bluuebunny/crossref_metadata_2025 huggingface dataset:
Brachial Artery Revascularization Following Cardiac Catherization
Authors: Cistemino Silvestro , Schultz Richard D. , Feldhaus Richard J. , Farino Carlo , Sterpetti Antonio V.
Published: August 2008

From January, 1973, to December, 1987, 63 arterial revascularization procedures were performed in 50 pa tients suffering from brachial artery injuries following cardiac catheteriza tion. There were 15 occlusive compli cations (30%) after the primary attempt to revascularize the damaged brachial artery. Thrombectomy asso ciated with a simple repair of the arte rial cutdown (Type IA) led to 8 compli cations of 9 procedures performed. Technical details of repair of the dam aged artery—debridement, venous patch graft, resection, end-to-end anastomosis, and venous bypass inter position—were found to be important and led to long-term patency.
Tracheal Homograft as Aortic Conduit: Early Phase Results
Authors: Muralidharan S. , Laub Glenn W. , Gu Jiang , Daloisio Connie
Published: August 2008

The aim of this study was to evaluate the performance of tracheal homografts as aortic conduits. Fourteen tracheal grafts freshly procured from rats were preserved by the following two methods: cryopreservation (n = 6) and treatment with glutaraldehyde 0.2 % (n = 8). The explanted tracheae were stored for ten to twenty days prior to implantation. They were subsequently implanted into the infrarenal aorta of the recipient rats. The average length replaced was 1 to 1.5 cm. The grafts were then evaluated after a period of one (n = 6, 2 cryopreserved, 4 gluteraldehyde), two (n = 4, 2 cryopreserved, 2 glutaraldehyde), and three (n = 4, 2 cryopreserved, 2 gluteraldehyde) weeks for their performance, morphol ogy, and histopathology. The rats did well postoperatively with adequate distal perfusion. Two of the 6 rats with cryopreserved grafts had reduced flow as evidenced by lack of pulsation in the aorta distal to the graft, and histologic examination revealed incompletely occluding thrombus adherent to the luminal surface. The remaining cyropreserved and glutaraldehyde-fixed grafts had good flow and did not show any radiologic evidence of narrowing at the site of anastomosis or in the region of the graft. Histopathologic examination showed that the glutaraldehyde-treated homografts had better morphology, intact carti lage, and no or mild inflammatory response. The cryopreserved tracheal homo grafts showed degenerative changes in the cartilage. The inflammatory response was moderate, and the mucosa was either ruptured or absent. In the 2 that had reduced flow, there was marked cartilage necrosis and inflammatory response with thrombus formation in the lumen. This early phase study shows that tracheal homografts functioned well as conduits in the aortic position and gluaraldehyde treated homografts have better morphology than cryopreserved homografts.
Treatment of Osteomyelitis in the Diabetic Foot with Systemic and Locally Injected Antibiotics and the End-distolic Pneumatic Compression Boot—Case Studies
Authors: Dillon Richard S.
Published: August 2008

The treatment of 35 patients for 42 episodes of osteomyelitis in the distal lower extremity is summarized and the long-term courses of 3 patients are illustrated in detail. Systemic antibiotics were used both to help control infection in the foot and to prevent septic emboli. The systemic antibiotics were given by the oral route alone (16 episodes), by the parenteral route alone (4 episodes), or by both oral and parenteral routes (22 episodes). Local foot treatments included injections of antibiotics into the infected areas of the foot, multielectrolyte-antibiotic foot soaks, and the end-diastolic pneumatic compression boot. X-ray evidence of osteomyelitis was found one to four weeks after it was clinically suspected and was associated with an improvement in the clinical status of the foot. Osteomyelitis was not considered an indication for amputation. The osteomyelitis lesions healed and foot structure and function were maintained.
Hepatomegaly in Aortocaval Fistula: Case Report
Authors: Herrema Idse H. , Johnson Brian F. , Cotton Dennis W. K.
Published: August 2008

The authors present a case of aortocaval fistula with interesting findings: peritonitis; a springy, distended liver; and an apparently intact abdominal aortic aneurysm. Postmortem examination revealed that the aneurysm was not intact.
A Study on the Effect of Hydroxyethylrutoside on Transcutaneous Oxygen Tension Measurements in Patients with Severe Venous Insufficiency
Authors: Quigley F.G. , Faris I.B.
Published: August 2008

Chronic venous insufficiency is thought to cause tissue hypoxia and ulceration through pericapillary deposition of fibrin. Transcutaneous tissue oxygen tension measurements (TCpO 2) were made on 17 patients with severe venous insuffi ciency and repeated after three and six months of treatment with O-(B- hydroxyethyl)-rutosides, a drug recommended for treatment of venous insufficiency that is thought to enhance tissue fibrinolysis. After six month's treatment, TCpO 2 measurements were significantly better than inital values (0.01 < p < 0.05). This improvement in TCpO2 measurements is consistent with the hypothesis that O-(B-hydroxyethyl)-rutosides act by enhancing tissue fibrinolysis and might reduce the pericapillary fibrin that is thought to be a major factor in the pathogenesis of venous ulceration.
Treatment of Acute Mesenteric Infarction by Resection of the Bowel and Reimplantation of the Superior Mesenteric Artery into the Aorta: A Case Report
Authors: Demirci Salim , Yerdel Mehmet Ali , Kutlay Jehat , Kocaoglu Hilmi , Avsar Fatih , Tuzuner Altan
Published: August 2008

In this report the authors present a case of acute mesenteric infarction resulting from the thrombotic occlusion of the superior mesenteric artery in which a reimplantation technique was used as a revascularization procedure with success.
Angiographic Findings of Great Vessel Involvement in Behçet's Disease
Authors: Bayraktar Yusuf , Balkanci Ferhun , Dündar Semra , Kansu Emin , Telatar Hasan
Published: August 2008

Behçet's disease (BD) is a systemic disorder and vasculitis is a common pathologic finding that may give clues in the understanding of the vascular involvement. During the period between 1968 and 1988, 30 patients with BD had vascular complications that were diagnosed by conventional venography (indud ing cavography) (in 15 patients prior to 1985) and then by computed tomography, digital subtraction angiography (DSA), and sonography in the remaining 15 patients for the last four years . The group included 13 patients with superior vena caval obstruction (SVCO), 3 with inferior vena caval obstruction (IVCO), 4 with both SVCO and IVCO, 2 with IVCO and hepatic veins obstruction (Budd-Chiari syndrome, BCS), 1 patient with SVCO, IVCO, and BCS, 1 with BCS, 1 with portal vein and IVCO, 4 patients pulmonary artery occlusion (1 of them also had pulmonary artery aneurysm), and finally, 1 patient with right illiac artery aneurysm. In many cases, classical clinical features of BD were not evident when great vessels were involved.

The authors concluded that DSA and sonography are the preferred method in demonstrating vascular complications of BD and that BD should be taken into consideration when a patient presents with a great vessel involvement due to unknown cause.
The Combination of Surgery with Intraoperative Balloon Angioplasty in the Treatment of Median Arcuate Ligament Syndrome: A Case Report
Authors: Ali Bedirhan Mehmet
Published: August 2008

Surgery plus intraoperative balloon angioplasty was performed in a young man with the complaint of celiac ischemia because of median arcuate ligament syndrome. Division of the celiac ligaments and dilation of the celiac artery through the lienal artery was accomplished with success. The patient was found symptom free in one-year follow-up.
Primary Effort Thrombosis: Treatment Options in Acute and Chronic Disease—Case Reports
Authors: Adams Carlton Zelliot , Vincent G. Steven , Vermilion Blair , Hoover Eddie L.
Published: August 2008

Primary axillary-subclavian vein thrombosis (effort thrombosis) is a unique variant of thoracic outlet syndrome that effects young, active adults. The majority of cases have been demonstrated to be secondary to contriction of the axillary- subclavian vein junction between the interval of the clavicle and the first thoracic rib. Owing to the limited clinical experience with this disorder, prevention of long-term disability has resulted in several proposed surgical procedures that have not always decreased late morbidity. Recently the availability of fibrinolytic agents has improved therapeutic results in primary thrombotic syndromes. The authors report 4 cases involving both acute and chronic effort thrombosis treated either by (1) sequential therapy involving fibrinolytic agents, anticoagulation, then decompressive surgery (first rib resection), (2) anticoagulation and first rib resection or (3) fibrinolytic agents and long term anticoagulation without surgery. Their experience with both acute and chronic effort thrombosis has resulted in sustained venous patency without the need for chronic anticoagulation in those patients who ultimately underwent rib resection as part of their treatment. The authors believe that this sequential therapy is the treatment of choice in the management of both phases of this syndrome and will eliminate the need for long-term anticoagulation and drastically reduce long-term disability.
Sequential Fibrinolytic Treatment with Urokinase and rt-TPA in two Cases of Acute Arterial Thromboembolism—Case Reports
Authors: Cina Gregorio , Ferrante Angela M. R. , Marra Roberto , Storti Sergio , Pagano Livio , Bizzi Bruno , Crucitti Francesco
Published: August 2008

Thrombolytic drugs may be an alternative therapy for acute limb ischemia in patients who are not surgically treatable.

Two cases of acute limb ischemia managed successfully with a sequential intraarterial infusion of urokinase and recombinant-type tissue plasminogen activator (rt-TPA) are reported.

The positive results suggest the two drugs have a synergistic action. Further studies are needed to demonstrate the interactions between these thrombolytic agents
Hydroxyethyl Starch (HES) as a Priming Solution in Cardiopulmonary Bypass
Authors: Gürbüz Ali , Berki Turan , Akinci Esat , Koçak Tuncer , Yakut Cevat
Published: August 2008

Various priming solutions are currently used to prime heart-lung machines for cardiac operations. Hemodilution has resulted in considerable conservation of blood, as well as diminution of plasma and corpuscle damage, by decreasing the concentration of these elements in blood during extracorporeal circulation. Controversy has existed regarding the relative efficacy of various hemodilution solutions. In this prospective study two groups of similar open-heart patients, the first receiving hydroxyethyl starch (HES) and the second 5% albumin as a priming solution were compared. Hematocrit, platelet counts, plasma fibrinogen levels, postoperative drainage, prothrombin and partial thromboplastin time, urine output, and administration of blood products were investigated and compared. There were no differences in chest tube drainage, blood use, urine output, coagulation, and hematologic and hemodynamic parameters, except for an early postoperative increase in platelet count in the HES group. HES is a safe, effective, inexpensive volume expander in cardiac surgery patients.
Surgery of Carotid Body Tumors: Clinical Experience with 10 Cases
Authors: Geiger Armin , Soeparwata Rasjid , Schmidt Johannes , Scheld Hans H.
Published: August 2008

Within a population of 1150 vascular patients only a small percentage of the correct preoperative diagnosis of carotid body tumors (synonym chemodectoma) was found (2 patients). Before being treated by a specially trained vascular surgery team 8 patients did undergo inadequate operations. These were performed with high risk of local complications, even though by simple use of intravenous angiography (digital subtraction technique) the typical intercarotid widening with rich vascular filling could have led to the correct diagnosis.

Malignancy was detected in 1 case (pulmonary metastasis). In 2 cases concomitant tumors of the jugular vein were seen.

Since the blood supply from carotid body tumors is derived nearly exclusively from the external carotid artery, interruption of blood flow in this vessel simplifies the surgical approach substantially.

Ligature of the external carotid artery (5 patients) and interposition of venous grafts (10 patients) were employed as surgical therapies.

In 1 case extirpation of a larger tumor (18 x 11 x 9 cm) extending from the skull base and almost reaching the left clavicular bone was successfully carried out. At present there is no other satisfactory therapeutic approach to benign carotid body tumors available. For this reason surgical intervention, even in far advanced stages, is always justified.
Microvenous Grafts In Reconstructive Lymphatic Microsurgery: 7 Years' Clinical Results
Authors: Campisi Corradino
Published: August 2008

The author reports his experience with 32 cases of lymphatic-venous-lym phatic anastomoses (LVLA), an alternative microsurgical solution, personally conceived, proposed for the treatment of chronic lymphedemas of limbs, partic ularly in those cases in which there exists a venous disease associated with the lymphatic one in the same limb and, therefore, in which the most common lymphatic-venous anastomoses (LVA) would not be indicated.

The preliminary diagnostic investigations, including lymphoscintigraphy, lymphography, and above all, the venous flowmetry and manometry be Doppler's method, play an important role in a precise choice of the indications for this kind of microsurgical technique, for they allow the investigator to point out, besides the lymphatic stasis, a more or less disguised venous pathology.

The author's microsurgical method consists in the interposition of venous grafts, more or less long and with a suitable caliber, between lymphatic vessels placed upon and below the obstacle to the lymphatic circulation of the limb.

The results of this personal LVLA microsurgical technique proved to be very satisfactory. All 32 cases treated by this method showed a significant and perma nent decrease of the edema, with a follow-up till five years after operation.
Graft Replacement of Ascending Aortic Aneurysms. Surgical Results in 84 Consecutive Patients
Authors: Karagoz Haldun Y. , Zorlutuna Yaman , Babacan Korhan , Keceligil Tahsin , Tasdemir Oguz , Yakut Cevat , Bayazit Kemal
Published: August 2008

Between January, 1977, and March, 1990, 84 consecutive patients underwent graft replacement of an ascending aortic aneurysm. There were 22 women and 62 men patients, ranging in age from twenty-two to sixty-nine years (mean 44.3). Surgical procedures employed were as follows: composite graft replacement with coronary reimplantation in 53 cases, supracoronary graft replacement (SGR) in 23 cases, SGR + aortic resuspension in 2 cases, and SGR + aortic valve replace ment in 1 case. Twenty-eight patients (33%) underwent concomitant aortic arch replacement. Five cases were operated on by "elephant-trunk" technique for extensive aneurysms involving the ascending, arch, and descending thoracic aorta. In 71 cases, a shunt was inserted between the periprosthetic space and the right atrium.

Hospital (thirty-day) mortality was 15.5%. Contemporary (1987-1990) mortality rate was 8.7%. After a mean follow-up period of 42.6 months (range three to one hundred eighteen), there were 2 late deaths (1.1%/patient-year). Late reoperation was necessary in 2 cases (1.1%/patient-year). Ninety-one per cent of the survivors were in NYHA class I or II. The long-term survival rate was 76% ± 12%. The type of operation (ie, composite graft replacement or SGR) or concomitant aortic arch replacement had no influence on surgical outcome. The periprosthetic right atrial shunt was found to be effective in avoid ing complications related to blood accumulating between the aortic graft and the aortic wraparound.
Ideal Measurement of Cardiac Output: Is Impedance Cardiography the Answer?
Authors: Franko Edward R. , Van De Water Joseph M. , Xiang Wang
Published: August 2008

The ideal measurement of cardiac output (CO) would be a system that is ac curate, noninvasive, reproducible, continuous, and technician-free. Impedence cardiography (ICG) has the promise of meeting these criteria. The authors have developed a unique ICG system that analyzes the analog signals from an impe dence cardiograph by an original software program. This was compared against standard thermodilution (TD) measurement of CO (CO TD) in patients in the in tensive care and heart surgical units.

Simultaneous measurements by COTD and by COICG were performed in 65 patients. A good correlation was noted between COTD and COICG over a range of 2.4 to 9.7 L/min (r = 0.73, p < 0.002). If patients with factors known to inter fere with ICG were excluded, an improved correlation was found (r = 0.89, p < .002). COICG followed a similar trend as COTD even in these excluded pa tients. The reproducibility of the COICG was good (coefficient of variation = 0.071).

The COICG was found to be simple and automatic. The results show that it is reproducible and correlates well with COTD. It also has the added advantages of being continuous and noninvasive. Factors such as arrhythmias, severe COPD, and mitral regurgitation were found to interfere with the COICG values. Over all, the versatility of. COICG gives the promise of very good noninvasive monitoring in critical care units and preoperative evaluation in the outpatient setting.
Assessment of Varicocele with Angiodynography (Color-Coded Triplex)
Authors: Ledda A. , Belcaro G. , Laurora G. , Iasonni V. , Tenaglia R.
Published: August 2008

We evaluated by angiodynography 228 patients with clinical and 107 with subclinical varicocele and 22 normal subjects studying vein dilatation and reflux peak flow velocity (PFV).

PFV was 18 cm/sec in subclinical varicocele, significantly lower than in clin ical varicocele (24 cm/sec). The mean reverse flow (reflux) was also significant ly lower in subclinical varicocele.

The study demonstrated that there is a good correlation between the mean duration of reflux (in seconds) and the quantity of reverse flow measured by angiodynography.

The correlation between descending phlebography and angiodynography, in a randomly selected group of 69 patients was 100% both in clinical and subclin ical varicocele.

In conclusion, angiodynography could be considered the best noninvasive technique to evaluate and quantify varicocele and the effects of treatment on venous dynamics.
A Twenty-Year Experience with Axillofemoral Bypass: Analysis of 63 Consecutive Cases
Authors: Mingoli Andrea , Cavallaro Antonino , Sciacca Vincenzo , di Marzo Luca , Agosta Filippo , Maggiore Claudia , Stipa Sergio
Published: August 2008

The results of 63 consecutive axillofemoral bypass grafts are presented.

A computerized analysis of the data was performed according to the possible variables apt to influence the results of the reconstruction: different indications, stage of disease, previous reconstructions, presence of graft infection, unilateral or bilateral revascularization, iliac artery and runoff status, and graft caliber and material. A higher five-year graft patency rate was obtained with bypasses performed in poor-risk patients with occlusive arterial disease (axillounifemoral graft: 53.7%; axillobifemoral graft: 41.6%) than in procedures performed in emergency (p < 0.025) or for infection of previous vascular reconstructions (p < 0.001). There was a similar five-year patency rate in axillounifemoral and axillobifemoral grafts (p = NS) and in the bypasses performed in patients with iliac artery occlusion or stenosis (p = NS). A higher patency rate was obtained when there were two or three patent tibial vessels (p < 0.001). Finally the authors observed a greater infection rate in polytetrafluoroethylene grafts than in Dacron grafts (p < 0.05). Their results confirm the important role of the axillofemoral bypass in revascularizing high-risk patients with severe limb ischemia (rest pain and necrosis) or patients with graft infection, repeated graft failures, and arterial occlusive disease when laparotomy is contraindicated.
Biosynthetic Patch in Carotid Angioplasty
Authors: Pratesi Carlo , Pulli Raffaele , Michelagnoli Stefano , Innocenti Alessandro Alessi , Sabato Alfredo , Bertini Domenico
Published: August 2008

Since early embolic events and recurrent stenosis are, after intraoperative ischemia, the main problems of carotid endarterectomy (CEA), technical im provements that may reduce the incidence of these feared complications are required. The causes of recurrent carotid stenosis may be related to progression of the atherosclerotic disease, to myointimal hyperplasia at the site of endar terectomy, or to technical mistakes during intervention. The choice of patching material seems to be important in preventing late complications.

The authors present their original experience with a biosynthetic ovine patch in carotid surgery. In the period from January, 1988, to June, 1989, 211 carotid endarterectomies were performed for atherosclerotic disease at the carotid bi furcation in 176 patients. A primary closure of the carotid arteriotomy was performed in 82 cases and a patch angioplasty was employed in 129. As the material employed in the patch angioplasty, the authors used the biosynthetic ovine patch in 30 cases.

No deaths and no permanent neurologic deficits were registered in this series during the awakening and during the postoperative care. One patient died one month after the surgical procedure because of myocardial infarction without neurologic symptoms. These patients were admitted to the prospective study for the evaluation of the carotid that was operated on. The study was performed with clinical and instrumental examinations (duplex scanner). Each patient was seen at months 1, 3, 6, and 12 after surgery. All the patients except 3 had a twelve-month follow-up; by echo tomography a case of nonhemodynamic restenosis was detected in an asymptomatic patient six months after CEA.

The authors' preliminary experience with this biosynthetic graft as patching material has been satisfactory. They conclude that this biosynthetic graft, be cause of its handling and particularly its healing characteristics, can be consid ered as a graft material for patching at the carotid level.
Small-Caliber Arterial Anastomosis Using a CO2 Laser
Authors: Zempo Nobuya , Esato Kensuke , Yoshimura Koichi , Seyama Atsushi , Harada Mikihiko , Takenaka Hiroaki , Fujioka Kentaro , Ohara Masaki
Published: August 2008

The present study was designed to determine whether the use of CO2 laser irradiation could effectively maintain long-term patency in small-caliber arteri al anastomoses less than 3 mm in diameter. A preliminary study was conducted to examine the relationship between laser energy and histologic changes. The laser output of 30 to 40 mW produced a less inflammatory response, than 50 mW did and almost normal aortic architecture one month after the exposure. Therefore, a 30 to 40 mW range, over a twenty-second period, was seen as a suitable laser energy. Arterial anastomoses using a CO2 laser were performed (12 rabbits) with a suitable laser energy. Conventional anastomoses were per formed as controls (12 rabbits). The operation times, patency rate, and histo logic changes were compared in both groups at one week and at one, three, and six months after anastomoses. The anastomotic time was shorter in the laser anastomosis group than that in the control group. The patency rate was equal in both groups. However, the conventional anastomosis group revealed slight intimal hyperplasia at six months, whereas the laser anastomosis group showed almost normal neointimal development. It was hence concluded that CO2 laser welding of the anastomosis is an acceptable alternative to conventional anastomosis.
Elective Arterial Reconstruction for Intermittent Claudication is Justified
Authors: Esato Kensuke , Zemp Nobuya , Fujioka Kentaroh , Ohara Masaki
Published: August 2008

This study evaluates the appropriateness of performing arterial reconstruc tion in patients with intermittent claudication due to arteriosclerosis obliterans. Among 163 symptomatic patients, 175 limbs in 130 patients underwent surgical revascularization as the primary mode of therapy. There were 3 operative deaths and 21 late deaths after an average of 3.5 years of follow-up. The most common cause of death was heart failure, including ischemic heart disease. The five-year cumulative patency rate was 92.5% for aortoiliac, 70.6% for femorodistal, and 82.0% for aortofemorodistal reconstructions. The long-term symptom free rate was 87.3% for aortoiliac, 57.7% for femorodistal, and 86.7% for aorto femorodistal reconstructions.

The authors conclude that intermittent claudication is an appropriate indi cation for surgery in patients with lower extremity ischemia to enhance the quality of life, except in patients with serious concomitant medical illness.
A New Approach to Vascular Access for Endovascular Procedures
Authors: Sanfelippo Peter M.
Published: August 2008

This study examined a new approach to vascular access for endovascular procedures employing an expandable access catheter (EAC). The experience in 6 patients and 7 procedures was evaluated.

There were no complications related to the EAC. The EAC permitted simul taneous introduction of diagnostic and therapeutic devices, decreased blood loss from the site of insertion, and decreased the volume of irrigant used for satis factory visualization during angioscopy by obstructing collateral inflow.
Transient Hypercapnia After Aortic Cross-Clamping — A Case Report
Authors: Cernaianu Aurel C. , DelRossi Anthony J. , Moore Michael W. , Santos Zorina L. , Posner Mark A.
Published: August 2008

Despite adequate monitoring of ventilatory parameters and prophylactic treat ment with alkali, severe acidosis and hypercapnia may develop during the ischemic and reperfusion phase of the operation of the thoracic aorta when cross-clamping is used. The authors present a case wherein the use of sodium bicarbonate made possible the development of transient paradoxical acidosis and severe hypercap nia. Their report is focused on initial presentation and management.
New Horizons in the Operative Treatment of Deep Venous Incompetence of the Lower Limb
Authors: Psathakis Dimitrios N.
Published: August 2008

Venous incompetence of the lower limb is necessarily connected with a popliteal reflux accounted for by valvular incompetence of the popliteal vein, the presence of which must be clarified. The investigation of the deep venous system will begin by Doppler ultrasound. Only patients with popliteal reflux de tected by Doppler ultrasound are furthered examined by venous pressure meas urements and by phlebography. An operation in the deep veins is admissible only when a popliteal reflux of more than 40%, an ambulatory venous pressure more than 60 mmHg, a refilling time of less than fifteen seconds, a venous insuffi ciency of more than 20%, and a patency or recanalization of the deep veins of more than 70% have been confirmed.

In a series of 46 patients (61 limbs) operated on the last two years the selec tion for operation was successfully made only by Doppler ultrasound.

The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 191 patients (221 limbs) with deep venous incompetence of the lower limbs, primary or postthrombotic. Results were as sessed clinically, by Doppler ultrasound, by venous pressure measurements, and partially by phlebography. In the above series of 46 patients (61 limbs) the results were assessed only by Doppler ultrasound, which correlated with the clinical con dition, consisting of abolition or minimizing of the popliteal reflux. In our pa tients clinical improvement in 209 of 221 limbs was associated with reduction of ambulatory venous pressure and prolongation of refilling time with interrup tion of the popliteal reflux as assessed by Doppler and by phlebographic evi dence of the valve-like effect of the silastic tendon on the popliteal vein.
Unruptured Congenital Aneurysm of the Sinus of Valsalva Associated with LV-RA Communication. Surgical Repair in an Infant—A Case Report
Authors: Akasaka Tadayoshi , Ogura Yoshimitsu , Anbe Jiro , Nakajima Hiroshi , Ozeki Masayoshi , Mitsuishi Tsuzuki , Takahashi Shigeru , Kato Hitoshi , Yanagawa Yukishige
Published: August 2008

A case of a six-year-old girl with an unruptured aneurysm of the sinus Val salva with a left ventricle-right atrium communication is reported. Emphasis is put on the diagnostic value of the echocardiogram, especially for differentiation of the sinus of Valsalva from the aortic cusp and visualization of intracardiac hemodynamics through the shunt. She showed neither cardiac failure nor aortic regurgitation preoperatively. Because rupture was likely to occur, the aneurys mal sac was resected and plicated, and primary surgical closure of the shunt was done. Postoperative echocardiography showed no shunt and sufficient pli cation of the aneurysm.
Nonprosthetic Reconstruction of Isolated Iliac Artery Aneurysms—Case Reports
Authors: Lewis P. , Davies W.T.
Published: August 2008

An aneurysm of an iliac artery without an associated aortic aneurysm is an uncommon condition with a high risk of rupture. Reconstruction using a pros thetic graft is the currently recommended method of treatment. The authors present 2 patients with isolated iliac aneurysms who underwent reconstructive surgery without prosthetic material.
Infection Prophylaxis and Infection Control in Vascular Access Surgery
Authors: Keferstein Rolf D. , Fiedler Cornelia , Pelster Fritz W. , Reers Berthold
Published: August 2008

This review of 133 arteriovenous (AV) fistulas, created by implantation of polytetrafluoroethylene (PTFE) graft material, reports an infection rate of 16.4% in the first period from 1982 to 1985. The infection rate decreased to 5.6% in the period from 1986 to 1990.

Graft infections occurred at a higher rate of 46.2% versus 20% when reoperations because of malfunction, occlusion, aneurysm, or bleeding were necessary.

Graft infections can be reduced by the development of standard surgical procedures, by the local and systemic application of antibiotics, and by a careful puncture technique. The treatment of septic graft complications after primary operations resulted in a maintenance of graft function in 50%. After secondary operations the graft had to be excised in all but 1 case.
Dacron Graft Aneurysm: A Report of Five Cases
Authors: Aarnio P. , Keskitalo E. , Hannukainan J. , Sahlman A. , Järvinen A.
Published: August 2008

Dacron prostheses have been long used in vascular surgery. The usual com plications concerning prosthetic vascular grafts are infection and anastomotic pseudoaneurysm formation. The authors present an unusual complication, namely, Dacron graft aneurysm. Five patients had been operated on eleven, ten, ten, nine, and seven years previously because of atherosclerotic occlusive dis ease ; an aortobifemoral reconstruction had been done in 4 patients and an axil lofemoral reconstruction in 1 patient—all with a Dacron prosthesis. The presenting symptom was abdominal pain in 1 case and a pulsating mass in 2 cases. In 2 cases the aneurysms were noticed during the angiography and repair operation of inguinal pseudoaneurysm formation. In 2 cases the reconstruction was made with an inlay technique for the Y-graft repair, in 1 case only the limbs of the Y-graft were reconstructed, and in 2 cases axillofemoral graft reconstruc tion was done. All 5 patients recovered from the operation.
Ten-year Follow-up of Femoropopliteal Bypass Grafts: Comparative Review of Late Patency Rates of PTFE and Saphenous Vein Grafts for Lower Extremity Ischemia
Authors: Dayioglu Enver , Barlas Semih , Onursal Ertan , Kargi Aydin , Barlas Cemil
Published: August 2008

Between January, 1987 and June 1988, 335 femoropopliteal bypass (FPBP) operations were performed on 308 patients who had limb ischemia caused by femoropopliteal occlusion. The greater saphenous vein graft (SVG) was used whenever possible (165) and polytetrafluoroethylene (PTFE) prosthesis was used in 165. In addition, 4 Dacron grafts and 1 umbilical vein graft were used in 5 operations but were excluded from comparison in this study. The two groups did not differ significantly regarding stage of peripheral ischemia, preoperative indication, distal popliteal anastomotic site, and number of patent runoff ves sels. Overall cumulative patency rates according to occlusive criteria alone were calculated by the life table method. Graft occlusion was determined by angiog raphy, Doppler assessment, loss of previously palpable pulses, or return of symp toms. Diabetes mellitus was associated with a significantly lower patency rate.

It is concluded from this study that the saphenous vein is superior to PTFE as femoropopliteal bypass.
Pacemakers: Dual or Single Chamber Implantation
Authors: Mayer David A. , Tsapogas Makis J.
Published: August 2008

One hundred and seventy-five consecutive patients receiving transvenous per manent pacemakers were reviewed in a comparison of the morbidity of 70 atri oventricular (AV) implantations (DDD 60, DVI 10) and 105 ventricular implantations (VVI 104, VVIR 1). Two atrial lead dislodgements occurred in the first 10 AV implants. Screw-in atrial electrodes eliminated dislodgement in 60 subsequent cases. Ventricular electrode dislodgement was present in 13.3% of the first 15 implants, but in only 1.2% of the next 90 implants, when smaller tined leads became available. Routine use of active endocardial fixation improved the overall 2.8% electrode malposition and dislocation rate to 1.4% in the AV group and 0.9% in the ventricular group. Skin erosion and infection was found in 1.4% of AV implants as compared with 3.8% of ventricular implants and appeared related to pulse generator size. Moreover, 5.7% of VVI implants re quired upgrading to DDD units for treatment of pacemaker syndrome. Improved pacemaker and lead technology lowered the overall 4% early secondary inter vention rate to 2.9% for AV and 1.9% for ventricular implants over the latter 150 cases. The data suggests that dual-chamber implantation can be accomplished with morbidity comparable to that of single-chamber implantation. The inher ent hemodynamic and electrophysiologic advantages make the DDD unit an at tractive choice in the majority of patients with appropriate atrial rhythm who require permanent pacing.
Oxygen Tension on the Surface of Suction Blister Wounds Measured with a Polarographic Technique in Healthy Volunteers
Authors: Svedman Paul , Lundquist Magnus , Svedman Christer
Published: August 2008

A polarographic oxygen electrode, operated at a temperature close to that of the local tissue, was used to measure oxygen tension in blister wounds in healthy volunteers (n: 18). The coefficient of variation (CV) in repeated assessments in single wounds on the lower leg varied between 7.8% and 15%. When deter mined in different volunteers, wound oxygen tension (PO2) was 8.9±2.0 kilopas cals (kPa) (mean±SD) (CV: 22.7%) on the day of infliction and 7.2±1.4 kPa (CV: 20.0%) on day 1. The oxygen values decreased gradually as healing pro ceeded. It was not established at which stage the reformed epidermis constituted an impediment to oxygen passage from the wound to the electrode, and to avoid this factor it would seem prudent to restrict measuring of wound PO2 to the first two to three days. The wound PO2 values were proportional to the oxygen pres sure of air inhaled at 101 kPa and 283 kPa. In forearm wounds, values de creased to zero kPa during brachial arterial occlusion. The oxygen values did not increase beyond the preocclusion level following the release of occlusive pressure. Repeated injections of increasingly concentrated noradrenalin into the blister wound resulted in a decrease in PO2 followed at higher concentrations by an increase. The findings indicate that the technique may be useful for as sessing oxygen supply to blister wounds.
Effects of Prostacyclin on Heparin Reversal with Protamine
Authors: Katircioglu S. Fehmi , Küçükaksu D. Süha , Bozdayi Mithat , Saydam Gül , Zorlutuna I. Yaman , Taşdemir Oguz , Bayazit Kemal
Published: August 2008

This study was planned to show the beneficial effects of prostacyclin (PGI2) utilization on adverse effects of protamine. PGI2was administered at a rate of 5 ng/kg/min. Twenty patients entered this study. Half of them received PGI2whereas the others did not.

Right ventricular end-diastolic volume index and right ventricular stroke work index were 72 mL/m2and 2.2 g.m/m2, respectively, after patients were weaned off the bypass and 79 and 1.5, respectively, at five minutes after pro tamine administration in the control group; these values were 88 and 3.2, re spectively, and 86 and 3, respectively, in the PGI2group. Left ventricular stroke work index (g.m/m2) was 27.9 in the control group and 36.7 in the PGI2group (p < 0.05) after protamine administration.

Thromboxane B2levels (pmoL/mL) in coronary sinus (CS) blood were 251 in the control group and 90 in the PGI2group at five minutes after protamine administration (p < 0.05). Myocardial blood flow was 174 mL in the control group and 245 mL in the PGI2group at five minutes after protamine adminis tration (p < 0.05). Cyclic adenosine monophosphate (cAMP) and cyclic guano- sine monophosphate (cGMP) levels in CS blood were 17 pmoL/mL and 2.1 pmoL/mL, respectively, in the control group and 36 and 0.3, respectively, in the PGI2group at five minutes after protamine administration. Leukotriene B4level was 129 and 57 pmoL/mL in the control and PGI2groups, respectively (at the same time as the cAMP measurement) (p < 0.05).

From the results of this study the authors conclude that adverse effects of heparin reversal with protamine can be reduced with the use of PGI2.
Late Improvement in Blood Cell Filterability and Cardiac Function Following Open Heart Surgery
Authors: Belboul Ali , Al-Khaja Najib , El-Gatit Abdusalam , Bo Liu  , Roberts Donald , William-Olsson Göran
Published: August 2008

Coronary artery bypass grafting (CABG) and valve replacement (VR) were performed in 50 patients respectively, and these two groups participated in a prospective study wherein the authors investigated the changes of blood cell fiterability, exercise tolerance, ejection fraction (EF), and NYHA classes.

The CABG group showed significant (p < 0.001) improvement in both red cell filtration rate (RFR) and white cell filtration rate (WFR) at the follow-up time. This was still, however, significantly lower (p < 0.01) than the reference values of healthy individuals in the same age range. Similar results were also seen in the VR group regarding filterability.

In the CABG group, significant improvements in exercise tolerance (p < 0.001), EF (p < 0.001), and NYHA classes (p < 0.001) were seen in the postoperative period. In the VR group a similar postoperative improvement was registered both in EF (p < 0.003) and NYHA classes (p < 0.001).

This study demonstrates an improvement in exercise tolerance, EF, NYHA classes, RFR, and WFR in both groups postoperatively. However the blood cell filterability was still disturbed even two years postoperatively, suggesting that the effects of the primary disease were not reversed and that surgical treatment produced excellent palliation and a good potential to improve quality of life.
Primary Cardiac Tumors: A Twenty-Year Review
Authors: Gruber Hans P. , Fraedrich Gustav , Kasper Wolfgang , Schindler Michael , Schlosser Volker
Published: August 2008

Twenty-five patients underwent resection of atrial tumors between 1970 and 1990. There were 14 primary cardiac tumors, consisting of 12 atrial myxomas, 1 angiosarcoma, and 1 fibrosarcoma. Eleven patients were excluded from echocardiographic follow-up; 7 of them had an atrial ball thrombus, and 4 had pericardial manifestations of malignant lymphomas. The remaining patients were routinely investigated by echocardiography. In 1 patient, myxoma was familial, and 2 patients had a myxoma syndrome with endocrine hyperactivity and lentiginosis. There were no operative deaths. The 2 patients with malignant tumors died three and sixteen months, respectively, after operation. All patients with atrial myxoma had follow-up by echocardiography up to eighteen years after operation with a mean follow-up of six and a half years. All patients are still alive and well. Myxoma recurred in 1 patient, detected by echocardiography on follow-up examination. Echocardiographic follow-up after myxoma resection is recommended for detection of late recurrence.
Modification of Myocardial Reperfusion by Exogenous Prostacyclin
Authors: Yee Edward S. , Hsieh Wen-Ren
Published: August 2008

The multiple pharmacologic consequences of the antiplatelet, antithrombotic, and vasoactive effects of exogenous myocardial prostacyclin PGI2 on postischemic reperfusion were studied. In an isolated canine model, 20 hearts underwent one hour of cardioplegia arrest under moderate hypothermia (27-28 ° C) and one hour of no perfusion. Left ventricular function (peak systolic pressure [PSP], rate of rise of left ventricular pressure [dp/dt], compliance), myocardial edema, coronary blood flow, and oxygen content were measured and compared for control and PGI2 groups. While there were no differences in compliance or edema, there was an increase in both myocardial blood flow and oxygen delivery (p=0.025). This modification increased nutritive resuscitation of the ischemic heart during one hour of reperfusion and increased left ventricular function after ischemic arrest (PSP and dp/dt; p=0.04).

Myocardial recovery after global ischemia is time-dependent with maximal resuscitation after one hour of supported reperfusion. PGI2 modified this time course by sustaining the coronary vasodilatory effects during the reperfusion hour with increased coronary blood flow, improved oxygen extraction, and enhanced myocardial performance (PSP and dp/dt). PGI2 can play an important role by providing maximal vasodilatory effects to enhance the nutritive recovery of postischemic myocardium.
Thrombolytic Therapy for Iliofemoral Venous Thrombosis
Authors: Molina J. Ernesto , Hunter David W. , Yedlicka Joseph W.
Published: August 2008

The authors outline a new approach to management of ileofemoral venous thrombosis: direct thrombolysis of the clot; identification of the cause of the thrombosis (usually iliac vein stenosis); then treatment of the obstructive process by balloon dilation, with or without the use of expanded stents; and reestablishment of venous flow.
Continuous Piezoelectric Pulse-Sensor Monitoring of Peripheral Vascular Reconstructions
Authors: Cavaye Douglas M. , Tabbara Marwan R. , Kopchok George E. , White Rodney A.
Published: August 2008

Postoperative assessment of vascular surgical reconstructive procedures is most commonly performed by means of Doppler flowmetry or manual pulse palpation. Because these techniques are intermittent and can be subjective, the authors have investigated the application of a piezoelectric pulse sensor in monitoring distal pulses continuously in patients undergoing limb revascularization. By placing a piezoelectric sensor on the skin overlying an artery, systolic displacement of the underlying vessel wall and tissue is converted into a graphically displayed real-time waveform. Hardcopies of the waveforms (n = 90) were obtained at hourly postoperative intervals from a total of 10 patients undergoing vascular surgery for occlusive disease.

In all cases, continuous monitoring confirmed ongoing patency of the reconstructions, despite impalpable distal pulses in 60% of the patients. The amplitudes of the waveforms increased (mean = 18%, range = 6% to 33%) during the first eight postoperative hours. Because of the small size and sensitivity of the sensor, this technique was especially useful in patients with foot lesions requiring occlusive dressings, or where sequential stenoses prevented accurate assessment of postoperative circulation by manual palpation or Doppler examination.

The authors conclude that continuous postoperative piezoelectric pulse monitoring allows accurate, continuous assessment of limb revascularization and alleviates the subjective, time-consuming observations by physicians and ancillary personnel.
Horseshoe Kidney and Buerger's Disease: An Unusual Indication for Axillofemoral Bypass — A Case Report
Authors: Coskun Hasan , Kürsat Bozkurt A. , Sami Vural Fikret
Published: August 2008

Buerger's disease is characterized by multiple peripheral arterial occlusions in young, male smokers. It is rarely considered in the differential diagnosis of iliac artery occlusion. This report describes a patient with clinical, radiologic, and pathologic manifestations of Buerger's disease who underwent an axillofemoral bypass procedure because of left iliac artery occlusion in the presence of horseshoe kidney.
Immunoglobulin Treatment Before Vascular Surgery in Patients with Chronic Idiopathic Thrombocytopenia
Authors: Mastroroberto Pasquale , Chello Massimo , Marchese Antonietta R.
Published: August 2008

The authors describe 2 patients with chronic idiopathic thrombocytopenic purpura (ITP) associated with atherosclerotic peripheral vascular disease dem onstrated by Doppler examination and digital intravenous arteriography.

Two weeks before surgical treatment, a daily venous infusion (for five days) of 400 mg/kg of immunoglobulin was performed. The platelet count at the be ginning of treatment was 23,000/mm3 in the first patient and 25,000/mm3 in the second. Ten days later, the patients had a good response with a platelets increase of 151,000/mm3 and 162,000/mm 3 respectively. Subsequently two aortobife moral operations were required without surgical or ITP-related complications.

At the follow-up the platelet count was 110,000/mm3 in the first patient (ten months) and 132,000/mm 3 in the second (fourteen months).

Their results suggest that an adequate preoperative preparation in patients with chronic ITP may lead to a good response without postoperative bleeding or other complications.
Pseudoaneurysm of the Superficial Femoral Artery Caused by Salmonella Enteritidis
Authors: Kaplan Daniel M. , Lantsberg Leonid , Khoda Jalinus
Published: August 2008

An eighty-two-year-old woman presented in the casualty room with fever and a pulsatile mass in the upper third of her left thigh. Ultrasonography re vealed an aneurysm of the superficial femoral artery, and emergency angiogra phy confirmed the diagnosis. Signs of aneurysmal leakage were present, and the patient underwent an emergency operation. Salmonella enteritidis was grown from intraoperative culture. Immediate postsurgical recovery was satisfactory, but three weeks later the patient developed Pseudomonas aeruginosa sepsis and died. The authors discuss this rare vascular pathology.
The Surgical Management of Vascular Ring Formed by Right Aortic Arch with Aberrant Left Subclavian Artery and Left Ligamentum Arteriosum—A Case Presentation
Authors: Hiekata Tomizo , Takei Hiroshi , Koyama Teruyuki , Endo Shin-ichi , Kashimura Tohko , Maeda Chohsei
Published: August 2008

Reports on the surgical management of the vascular ring formed by the right aortic arch with aberrant retroesophageal left subclavian artery and ligamen tum arteriosum are relatively few. The authors present a case of a forty-four- year-old woman who had dysphagia lusoria caused by this abnormality. Surgical management, which was performed through a left posterolateral thoracotomy, included division of the ligamentum arteriosum and of the aber rant left subclavian artery, reanastomosis to the left common carotid artery, and resection of the Kommerell's diverticulum.

Complete surgical management should include all of these procedures when the Kommerell's diverticulum causes an additional compression to the esopha gus. Only 2 such cases have been reported so far, including the presented case. The authors' experiences have proved that the posterolateral left thoracotomy provides a sufficient view for performing the complete surgical management of this abnormality.