bluuebunny/crossref_metadata_2025 huggingface dataset:
Mycotic Aneurysm in Recoarctation of the Aorta
Authors: Galinanes Manuel , Stanley Paul , Kratz Christa , Guérin Ronald , Chartrand Claude
Published: November 2007

We report the case of an 8 year old boy with a post-recoarctation mycotic aneurysm demonstrated by angiography 11 months after an episode of fever and peripheral embolism successfully treated as an endocarditis. At reoperation a Gott shunt between the ascending and descending aorta was used, the recoarcted segment and aneurysm were resected and replaced by a microporous synthetic graft. Post-operatively, he developed fever associated with a pericardial friction rub. He was treated with antibiotics and became asymptomatic before discharge. Nine days later, he arrived dead in the emergency room following cardiac tamponade secondary to the rupture of false aneurysms originating at the sites of canulation for the temporary shunt. Although no infectious agent was found in cultures done post-operatively it is thought that the false aneurysms were of infectious origin. This is the first postrecoarctation mycotic aneurysm reported in the literature. The etiology, clinical evolution and treatment of post-coarctation mycotic aneurysm are reviewed. Because of the high risk of rupture and peripheral embolism in these cases, antibiotherapy and prompt surgical treat ment are indicated.
A New Approach for Removal of the Short Saphenous Vein as a Transplant Graft
Authors: Rendl Karl-Hans , Prenner Konrad
Published: November 2007

A new approach for removal of the short saphenous vein as transplant is described. Whereas it is otherwise removed from lateral-dorsal as in varix strip ping, the vein can be found rapidly and certainly as in exposure of the terminal popliteal portion subfascially from the medial direction with displacement of the gastrocnemius musculature.
Experience With Umbilical Vein for Femoropopliteal Reconstruction: Comparison With Other Materials
Authors: Jarrett Fredric , Hirsch Stanley A.
Published: November 2007

We present two to five year patency rates of 59 femoropopliteal bypasses performed with stabilized human umbilical vein (SHUV). Strict adherence to precise technique is emphasized. Our overall patency rate calculated by the actuarial life table method was 54.5% at five years. Patients operated upon for limb salvage was 50% and in patients operated on for disabling claudication the rate was 65.6%. Properly utilized SHUV can provide patency rates in femoro popliteal bypass similar to those utilizing autologous saphenous vein and better than polytetrafluoroethylene, Dacron, and bovine heterograft when these are used for below knee anastomosis.
Idiopathic Spontaneous Perforation of the Aorta During Pregnancy
Authors: Dieter Raymond A.
Published: November 2007

A thirty-four year old white female who was six to seven months pregnant developed abdominal distress. She rapidly deteriorated and developed cardiac arrest. Following attempted resuscitation at home, she was admitted to the hos pital and had emergency laparotomy and cesarian section, both of which were unsuccessful. At surgery, massive hemorrhage was found. At autopsy, three lacerations were found in the upper abdominal aorta without evidence of micro scopic cystic medial necrosis despite an apparent history of such in her mother. This represents a rare spontaneous idiopathic perforation of the aorta during pregnancy.
Angioplasty of Acute Occlusion of the Popliteal Artery After Unsuccessful Surgical Repair: A Case Report
Authors: Al-Bassam Mahdi S. , Rubio Pedro A.
Published: November 2007

In the following case, percutaneous transluminal angioplasty was used to treat acute occlusion of the popliteal artery in a 28-year-old accident victim who had undergone previous unsuccessful repair. Although transluminal angioplasty has proved valuable in treating peripheral vascular lesions, we are not aware of any other case in which this technique has been used to treat postoperative vascular occlusion.
Composite Saphenous Vein Grafts in Portacaval Shunting Evolution, Technique, Experience
Authors: Byer Arnold , Moss Charles M. , Keys Roger C.
Published: November 2007

Nine patients with portal hypertension and bleeding esophageal varices un derwent composite saphenous vein graft (CSVG) portacaval shunts. CSVG por tacaval shunts incorporate the widely accepted and practiced principles of "H" grafting, as well as the known benefits of autogenous vein grafting in the venous system.

The evolution and validity of these principles is outlined. The technique of CSVG portacaval shunts is described in detail and illustrated.

Clinical experience with these shunts during a 13 year period has yielded satisfactory results. Other applications of this technique are suggested.
Synthetic Arterial Graft Conduits
Authors: Jackson David R.
Published: November 2007

This paper is presented to describe the different types of synthetic arterial graft conduits. Included are: woven and knitted dacron, externally-supported- polypropylene dacron, endothelial-cell-lined dacron, pyrolytic-carbon-coated dacron and collagen-impregnated dacron. It also includes PTFE graft, polyure thane elastomers and antibiotic-impregnated dacron. All of the different uses, longevities, complications and possible future evolvings are described.
Balloon Septostomy for Membranous Obstruction of the Vena Cava in Budd-Chiari Syndrome
Authors: Indeck Matthew , Puyau Frank , Kerstein Morris D.
Published: November 2007

The Budd-Chiari Syndrome secondary to a membranous web in the inferior vena cava was successfully treated in a 38-year-old man by Gruntzig—triple balloon dilatation. Follow-up at one year showed near absent ascites.
Aneurysm of the Membranous Septum and Spontaneous Closure of Ventricular Septal Defects
Authors: Singh Ram N.
Published: November 2007

Two cases of aneurysm of membranous septum (AMS) in adults are pre sented, both of which support the hypothesis that it may be the mechanism of spontaneous closure of ventricular septal defects (VSDs). In one case, a trivial residual VSD persisted. In the second case, serial catheterization studies were available; the VSD was large in childhood, gradually became smaller, and com pletely closed with the formation of AMS after the age of 14.
The Carotid Artery as a Coronary Bioprosthesis: Five Potential Donor Species
Authors: Wu Hong-De , Kaplan Svetlana , Sauvage Lester R. , Robel Stephen B. , Berger Knute , Walker Mark , Sado Steven J.
Published: November 2007

Bovine, porcine, ovine, caprine and canine carotid arteries were chosen for study as potential sources of aortocoronary bypass biologic prostheses for use in patients undergoing reconstructive surgery. Anatomic and histologic evalua tions, structural measurements and static mechanical property tests were per formed. The canine carotid arteries have an average length of about 20 to 21 cm with the considerable advantage that there is only one branch, located near the distal end. They also offer the most uniform luminal diameter of 3.0 to 4.0 mm and the most uniform wall thickness (approximately 0.5 mm). The suitable lu minal diameter and wall structure provide a good match to the coronary arte rial anastomosis. Although the canine carotid artery has a thinner wall, static mechanical property tests demonstrate that wall strength and elasticity are com parable to the four other species studied. The canine carotid artery appears to best fit the suggested criteria for a biologic aortocoronary bypass prosthesis from a readily available source. As such, the canine carotid artery in a properly processed form appears worthy of experimental study for aortocoronary bypass surgery.
The Diagnosis of True and False Aneurysms With 111-Indium Labelled Platelets
Authors: Lane I.F. , Poskitt K.R. , Sinclair M. , McCollum C.N.
Published: November 2007

Thrombus formation within arterial aneurysms may lead to embolisation and distal ischaemia. We have investigated the use of 111-indium labelled plate lets in the diagnosis of atherosclerotic and false aneurysms. Autologous platelets labelled with 111-indium oxine were injected into patients with eleven proven aneurysms (8 atherosclerotic, 3 false) . Gamma camera imaging performed be tween 24 and 72 hours later was positive for 10 of the aneurysms. In every case there was increased uptake of label over the aneurysm when compared to undis eased blood vessels (p < 0.05). Most aneurysms could be demonstrated within 24 hours of labelling platelets. 111-indium labelled platelets may prove useful in identifying the source of peripheral arterial emboli.
Venous Hypertension Associated with Asymptomatic Bilateral Axillary Vein Thrombosis and Graft Arteriovenous Fistula A Case Report
Authors: Purcell Roland R. , Guillermo Peña F.
Published: November 2007

Surgically created arteriovenous fistula is a widely used form of treatment for end-stage renal disease. Even though it causes hemodynamic changes, they are not sufficient to produce significant alteration in the local as well as systemic circulation. The venous outflow has a crucial importance in the functioning of the fistula. Venous circulation is usually subjected to repeated injury in patients with chronic or critical illnesses. We present here a case in which sequential attempts to obtain angio access were unsuccessful due to bilateral axillary-sub clavian vein thrombosis, causing severe outflow obstruction and venous hyper tension. The role of angiography is to be considered in these situations.
Surgical Repair of True Femoral Aneurysms
Authors: Huard G. Stedman , Hardin Creighton A.
Published: November 2007

True aneurysms are rare. All patients were white Caucasian males. The most common physical sign was an expanding pulsatile mass. Femoral aneu rysms should be exercised with graft replacement. The complication of distal arterial emboli or rupture will be obviated. When the superior femoral artery is completely occluded in the presence of a femoral aneurysm femoral-popliteal bypass also should be done. The occurrence of both abdominal or iliac aneu rysms and femoral aneurysm can call for staging or complete repair. This judg ment depends on the patient's condition and the surgeon's experience.

A retrospective study revealed that 23 patients had 31 arteriosclerotic true femoral aneurysms. Twenty-three of 27 patients had a complete recovery with aneurysmectomy and prosthetic grafts. Preprosthetic endoaneurysmorrhaphy resulted in two early and late below-knee amputations. No improvement in claudication was present in two patients.
Pseudoaneurysm: A Rare Complication of Balloon Embolectomy: A Case Report
Authors: Ruddock Sue , Downing Richard , Ashton Frank
Published: November 2007

A rare complication of balloon embolectomy — pseudoaneurysm of the pos terior tibial artery — is described in a 72 year old patient who underwent femo ral embolectomy after emergency aortic aneurysmectomy.
Transluminal Recanalization for Hepatic Vein Occlusion with a Web of the Inferior Vena Cava in Budd-Chiari Syndrome: A Case Report
Authors: Yasugi Takumi , Tsunekawa Kengo , Iwahashi Kanji
Published: November 2007

The Budd-Chiari syndrome resulting from hepatic vein thrombosis associ ated with a rudimentary web and thrombosis of the inferior vena cava was successfully treated in a 10-year-old boy by balloon dilation. After the proce dure, hepatomegaly decreased, ascites and the dilated superficial veins on the upper abdominal wall disappeared.
Intrahepatic Arteriovenous Fistula Secondary to Penetrating Trauma: Report of Case and Selected Review of the Literature
Authors: Obeid Farouck N. , Sharma Rajinder , Meyers Eugene , Obeid Farouck N.
Published: November 2007

A traumatic arteriovenous fistula developed following penetrating liver trauma due to a gunshot wound. The initial liver injury was managed by over sewing the hepatic laceration and draining the area of injury. Post-operatively the patient developed the clinical triad of jaundice, gastrointestinal bleeding and abdominal pain consistent with hemobilia. Selective hepatic arteriography was utilized to confirm the diagnosis and to demonstrate an hepatic artery to portal vein fistula. The fistula was successfully occluded by transcatheter embo lization of the right hepatic artery.

This case and a review of the literature illustrates two points. First, although traumatic hemobilia is relatively uncommon, and traumatic intrahepatic arteri ovenous fistulae are rare sequelae of trauma, the diagnosis should be considered when the triad of pain, jaundice and gastronintestinal bleeding occur following hepatic injury. Second, transcatheter embolization may be a useful alternative to operative intervention in management of the intrahepatic source of bleeding.
Left Ventricular-Right Atrial Communication: A Report of Seven Cases With Surgical Treatment
Authors: Morishita Yasuo , Arikawa Kazuhiro , Yuda Toshiyuki , Ishibe Ryohei , Taira Akira
Published: November 2007

Left ventricular-right atrial (LV-RA) communication is a rare congenital malformation. The diagnosis is rarely made clinically, and the true nature of the defect is usually not established until catheterization or surgery. We experienced seven cases of LV-RA communication: the infravalvular type in six and supravalvular in one. In four of seven patients the diagnosis of this anomaly was suggested before surgery. Operative death occurred in one patient — a 6.0-kg infant with a right-to-left shunt, Eisenmenger's complex. The six patients surviving are doing well and have been free of symptoms for postoperative periods ranging from 6 to 29 months. Characteristic features of this anomaly from clinical, radiologic, electrocardiographic, echocardiographic, and catheterization findings are discussed.
Management of the Embolized Indwelling Venous Access Catheter: Case Report
Authors: Bender Gail P.
Published: November 2007

This report describes a case of catheter embolization in a patient with metastatic adenocarcinoma who had a totally implantable catheter positioned for administration of chemotherapy. The catheter transected as it entered the subclavian vein, and a fragment lodged in the heart and pulmonary outflow tract. The catheter fragment was successfully withdrawn by use of a pigtail catheter with an attached guidewire. Fortunately, the patient was asymptomatic during the three days in which the catheter fragment was retained. Since a high incidence of serious or fatal complicatons has been reported to be associated with retained catheter fragments, rapid removal is mandatory and percutaneous retrieval techniques are preferable.
Postmastectomy Edema and Recurrent Cellulitis: Prevention and Treatment
Authors: Gallagher Philip G.
Published: November 2007

Edema of the arm with associated recurrent bouts of cellulitis, occurring immediately or as late as twenty years after treatment of breast cancer, has been a very common and major complication since the initiation of surgical treat ment of breast cancer. We now know the cause and have developed methods to prevent and treat the complication.
Perfusion Fluorometry: A New Test for Chronic Venous Insufficiency
Authors: Taheri Syde A. , Plonka Andrzej , Pollack Larry , Pendergast David , Adelman Martin
Published: November 2007

Although existing noninvasive and invasive techniques have the ability to diagnose venous insufficiency, results from perfusion fluorometry in ischemic legs stimulated us to use it in venous insufficiency. Fourteen individuals received 2 mg/kg diluted sodium fluorescein in the vein of the dorsum of the foot. A ratio of leg/arm fluorescein perfusion was devised. After eighteen minutes of infu sion, patients had a ratio of less than 0.65, whereas all the controls had values of 0.65 or greater. It seems that using perfusion fluorometry is a viable test for diagnosing venous insufficiency syndrome.
The Use of Hemorheological and Microcirculatory Parameters in Evaluating the Effect of Treatment in Raynaud's Phenomenon
Authors: Jacobs M.J.H.M. , Slaaf D.W. , Lemmens H.A.J. , Reneman R.S.
Published: November 2007

Hemorheological and microcirculatory techniques were used to explore whether these methods could be used to make objective the possibly subjective changes induced by therapeutic intervention. In this study a vasoactive drug, ketanserin, was used in the treatment of patients with primary and secondary Raynaud's phenomenon.

The subjective clinical improvement in the acute situation could be con firmed by an increase in red blood cell velocity in the nailfold capillaries before and after cold provocation. Dynamic capillary microscopy even allowed dis crimination between patients who did and those who did not respond to longer lasting treatment with ketanserin. The hemorheological parameters did not dis tinguish respondents from nonrespondents.

In conclusion, dynamic capillary microscopy can be used to evaluate subjec tive changes of treatment and to distinguish respondents from nonrespondents to treatment.
Risks and Benefits of Peripheral Arterial Reconstructions in Octogenerians
Authors: Gänger K.H. , Reuteler Ch. , Senn A.
Published: November 2007

The purpose of this study is to analyze the real benefit of peripheral arterial reconstructions of very old patients in relation to the underlying risk in terms of hospital mortality, long-term survival, amputation rate and level, grade of reha bilitation, and relief of symptoms. In this retrospective analysis, 120 patients with an average age of 85 years were evaluated, 224 peripheral arterial recon structions, repeat-operations, and amputations having been performed. Limb salvage was the leading indication for surgery in 93% of all patients, disabling claudication in only 7%.

Twenty-one patients (18%) died in the hospital, 65 (54%) survived the opera tion for an average of 2½ years, and 34 (28%) are still alive at the end of the observation period; 34 (28%) required amputations and 65 (54%) improved; 81 patients (69%) were ambulant on discharge from the hospital, 68 (79%) in the group without amputation but only 13 (38%) in the amputated group.

This study comes to the conclusions that more than half of the octogenerians benefited from peripheral arterial reconstructions, that the risk of arterial re constructions is acceptable even in this poor-risk group of patients, and finally that arterial reconstructions should be tried whenever feasible to improve the old patient's chance for rehabilitation.
Use of Transcutaneous Oxygen Tension Before, During, and After Arterial Reconstructive Surgery
Authors: Katsamouris Asterios N. , Megerman Joseph , Stassen Laurents , Brewster David C. , Abbott William M.
Published: November 2007

The diagnostic and predictive value of transcutaneous oxygen tension (tcPO2) measurements in patients undergoing lower extremity arterial recon structive surgery were evaluated. Foot tcPO2 was measured preoperatively in 114 patients, intraoperatively in 59 patients, and again seven days after surgery in 82 patients. Preoperative tcPO 2 values less than 30 mmHg were indicative of severe limb ischemia in 90% of patients with rest pain, impending gangrene, or ischemic ulcer. Fifteen minutes after revascularization, tcPO2 greater than 30 mmHg was predictive of a "good" result (determined clinically at one month) in 94% of patients, whereas values less than 30 mmHg predicted a "poor" result in 70% of patients. Measurements obtained seven days postoperatively exhibited an improved negative predictive tcPO2 value (85%) as compared with those ob tained intraoperatively. TCPO2 changes induced by oxygen inhalation were the most promising predictor of the outcome of surgery. TCPO2 was uniformly more reliable than hemodynamic tests (pulse volume recording and Doppler systolic pressure) when more severe disease was present and vice versa; their comple mentary nature suggests the two techniques can be used together to maximize noninvasive diagnostic value.
Technical Considerations in the Use of PTFE
Authors: Taricco Alfred
Published: November 2007

PTFE grafts should not be used by surgeons with little or no vascular experi ence. Because numerous reports by experienced vascular surgeons have de scribed the positive attributes of this graft material, many inexperienced surgeons have chosen to use it occasionally. Often the results have been less than expected and probably were related to poor case selection for the graft's use. These surgeons also chose a material that is not elastic and therefore not forgiv ing. It is best suited for use by an experienced vascular surgeon.

This presentation describes techniques in the use of PTFE grafts to enhance positive results in properly selected cases. It is an outgrowth of personal experi ence and that of others to foster an armamentarium of techniques to facilitate the employment of this sophisticated graft by the inexperienced user of the ma terial. Also included is a discussion of nonvascular graft usage.
Takayasu's Arteriopathy with Associated Descending Thoracic Aortic Dissection During Pregnancy: A Multidisciplinary Approach Leading to a Successful Outcome: A Case Presentation
Authors: Griffith Lee D. , Raney Aidan A. , Dembitsky Walter P. , Hartley-Winkler Mary , Daily Pat O.
Published: November 2007

Takayasu's arteriopathy is a rare arterial inflammatory disease of unknown etiology that commonly affects the aorta, its major branches, and the pulmo nary artery. Although this process most often causes narrowing and occlusion of the vessels involved, it is associated only rarely with aneurysm formation or dissection of the vessel. Although there are sporadic reports of pregnancy in conjunction with Takayasu's arteriopathy, the combination of this disorder with pregnancy and an aortic dissection is very unusual.

This case report and literature review details the clinical management of a gravid female with clinical problems that were managed through close coopera tion among cardiothoracic surgery, anesthesia, obstetrics and gynecology, and perinatology units. This multidisciplinary approach led to the successful opera tive repair of a descending thoracic aortic dissection in a pregnant woman with Takayasu's arteriopathy who later delivered a normal full-term infant.
Primary Thoracic Hemangiopericytoma— A Case Report
Authors: McIntire Timothy L. , Berry Allen D. , Wolf Rodney R.
Published: November 2007

Primary vascular tumors of the thorax are rare, often presenting with simi lar radiologic and histologic characteristics. The angiographic, histologic, and ultrastructural data on a patient with a hemangiopericytoma arising in the pos terior mediastinum are presented.
An Unusual Complication Associated With the Use of the Pruitt-Inahara Shunt—A Case Report
Authors: Celoria Giovanni M. , Berman Joel A.
Published: November 2007

The routine or selective use of an intraarterial shunt during carotid endar terectomy (CEA) remains a controversial issue. Numerous investigators have proposed various shunting devices in an effort to minimize possible associated complications. The presented case illustrates an unusual complication that de veloped during a CEA, felt to be related to a malfunction of a Pruitt-Inahara (P I) shunt.
New Doppler Signal Processor for Arterial Relative Section Evaluation
Authors: di Marzo Luca , Schultz Richard D. , Di Giuliomaria Claudio , Sacco Romeo , Davenport Kathy , Bailey Robert T.
Published: November 2007

A new device has been developed that is capable of processing information from a standard Doppler signal on the relative section (RS) of arteries during the cardiac cycle. RS is a new parameter proportional to the vessel cross-section and its changes during the cardiac cycle. This parameter does not give any morphologic information on the vessel itself, but it can help in completing Dop pler analysis, providing information on vessel elasticity. RS radius (R) and ve locity (V) (traditional Doppler) signals were routinely recorded under constant-pressure conditions. The device was tested in vivo by recording the R and V tracings on 20 common femoral arteries (cf) in dogs. These measure ments were compared with the R and V tracings obtained from the largest femoral branch (fb). R and V tracings were also obtained on 20 femoral arteries after surgically induced stenosis (above, at, and below the stenosis). Both exper iments showed a significant depression of the R tracings (p < 0.01). No signifi cant difference was found between the radius value and three-projection angiography of the stenosis (p=ns). The ability of the device to determine the elasticity of the arterial wall was evaluated in vitro on 10 specimens of athero sclerotic human tibial arteries, obtained from amputated lower extremities, and on 10 samples of dog femoral arteries, and the evaluations were compared. A significant difference in the radius root mean square values was found between the 2 groups (p < 0.01). The authors conclude that this device is capable of determining a new parameter (RS) that is proportional to the cross-section of the examined artery. They have also demonstrated that RS provides useful in formation about arterial wall elasticity.
Cardiac Contusion with Early Ventricular Rupture—A Case Report
Authors: Timberlake Gregory A. , Mandry Cristabal V. , Bellone James L. , Pehr Marcia B. , Martinez Jorge A. , McSwain Norman E.
Published: November 2007

Myocardial contusion is a common concomitant of high-speed deceleration injuries in our modern society. Despite increasing awareness of this entity among health care professionals, in many cases the diagnosis remains a difficult one to make because of a scarcity of physical signs. The diagnosis is, however, extremely important because of the possible complications, which include low cardiac output state, conduction defects, atrial and ventricular dysrhythmias, and, rarely, even cardiac rupture. Much less common, but also clinically impor tant, is rupture of the free cardiac wall from blunt trauma.

A case of cardiac contusion caused by blunt trauma sustained in a motor vehicle accident complicated by early ventricular rupture is presented. Ten hours after arrival at the hospital, this patient abruptly became hypotensive and sustained a cardiopulmonary arrest, which did not respond to the usual medical measures. Upon open thoracotomy the patient was found to have suffered a right ventricular rupture, which was repaired; however, the patient subse quently expired.
Revascularization for Acute Renal Failure — A Case Report
Authors: Bonta Marco J. , Polder Richard M. , Blackford James M.
Published: November 2007

An interesting case of aortorenal bypass allowing discontinuation of renal dialysis is presented, along with a brief review of the literature.
An Effective Surgical Technique for Limb Salvage in Femorodistal Bypass
Authors: Ballotta Enzo , Alvino Simonetta , Franceschi Lorenza , Grego Franco , Deriu Giovanni P. , Giovanni P. , Deriu M.D.
Published: November 2007

Usually, the extension of revascularization of lower extremities to the distal arteries is performed to avoid limb amputation.

Technical errors in the performance of the distal anastomosis or poor runoff cause early failure of the bypass; myointimal fibroplasia or new atherosclerosis at the distal suture edges cause long-term failure.

A new modified technique was used in 20 patients to facilitate the perform ance of the distal anastomosis. A vein patch is employed to widen the distal arteriotomy, and then, the graft is sutured into the vein patch so that the caliber of the distal artery is increased; potential technical defects and the risk of an early thrombosis are thus avoided.

Care is always taken to guarantee a backflow in the vessel, which will permit limb salvage even if the distal runoff is not maintained in long-term follow-up because of occlusion of the outflow.

From 1979 to 1985, 20 patients underwent 21 distal arterial reconstructive procedures with this new technique. All patients presented an absolute indica tion for surgery: rest pain (6), gangrene or ulcer (12), and severe ischemia (2). For the bypass procedure, the great saphenous vein was employed in 13 cases and PTFE in 8. Three major amputations were necessary within eight days of the operation. There was no operative mortality. Long-term patency rate was very high (85%).
Free Internal Mammary Artery Graft as Arteriovenous Fistula: An Experimental Study
Authors: Aarnio P. , Harjula A. , Lehtola A. , Sariola H. , Mattila S.
Published: November 2007

To evaluate the behavior of the free internal mammary artery (IMA) graft in coronary bypass surgery an experiment was carried out in canine arteriovenous shunt position. From 6 dogs the IMA was dissected free from the right side as a naked artery and from the left side with the 2-cm-wide surrounding tissue. Three-cm-long free IMA grafts were anastomosed between the carotid artery and the contralateral external jugular vein as arteriovenous fistulas. After six months the grafts were harvested and studied by light microscopy and scan ning electron microscopy (SEM). Of 12 grafts, 10 were patent. In 1 dog both free IMA grafts were throm bosed. By light microscopy intimal thickening was seen in 2 IMA grafts with the surrounding tissue, and me dial fibrosis was seen in 1 naked IMA

graft. In the SEM study in 4 samples of naked IMA grafts and in 2 samples of the IMA grafts with the surround ing tissue, the endothelium covered the luminal surface, although it had degenerated. In other samples the basement membrane was almost de nuded of endothelial cells. This study showed that free IMA grafts main tain their patency well in arterioven ous shunt, although the endothelium was severely degenerated in all grafts.
Free Internal Mammary Artery as Canine Coronary Artery Bypass Graft
Authors: Aarnio P. , Harjula A. , Lehtola A. , Sariola H. , Merikallio E. , Mattila S.
Published: November 2007

From 8 dogs both internal mam mary arteries (IMA) were harvested: the right IMA as a naked artery with out surrounding tissue and the left IMA with 2-cm-wide surrounding tis sue. Both free IMA grafts were anas tomosed to the proximal end of the left IMA one after another and then to the left anterior descending coro nary artery. At six months the free IMA grafts were harvested and stud ied by light microscopy and scanning electron microscopy (SEM). Six dogs lived the period of six months and all free IMA grafts were patent at that time. In the histologic study 3 grafts were graded as normal and intimal thickening was seen in 8 cases. The endothelial cells were covering the lu minal surface of every free IMA graft in SEM, although some degeneration was seen. This study showed that free IMA grafts maintain their patency well and the method of the dissection of the IMAs did not have any effect on the results.
Microcalorimetric Measurements of Platelet Metabolism After Synthetic Arterial Bypass Procedures in Sheep and the Effect of Low Molecular Weight Dextran
Authors: Christenson Jan T. , Al-Huneidi W. , Abu Saleh R.
Published: November 2007

The overall metabolic activity in platelets after vascular grafting procedure with polytetrafluoroethylene arterial grafts was studied in 18 sheep by use of microcalorimetric measurements. It was found that the heat production (P) from platelets was abnormally low in grafted animals, P=51±8 fW/cell com pared with nongrafted controls, P=60±11 fW/cell, p < 0.001 (fW = 10-15 W). When low molecular weight dextran (LMWD) was given, a significantly higher heat production was observed, P =132 ± 6 fW/cell, thus suggesting a direct platelet effect by the dextran. Platelet aggregation response was decreased after grafting without statistically significant differences between grafted control ani mals and LMWD-treated animals. After the grafting procedure, a drop in platelet count was noted, but it was less pronounced in the LMWD-treated group.
Abdominal Aortic Aneurysms, Cholesterol Gallstones, and the "Einstein Sign"
Authors: Borrero Edgar , Queral Luis A.
Published: November 2007

Between January, 1981, and De cember, 1986, 386 patients under went an elective abdominal aortic aneurysmorrhaphy of which 18 pa tients had a concomitant cholecystec tomy (6 other patients had had a cholecystectomy for biliary colic pre viously). The 24 patients (20 male and 4 female) had an average age of seventy-two years. All patients had cholesterol gallstones, and no patient had cholecystitis. There were no post operative complications and no mor tality attributable to having performed the combined procedures. The operative time was increased by only eighteen minutes and the length of hospital stay was not prolonged. Two patients with known cholelithia sis and abdominal aortic aneurysm presented with right-sided abdominal pain (Einstein sign), and emergency CT scans demonstrated retroperito neal hemorrhage. Cholecystectomy was not performed when a ruptured aneurysm was repaired. It is recom mended that concomitant cholecys tectomy and abdominal aortic aneurysmorrhaphy be performed if there are no mitigating circumstances in elective cases but that cholecystec tomy not be combined with repair of a ruptured aneurysm.
Intravascular Permeation of Uterine Stromal Endometriosis: Case Report
Authors: Gregory P.J. , Coady A. , McCollum C.
Published: November 2007

A case of inferior vena caval (IVC) tumor penetration and obstruction, twenty years after treatment of uterine stromal endometriosis (low-grade stro mal sarcoma) is presented.
Nonresective Therapy for Abdominal Aortic Aneurysm in the High-Risk Patients—Case Reports
Authors: Mingoli Andrea , Sciacca Vincenzo , di Marzo Luca , Cisternino Silvestro , Bartoli Stefano , Cavallaro Antonino
Published: November 2007

Three high-risk patients with an abdominal aortic aneurysm have been man aged with nonresective treatment, including ligation of femoral arteries and, in 2 cases, introduction of Gianturco-Wallace coils into the sac, to induce acute thrombosis of the AAA, and an axillo-bifemoral bypass for restoration of arte rial flow to the lower limbs. One patient died postoperatively.

The literature on this alternative treatment is reviewed. It is stressed that there are a high mortality rate and a high incidence of serious and often lethal complications and that rupture of the aneurysm is not fully precluded. Thus noresective treatment of AAA has to be used with extreme precaution in high- risk patients.
Studies on the Survival of Transmetatarsal Amputation Stumps
Authors: Friedmann Lawrence W. , Padula Patricia A. , Weiss Jay M. , Root Barry , Polchaninoff Michael , Shapiro Daniel
Published: November 2007

Through the use of electrodynog raphy the authors have quantified foot forces in the transmetatarsal am putee with respect to their location, severity, and duration. They have tried to relate this to the potential for foot breakdown. Their aim through electrodynography studies and through their questionnaire is to be gin to find those factors common to those who have not progressed to fur ther amputation.

This provides a beginning to the data collection and evaluation of an extremely difficult problem. There is still a great need for further work, and the authors are continuing to ex amine their patients for the other fac tors involved, without which their data only hint at both causation and treatment. A natural extension of these studies is also examining forces in other partial foot, below-knee, and above-knee amputees, and these are also planned as future projects.
Primary Mycotic Abdominal Aortic Aneurysm Due to Candida—A Case Report
Authors: Joffee Boris , Shemesh Yiftach , Bourvine Avraham
Published: November 2007

A sixty-eight-year-old man with a huge abdominal aortic aneurysm devel oped disseminated candidiasis immediately after surgery. Candida organisms were present in the aneurysm content in the blood and, later, in the brush speci mens of the lungs. The authors believe that this is the first reported abdominal mycotic aneurysm due to Candida.
In Vivo Study of Expanded Polytetrafluoroethylene Vascular Suture
Authors: di Marzo Luca , Hunter William J. , Schultz Richard D. , Feldhaus Richard J.
Published: November 2007

Routine use of high-quality suture material has often been described as a factor in preventing complications such as false aneurysms, infection, and me chanical failure of implanted gafts. Optimal characteristics for a vascular su ture are to maintain its strength without causing an important "foreign body" reaction. Polypropylene monofilament has both characteristics and successfully replaced braided sutures for many years. A new monofilament suture material, which is made of expanded polytetrafluoroethylene (EPTFE), has recently been introduced. The purpose of the present study was to evaluate this new vascular suture and compare it with the widely and successfully used polypropylene su ture. The authors implanted a total of 20 infrarenal aortic reconstructions in dogs using both sutures to perform each anastomosis. Two dogs were sacrificed after 3, 7, 10, 14, 21, 30, 60, 120, 285, and 360 days.

Light and scanning electron microscopy of the anastomotic site was routinely performed in order to compare the two suture materials. Thickness of inflam matory reaction around the sutures was measured at three different sites of each suture and statistically compared. Inflammatory reaction was minimal for both sutures and no significant difference was noticed by use of the Student's T- test (p=NS). No ingrowth was shown in either suture. EPTFE, in contrast to polypropylene, at scan electron microscopy, showed a nice layer of fibrin sur rounding the suture and a tendency to adapt to mechanical stress by being oval, elliptical, or circular. In the authors' opinion, EPTFE suture is, therefore, a valuable alternative for use in cardiovascular surgery.
Recurrence of Varicose Veins Following Surgery
Authors: Elbaz Cl.
Published: November 2007

Analysis of 436 recurrent varicose veins shows that the main cause is an inadequate operative technique that fails to ligate the saphenous veins flush to the femoral or the popliteal veins. The recurrence may also be due to a faulty diagnosis that over looks an incompetent short saphe nous vein or incompetent perfora tors. A careful clinical examination and complete investigation through echography and venography are needed. Reoperation should be per formed in order to obliterate all the points of reflux.

The surgical approach to the re maining stump of a saphenous vein is very difficult through dense scar tis sue and lymph nodes closely adherent to the recurrent veins, which are fragile and thin-walled. It is a real challenge to the surgeon and requires a great deal of experience and opera tive skill.
Bacterial Growth in Venous Ulcers of the Lower Extremity and Its Sensitivity to Antibiotics
Authors: Annoni Federico , Rosina Mariele , Pezzoni Fabio , Pisani Franco , Montorsi Walter , Marincola Francesco M.
Published: November 2007

From 154 consecutive patients, 154 different cultures were obtained from the exudate of lower extremity ulcers due to venous insufficiency.

Subjects were outpatients with venous ulcers from whom cultures were rou tinely obtained at the first visit in the clinic. This prospective study lasted three years. Forty-two cultures failed to grow bacterial contaminants. Among the remaining 112 samples in which bacterial colonization was demonstrated, 78 grew a single microorganism and 34 grew more than one. A total of 124 bacteria species was recorded. Of the 76 Gram-positive cultures, 50 contained Staphylo coccus aureus ; the second most common organism was Staphylococcus epidermi dis, and this was followed by Candida, Streptococcus hemolyticus, and bacilli. Within the 48 Gram-negative bacteria the most common was Pseudomonas aeruginosa followed by Escherichia coli, Enterobacter, Proteus, Acinetobacter, Klebsiella, and Serratia.

Sixteen chemotherapeutic drugs were evaluated by scoring the effect on the bacterial growth and the specificity of activity. The most effective drugs against Gram-positive bacteria were clindamycin (91%), cefotaxime (79%), erythromy cin (76%), and netilmicin (69%), and against Gram-negative bacteria were aztreonan (87%), norphloxacin (85%), netilmicin (79%), and cefotaxime (72%).

The combined antibacterial effectiveness for each ulcer, whether growing single or more microorganisms, was 71 % for cefotaxime, 69% for netilmicin, 66% for norphloxacin, 57% for gentamicin, 50% for cotrimoxazole, 38% for tetracyclines, and 21% for amoxicillin. These data have some practical interest: even though antimicrobial treatment is not usually necessary in the authors' experience if the ulcer does not show clinical evidence of infection, in some instances ulcers do present evidence of active infection. In their opinion the best option in these cases is to collect the exudate, culture it, and while waiting for the result, start with an empiric treatment based on the results as presented in this paper. A prospective clinical study evaluating the effect of these antibiotics on ulcers affected by clinical signs of infection is presently ongoing in their institution with the purpose of giving clinical support to these laboratory find ings.
Assessment of Mitral Valvuloplasty Perioperatively
Authors: Mobarhan H. , Shahidnoorai S. , Amini M.
Published: November 2007

In a total of 100 consecutive cases of mitral valve manipulation: including 60 cases of mitral commissurotomy, 32 cases of mitral valvuloplasty, and 8 cases of mitral cleft associated with interatrial septal defect, the repair was assessed by inserting a catheter with an extra hole into the left ventricle via the aorta, to fill the left ventricular cavity with blood. This maneuver proved to be more effica cious, at least in the authors' hands, than other prevailing methods. It can be repeated easily and is a reliable method with no untoward complications.
Lower Extremity and Renal Ischemia Following Renal Transplantation —A Case Report
Authors: Fanning William J. , Henry Mitchell L. , Sommer Bruce G. , Ferguson Ronald M.
Published: November 2007

Renal transplantation in the older recipient has become commonplace. As the age range continues to widen, it is inevitable that one encounters age-related complications in this group, particularly that of advanced atherosclerosis. Lit erature regarding the management of patients with a previously transplanted kidney requiring proximal arterial replacement is available; however, manage ment strategies of acute inflow abnormalities during transplantation is lacking. The authors describe the identification, treatment, and outcome of a patient with acute ischemia of a newly transplanted kidney and ipsilateral extremity runoff, as a direct result of inflow abnormalities.
The Simultaneous Revascularization Method of Chronic Intestinal Ischemia with the Left Renal, Right Common Iliac, and Left Superficial Femoral Arteries—A Case Report
Authors: Tomikawa Masaki , Ueyama Takeshi , Yokokawa Masayasu , Ikeya Tomohiko , Sugiki Minoru
Published: November 2007

A case of a fifty-eight-year-old man with chronic intestinal ischemia, reno vascular hypertension, and multiple areas of arterial stenosis in the lower ex tremities is described. The results of angiography demonstrated complete occlu sion of the right subclavian and left internal iliac arteries, as well as marked areas of stenosis at the origin of the celiac axis, superior mesenteric, left renal, right common iliac, and left superficial femoral arteries. After the simultaneous revascularization of the celiac axis, superior mesenteric, left renal, right com mon iliac, and left superficial femoral arteries, the patient no longer manifested the symptoms of chronic intestinal ischemia, renovascular hypertension, and intermittent claudication of both lower extremities.
Synchronous Aortic Graft-Enteric Fistulae: A Case Report and Review of the Literature
Authors: Borrero Edgar , Chang John B.
Published: November 2007

Secondary aortic graft enteric fistulae have been reported since the introduc tion of graft replacement of the abdominal aorta. Synchronous secondary aortic graft enteric fistulae are a very rare complication following abdominal aorta graft replacement. They have occurred between the graft and the duodenum and the ileum, and the duodenum and the cecum. Presented is the first reported case of synchronous secondary aortic graft enteric fistulae involving the duode num and the jejunum.
Aneurysm Formation After Remote Closure of an Arteriovenous Fistula — A Case Report
Authors: Perlmutt Louis M. , McCann Richard L.
Published: November 2007

The anatomic and physiologic changes of an arteriovenous fistula are usually reversible with closure of the fistula. With delayed closure, however, anatomic changes may persist and actually progress. A case of this unusual phenomenon is presented.
Severe Atherosclerosis of the Intestinal Arteries Resulting in Chronic Ischemia-A Case Report
Authors: Barbee Charles W. , Robinson Susan M.
Published: November 2007

Chronic abdominal angina is relatively uncommon, and thus most surgeons have limited experience in recognizing and treating this malady. The authors report the case of a sixty-eight-year-old woman with severe atherosclerosis in all of the visceral arteries, resulting in abdominal pain and profound weight loss. Successful treatment included endarterectomy of the renal, celiac, and inferior mesenteric arteries and a Dacron bypass graft to the superior mesenteric artery.
Therapeutic Alternatives in Primary Aortic Salmonellosis—A Case Report
Authors: Harrington Elizabeth B. , Schwartz Myron E. , Palestro Christopher , Miller Charles M. , Haimov M.
Published: November 2007

Salmonella infection of the abdominal aorta has been associated with a high morbidity and mortality rate. Two cases of primary aortic Salmonellosis are reported, illustrating alternative approaches to surgical therapy. Improved di agnostic techniques, changing surgical options, and newer antibiotics have led to increased survival.
Persistent Sciatic Artery Aneurysm
Authors: Orend K.H. , Storck M. , Brandl R. , Becker H.M.
Published: November 2007

A persistent sciatic artery is a rare vascular anomaly Since the first description of Green in 1832, only 54 cases have been reported in literature so far. The authors report a case of acute ischemia of the left lower limb in a twenty-three-year-old man with an ipsilateral sciatic artery aneurysm. After emergency admittance, preoperative diagnosis was made by clinical examination, ultrasonography, angiography, and computed tomographic scan. During operation, the aneurysm was proximally and distally ligated, but not removed, to avoid injury of the sciatic nerve. Arterial reconstruction was performed by implantation of an iliopopliteal bypass using autologous vein.
Morphogenic Considerations on Popliteal Entrapment Syndrome. A New Classification?
Authors: Acín Francisco , Alvarez Rocio , March Jose R. , Guilleuma Juan , De Benito Luis , Segura Juan
Published: November 2007

Popliteal artery entrapment syndrome may result from anomalous positioning of the popliteal artery itself or from abnormal attachments of the medial head of the gastroc nemius muscle. Other popliteal fossa muscles or anatomic structures may be implicated. The authors present 3 cases of this syndrome, describing symptomatology, angiographic patterns, and surgical management, and discuss the anatomic findings from the basis of a dysmorphogenic embryologic development, proposing a new classification: entrapment derived from arterial development anomalies (type I) and entrapment derived from alter ations during the medial gastrocnemius migration (type II), which can explain some findings not easily classified previously