein valves while occluding venous side branches from within the saphenous vein. These initial studies demonstrate that the nitinol catheter can occlude venous tributaries from within a vein by coil embolization. Further development of this technique for clinical investigation is warranted.
Alternative Conduits for Coronary Revascularization: A Novel Approach for Harvest of the Lesser Saphenous Vein
Authors: Chang B. B. , Ferraris V. A. , Sadoff J. , Shah D. M. , Leather R. P. , Berry W. R. , Klingman R. R. , Dal Col R. H. , Anene C.
Published: September 2022

Previous use of the greater saphenous vein limits the subsequent availability of conduit for coronary artery bypass grafting (CABG). One readily available alternative conduit is the lesser saphenous vein (LSV). During a 4-year period, 34 LSVs were explored in 23 patients using a novel surgical approach. The incision used for LSV harvest was carried through and deep into the muscular fascia, posterior to the tibia, along the length of the leg, developing a fascial-cutaneous flap. The LSV in all patients was imaged before operation by venous duplex scanning. Important anatomic details were mapped on the patient's leg before surgery using indelible ink. Findings at operation correlated well with the duplex imaging results. Of the 34 LSVs explored 31 were judged usable by the operating surgeon, in eight patients bilateral LSVs were used and in two this vein was the only conduit available. Among patients undergoing LSV harvest there was no operative mortality and minimal operative morbidity related to harvesting. Only one wound infection developed at the incision site. There were no documented cases of deep vein thrombosis. A case-control study was performed in which a control group of 25 patients undergoing CABG without use of the LSV were compared with the 23 who had LSVs harvested; patients in both groups underwent preoperative venous duplex studies. There were no significant differences in operative mortality or morbidity rate between groups (statistical power > 0.8 for these negative observations), suggesting that harvest of the LSV is usually successful when used in conjunction with preoperative venous duplex scanning. The method described allows a high utilization rate of LSV, is associated with ease of harvesting and preparation, provides a venous conduit with handling properties similar to those of the greater saphenous vein, and does not result in additional morbidity.
Non-Obstructive Hypertrophic Cardiomyopathy with Mitral Regurgitation Requiring Valve Replacement
Authors: Nawa S. , Yamamoto T. , Tsuji K. , Nakata T. , Miyachi Y. , Hayashi K.
Published: September 2022

Non-obstructive hypertrophic cardiomyopathy (HCM) is rarely associated with mitral regurgitation severe enough to require valve replacement A 39-year-old man, previously diagnosed as having non-obstructive HCM with mitral regurgitation, developed atrial fibrillation with tachycardia and congestive heart failure. Echocardiography and cardiac catheterization, including left ventriculography, documented an unusual type of non-obstructive HCM with severe mitral regurgitation. The patient underwent successful mitral valve replacement.
Prevention of Reperfusion Syndrome in Acute Muscular Ischaemia with Free Radical Scavengers and Membrane-Protecting Compounds: An Experimental Study
Authors: Pedrini L. , Guarnieri C. , Pisano E. , Masetti L. , Vaona I. , Muttini A. , Motta R. , Sardella L. , Saccà A. , D'Addato M.
Published: September 2022

The prevention of oxidant-induced damage following reperfusion was experimentally evaluated. Two pharmacological regimens containing different combinations of antioxidant factors and membrane-stabilizing compounds, such as α-tocopherol (vitamin E), methionine, dexamethasone, mannitol and cysteine, were administered. The reduced/oxidized glutathione (GSH/GSSG) ratio in muscle was used to evaluate oxidative stress. Ischaemia was induced by occluding the aorta and the inferior vena cava with an irrigation-occlusion catheter. After 4h of ischaemia, five sheep were reperfused without any treatment (control group) and five treated with an endoaortic bolus administered at declamping (treatment 1). In five other sheep, treatment started during ischaemia (treatment 2). Ischaemia and, in particular, reperfusion significantly reduced the muscle GSH content, compared with the basal value in the control group; thus the GSH/GSSG ratio decreased significantly in the control group from 10.5(2.2) (mean(s.e.) basal value) to 0.687(0.3) at reperfusion ( P<0.009). Both treatments 1 and 2 significantly prevented a reduction in GSH content induced by reperfusion following ischaemia; the GSH/GSSG ratio (10.5(2.2) basal value) increased to 19.67(4.6) with reperfusion in the treatment group 1, mainly because of a lower decrease of GSH and a lower level of GSSG while it did not change in treatment group 2 (10.7(5.0)). Levels of creatine phosphokinase did not change in the treated groups, although they increased significantly in the control group ( P<0.006). Although oxidative stress is not the only cause of damage in revascularization, this study confirms the protective ability of treatment with free radical scavengers and membrane-stabilizing compounds.