bluuebunny/crossref_metadata_2025 huggingface dataset:
Focal Occlusive Disease of the Common Femoral Artery: A Report of 20 Cases
Authors: Mandalam K. Ravi , Rao V. R. K. , Sandhyamani S. , Gupta A. K. , Joseph S. , Unni N. Madhavan , Rao A. Srinivasa , Neelakandhan K. S. , Unnikrishnan M.
Published: September 2024

Occlusive disease localized to the common femoral artery without contiguous involvement of the external iliac and superficial femoral arteries is distinctly uncommon in vascular surgical practice. Twenty patients with focal occlusive disease in 21 common femoral arteries are featured in this report. All except one had severe disabling symptoms: Fontaine classification was stage I in one patient, stage lIb in 13, and stage III in six patients. The probable aetiology, based on clinical features and angiographic observations, was identified as atherosclerosis (nine cases), thromboangiitis obliterans (three) and Takayasu's arteritis (two). Histological features of mucoid vasculopathy, a novel disorder, was seen in one patient while no specific aetiology was evident in five patients. Associated lesions were seen in fourteen patients: aortoiliac in one, femoropopliteal in seven (without any continuity to the common femoral lesion), internal iliac in three and tibial in three. Balloon angioplasty of the common femoral artery lesions was attempted in 14 patients with successful outcome in nine. Three patients (including two with failed balloon angioplasty), underwent thromboendarterectomy and two bypass procedures (iliofemoral, one; femoropopliteal, one). Late reocclusion occurred in one patient each in the angioplasty and surgical groups. There were no procedure-related complications in either group.
Treatment of Thoracic Outlet Syndrome with Combined Scalenectomy and Transaxillary First Rib Resection
Authors: Cinà C. , Whiteacre L. , Edwards R. , Maggisano R.
Published: September 2024

Of a total of 225 patients with suspected thoracic outlet syndrome, 37 (16.4%) underwent surgery. Some eight patients required bilateral operations. One patient had a cervical rib and one a prominent C7 transverse process. A total of 45 limbs were operated on. Thirty-nine procedures were performed as combined scalenectomy and transaxillary first rib resection, four as two-stage scalenectomy and transaxillary first rib resection and two as simple scalenectomy alone. Follow-up from 6 to 60 (mean 17) months was available for 39 operations. A two-tier assessment method was used to improve the accuracy of the results of surgery, including the patient's own evaluation of the benefit of operation communicated to an independent observer and the surgeon's clinical appraisal. Assessment of outcome by the physician was excellent in 54%. good in 28%. fair in 10% and 8% had recurrent symptoms. Similar results were achieved in the patients' subjective evaluation with approximately 50% reporting an excellent outcome. about 40% good and 10% fair. A poor result was not recorded in those who underwent combined scalenectomy and transaxillary first rib resection. A radical surgical approach combining scalenectomy and transaxillary first rib resection is advocated to minimize the recurrence rate and improve results.
Carotid Endarterectomy for Non-hemispheric Ischaemia: Long-term Follow-up
Authors: Ricotta J. J. , O'Brien M. S. , DeWeese J. A.
Published: September 2024

Earlier results reported by the authors suggest that carotid endarterectomy can relieve symptoms of non-hemispheric ischemia in patients who present with hemodynamically significant carotid stenosis. Long-term follow-up of a subgroup of these patients is described. Some 61 patients with non-hemispheric ischemia who underwent carotid endarterectomy were reviewed. Indications for surgery and postoperative results (stroke, death, symptom relief) were determined by office visit or phone interview. Results in these patients were compared with those of an entire patient population who underwent endarterectomy performed by the authors. Mean(s.d.) follow-up was available for 42.3(31.7) months. Perioperative stroke rate (4.9%), survival (85.3 and 64.9% at 3 and 5 years respectively) and stroke-free survival (77.1 and 63.4% at 3 and 5 years respectively) were not different from that entire cohort of 553 patients. During follow-up, 11 patients (18%) developed recurrent symptoms of non-hemispheric ischemia. Carotid endarterectomy is successful in providing long-term relief of symptoms of non-hemispheric ischemia in most patients with significant carotid bifurcation stenosis. Results in such patients are similar to those seen in patients with symptoms of anterior cerebral ischemia or with symptom-free stenoses.
Surgical Management of Extracranial Internal Carotid Artery Aneurysms
Authors: Rosset E. , Roche P.-H. , Magnan P.-E. , Branchereau A.
Published: September 2024

Between 1980 and 1991. 13 of 1312 carotid artery reconstructions were performed for aneurysms of the extracranial internal carotid artery. The patients included 12 men and one woman, mean age 56 years. Postoperative aneurysms and aneurysms involving the common carotid artery were excluded from the study. In six cases, the upper part of the aneurysm was higher than a line joining the mandíbula to the tip of the mastoid process. Six aneurysms were atherosclerotic, two post-traumatic, four dysplasic and one post-traumatic and atherosclerotic. Nine patients had focal neurological symptoms (seven hemispherical, two ocular), one presented with cranial nerve compression, two had non-hemispheric symptoms and one was symptom-free. Surgical reconstruction was achieved by 12 venous grafts and one aneurysmorrhaphy. A conventional cervical approach was used in seven cases: in four cases subluxation of the mandible with resection of the posterior belly of the digastric muscle and division of the styloid process and its attached muscles was used. An infratemporal approach with release of the 7th nerve and opening up of the first portion of the carotid canal was used in two patients. There were no deaths or strokes but two patients had a transient ischaemic attack. In four cases, a cranial nerve palsy developed; one involving the 9th nerve did not recover. Patency was assessed by postoperative angiography in all cases. Mean (range) follow-up was 46 (4-126) months. One patient died after 2 years as a result of myocardial infarction. One patient had a transient Ischaemic attack during the 2nd postoperative year. All survivors were assessed in January 1992. when all reconstructed arteries were patent.
Division-Endarterectomy-Anastomosis of the Internal Carotid Artery: A Prospective Randomized Comparative Study
Authors: Vanmaele R. G. , Van Schil P. E. , DeMaeseneer M. G. , Meese G. , Lehert Ph. , Van Look R. F.
Published: September 2024

Saphenous vein patch angioplasty is reported to yield superior results for carotid endarterectomy. In order to evaluate an alternative technique, which leaves the saphenous vein intact for other possible graft purposes, 200 carotid endarterectomies were included in a prospective randomized comparative study. Patients were randomized to two statistically equivalent groups: one group underwent classical carotid endarterectomy through a longitudinal incision with saphenous vein patch angioplasty; the other had endarterectomy through an oblique division of the internal carotid followed by in situ anastomosis. Cross-clamping time was approximately 5min shorter with the division-endarterectomy-anastomosis technique. The overall perioperative (<30 days) mortality rate was 2.5% and cumulative mortality-morbidity rate 8% in the patch group compared with 4% in the other ( P> 0.05). There were significant more cranial nerve injuries in the patch group, most of which were transient ( P< 0.01). The mean follow-up was 365 days. The late mortality rate was 5.5%. There were no late permanent or fatal strokes, but 3% of patients sustained mild transient neurological events. Only three significant (> 60%) stenoses developed during follow-up. all within 9 months. Dilatation and disturbed flow were more pronounced in the patch group ( P< 0.05). There were no statistically significant differences between both techniques on mortality, disabling neurological morbidity and recurrent stenosis. In conclusion, the results of the divislon-endarterectomy-anastomosis technique are equivalent to those with patch angioplasty, leaving the patient's venous capital intact.
Carotid Endarterectomy for Symptom-free Stenosis: The Patient's Point of View
Authors: Adar R. , Adar R. , Cohen E. , Kreitler S.
Published: September 2024

Determining the indication for carotid endarterectomy in a given patient with a totally symptom-free internal carotid artery stenosis depends on objectively assessing the risk of non-operative versus operative treatment, as well as on the patient's attitude towards immediate versus long-term risk. In order to study patients' attitudes and preferences, four groups of subjects were asked to coniplete two questionnaires: the first examined people's perceived deterioration in their quality of life if they sustained a stroke of a defined severity. The second checked the attitude towards risk of operative versus non-operative treatment at different levels of an expected annual stroke rate without surgery. This preliminary study showed the feasibility of studying these subjective elements, and also pointed to problem areas in this type of research. The existence of individual as well as group differences In patients' values and preferences should be considered in the decision-making process.
Morphological, Immunohistological and Fibrinolytic Features of Patch Grafts for Reconstruction of the Inferior Vena Cava
Authors: Iha K. , Koja K. , Kusaba A.
Published: September 2024

Morphological and immunohistological features and fibrinolytic activity of the neointima of various grafts implanted in the thoracic inferior vena cava (IVC) in dogs were examined. Autologous pericardium (group 1), treated porcine pericardium (group 2), treated bovine pericardium (group 3). treated horse pericardium (group 4) and expanded polytetrafluorethylene (e-PTFE) (group 5) were used as patch grafts. Grafts harvested 12–30 (mean 15.2) months after implantation were all patent in each group. The luminal surface of the grafts was completely covered with endothelial cells, which were positive for immunohistological staining of factor VIII and had active fibrinolytic activity. The gross appearance of the neointima of the grafts in group 1 was smooth; however, the grafts in groups 2–5 were severely deformed with retraction. The concavity of the retracted grafts in groups 2–5 was filled with thick neointima, which consisted of a superficial layer with mature smooth muscle cells and the deeper layer with fibroblast-like ceils and extracellular collagen fibres. Fibroblast-like cells were thought to be a synthetic form of fibroblasts. The deeper layer of the neointima of the implanted biografts and e-PTFE graft was considered to be in the active phase in cell proliferation, even at ≥ 12 months after implantation. It is concluded that autologous pericardium is the material of choice for patch grafts in reconstruction of the IVC and that biografts and synthetic grafts are less than satisfactory.
Assisted Circulation in Pericardiotomy Heart Failure: Experience with the Bio-Medicus Centrifugal Pump in ten Patients
Authors: Paolini G. , Triggiani M. , Credico G. Di , Pocar M. , Stefano P. , Montorsi E. , Simeone F. , Paolillo G. , Grossi A.
Published: September 2024

Between January 1990 and September 1992, ten patients required assisted circulation for postcardiotomy heart failure which was unresponsive to inotropic drugs and aortic counterpulsation. All patients were supported by a Bio-Medicus centrifugal pump (biventricular assist in Ave, left ventricular in three, right ventricular in two); six had ischaemic heart disease, two a congenital ventricular septal defect, one an acute mitral valve incompetence and one an aortic type ‘A’ dissection. The mean duration of circulatory support was 5.1 days (range 2 hours to 8 days). Six patients were weaned from the device and four were discharged; the perioperative deaths among the patients weaned from support were the result of cerebral haemorrhage and multiorgan failure respectively. No late deaths occurred at a mean follow-up of 15 months. Common complications were bleeding (40%), acute renal failure (30%) and sepsis (30%). All patients who developed renal failure died. The high incidence of haemorrhagic complications makes the use of pre-heparinized circuits desirable as these patients do not then require additional anticoagulation.
Embolizing Fibroelastoma of the Aortic Valve
Authors: Ragni T. , Grande A. M. , Cappuccio G. , Arbustini E. , Grasso M. , Tramarin R. , Vigano M.
Published: September 2024

Papillary fibroelastomas are very rare cardiac tumours that can present with embolization of coronary and peripheral arteries and sudden death. The diagnosis can be made by two-dimensional or transoesophageal echocardiography. A 53-year-old man with an aortic valve papillary fibroelastoma who presented with several transient ischaemic attacks is reported.
Surgical Priorities in the Management of Arteriopaths
Authors: Bryan A. J. , Regragui I. , Davies A. , Angelini G. D.
Published: September 2024

Coronary artery disease and its complications remain the leading cause of death in Western society. With an ageing population there is an increasing number of patients with severe multilevel atherosclerosis. Atheromatous disease affecting the coronary, carotid, abdominal aorta and peripheral vasculature may co-exist, and vascular surgical reconstruction is commonly indicated to more than one site. The investigation and sequence of surgical interventions to minimize morbidity and mortality in this group of patients are discussed.
Reperfusion Injury in Skeletal Muscle: Interaction of Osmotic and Colloid-Osmotic Pressure in the Initial Reperfusate for Oedema Prevention
Authors: Matheis G. , Beyersdorf F. , Hanselmann A. , Unger A. , Wildhirt A. , Krüger S. , Zimmer G. , Satter P.
Published: September 2024

Previous studies from the authors' laboratory have shown that controlled limb perfusion after prolonged, acute ischaemia minimizes reperfusion injury. The present study was performed to investigate the role of osmotic and colloid-osmotic pressure in the initial reperfusate in order to reduce postischaemic limb oedema and subsequent reperfusion injury. A total of 96 isolated rat hindlimbs were used: 18 were perfused immediately after amputation (no ischaemia; untreated) and 78 limbs were subjected to 4 h of warm ischaemia in a moist chamber. Thereafter eight limbs were used to investigate the effects of the addition of mannitol to the initial reperfusate. The remaining 70 limbs received controlled reperfusion (modified reperfusate with various osmotic (315-580 mosmol/l) and colloid-osmotic pressure (0-50 mmHg, perfusion pressure 50 mmHg) during the first 30 min after ischaemia. Controlled reperfusion was always followed by uncontrolled reperfusion (30 min, perfusion pressure 100 mmHg) to simulate the clinical condition where normal blood perfusion at systemic pressure will follow controlled reperfusion. Functional recovery, limb weight, water content of the soleus muscle, limb flow and tissue high-energy phosphates were assessed at the end of the experiment. Results show that a reperfusate without colloid-osmotic pressure (i.e. without macromolecules) produces severe limb oedema (84.6(2.0)% water content) and allows no functional recovery after prolonged warm ischaemia. Addition of mannitol to the initial reperfusate does not prevent severe reperfusion injury. In contrast, a hyperosmotic reperfusate with a colloid-osmotic pressure of 26 mmHg effectively prevents limb oedema (78.6(0.9)% water content, 110.8(2.4)% of control weight). Physiological osmotic pressure (315 mosmol/l), however, will not reduce oedema formation (82.7(0.4)% water content). Furthermore. colloid-osmotic pressure >26 mmHg increases the viscosity of the reperfusate (flow decreases to <50% of control) and does not allow an optimal functional recovery. Macromolecules used to create the colloid-osmotic pressure should be of similar molecular weight to albumin (69 000 Da); those with a smaller molecular weight (e.g. hydroxyethyl starch40000/0.5) produce excessive limb oedema (184.9(13.5)% control weight: 85.7(1.4)% water content) without functional recovery (0% control contractions). The present data suggest that after prolonged limb ischaemia: (1) addition of mannitol to a crystalloid solution does not prevent oedema; (2) hyperosmotic reperfusates (380-480 mosmol/l) with a colloid-osmotic pressure of 26 mmHg are most effective in preventing limb oedema; and (3) macromolecules used to achieve colloid-osmotic pressure should have a molecular weight similar to albumin.
Cardiac Transplantation: A Review
Authors: Yeatman M. , Smith J. A. , Dunning J. J. , Large S. R. , Wallwork J.
Published: September 2024

Cardiac transplantation is currently a highly successful treatment for selected patients with end-stage cardiac failure. The long-term results are limited by the development of coronary artery vasculopathy, infection and malignancy. The activity of transplantation programmes worldwide is severely limited by the availability of donor organs. Further refinements of immunosuppressive agents are likely to result in improved prevention of both acute and chronic rejection. The donor pool is unlikely to be significantly extended as a result of measures to increase donor organ supply. Alternative methods to allograft transplantation need further investigation to increase the number of therapeutic options available for those patients with end-stage heart failure.
Surgical Treatment of Thoracic Aneurysm: A 5-Year Experience
Authors: Hessmann M. , Dossche K. , Wellens F. , Vanermen H. , De Geest R.
Published: September 2024

The surgical results of 77 patients with an aneurysm of the thoracic or thoracoabdominal aorta who were surgically treated during a 5-year period were retrospectively evaluated. Eighty-four operations were performed. The aneurysm was located on the ascending aorta in 20 patients, on the arch in nine, and on the arch and ascending aorta in eight. Sixteen aneurysms involved the descending thoracic aorta and 27 were thoracoabdominal. Associated surgery was performed in 12 patients. Deep hypothermia and circulatory arrest were employed in 30 patients. Partial cardiopulmonary bypass was used in 15 patients. Mortality was significantly higher if operation was performed under emergency conditions: the early mortality rate was 11.7%. Aggressive surgical management of untreated aneurysm is justified, as rupture of such lesions is the most common cause of death and associated mortality is high, with a 5-year survival rate of less than 20%.
Results of an Exclusion Technique for Treatment of Abdominal Aortic Aneurysm
Authors: Marnette J. M. , Creemers E. , Trotteur G. , Limet R.
Published: September 2024

An exclusion technique for the treatment of abdominal aortic aneurysm was used in six patients considered to be at high operative risk mainly because of chronic pulmonary disease. There were no deaths or immediate major complications. Thrombosis of the aneurysm was achieved in four of the six patients. However, in three cases, repeated percutaneous embolization was required to produce thrombosis. One patient developed a secondary rupture of a persisting infrarenal sac resulting from a patent inferior mesenteric artery. This patient was successfully managed by ligature of the infrarenal portion of the abdominal aorta through a median laparotomy. This study emphasizes the limits and the risks of the exclusion technique.
Incidence of Rupture of Aortic Aneurysms after Coincidental Operation
Authors: Lalak N. , Englund R. , Hanel K.C.
Published: September 2024

The clinical course of 76 patients with aortic aneurysmal disease undergoing 107 coincidental surgical procedures was analysed in order to examine the relationship between aortic aneurysmal rupture and coincidental treatment. Additionally the incidence of aneurysmal rupture was assessed following 82 endoscopic procedures in 42 patients with aortic aneurysms. Two patients ruptured an aortic aneurysm after operation, one after colonoscopy (maximal transverse diameter 7 cm) and one after coronary artery bypass grafting (maximal transverse diameter 5.6 cm). The mean maximal transverse diameter of aneurysms in 76 patients was 5.08cm (95% confidence interval 4.7–5.4 cm). Both patients with ruptured aortic aneurysms were outside these confidence limits and were known hypertensives whose perioperative control of hypertension was questionable. The present series of patients is discussed with reference to induction of collagenase activity as a precipitating cause for postoperative rupture of aortic aneurysms, perioperative control of hypertension, transverse aneurysm diameter as a predictor of postoperative rupture and conduct of coincidental procedures in the presence of aneurysmal disease.
Management of Neglected Embolic Occlusions in Lower-Limb Arteries Using Arterial Lavage
Authors: Hachem M. M. , Grillo I. A.
Published: September 2024

Fourteen patients (seven males and seven females aged between 8 months and 100 years) with embolic lower-limb arterial occlusions of 1 to 6 days' duration were treated at Assir Central Hospital, Abha, Saudi Arabia over a 27-month period. On admission, the limbs were ischaemic up to mid-thigh and peripheral pulses were absent. Doppler studies showed absence of blood flow. The anatomical block was localized by angiography and ultrasonography. Fogarty catheter embolectomy was performed in all patients followed by rapid positive-pressure lavage of the vascular tree with 4–61 Ringer's lactate solution containing mannitol in an attempt to remove free radicals. Three patients died; one transmetatarsal amputation was performed. The remaining 11 limbs were salvaged and these patients remain ambulatory 21 to 42 months after surgery.
Treatment Plan Used for Vascular Injuries in the Afghanistan War
Authors: Roostar L.
Published: September 2024

The outcome of 961 patients with vascular injuries received in the Afghanistan war is reported. Some 755 (78.6%) patients had to have a primary amputation while only 206 (20.9%) had restorative surgery. The vessels were simply ligated in 85 cases and reconstructive surgery was performed in 121. Ligation resulted in 46 (54%) cases of limb salvage and functional restoration; 30 (35%) went on to amputation and nine (11%) died. Of the 121 patients treated by reconstructive surgery, 83 (68.5%) had completely patent vessels, 19 (15.7%) collateral compensation. 13 (10.7%) proceeded to subsequent amputation and six (4.9%) died. Although the location of the injury and the duration of the ischaemic period are important in deciding how to treat the vascular injuries of war, the decisive factor appears to be the pre-existing severity of regional ischaemia.
Short-term and Long-Term Outcome following Renovascular Reconstruction
Authors: Lamawansa M. D. , Bell R. , House A. K.
Published: September 2024

Experience with renovascular reconstruction at the authors' institution over the past 16 years has been reviewed. A total of 76 patients underwent surgical intervention for renovascular disease during that time. This included 62 patients with atherosclerosis and 11 with fibromuscular hyperplasia. Indications for intervention were uncontrolled hypertension in 42 patients and to restore renal impairment in eight. The procedure was performed for both indications in 26 patients. Ten patients (13%) died in the perioperative interval, which correlated strongly with comorbidity. With the exception of one patient, all deaths occurred in the elderly (> 65 years). While an increased mortality rate ( P< 0.05) was observed in those undergoing concomitant surgical procedures (20%) as opposed to those undergoing renovascular reconstruction alone (6%). this was not an independent risk factor. Both the short term and long term response of hypertension control to renovascular reconstruction were favourable, with age < 60 years, shorter duration of hypertension (< 5 years) and diagnosis of fibromuscular hyperplasia predictive of a better response. Renovascular reconstruction, while successful in stabilizing or even improving renal function in the short term, was poor at restoring function long term, especially in the subgroup of patients whose serum creatinine was > 200 μmol/l at the time of reconstruction
Congenital Aneurysm of the Internal Jugular Vein in a Pregnant Woman
Authors: Calligaro K. D. , Ahmed S. , Dandora R. , Savarese R. P. , Dougherty M. J. , DeLaurentis D. A.
Published: September 2024

A pregnant woman with a symptom-free congenital aneurysm of the internal jugular vein (IJV) is described. A color duplex scan revealed an aneurysm (2.4 cm in diameter) of the right IJV in the mid-neck without evidence of thrombus. To the authors' knowledge, this is the first reported case demonstrating that such a lesion in a pregnant woman can be safely managed without excision.
Doppler Analysis of the Left Venting Line: An Effective and Simple Technique to Control Heart De-Airing
Authors: Rescigno G. , Riom H. , Hallali P. , Nottin R. , Amaud-Crozat E.
Published: September 2024

Air embolism is still a major risk of open-heart surgery. Different techniques of air removal have been established, even though none is completely effective. Since 1989 the authors have used a new technique to avoid air passage into the left vent line when the left heart cavities are open. A specially designed probe attached to a vascular Doppler analyser is fixed to the left vent tubing. Air passage is detected by a characteristic acoustic signal. Air removal procedures are continued until no audible signals are detected. This technique was carried out in 150 open left heart operations in which there were no clinical signs of air embolism. To validate this procedure, simultaneous assessment of air removal was made using transoesophageal echocardiography (TEE) and carotid Doppler (CD) in six patients. When Doppler signs of air in the left vent disappeared, TEE revealed that a small amount of air was still present in two patients; carotid Doppler showed only minimal passage of air bubbles in three patients after left vent removal while the heart was freely ejecting. These results demonstrate that this technique is a reliable method of assessing air removal, which is especially useful when de-airing is difficult during reoperation.
Combined Internal Cardioverter-Defibrillator Implantation and Myocardial Revascularization for Ischemic Ventricular Arrhythmias: Optimal Cost-Effective Strategy
Authors: Lee J. H. , Folsom D. L. , Biblo L. A. , Carlson M. D. , Johnson N. J. , Waldo A. L. , Geha A. S.
Published: September 2024

During the 7-year period from August 1986 to July 1993, 203 patients with malignant ventricular arrhythmias underwent 203 implantable cardioverter-defibrillator (ICD system) implantations at the University Hospitals of Cleveland. Sixty-four patients had significant coronary artery stenoses amenable to myocardial revascularization and thus, at the time of the operation for ICD placement, also underwent coronary artery bypass graft. A retrospective analysis of the course of these 64 patients was carried out to determine the effect of two different treatment strategies on the outcome and cost of therapy. Thirty-six patients (group 1) underwent concomitant implantation of the ICD leads, patches and generator at the time of myocardial revascularization; 28 patients (group 2) underwent a two-stage strategy of Initial placement of the ICD leads and patches at the time of myocardial revascularization followed by postoperative electrophysiologic testing to determine the persistent need for generator implantation. Of this latter group, 16 patients still had inducible sustained ventricular tachycardia during postoperative electrophysiologic testing and underwent generator implantation; 12 patients did not receive an ICD generator. The overall 30-day mortality rate was 4.7%. Two patients died in group 1 for a mortality rate of 5.5% and one died in group 2 for a mortality rate of 3.6%. The mean(s.d.) length of stay was 22.8(9.6) days at a mean(s.d.) cost of $93 000(33 000) for group 1 and 24.5(9.6) days at a mean cost of $82 900(30 000) for group 2 ( P = n.s.). The mean(s.d.) postoperative length of stay was 13.7(7.8) days for group 1 and 15.4(6.5) days for group 2 (P = n.s.). Other complications occurred in 23% of surviving patients in group 1 and 29% of surviving patients in group 2 ( P = n.s.). Mean follow-up was 33 months for group 1 and 23 months for group 2. At the end of 2 years, 78% of patients in group 1 and 86% in group 2 were alive ( P = n.s.). It is concluded that concomitant coronary artery bypass grafting and ICD implantation does not result in significantly shorter hospitalization or lower costs. A staged approach appears equally economical, particularly as some patients are spared the cost of the initial ICD generator, the subsequent periodic generator replacements and the mandatory ICD follow-up. This has important implications when the use of non-thoracotomy devices becomes widespread.
Ischemia-Reperfusion Injury of the Spinal Cord: The Influence of Normovolemic Hemodilution and Gradual Reperfusion
Authors: Wisselink W. , Nguyen J. H. , Becker M. O. , Money S. R. , Hollier L. H.
Published: September 2024

Recent studies have suggested that oxygen-derived free radicals play an Important role in ischemia-reperfusion injury of the spinal cord. In other organ systems, reperfusion injury has been reduced by limiting the availability of oxygen in the reperfusion phase. The purpose of this study was to test the effect of normovolemic hemodilution and gradual reperfusion on spinal cord function after aortic cross-clamping in 84 New Zealand White rabbits. All animals underwent 21 min of infrarenal aortic cross-damping in the conscious state by means of a previously placed aortic occlusion device and were randomized to four groups. Group 1 animals were hemodiluted to a mean(s.e.m.) hematocrit of 28(2)% by extracting 25% of the effective blood volume and reinfusing the plasma component after centrifugation concurrently with a volume of normal saline three times that of the discarded red cells. Group 2 animals (controls) were bled similarly but both plasma and red cells were reinfused, resulting in a mean(s.e.m.) hematocrit of 38(2)%. In the next two groups, distal aortic flow was recorded via an implantable Doppler device. After cross-clamping, flow was returned gradually over 45 min in animals of group 3. and abruptly in group 4. Animals were observed for 5 days and neurologic function was graded by an independent observer. Paraplegia at 5 h after clamping occurred in 75% of animals in group 1 versus 32% in group 2 ( P< 0.05), and in 33% of group 3 versus 28% in group 4 (not significant). Of those animals showing initial neurologic recovery, delayed-onset paraplegia was seen in 100% in group 1 versus 87% in group 4 (not significant), and in 50% of group 3 versus 92% of group 4 ( P< 0.03). The findings that the incidence of delayed-onset paraplegia in rabbits is reduced after gradual reintroduction of blood flow supports the hypothesis that this phenomenon is caused by reperfusion injury. Ischemic spinal cord injury is worsened by normovolemic hemodilution in this model.
Renal Artery Anomalies in Patients with Horseshoe or Ectopic Kidneys: The Challenge of Aortic Reconstruction
Authors: de Virgilio C. , Gloviczki P. , Cherry K. J. , Stanson A. W. , Bower T. C. , Hallett J. W. , Pairolero P. C.
Published: September 2024

Renal fusion or ectopia can present formidable challenges during aortic surgery. To evaluate morbidity and define optimal management, the clinical histories of 120 patients with renal fusion or ectopia who underwent 21 aortic procedures at the authors' institution over a 37-year period were reviewed. Indications for surgery included aortic aneurysm in 16 patients (infrarenal in 15 and thoracoabdominal in one) and aortoiliac occlusive disease in five (with renovascular hypertension in two). The abnormal kidney was detected before surgery in 13 patients (65%) by excretory urography, arteriography, computed tomography, or ultrasonography. Arteriography revealed multiple and/or anomalous renal arteries in nine of 12 patients studied. At surgery, 15 patients (75%) were found to have multiple or anomalous renal arteries. Six required renal revascularization (reimplantation four, endarterectomy one, aortorenal bypass one). The renal symphysis was divided in two patients. There were no operative deaths. Six major complications included bleeding requiring reoperation, renal failure requiring short-term dialysis, pancreatitis, gastrointestinal bleeding, pneumonia and thrombophlebitis. Preoperative aortography is recommended in patients with renal fusion or ectopia because of the high incidence of associated renal artery anomalies. The surgeon must be prepared to preserve or revascularize these anomalous renal arteries. Division of the renal symphysis is rarely required. Although perioperative morbidity is raised, aortic reconstruction in patients with renal fusion or ectopia can be safely performed without increased mortality.
Cardiac Myxomas: Surgical Treatment and Long-Term Results
Authors: Bastos P. , Barreiros F. , Casanova J. , Gomes M. R.
Published: September 2024

Twenty-six patients have undergone a resection of a cardiac myxoma since 1977. There were five males and 21 females, of age range 14–81 years (mean 50 years). Symptoms included congestive heart failure, emboli, palpitations and syncope. The tumours were located in the left atrium (21 patients), right atrium (four) and right ventricle (one). The hospital mortality rate was 3.8%. Late outcome was known for 24 of 25 (96%) patients. The total follow-up is now 2116 months (mean 88 (range 2-204) months per patient). One patient (4%) died of colonic malignancy 4 years after surgery. Long-term results were satisfactory. Echocardiographic information supporting the absence of recurrence was known for all 23 patients, evaluated at an average of 80 (range 2-196) months postoperatively. Surgical resection is the correct treatment for cardiac myxoma and is imperative following the diagnosis.
Myocardial Revascularization in a Sickle-Cell Trait Patient
Authors: Varvitsiotis P. S. , Jones J. W. , Nahas C. , Beall A. C.
Published: September 2024

A 56-year-old man with confirmed sickle-cell trait AS underwent successful triple-vessel myocardial revascularization with internal mammary artery and vein conduits. Variations in routine technique included limitation in hypothermia (32°C), avoidance of intraoperative autologous salvage, hypoxia, severe anemia (< 25% hematocrit), acidosis and postoperative reinfusion of mediastinal drainage.
Neurogenic Thoracic Outlet Decompression: Rationale for Sparing the First Rib
Authors: Cheng S. W. K. , Reilly L. M. , Nelken N. A. , Ellis W. V. , Stoney R. J.
Published: September 2024

A total of 168 primary supraclavicular decompressions were performed on 146 patients with neurogenic thoracic outlet syndrome. This report compares the results of rib resection (supraclavicular anterior and middle scalenectomy and first rib resection) with rib-sparing (supraclavicular anterior and middle scalenectomy alone) operations. All patients with cervical ribs were excluded In total. 125 rib resections and 43 rib-sparing procedures were performed between 1983 and 1992 by a single surgeon. The patients were otherwise comparable in symptoms and physical signs. During surgery there was a significantly higher proportion of pleural injury associated with rib resection (59%) than with rib-sparing (40%) procedures. The mean hospital stay was also prolonged by 1 day in patients undergoing rib resection (P=0 005) There was no significant difference in early success between the two groups (83% for rib resection 91% for rib sparing) and no difference in those resuming employment (52% and 63% respectively). Life-table analysis showed that the two groups have similar long-term results (69% and 76% at 2 years). The only important factor determining clinical outcome in primary supraclavicular thoracic outlet syndrome decompression was the duration of symptoms before operation. Some 83% of patients with symptoms less than 2 years had a successful result compared with only 68% in those with symptoms longer than 2 years ( P<0.05). Spontaneous or post-traumatic neurogenic symptoms responded to operation identically The theoretical benefit of first rib resection to relieve mechanical compression of the brachial plexus is not evident from this review. Thorough removal of the scalene musculature and other myofascial anomalies, preferably through the supraclavicular approach, leads to less patient morbidity, shortens hospitalization, and is recommended for patients with neurogenic thoracic outlet syndrome requiring operative intervention.
External Carotid Endarterectomy with Internal Carotid Artery Transposition Flap Angioplasty for Symptomatic Internal Carotid Artery Occlusion
Authors: Harris L. M. , Pillai L. , Ricotta J. J.
Published: September 2024

The external carotid artery is an important collateral pathway for cerebral perfusion when the internal carotid artery is occluded. After internal carotid artery occlusion, there is a definite risk of ipsilateral neurological events. The authors retrospectively examined their experience with endarterectomy of the external carotid artery for symptomatic internal carotid artery occlusion. Results based on the authors' experience and on historical data show external carotid endarterectomy to be a safe procedure. Obliteration of the cul-de-sac appears to be a very important factor in the prevention of reocclusion or recurrence of symptoms after external carotid endarterectomy. Use of the internal carotid artery stump for patching of the endarterectomized external carotid artery is both safe and effective in treating symptomatic internal carotid artery occlusion.
Carotid Dacron Patch Angioplasty: Immediate and Long-Term Results of a Prospective Series
Authors: Perler B. A. , Ursin F. , Shanks U. , Williams G. M.
Published: September 2024

The purpose of the present study was to determine the acute clinical results associated with the performance of Dacron patch angioplasty during carotid endarterectomy, and to define the incidence of residual and recurrent carotid stenoses in patched arteries. Some 115 consecutive patients (mean age 68.0 years) underwent 119 primary carotid endarterectomy procedures in which the arteriotomy was repaired with a Dacron patch. The patients underwent duplex/occulopneumoplethysmography evaluation at 6 months after surgery, and annually thereafter There was one (0.8%) operative death and two (1.7%) perioperative strokes. There were no immediate postoperative carotid thromboses. There were no wound or patch infections acutely, or in long-term follow-up. Thirteen patients (11%) were lost to follow-up; hence 106 arteries in 102 patients were followed for 1–65 (mean 17.8) months, including 66 arteries (62%) that have undergone serial OPG/duplex evaluation. The incidence of residual stenoses (within 3 months) was 4.5%, and that of recurrent stenoses 4.8%. The results of the study show Dacron carotid patch angioplasty to be associated with excellent clinical results, with a relatively low incidence of residual/recurrent carotid stenoses.
Carotid-Subclavian Bypass and the Carotid Steal Phenomenon
Authors: Hadjipetrou S. , Lord R. S. A. , Crazier J. A. , Sommerville K. , Meek A. C.
Published: September 2024

Twelve patients with patent carotid-subclavian bypass grafts were investigated by colour flow duplex imaging to look for a carotid steal. Centre-stream peak systolic flow velocities in the common carotid arteries distal to the take-off of the bypass graft were equivalent to those in the contralateral common carotid artery. On the side of the bypass, common carotid flow proximal to the graft was almost double that on the distal side. Steal phenomena were not identified in the carotid artery either with the arm at rest or during hyperaemia. However, in two instances arm hyperaemia caused reversal of flow in the ipsilateral vertebral artery, suggesting the induction of a subclavian steal. The method of centre-stream peak systolic velocity as an index of flow confirmed that carotid-subclavian bypass can be safely carried out without depriving the cerebral circulation of the normal carotid inflow.
Non-Invasive Impedance Analysis: A New Noninvasive Test for Graft Surveillance
Authors: Arora S. , Meier G. H. , Pedersen H. , Brophy C. , Lacey K. , Gusberg R. J.
Published: September 2024

Detection of failing grafts with early reoperation is clearly associated with better long-term patency than intervention after graft failure. Duplex ultrasonography is more accurate than ankle:brachial index for graft surveillance, but is expensive, time consuming and technically demanding. Non-invasive estimation of graft impedance is now possible. The present study was undertaken to evaluate the utility of non-invasive impedance in detecting the failing vein graft. Sixty-nine grafts in 51 patients were followed over a period of 12 months (April 1992-March 1993). High risk infrainguinal arterial vein bypass patients were entered into a graft surveillance program. Ankle:brachial index, non-invasive impedance and duplex ultrasonography were performed upon discharge. 1 month after surgery and then at 3-monthly intervals. Non-invasive impedance was measured using a mean Doppler flow signal obtained from both upper and lower ends of the graft paired with the mean pulse volume recording obtained from the distal arterial bed. The mean pulse volume recording and flow signals were digitized by discrete Fourier transform and an impedance index generated. An impedance index >= 0.5 was considered abnormal. Impedance results were compared with ankle:brachial index, duplex ultrasonography and angiography when appropriate, and detected 28 failing and five failed grafts. Non-invasive impedance achieved a sensitivity of 91% and a specificity of 94%. Similarly, duplex ultrasonography was 91% sensitive and 97% specific, while ankle:brachial index was 58% sensitive and 94% specific. Non-invasive impedance is a simple, inexpensive and effective test which detects the failing graft and is an appropriate first-line alternative to duplex ultrasonography for postoperative graft surveillance.
Significance of Radiological Diagnosis for Detection and Staging of Inflammatory Abdominal Aortic Aneurysm
Authors: Bartels C. , Wedekind G. , Claeys L. , Beyer D. , Horsch S.
Published: September 2024

Operative morbidity and mortality are elevated in patients with inflammatory abdominal aortic aneurysm. Preoperative identification of inflammatory abdominal aortic aneurysm, the detection of the proximal level and of adhesions to adjacent structures are important for surgical management. The sensitivity and specificity of ultrasonography and computed tomography (CT) for identification and staging in 13 patients with inflammatory abdominal aortic aneurysm were studied. Preoperative radiological diagnoses were validated by intraoperative findings. Correct identification of inflammatory abdominal aortic aneurysm could be achieved in 85% by the use of CT and in 62% by ultrasonography. The proximal level of inflammatory abdominal aortic aneurysm was correctly determined by CT in all patients and by ultrasonography in 62%. Using a transperitoneal approach, the condition was considered inoperable in two patients as a result of the suprarenal extent of the aneurysm and because of unremovable adhesions in two other cases. In the latter pair, it was impossible to predict inoperability by radiological findings. Sensitivity (85%) and specificity (100%) of standard radiological techniques to identify inflammatory changes are high. Inoperability caused by suprarenal extent could be detected correctly by routine radiological procedures. However, identification of dense adhesions appears uncertain.
Inhibitory Effect of Type 1 Collagen Gel Containing α-Elastin on Proliferation and Migration of Vascular Smooth Muscle and Endothelial Cells
Authors: Ito S. , Ishimaru S. , Wilson S. E.
Published: September 2024

The purpose of this study was to investigate in vitro the potential effect of type 1 collagen gel containing α-elastin on the proliferation of vascular smooth muscle cells and vascular endothelial cells, and on smooth muscle cell migration. Vascular smooth muscle cell and endothelial cell were cultured in 12-well plates precoated with collagen gels and α-elastin. Cell proliferation rates were measured by monitoring [3H]-thymidine incorporation. After 2, 3 or 4 days of culture, the proliferation rate of both smooth muscle cells and endothelial cells was significantly decreased on collagen gel containing 10 mg/ml α-elastin compared with collagen gel only as control. Smooth muscle cell proliferation on collagen gel containing α-elastin on the 4th day of culture was decreased dose-dependently, e.g. 1 mg/ml of α-elastin (74.8(2.3)% of control. P = n.s.); 5 mg/ml (56.7(2.1)%; P<0.05); 10 mg/ml (30.3(3.1)%; P<0.005). In the case of cultured endothelial cells, however, [3H]-thymidine incorporation was not decreased significantly in the presence of 5 mg/ml α-elastin (83.1 (7.9)%, P = n.s.). After stimulation by platelet-derived growth factor, the smooth muscle cell migration rate on collagen gel containing α-elastin (5 mg/ml) was decreased over time. The area of migration on the 6th day of culture was also significantly decreased dose-dependently in the presence of α-elastin. e.g. 1 mg/ml (72.6(3.4)% of control. P<0.05), 5 mg/ml (56.9%(1.5)%; P<0.05); 10 mg/ml (37.3(2.7)%; P<0.0005). In conclusion, α-elastin inhibited the proliferation and migration of smooth muscle cell in a dose-dependent manner on collagen gel culture, however, at high concentrations of α-elastin (10 mg/ml), the endothelial cell proliferation rate was also inhibited. At 5 mg/ml, α-elastin significantly inhibited smooth muscle cell proliferation and migration but did not significantly inhibit endothelial cell proliferation. Incorporation of collagen gel containing α-elastin into the structure of arterial prosthesis offers the possibility of inhibiting smooth muscle cell hyperplasia without significant effect on endothelial cell formation.
Effects of Albumin Coating of Knitted Dacron Grafts on Transinterstitial Blood Loss and Tissue Ingrowth and Incorporation
Authors: Kang S. S. , Petsikas D. , Murchan P. , Cziperle D. J. , Ren D. , Kim D. Un , Greisler H. P.
Published: September 2024

Transinterstitial blood loss at implantation and the degree of graft incorporation and inner capsule thickening was compared in serial explants of albumin-coated Dacron versus blood preclotted Dacron grafts in the canine thoracoabdominal aortic position (8 mm internal diameter × 30 cm length). The coated grafts were Bard DeBakey Vasculour II knitted Dacron prostheses impregnated with carbodiimide-cross-linked human albumin. Control grafts were otherwise identical and preclotted with the recipients' whole blood before heparinization during surgery. Transinterstitial blood loss after establishing flow was measured by weighing sponges wrapped around the grafts. Albumin pretreatment resulted in significantly less median blood loss (5.1 g versus 11 g, P = 0.04; Mann—Whitney rank sum test). Grafts were explanted at 1 week, 4 weeks, 10 weeks, and 20 weeks. Patency was 100% in both groups. Graft incorporation at explantation was graded by the surgeon as: 1 = none, 2 = minimal, 3 = moderate, or 4 = extensive. No significant differences were noted at any time period. Inner capsule thickness measurements were made every 2.5 mm along the length of all explants. Grafts explanted at 1 week displayed no inner capsules. By 20 weeks, median inner capsule thickness was significantly less in albumin-coated grafts (190 μm versus 235 μm; P <0.0001). These inner capsules in both groups formed as islands, containing abundant myofibroblasts and collagen, covered by endothelial cells and surrounded by residual fibrin coagula. In conclusion, albumin-coated knitted Dacron grafts displayed less transinterstitial blood loss at implantation, and qualitatively similar incorporation, but significantly thinner inner capsules at 20 weeks.