bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Partial Open Beam Laser Probe in Laser-Assisted Angioplasty
Authors: Diethrich Edward B. , Timbadia Ela , Bahadir Ilhan
Published: August 2008

A partial open beam laser delivery system was evaluated in a series of 664 lower extremity laser-assisted an gioplasties performed in 349 consecu tive patients with atherosclerotic oc clusive disease. The 2.5 mm, metal- capped, fiberoptic probe featured a 2 μm central window through which 10-20% active laser light was emitted. In combination with the thermal ef fect produced by the metal tip, the partial beam probe was designed to more effectively ablate calcified ath eroma that had been resistant to the closed beam hot tip probes.

In 28 (4%) angioplasties, lesions recalcitrant to the closed beam probe were treated with the partial beam delivery system. This probe opened 23 (82%) arteries without difficulty. Three of the 5 probe failures were in lengthy occlusions (> 10 cm) in the superficial femoral artery. In the other 2 lesions, the delivery system opened a channel too small for the probe's body to pass easily.

The partial beam laser delivery system works satisfactorily in recana lizing many of the peripheral vessels resistant to the standard closed beam probe.
Bilateral Carotid Body Tumors in a Patient with Cyanotic Congenital Heart Disease—A Case Report
Authors: Jewkes Alan J. , Ward Roger S. , Black John
Published: August 2008

This case illustrates an apparent relationship between chronic hypoxic con ditions and the development of carotid body tumors. Radioisotope scanning assisted in establishing the diagnosis. Presentation and management of this rare disease are discussed.
Multiple Aneurysms with Associated Ectasia: Case Report
Authors: Tuma Martin A.
Published: August 2008

Multiple aneurysms of the infrarenal aorta and lower extremities with asso ciated arteriomegaly or ectasia can be safely treated by complete revasculariza tion at the initial operation by using an in-situ technique, in type III ectasia.
Significance of Distal Runoff and Concomitant Lumbar Sympathectomy in Bypass Surgery for Patients with Thromboangiitis Obliterans
Authors: Doko Soroku , Katsumura Tatsuki , Fujiwara Takashi , Inada Hiroshi , Masaki Hisao
Published: August 2008

The graft patency of bypass surgery to or distal to the popliteal artery for 29 lower extremities with thromboangiitis obliterans (TAO) and for 67 lower ex tremities with arteriosclerosis obliterans (ASO) and six factors influencing graft patency were studied and a new method of scoring distal runoff determined from angiographic findings was employed.

Early graft occlusion (EGO, < one month) was found only in lower extremi ties with distal runoff of 5 or less and more frequently in patients with TAO than in those with ASO, although distal runoff in TAO patients (n=29) was signifi cantly less than that in ASO.

Among TAO patients with distal runoff of 5 or less, EGO (n = 7) was found only in those without concomitant lumbar sympathectomy (CLS), but the dif ference in distal runoff between patients with EGO and those without it was not significant.

From these results, it was concluded that: (1) EGO in patients with TAO is probably due to poor distal runoff with high constrictivity and (2) CLS for such patients could improve EGO, which, in turn, would result in a better cumula tive patency rate.
Noninvasive Imaging and Frequency Analysis for Carotid Artery Diagnosis and Surgical Decisions
Authors: Lefemine Armand A. , Broach James
Published: August 2008

An analysis of 212 carotid arteries studied by Doppler imaging, B-mode imaging, and spectral analysis reveals poor correlation though similarity of data base by chi-square and gamma is strong. The differences between arteriogra phy and the noninvasive techniques appear mainly in the categories of normal and > 50% stenosis. Arteriography classifies more patients as normal and non invasives classify more patients as > 50% by a ratio of 2:1. Noninvasive studies can be used to verify the findings using multiple techniques without risk and correlate best with operative findings. Evidence indicates that multimodality noninvasive studies are a reliable way of diagnosing carotid bifurcation disease and may be used in place of arteriography.
Orthotopic Cardiac Transplant and Straight-Back Syndrome: A Case Report
Authors: de Marchena Eduardo J. , Futterman Laurie G. , Bolooki Hooshang
Published: August 2008

Straight-back syndrome is a common malformation of the thoracic spine that is associated with a marked decrease in the anterior-posterior intrathoracic cavitary space. The authors describe their experience with a patient with straight-back syndrome who required orthotopic cardiac transplantation. Mi nor modification of the procurement and surgical procedure was required to facilitate graft implantation without cardiac compression.
Bypass Graft to the Isolated Popliteal Artery Segment for the Nonhealing Below-the-Knee Amputation — A Case Report
Authors: Mobin-Uddin Kazi
Published: August 2008

The efficacy of femoropopliteal bypass to the isolated popliteal artery seg ment (IPAS) for limb salvage has been reported. The purpose of this study was to determine if a femoropopliteal bypass to the IPAS in a limb with below-the- knee amputation (BKA) would function. A case report describes a patient with a nonhealing BKA wound in whom a reversed saphenous vein femoropopliteal bypass to the IPAS was performed. The bypass graft functioned well and the amputation wound healed. The patient has been rehabilitated to ambulation with artificial prosthesis.
Surgical Treatment of Tricuspid Regurgitation in Combined Valvular Disease
Authors: Morishita Yasuo , Arikawa Kazuhiro , Yuda Toshiyuki , Shimokawa Shinji , Hashiguchi Masahiko , Uehara Kagemitsu , Fukuda Shigeru , Moriyama Yukinori , Iguro Yoshifumi , Taira Akira
Published: August 2008

Ninety-nine patients were operated upon for tricuspid regurgitation (TR) in combined valvular disease. According to surgical procedures for the tricuspid valve, two groups resulted in "repaired" and "ignored," including 60 patients in the former group and 39 in the latter. There is no significant difference be tween the two groups in the preoperative data, except right atrial pressure (P < 0.04). The repaired group included insertion of 41 Carpentier rings, 11 De Vega annuloplasties, 2 Kay's annuloplasties, and 6 tricuspid valve replacements. Early and late mortalities in the repaired group were 6.7% and 8.3%, respec tively. In the ignored group, they were 5.1% and 7.7%, respectively. Long-term postoperative assessments (mean of forty-nine months) were done in 28 patients in the repaired group and in 21 patients of the ignored group. Residual TR developed in more than 50% of the repaired group patients, in whom tricuspid annuloplasty (TAP) was performed with the insertion of a Carpentier ring. On the other hand, residual TR was present in 33.3% of the ignored group patients. The authors presently recommend TAP by the De Vega's method in patients with mild or moderate TR and tricuspid valve replacement in patients with severe TR. Progressive heart failure secondary to TR developed in several pa tients of the ignored group. This consideration has prompted a more aggressive approach to the management of TR in combined valvular disease.
Problem of Revision of Major Lower Extremity Amputation
Authors: Ellison Melanie A. , Akers Donald L. , Rice Janet C. , Kerstein Morris D.
Published: August 2008

Should one consider a primary above-the-knee (AK) amputation ignoring the benefits of rehabilitation of a below-the-knee (BK) amputation if there is a chance the BK amputation may fail? This is a retrospective study of 112 patients (42% women, 58% men) with an average age of fifty-seven years who under went conversion of a BK to AK amputation. A total of 3,731 BK amputations were performed during the same time period; thus 3% of the total required revisions. Of 29 deaths, 17 patients died of myocardial infarction and 7 second ary to cerebrovascular accident. Of the patients who died, 59% had diabetes and 100% had heart disease: 100% of the patients who died with cardiac causes had hypertension, 83% smoked, and 5% had a history of cerebrovascular acci dent. Thirty-six of the 112 (32%) patients had had a vascular reconstructive procedure previously. The mortality rate of 26% (29/112) reported in this series of patients undergoing revision of BK to AK amputation is similar to that in the reported literature for isolated primary AK amputation. The level of amputa tion was based on vascular evaluation and clinical judgment at the time of oper ation. The lack of increased morbidity and mortality should encourage surgeons to persist in doing as many BK amputations as clinically warranted to improve rehabilitation; no increased mortality occurs in the requirement for a second operative procedure.
Selective Arterial Thrombosis Using the Electromagnetic Field Focusing (EFF) System: A Feasibility Study
Authors: Patil Arun-Angelo , Hahn Francis , Yamanashi W.
Published: August 2008

The electromagnetic field focusing (EFF) probe, based on the principle of eddy current convergence, produces pinpoint heat at its point of contact so intense that it can thrombose vessels. Since the probe diameter can be as small as 0.2 mm and can be flexible, it can be navigated transvascularly to a desired point in order to thrombose vessels. The present experiments were conducted to study intravascular thrombosis of arteries. Six arteries in 2 dogs were used for the study. The tip of a flexible probe with a probe tip length of 7 mm was placed in the artery at a desired point and exposed to 150 watts of electromagnetic field. Arteries that were 3 millimeters (mm) in diameter could be thrombosed when exposed to the electromagnetic field for twenty to thirty seconds (4 arter ies). Fifty seconds of exposure resulted in perforation of the artery (1 artery). A larger artery (6 mm in diameter) could not be thrombosed with this method. Histologic studies showed a firm thrombus with no changes in the arterial wall. This technique could be used to thrombose arteries feeding vascular tumors, arteriovenous malformations, and certain intracranial aneurysms, and for arte rial embolization in bleeding problems.
Carotid Endarterectomy: Experience at a Community Hospital
Authors: Vo Nghia M. , Floresguerra Carlos , Sutter Janice , Watson Scott , Blankenship Joan , Stanton Paul E.
Published: August 2008

One hundred and nineteen consecutive carotid endarterectomies (CEAs) performed on 86 patients have been reviewed. Thirty-three patients had bilateral CEAs. The indications were: (1) asymptomatic stenosis or ulceration (29%); (2) transient ischemic attack and amaurosis fugax (58%); and (3) reversible is chemic neurologic deficit and stroke (13%). Sixty percent of patients were shunted and 40% were not. There were 1 postoperative death in the first group and 2 strokes in each group. The overall stroke and death rates were 3.4% and 0.8% respectively. Eighty-eight percent and 83% of patients were alive and stroke free respectively during the forty-two-month follow-up period.

The authors conclude that (1) CEA can be safely performed at a community hospital and (2) routine shunting or no shunting does not affect the patient's outcome.
Closed-Tube Thoracostomy—A New Technique Using a Disposable Surgical Trocar and Sleeve
Authors: Shaikh Khaleel A. , Cilley Jonathan H. , DelRossi Anthony J.
Published: August 2008

Closed-tube thoracostomy is usually the only surgical procedure needed in 85% to 90% of thoracic trauma patients. Every primary care physician should be familiar with the techniques of chest tube insertion. In performing closed- tube thoracostomy, many techniques have been used. A new safe, quick, and easy method of performing closed-tube thoracostomy using a disposable surgi cal trocar and sleeve is presented.
Flow Velocity Measurement and Differentiation Between True and False Lumens in Patients with Abdominal Aortic Dissection by Use of Pulsed Doppler Echocardiography
Authors: Okamoto Mitsunori , Tsubokura Tokuo , Kajiyama Goro , Miyatake Kunio , Kinoshita Naokazu , Sakakibara Hiroshi , Nimura Yasuharu
Published: August 2008

Feasibility of differential diagnosis between the true and false lumens was studied with pulsed Doppler echocardiography in 8 patients with abdominal aortic dissection. The blood flow signal was obtained in both lumens in 7 of the 8 patients and in only the true lumen in the remaining 1 patient. The blood flow pattern was abruptly changed when the sample volume was moved from the true lumen to the false one. The peak flow velocity was higher in the true lumen (95 ± 19 cm/sec) than in the false one (28± 12 cm/sec) and ejection flow duration was longer in the former (306 ±103 ms) than in the latter (163 ±53 ms). The appearance time of ejection flow was not different between them. The presence of reverse flow during the ejection phase was more frequent in the false lumen (5/7) than in the true one (2/8). Thus, the conventional pulsed Doppler study may provide useful information in making a differential diagnosis between the true and false lumens in patients with abdominal aortic dissection.
Dipyridamole and Nifedipine—Studies on Their Protective Effects for Heart Graft Arterial Stenosis
Authors: Ueda Keisuke , Herskowitz Ahvie , Pearson Thomas A. , Dillman John M. , Suzuki Masako , Adachi Hideo , Omoto Ryozo , Baumgartner William A. , Reitz Bruce A.
Published: August 2008

The etiology of accelerated graft coronary arterial stenosis (CAS) was stud ied in a rat heterotopic heart transplantation model. Spontaneously hyperten sive rats (SHR), Wistar rats (WR), and Lewis rats (LEW) were used. Thirty-four recipients rats fed a hypercholesterol diet (HCD) and saline for eight weeks were divided into six groups. Group 1 and 2 (5 rats each) were hypertensive isograft models (SHR to SHR), group 2 being treated with cyclos porine (CsA: 10mg/kg/day orally). The other 4 groups (6 rats each) represented the allograft models. Group 3 (LEW to WR) was the CsA-treated normotensive model, and Groups 4, 5, and 6 (LEW to SHR) were CsA-treated hypertensive models. Additionally, group 5 was treated by dipyridamole (DP; 25mg/kg/day orally) and group 6 was by nifedipine (NF; 3mg/kg/day orally). The coronary stenosis index (CSI) was calculated in each case and the proportion of arteries affected (AR, %) was estimated in each group. AR and CSI were 6.1% and 0.53 ± 0.76 in group 1, 3.6 % and 0.50 ± 0.71 in group 2, 23.7 % and 1.85±0.52 in group 3, 58.2 % and 2.45 ±0.18 in group 4, 32.3% and 2.25 ±0.29 in group 5, and 27.7% and 1.93 ± 0.48 in group 6. AR and CSI were significantly increased in group 3 vs group 1 (p < 0.05) and in group 4 vs group 3 (p < 0.05). AR was reduced in groups 5 and 6 vs group 4 (p < 0.05), and CSI was also reduced in group 6 vs group 4(p < 0.05). In conclusion, hypercholesterolemia and hyper tension were recognized as risk factors for CAS aggravation in allografts but failed to affect the coronary arteries of isografts. Both antiatherogenic agents reduced the number of affected vessels, but only NF reduced the degree of CAS. However, neither controlled graft CAS completely.
Aneurysm Formation and Perforation in Glutaraldehyde-Tanned Umbilical Vein Grafts
Authors: Ratto G.B. , Romano P. , Truini M. , Badini A. , Zaccheo D. , Motta G.
Published: August 2008

Dilatation and perforation of the prosthetic wall represent major problems limiting long-term function of biologic arterial substitutes. One case of multiple aneurysm formation and one of graft wall perforation, occurring nine and three years, respectively, after human umbilical vein (HUV) femoropopliteal recon structions, are reported. Both grafts were well functioning. At microscopic ex amination, the aneurysmal HUV wall showed no degenerative changes, while appearing thinner with respect to the undilated zones (about one third). The HUV flow surface remained thromboresistant, except for the dilated areas. Par tial endothelialization of the inner graft surface was documented. In conclusion, the risk of HUV graft dilatation and perforation increases when function is maintained for periods longer than three years from implantation. However, the umbilical vein retains over time its thromboresistant properties.
Percutaneous Transpopliteal Venography : A New Method of Evaluating Lower Extremity Venous Valvular Function
Authors: Zhang Pei-Hua , Sun Jian-Min , Liu Lu Sheng
Published: August 2008

The authors advocate percutaneous transpopliteal venography as a new and reliable method of evaluating the function of the valves in the deep veins, espe cially those in the femoropopliteal vein, of the lower extremity. At the popliteal fossa, the popliteal vein is punctured and a catheter is inserted proximally for venographic study of the valves. By this method, not only is the iliofemoropopli teal vein clearly visualized, but also the function of the valves in this venous segment may be accurately tested one by one, making up for the shortcomings of ascending and descending venography. It has been found, through this venog raphy, that even if the highest valve of the superficial femoral vein is competent, the distal valves in the femoral and popliteal veins may become incompetent, also resulting in primary valvular incompetence of the deep veins in the lower extremity.
Cost:Benefit Analysis of Elective Retroperitoneal Aortic Bypass
Authors: Markowitz Ira P. , Bell William H. , Senkowsky Jon , Fernandez Jose I. , Swetnam Jeffrey A. , Rubino Linda J. , Kerstein Morris D.
Published: August 2008

Of 72 consecutive patients needing abdominal aortic surgery, the transperi toneal approach (TA) was used in 34 patients. In this TA group, with a mean age of fifty-eight years, 28 patients had aortoiliac or aortobifemoral grafts. Of the 38 patients operated via the retroperitoneal approach (RA), 27 had aortoiliac disease and 11 had aneurysms. In the RA group, the mean age was fifty-nine years; 32 patients in this group had aortofemoral grafts. The groups were simi lar with regard to hypertension, heart disease, obstructive pulmonary disease, previous myocardial infarction, and stroke.

The TA was associated with the larger intraoperative blood loss (1,100 mL) when compared with the RA (mean: 400 mL). Intraoperative crystalloid re quirements were significantly higher for the TA (5,500 mL) versus the RA (3,000 mL). Similarly, the intraoperative blood requirements were higher for the TA (3.0 units packed red blood cells [PRBC]) than the RA (1.0 unit PRBC). The numbers of units of PRBC transfused after surgery were significantly less with the RA (1.25 units) compared with the TA (0.5 unit). The total operative time for the TA was 225 minutes; the time for the RA was 165 minutes (p < 0.01).

The number of hospitalized postoperative days in the TA was 11.5 compared with 6 days in the RA; average number of days of nasogastric intubation was 4 days for the TA compared to 0.25 day for the RA; and tolerance for regular food was initiated at 5.5 days in the TA compared with 1.5 days in the RA. The number of hours of postoperative intubation for the TA was an average of 19.5 compared with 4.5 for the RA; the number of postoperative verbal orders in the TA was 14.0 compared with 4.5 in the RA; and complications in the TA were six times greater than in the RA. Most of the TA complications were pulmonary; these were not present in the RA. The incidence of wound infection was zero in both groups; mortality was zero in both groups. The average hospital cost of the TA was $20,125.26 compared with $5,164.05 for the RA. The RA for abdominal aortic vascular surgery is more cost effective than the TA.
Traumatic Disruptions of the Aorta: Management of 20 Cases
Authors: Madden Lawrence D. , Cilley Jonathan H. , Camishion Rudolph C. , Spence Richard K. , Alexander James B. , Ross Steven E. , DelRossi Anthony J.
Published: August 2008

Twenty-two consecutive patients with thoracic aortic disruptions were treated over a three-year period. With the exception of 3 patients who required emergency thoracotomy, aortography was performed on all patients. The disruption was identified just distal to the left subclavian in all cases. Two patients died intraop eratively prior to repair. A Gott shunt was utilized in 5 patients, cardiopulmonary bypass in 1, and the "clamp-and-sew" technique in 14. Paraplegia occurred in 2 patients (14%) of the "clamp-and-sew" group. These patients had aortic cross- clamp times in excess of thirty minutes. Paraplegia did not develop when either cardiopulmonary bypass or a Gott shunt was used. Additionally, multiple tears of the descending aorta, which were not visualized on aortography, were found intraoperatively in 2 of 19 patients (10.5 % ). One was treated with graft insertion on cardiopulmonary bypass, and the second, with graft insertion of the "clamp- and-sew" technique. The second patient developed paraplegia, attributed to the prolonged clamp time. In conclusion, a shunt procedure would seem to provide better protection of the spinal cord, especially when multiple sites of aortic injury are identified.
Disseminated Intravascular Coagulation Caused by an Abdominal Aortic Aneurysm—A Case Report
Authors: Pai Narayan B. , Subba Rao M.J. , Parithivel Vellore , Gerst Paul H.
Published: August 2008

Disseminated intravascular coagulation occurs in about 2 % of patients with abdominal aortic aneurysm. Herein, the authors describe a patient who developed disseminated intravascular coagulation as a result of a stable abdominal aortic aneurysm. The coagulation disorder resolved completely within a week after aneurysmectomy.'"
Aneurysm of the Extracranial Internal Carotid Artery Seven Years After Trauma: A Case History and Literature Review
Authors: Vanmaele R.G. , Vaneerdeweg W. , Haenen L. , Koekelkoren E.
Published: August 2008

A false aneurysm of the extracranial internal carotid artery developed seven years after the effects of a motorcar accident had been treated in the Depart ment of Otolaryngology. Excision and reconstructive surgery were successfully performed in the Division of Vascular Surgery.

Literature study shows aneurysms of the extracranial carotid artery to be a rare condition. Trauma is mentioned as a major cause. Active treatment is man datory. Surgical resection and reconstruction should be preferred.
Aortic Graft-Enteric Erosion Diagnosed by Contrast Sinography: Case Report and Review
Authors: Harding Alfred D. , Kirt Nichols W.
Published: August 2008

A case of aortic graft-enteric erosion diagnosed by contrast sinography is presented. Only 2 other cases of graft-enteric erosion have been demonstrated in this way. The literature regarding pathogenesis, diagnosis, and treatment of aortic graft-enteric erosion is reviewed.
Generation of Free Radicals During Cold Injury and Rewarming
Authors: Iyengar Jaisimha , George Anna , Russell John C. , Das Dipak K.
Published: August 2008

Cold injury is often associated with irreversible cell damage. At present, however, the pathophysiology of cold injury is not known. This study examines the mechanism of such injury. New Zealand white rabbits were anesthetized and their femoral artery and vein were exposed. After baseline measurements one hind limb was cooled with a freezing mixture to 0°C, followed by rewarming. The other hind limb served as control. During the experiment blood samples were withdrawn from the femoral artery and vein for the subsequent analysis of creatine kinase (CK), lactate dehydrogenase (LDH), and malonaldehyde (MDA). At the end salicylate was injected through the femoral vein to trap any hydroxyl radical (OH°) formed. Rabbits were immediately sacrificed, and biop sies were withdrawn and frozen at liquid nitrogen temperature for analysis of OH° and high-energy phosphate compounds.

The results indicate that local blood flow in the cold-exposed hind limb was reduced significantly, suggesting that cold injury was associated with ischemic insult. CK and LDH increased after cold exposure and increased further during rewarming. MDA formation followed a similar pattern. OH° generated after cooling increased significantly upon rewarming. These results indicate that re warming is associated with an episode of ischemia/reperfusion with simultane ous generation of free radicals, which, at least in part, may be responsible for cellular injury associated with rewarming.
Timing of Amputations in Peripheral Vascular Disease
Authors: Vasiljevich Jeanne M. , Lo Albert C. , Light Jerry T. , Kerstein Morris D.
Published: August 2008

The medical charts of 29 patients who underwent 31 episodes of foot ampu tations, toe or transmetatarsal, preceded by arterial bypass procedures for limb salvage in the presence of ischemic gangrene, were reviewed retrospectively. Seventy-one percent of the attempts were successful and the success rate ap peared to be affected by the timing of the procedures, with 88% limb salvage for those undergoing bypass first versus 50% for those undergoing amputation first or at the same time as bypass. This significance was duplicated in reviewing both diabetic patients and those with wet gangrene. The authors recommend that in most cases, patients with reconstructable vascular lesions and concomi tant localized gangrene should have bypass procedures preformed before ampu tations.
Vascular Problems Associated with The Management of Head and Neck Tumors—A Case Report
Authors: Barone Gary W. , Tribble Curtis G. , Kron Irving L.
Published: August 2008

The approach to vascular complications associated with the treatment of head and neck carcinomas can be very challenging. The major vascular prob lems are related to the carotid artery and include tumor involvement, carotid rupture, and radiation-induced accelerated atherosclerosis. This is a case report of carotid artery involvement by a squamous cell carcinoma and a review of the management of these vascular problems.
Effect of Ticlopidine on Graft Patency Following Arterial Reconstructive Surgery in the Lower Extremity: A Multicenter Three-Year Prospective Study
Authors: Shionoya S. , Sakurai T. , Ueyama T. , Kusakawa M. , Sakaguchi S. , Tsuchioka H. , Numata M. , Hirose H. , Yoshizaki S.
Published: August 2008

A multicenter, randomized, prospective trial was conducted to determine the clinical efficacy of ticlopidine, an antiplatelet agent, in the prevention of graft occlusion following vascular reconstructive surgery of the lower extremity for arteriosclerosis obliterans. Ticlopidine was administered for two years to one group of patients (112 reconstructed arterial segments) while a control group received no antithrombotic therapy (108 segments). There was no significant difference between the treated and control groups in the overall cumulative patency rates for both suprainguinal and infrainguinal reconstructions. In the treated group, however, there was a significant reduction of occlusions in pa tients with rest pain or ischemic gangrene (p < 0.1) and in those with hyperlipi demia (p < 0.05). Ticlopidine-treated patients with infrainguinal arterial reconstructions developed more occlusions than controls between three and twelve months after surgery, but the controls had more occlusions both immedi ately after surgery and in the second postoperative year. It appeared, therefore, that ticlopidine reduced graft failure due to neointimal fibrous hyperplasia or progression of the underlying condition but caused an adverse effect by delaying graft healing. The clinical usefulness of antiplatelet therapy is limited, but it may be effective in the prevention of graft occlusion when administered to the selected patient groups above mentioned. Controversy about antiplatelet ther apy and future research on adjuvant drug therapy after arterial reconstruction are discussed.
Human-to-Rabbit Xenograft Model for Evaluation of Recanalization Techniques
Authors: Oz Mehmet C. , Lemole Gerald M. , Trokel Stephen L. , Treat Michael R. , Andrew James E. , Barr Mark L. , Popilskis Sulli J. , Nowygrod Roman
Published: August 2008

The authors describe a xenograft model created by interposing human ath erosclerotic tissue into the rabbit aorta. Human atherosclerotic tissue obtained from either peripheral vascular operative specimens or from resected hearts of patients undergoing orthotopic cardiac transplantation were sectioned into 10 patches and 5 vessel segments and placed into the aortas of 15 rabbits. A thin platelet-fibrin layer adhered to the luminal surface of the graft but did not progress to occlude the graft. This layer matured over a two-week period, with ingrowth of fibroblasts. Endothelialization occurred only at the anastomotic sites. Rejection was characterized by development over a ten-day period of mul tinucleate giant foreign body cells and a dense inflammatory infiltrate advanc ing from the adventital surface. No necrosis of the xenograft was evident. This model is applicable to study the effects of balloon angioplasty, "hot tip" devices, mechanical atherectomy instruments, and various laser systems on human cal cific atherosclerotic vessels. Currently available animal atherosclerosis models do not provide a comparable test system.
Aneurysm Formation After Laser-Assisted Microvascular Anastomosis: Etiology, Growth Rate, and Prevention
Authors: Wang Su , Basu Samir , Thomsen Sharon , Marini Corrado , Tachmes Lenny , Jacobowitz Israel J. , Cunningham Joseph N.
Published: August 2008

Aneurysm formation has been a major complication in laser-assisted micro vascular anastomosis (LAMA). The authors investigated the effect of increased laser energy on the formation and growth rate of aneurysms. In addition, possi ble methods of prevention were reviewed. End-to-end anastomoses were per formed on 89 rat femoral arteries with the placement of three stay sutures (120 degrees apart) followed by application of CO2 laser irradiation (power = 80 mW, pulse mode = 0.2 s, spot size = 0.275 m). In Group I (N=55), anasto moses were performed with 45 laser pulses, and in Group II (N = 34) 135 laser pulses were used. Each disruption of an anastomosis was repaired by use of 15 additional laser pulses. Six of 18 aneurysms in Group I were reevaluated at weeks 1, 3, and 8 to assess growth rate. All vessels were examined at week 3 for patency and aneurysm formation.

Overall aneurysm rates in the two groups were similar, despite the increased laser energy used in Group II (p > 0.05). There was a higher incidence of aneu rysm formation in disrupted vessels in both groups when compared with non- disrupted vessels (p < 0.05 in Groups I and II). The aneurysm rates did not differ between the two groups when vessels with no disruption or with 1 disrup tion were compared (p > 0.05). Mean aneurysm size increased 0.4 mm/week during the first week, 0.25 mm/week during the second and third weeks, and less than 0.1 mm/week during the remaining five weeks.

In conclusion, the authors have shown that aneurysm formation is not re lated to the total amount of laser energy applied and that disrupted anastomoses have higher aneurysm rates independent of laser energy. Aneurysm growth rate is maximal during the first week.
Vibration Syndrome: Legal Aspects and Staging
Authors: Laroche Gilles P.
Published: August 2008

Although vibration syndrome (VS) is now a well-known clinical entity and a legally described disease, many clinical and legal aspects aspects remain confused. Furthermore, complete reliance by the physician on the patient's own history of white finger and related symptoms in the absence of reliable and repeatable objective test for impairment determination has explained the reluctance to accept this professional disease .

The purpose of this paper, based on a review of 405 cases of Raynaud's phenomennon, of which 210 were vibration syndrome, is to help medical officers in assessing VS. It reviews some clinical facts essential to an adquate diagnosis and some factors of severity and reversibility. A simple staging is the harbinger of a proper assessment for legal estimation of impairment.
Looped Carotid Arteries Simulating Bilateral Aneurysms— A Case Report
Authors: Farsad G. Reza H.
Published: August 2008

Buckling and tortuosity of innominate arteries are of no prognostic signifi cance. Correct diagnosis, identification, and differentiation from true vascular pathologies and from mediastinal and pulmonary conditions will eliminate needless surgical procedures. This condition should be especially looked for in women with prolonged hypertension. Arteriography will establish the diagnosis promptly.
A Rare Vascular Complication of Behçet' s Disease: Peripheral Aneurysms: Case Reports
Authors: Tüzüner Altan , Ersöz Sadik
Published: August 2008

Six patients with peripheral aneurysms secondary to Behçet's disease are presented . These cases, together with the cases reported in the literature , indicate that peripheral aneurysms are an integral manifestation of Behçet's disease. A brief review of the syndrome is also included.
Takayasu' s Arteritis (Type III) in an 8-Year-Old Girl: A Takayasu's Arteritis (Type III) in an 8-Year-Old Girl: A Multimodality Approach to Staged Revascularization of the Heart, Head, and Abdominal Viscera—A Case Report
Authors: Longaker Michael T. , Hanley Frank L. , Goldstone Jerry , Teitel David F. , Finkbeiner Walter E. , Verrier Edward D.
Published: August 2008

Takayasu's arteritis is a rare disease involving the aorta and its branches. The peak incidence of the disease occurs in the third decade of life, and less than 10% of cases involve children. The authors present here a case of severe and progres sive type III Takayasu's arteritis requiring coronary, cerebral, and visceral revascularization in an eight-year-old girl. A multimodality approach was used including saphenous vein coronary artery bypass, percutaneous transluminal angioplasty of the carotid and subclavian arteries, and visceral thromboendar terectomy.
Recanalization of Occluded Peripheral Vessels with Use of a Bare Nd-YAG Laser Beam
Authors: Vo Nghia M. , Bridges Mac , Katras Tony , Chi David S.
Published: August 2008

Laser angioplasty using a bare Nd-Yag laser beam was used on 25 occluded vessels. Sixty-six percent of the vessels were successfully recanalized (GI), and this resulted in a higher increase in ankle brachial index (0.23 vs 0.07, p<.01) than in nonsuccessful cases (GII). The length of occlusion (14 and 16 cm) and length lased (11 and 11 cm) were not significantly different between GI and GII, respectively. Three perforations and five incomplete recanalizations resulted in no major morbidity to GII patients. Sixty percent (9/15) of lesions longer than 15 cm were recanalized compared with 78 % (7/9) of lesions shorter than 15 cm. Vessel calcifications were less commonly seen in GI than in GII (50% vs 100%, p< .05) . All noncalcified vessels were successfully recanalized. The authors con clude that Nd-Yag laser angioplasty is a safe and effective procedure in selected patients.
Clinical Presentation of Thrombosed Greenfield Filters
Authors: Kolachalam Ramachandra B. , Julian Thomas B.
Published: August 2008

The tour de force of this paper lies in the review of clinical presentation of occluded Greenfield filters in a group of patients contraindicated for postopera tive anticoagulation. Nine of 59 patients (15.3%) had occluded filters. Eight of these 9 patients (88.8%) had primary brain tumors. This study, for the first time, to the authors' knowledge, reports a high incidence of caval thrombosis in brain tumor patients (8/31:25.8%) and of an association between caval throm bosis and recurrent deep vein thrombosis. Deep vein thrombosis (DVT) was seen in 88.8% of patients with caval thrombosis in this service. It is the authors' contention that recurrent DVT, at least in brain tumor patients, should alert the physician to evaluate caval patency. Caval thrombosis was noticed even sixty weeks after the placement of Greenfield filter. The authors conclude, therefore, that brain tumor patients had a high incidence of occluded filters; lower extrem ity morbidity provided a clue to such an event, and such a scenario should raise concerns regarding caval patency, even in long-term follow-up.
Retroperitoneal Bleeding as a Presenting Sign of Ruptured Internal Iliac Artery Aneurysm: A Case Report
Authors: Friedman Menachem , Haddad Menashe , Landau Ofer , Zelikovski Avigdor
Published: August 2008

A case of internal iliac artery aneurysm is described. Overlooking this possi bility primarily, as the authors did because of its uncommon location, may lead to hazardous clinical deterioration. Therefore, when otherwise unexplained retroperitoneal bleeding occurs, the rare cause of ruptured internal iliac aneu rysm should be considered as a possibility and explored accordingly.
Abdominal Aortic Salmonellosis Complicated by an AortoEnteric Fistula: Case Report and Review of the Literature
Authors: Stansby G. , Dawson K. , Hamilton G.
Published: August 2008

A case is described in which an atherosclerotic abdominal aortic aneurysm infected with Salmonella presented as an aortoenteric fistula and was successfully treated surgically.
Evaluation of Claudicatory Extremities by Ankle Blood Pressure and Muscle Blood Flow in Exercise Testing Before and After Operations
Authors: Urayama Hiroshi , Watanabe Yoh , Iwa Takashi
Published: August 2008

To study the hemodynamics in the lower extremities before and after opera tions, ankle blood pressure and muscle blood flow in exercise testing were measured in 19 patients with chronic obstructive arterial disease and a chief complaint of intermittent claudication. The ankle and brachial pressures were measured before and just after exercise and the ankle pressure index (API) was obtained. The muscle blood flow was measured by 133Xe clearance method at thigh and calf. Arterial reconstruction was performed in 19 lower extremities of 17 patients and the claudication disappeared in all. The API of the revascularized lower extremities improved as much as the API of the nonclaudicatory lower extremities. The muscle blood flow during exercise of these extremities increased markedly in the calf after operation. The API and muscle blood flow in exercise testing increased in 2 lower extremities of a patient who received PGE 1 intraarter ial infusions but not significantly. However, the API and muscle blood flow did not change in 1 lower extremity after lumbar sympathectomy.
Arterial Flow Enhancement by Impulse Compression
Authors: Morgan R.H. , Carolan G. , Psaila J.V. , Gardner A.M.N. , Fox R.H. , Woodcock J.P.
Published: August 2008

Preliminary observations of rapid relief of ischemic rest pain following appli cation of a foot impulse compression device prompted this study to quantify its immediate effects.

Blood flow was calculated by means of a duplex ultrasound imager interfaced with a Doppler spectrum analyzer.

Twelve normal subjects and 10 patients with peripheral vascular disease (mean Doppler ankle/brachial systolic pressure index = 0.62 (range 0.33-0.74) were studied. Mean resting blood flow ( SD) was not significantly different in the two groups: 55.6 24.0 in normal subjects and 48.3 29.8 in the arteriopaths (p = > 0.1). During five minutes of pump application in a 45-degree foot-down position, mean popliteal blood flow increased by 93% in normal subjects (p < 0.0001) and 84 % in peripheral vascular patients (p < 0.03); there was no change in the opposite limb. In 5 normal subjects a "placebo" device produced no significant change in flow (p >0.1).

In 4 patients with vascular disease lying supine, impulse pumping produced no significant increase in popliteal blood flow.

It is suggested that the hyperemic effect may be explained by the liberation of endothelial-derived relaxing factor (EDRF), a powerful relaxant of vascular smooth muscle, produced in response to sudden pressure changes (hemodynamic shear-stress) within the venous system.
Catheter Angiography for Abdominal Aortic Aneurysms—Is It Still Necessary?
Authors: Wandschneider Wolfgang , Hagmueller George W. , Bull Philippe , Denck Helmuth
Published: August 2008

From 1985 to 1988, 205 patients were admitted to the authors' department for abdominal aortic aneurysm; 152 of them underwent preoperative conven tional catheter angiography (CA). These arteriograms were evaluated retrospec tively. Mean inner aneurysm diameter was 7.72 cm, which correlated well with sonographic findings. In 16.4% the diameter exceeded 10 cm. Aneurysms of the common iliac were present in 59.9%. In 21.0% we found stenoses of the common iliac vessels and in 16.4% stenoses of the external iliac arteries. Renal artery stenosis of more than 50% was diagnosed in 15.8% . In 6.6% accessory renal vessels were visualized, which had to be spared during aneurysm repair. In 9.2 % the inferior mesenteric artery was occluded, whereas all other visceral vessels were patent without pathologic lesions. Although newer noninvasive techniques are available today for vascular imaging, CA still is the "golden standard" for evaluating abdominal aortic aneurysms. It is the only method providing all the information a vascular surgeon needs for optimal aneurysm repair.
Cryopreserved Venous Allografts Pretreated with Cyclosporine Revisited
Authors: Donovan Thomas J. , Ruby Steven T. , Brockbank Kelvin G. M.
Published: August 2008

In 1983 Bandlien et al reported that pretreatment of cryopreserved jugular allografts with cyclosporine (CsA) reduced immunogenicity and increased the patency of these grafts in the canine carotid artery. The purpose of this study was to determine whether CsA pretreatment of nonreversed cephalic venous allografts modifies the histologic events or increases patency in the canine femoral artery. The authors also wished to document the histologic events in the nonreversed cryopreserved cephalic autograft and allograft over a five-month period.

Thirty-six nonreserved cephalic grafts were interposed in the canine femoral artery. Right venoarterial grafts were cryopreserved with CsA and the left grafts were cryopreserved without CsA. There were 28 allografts and 8 autografts so treated. Cryopreserved autograft endothelial cells (ECs) were quite well pre served on preoperative biopsies and rapidly repopulated the intima in one to three weeks like fresh autografts. All autografts remained patent. In contrast, allograft ECs disappeared early and were very slowly replaced with host ECs in the midgraft after five months. The allograft patency was more than 70 % in weighted analysis for the early periods studied without significant difference between CsA and control groups. Pretreatment with CsA did not appear to spare endothelium or influence the immune process significantly.
Acute Arterial Embolus
Authors: Solak Hasan , Yeniterzi Mehmet , Yiiksek Tahir , Ozpinar Cevat , Ceran Sami
Published: August 2008

Between December, 1983, and December, 1988, 100 patients (54 men, 46 women) with acute arterial embolus, ranging in age from twenty-three to eighty- three years, were treated in our clinics.

The main symptom of the patients was pain (94 % ), followed by coldness (72%), pallor (64%), sensory defect (42%), motor disorder (37%), muscular rigidity (10%), and tissue necrosis (7%).

We have determined the etiology to be atrial fibrillation in 53 cases, 36 of which arose from mitral stenosis: acute myocardial infarction (MI) in 14 cases; thromboembolus based on arteriosclerosis obliterans (ASO) in 27 cases; and tumor embolus in 2 cases; 4 cases could not be explained etiologically. The most common site of embolism was the femoral artery (33%).

Arterial exploration was done under local anesthesia in the 76 patients who did not have distal localization of the embolus. Embolectomy was performed in 49 of these cases and embolectomy plus localized tromboendarterectomy in 27. Owing to developing necrosis, amputation was necessary in 6 cases—4 above the knee and 2 above the elbow. Motor and sensory defect persisted to various degrees in 27 cases. The death rate was 4%.
Bacteremic Infectability of Vascular Grafts: An Experimental Study
Authors: Cavallaro Antonino , Sciacca Vincenzo , Cisternino Silvestro , di Marzo Luca , Mingoli Andrea , Farina Carlo , Gallo Piero , Bernucci Paola , Bordi Eugenio , De Mori Patrizia , Orefice Gabriella
Published: August 2008

The present study was undertaken with the aim of defining the differences, if any, in bacteremic infectability of some currently available arterial grafts.

The following prostheses were investigated:

• two kinds of expanded polytetrafluoroethylene (PTFE)

• Dacron knitted double velour

• Dacron knitted pretreated with gelatin

Forty beagle dogs were used . In each animal the infrarenal aorta was resected and replaced by means of ϕ.6 mm segment of:

• PTFE type I 10 dogs

• PTFE type II 10 dogs

• Dacron knitted double velour 10 dogs

• Dacron knitted pretreated with gelatin 10 dogs

At the end of the operation, each animal was administered IV with 100 mL of normal saline containing a suspension of Staphylococcus aureus coagulase-posi tive phage type 5504. The bacterial load was 105in 5 animals of each group, 107in the remaining 5.

The graft was retrieved after forty-five days and studied in the microbiology laboratory (study of graft homogenate) and in the pathology laboratory (study by conventional microscopy of graft healing). When culture yielded a strain of Staph. aureus, this was retyped for phage 5504 specificity.

All grafts were patent at the end of the experiment: partial thrombosis was, however, observed, coupled with a frank perigraft inflammation in:

• 3 PTFE type 1 (2 Staph. 105, 1 Staph. 107)

• 1 PTFE type 2 (Staph . 105)

• 1 Dacron knitted double velour (Staph . 107 )

Baterial colonies within the graft tissue were evident at microscopy in 4 PTFE grafts and in 1 gelatin-pretreated graft.

Culture was positive and specific in all the gelatin-treated Dacron grafts and in 60% of the nonpretreated Dacron and PTFE grafts.

An optimal result (good healing, no inflammation, no infection) was observed only in 3 PTFE and in 2 "conventional" Dacron grafts.

The possibility is suggested that bacteria may be harbored in graft tissue without any clinically evident effect; moreover, some late graft infection could be attributable to an early bacteremic contamination.
Arterial Embolism of Limbs: Recent Experience in a Saudi Referral Vascular Unit
Authors: Al Zahrani Hasan A.
Published: August 2008

Thirty-two patients with 40 acutely ischemic limbs due to arterial embolism were studied over a two-year period to define the pattern of etiologic factors and problems in management. The mean age was fifty-five years (range eight to one hundred), and the male-to-female ratio was almost 1:1. Only 8 patients (25%) presented within eight hours of onset. Lower limb ischemia occurred in 29 patients (90.6%), and the right side was affected in 16 limbs (55.2%). Large-vessel occlusion occurred in 21 patients (65.6%) and was usually treated by embolec tomy. Small-vessel occlusion was encountered in 11 patients (34.4%), and embo lectomy was performed in 3 of these patients (27.3%) Emboli arose from the heart in 20 cases (62.5 %) and rheumatic valvular heart disease was found in 6 patients (18.7%). Noncardiac sources were detected in 12 patients (37.5%). In 12.5 % of the cases, the author failed to determine a source. Six patients (18.7%) expired; death was associated mainly with the presence of a delayed, large embolus and myocardial ischemia. The author managed to save 22 limbs (55%). Amputation was performed on 6 limbs (15%). The author concludes that the pattern of etiologic factors of arterial embolism in Saudi Arabia is changing to one similar to that encountered in Western countries. Earlier detection and referral of cases is recommended in order to save more limbs in future.