bluuebunny/crossref_metadata_2025 huggingface dataset:
Descending Valvular Incompetence in Venous Pathophysiology — Experimental Proof
Authors: van Bemmelen Shalom P. , Hoynck van Papendrecht Arthur A.G.M.
Published: November 2007

Using a small animal experimental model a large number of angiographic studies were carried out in progressive degrees of venous insufficiency. The ex istence of the DVI mechanism in venous pathophysiology was demonstrated, stressing the need for correction of proximal valvular incompetence. Further more, the beneficial effect of lowering the pressure in the proximal venous sys tem on the distal veins was documented. This study provides experimental evidence for the usefulness of venous reconstruction and justifies the more wide spread clinical application of venous reconstruction at an earlier point in venous disease.
The Influence of Supporting Rings on the Healing of the Ringed Expanded Polytetrafluoroethylene Vascular Graft
Authors: Takenaka Kenji , Kholoussy A. Mohsen , Yeng Yang  , Emara Medhat , Fusaro James , Matsumoto Teruo
Published: November 2007

The influence of supporting rings on the healing of the ringed expanded polytetrafluoroethylene (ePTFE) vascular graft (ringed graft) was studied. In 12 dogs (32-42 kgm), a 4cm segment of each common iliac artery was excised and replaced with an equal length of 6mm ePTFE vascular graft. Ringed graft was used on one side and plain on the other. Dogs were sacrificed at intervals of 1, 2, 4, 6, 8 and 12 weeks.

All grafts remained patent. The degree of pannus extension and pannus thickness showed no differences between both grafts at each interval. It was covered by a monolayer of endothelial-like cells as seen by scanning electron microscopy. The growth rates of endothelialization measured from the proximal anastomosis were 1.3 and 1.4 mm/week in the plain and ringed grafts, respec tively. Anastomotic intimal hyperplasia (> 50 microns) was noted in 25% and 33% at the proximal and distal anastomoses, respectively, in both grafts. The outer surface was covered by adherent connective tissue particularly encapsu lating the rings without affecting the non-ringed portion in the ringed grafts. We conclude that the supporting rings of the ePTFE graft have no significant influence on the healing and neointimal development.
Emergency Surgery in Late Occlusion of Aortobifemoral Bypass Reconstructions
Authors: Deriu Giovanni P. , Ballotta Enzo , Grego Franco
Published: November 2007

Personal experience of 66 late reoperations following occlusion of aortofe moral bypass procedures of patients operated for occlusive arterial disease of the lower extremities emphasizes that two possibilities exist: either a situation of compensation allowing a deferred evaluation of the problem (55 cases) or an emergency situation (11 cases) due to: 1) acute ischemia of the lower limbs (6 cases); 2) possibility of intestinal infarction (3 cases); 3) ascending thrombosis of the abdominal aorta (2 cases).

The aim of the reoperation is to restore a good runoff usually with an endar terectomy of the profunda femoral artery (PFA) and angioplasty of this vessel or, when the profunda femoral artery does not give good reliability, with a fe moropopliteal or femorotibial bypass.

Moreover, adequate blood flow must always be guaranteed in at least one of the hypogastric arteries by retrograde flow, reimplantation of the internal iliac artery or, as a last resort, by reimplantation of the inferior mesenteric artery (IMA) . It is necessary to underline that in a patient with occlusion of one graft limb, who had been conservatively treated for unremarkable subjective symp tomatology, the occlusion of the contralateral branch usually requires reopera tion with revascularization of at least one external iliac artery.
Revascularization of the Femoral Artery by Femoro-Femoral Cross-Over By-Pass Utilizing PTFE-Grafts. Hemodynamic Changes During Follow-Up
Authors: Christenson Jan T. , Broome Albert , Qvarfordt Peter
Published: November 2007

From 1976 to 1981, 48 consecutive patients underwent femoro-femoral cross-over by-pass utilizing PTFE grafts. Indications were severe ischemia (69%) and claudication (31%). All were high-risk patients. Hemodynamic changes (ankle/brachial pressure index) and graft patency was studied during the first postop year.

No operative mortality was noticed. Graft thrombosis occurred in 13 cases during follow-up. Successful thrombectomy was done in 7 cases. Graft patency was 80% after 5 years in claudicants and 81% in severe ischemia. The limb salvage rate was 70% at 6 years follow-up. The walking distance increased sig nificantly during the 1st year. There was a good correlation between angiografi cally determined run-off and the ankle/brachial pressure index. In claudicants distal pressure index increased significantly from 0.38 to 0.60, 3 months postop in recipient leg. The same was true in severe ischemia, from 0,10 to 0.48, 3 months postop. No steel phenomena were observed. This procedure is useful for revascularization of a limb with occlusion of the iliac artery, with high graft patency and limb salvage rates and low morbidity and mortality. Even though ankle/brachial pressure index never is restored to normal a gradual increase is observed up to one year after operation. No adverse effects have been demon strated following the procedure. Patients have to be carefully selected for the procedure by preop angiography and hemodynamic evaluation.
Intraoperative Flow Evaluation During Reconstructive Arterial Surgery by C . W. Doppler Flowmeter and Angioscope
Authors: Raso A.M. , Rispoli P. , Carlin R.
Published: November 2007

In order to avoid errors of evaluation during reconstructive arterial surgery, some surgical teams, in addition to their personal skill and experience, have so far mainly employed intraoperative angiography. This method, still good and precise, but slightly unsafe and requiring very expensive equipment, is not ex empt from some limits, which have been clearly described. 2,15,16
Graft-Enteric Fistulas and Erosions, Complications of Synthetic Aortic Grafting
Authors: Salo J. , Verkkala K. , Ketonen P. , Harjola P-T.
Published: November 2007

Operative results of 12 patients with graft-enteric fistula (GEF) and two patients with graft-enteric erosion (GEE) operated on at our department be tween 1974 and 1984 were analyzed.

Preoperative gastrointestinal bleeding was noted in all patients and pre sented as melena in 11 (79%), hematemesis in 10 (71 %), and hematochezia in 7 (50%).

Eleven of 14 patients had signs of infection with fever, leukocytosis and hy persedimentation. Preoperative aortography or barium contrast studies were performed in 10 patients, but none of these investigations were diagnostic. Extirpation of prosthesis and closure of the bowel was performed in 10 pa tients. Operative mortality was 64,3%.

It is concluded that GEF or GEE must be suspected in all patients presenting with gastrointestinal bleeding after reconstructive aortic surgery. Immediate laparotomy with extensive and careful exploration of the graft region is the best and safest diagnostic procedure. Fibre-optic endoscopy of the upper gastroin testinal tract performed on the operating table is a reasonable investigation to rule out other causes of bleeding. Total graft excision with axillofemoral recon struction gives the best survival rates.
Infection in Cardiac Pacemaker Implantation is Avoidable
Authors: Rao Gopal , Lima Claudio A.B.
Published: November 2007

Methods of eliminating pacemaker infection are reported in a prospective study of ten years. The majority of 400 patients were in their 7th and 8th dec ade. All procedures were done in the operating suite. Skin was prepared with providine-iodine soap and solution and the surgeon's hands were scrubbed with an iodophor sponge. All patients were given prophylactic antibiotics, the major ity receiving cephalothin. No drains were used. Cephalic vein entry was used in almost all cases. The wound was irrigated with kanamycin solution. One third of the patients had risk factors such as diabetes, heart failure and temporary pacemakers. Pacemakers of ten different manufacturers were used. There was one infection in this series.
Management of Peripheral Arterial Embolism
Authors: Souka M.M. , Agha M.M. , Hamza M.A.
Published: November 2007

This study included one hundred patients with peripheral arterial embolism. The average age was 45 years with predominence of female over male patients (3:2). The source of emboli was found to be the left side of the heart in 90% of patients. Rheumatic heart disease was the primary cardiopathy in 70% of the cases. Eight percent of the patients were presented more than 24 hours after the onset of symptoms and embolectomy was carried out in 77% of cases. The pur pose of this study is to clarify the magnitude of the problem as to the etiology, different clinical presentations and the operative results after embolectomy us ing a Fogarty balloon catheter and its relation to time interval.
Systemic Coagulation Effects Associated with Intra-Arterial Infusions of Low Doses of Streptokinase for Peripheral Arterial Occlusions
Authors: Rubin Ronald N. , Comerota Anthony J. , Soulen Renate , Rubin Ronald N.
Published: November 2007

Streptokinase (SK) arterial infusion has become an increasingly used method in the therapy of peripheral arterial occlusive disease. Dosage regimens and durations of therapy are extremely variable. The degree of alteration in the coagulation system has not been adequately addressed. Such alterations might have profound significance regarding patient selection, nature of contraindica tions and degree of toxicity. We have systematically studied the effects of very low doses of SK given intra-arterially in peripheral arterial occlusive disease states. Our detailed studies demonstrate a profound systemic effect on the clot ting mechanism and function in such patients with marked lowering of fibrino gen, depletion of plasminogen and overall hypocoagulability. The effects of these findings on the clinical aspects of this therapeutic technique are discussed.
Experience With the Polytetrafluorethylene (PTFE) Bifurcated Graft: Case Reports
Authors: Benton Gary S. , Kerstein Morris D. , Kerstein Morris D.
Published: November 2007

Ten patients (eight men, two women) with a mean age of 61.8 years were operated on for atherosclerotic vascular disease or abdominal aortic aneurysm and had subsequent placement of Polytetraflourethylene (PTFE) bifurcation grafts. Follow up by the life table method at nearly five years reflects all patent grafts. We conclude the PTFE vascular grafts are an acceptable alternative to the current methodology in the aortofemoral position.
Impending Carotid Artery Rupture Presenting as Oropharyngeal Bleeding After External Neck Irradiation
Authors: Chung-Park Moonja , Toor Ashfaq H. , Shah Ajit C. , Sharan Vishwa M.
Published: November 2007

Carotid artery rupture is a rare complication of irradiation therapy of the neck and it may present with mild continuous bleeding. A prompt surgical intervention should be considered to prevent sudden fatal outcome when the patient develops oropharyngeal bleeding after neck irradiation without previous history of trauma or other medical reasons, such as hypertension or hematologic disorders. A case of carotid artery rupture after the usual 6000 rads of Cobalt 60 therapy for squamous cell carcinoma of the vocal cord is. herein reported.
Cardiac Metastasis of an Ovarian Adenocarcinoma Diagnosed by two Dimensional Echocardiography: A Case Report and Review of the Literature on Cardiac Masses Diagnosed by Cardiac Ultrasounds
Authors: Kouvaras George , Bacoulas George
Published: November 2007

The first case of right ventricular metastatic ovarian adenocarcinoma diagnosed by two dimensional echocardiography is described. A detailed review of the literature on cardiac tumors diagnosed echocardiographically is given.
Abscess of the Lower Leg Anterior Compartment and Osteomyelitis: A Complication of Failed Revascularization: A Case Report
Authors: Vo Nghia M. , Lefemine Armand A.
Published: November 2007

A case of abscess of the lower leg anterior compartment and secondary osteomyelitis of the tibia following an initially successful but later failed revascularization procedure is described. The management of this unusual case is also discussed.
Acute Arterial Injuries in Civilian Practice
Authors: Molokhia Farouk A. , Wali Hassan T. , El-Amrawy Ahmed , Hamza Mohamed , Naga Rafat , Salem Mohamed , El-Henawi Moustafa
Published: November 2007

One hundred and twenty cases of acute arterial trauma were managed in the Vascular Unit, Alexandria University Hospitals, Egypt, during the years 1980- 1985. Pulsating hematoma, AV fistulae, and complete transection constituted 70% of the cases. The extremity arteries were affected in 80%; 93% of the cases were males, and the second, third, and fourth decades were the most common ages. Knife or bullet wounds and car accidents were the most common injuries. Reconstructive arterial procedures were done in 68% of cases. The amputation rate was 8%, and the mortality rate was 1.7% of cases.
Iatrogenic Arterial Injury Causing Gangrene: A Case Report
Authors: Sadat-Ali Mir , Al-Awami Sayed Majed , Mostapha Hemeda M.
Published: November 2007

A rare case of extremity gangrene caused by accidental injection of haloperi dol, diazepam, and chlorpromazine in the ulnar artery is presented. The intra- arterial injection of drugs and its complications could be avoided by scrupulous selection of site, away from the cubital fossa. A free-flowing intravenous line should be established before any intravenous injection of medications is at tempted. This decreases any chance of such an incident. Expeditious measures to counteract the injected drug could minimize the complications.
The Role of Local Thrombolysis in Late Vascular Graft Thrombosis
Authors: Pratesi C. , Alessi Innocenti A. , Frullini A. , Matticari S. , Rega L. , Stefani P. , Bertini D.
Published: November 2007

The authors present their experience of late prosthetic thrombosis in which they performed a local thrombolysis as the first approach, aiming not only to cure the acute obstruction but also to get more information about the most appropriate therapeutic tactic to be used.

The therapeutic protocol consisted of: (1) urokinase: 200,000 IU in 15-20 minutes, and after this, 75,000 IU/hour for a maximum of 72 hours, always through the arterial catheter; (2) heparin: 5,000 IU before the thrombolytic treatment is started and then maintenance of a sodium heparin infusion with a pump, the activated partial thromboplastin time being taken at double the ini tial value.

They treated 21 late graft thromboses: 18 involved the prosthetic limb of an aorto-bifemoral bypass, and 3 were peripheral grafts in PTFE.
Reduced In-Hospital Mortality Following Intracoronary Streptokinase Treatment of Acute Myocardial Infarction
Authors: Salem Bakr I. , Gowda Siddhesh , Haikal Maged
Published: November 2007

Reduced short-term mortality following thrombolytic treatment of acute myocardial infarction has been reported by earlier studies. This study was per formed to compare data from our institution with such results.

From January, 1984, through January, 1986, a total of 628 consecutive pa tients were admitted with acute myocardial infarction. Ninety-one patients (Group A) underwent intracoronary streptokinase (IC-SK) infusion to the in farct-related vessel with a total dose of 440,000 units. The average timing for this intervention from the onset of chest pain was 4.1 ±2.7 hours. Successful recanalization was achieved in 71 of 91 patients (78%). Patients seventy-five years of age or older were not offered IC-SK infusion. In this group, most candidates suitable for coronary angioplasty or bypass surgery had the proce dure within the same hospital admission. The remaining 537 patients (Group B) underwent conventional medical therapy during their hospitalization.

In-hospital mortality for Group A was reported in 4 of 91 patients (4.4%) versus 100 of 537 patients (18.6%) from Group B. These results seem to con form with earlier data that indicate a reduced short-term in-hospital mortality from acute myocardial infarction following IC-SK treatment. Besides recanali zation, this beneficial effect in Group A could also be attributed to earlier inter ventions by revascularization procedures in the majority of patients after recognition of the extent of their coronary artery disease.
Are Noninvasive Doppler Arterial Studies Useful in Predicting Success of Infrainguinal Bypass Grafts?
Authors: Satiani Bhagwan , Biggers Karen , Burns Roger , Porter Robert , Das Mohan
Published: November 2007

The prediction of success of lower extremity bypass grafts based solely on noninvasive Doppler flow data has been questioned. The prognostic value of preoperative Doppler ankle pressures (APR), ankle/brachial indices (ABI), be low-knee pressures (BKPR), above-knee pressures (AKPR), and segmental pressure gradient indices was examined in predicting immediate (IF), late (LF), and overall failure (OF), as well as amputation (AMP) in 168 infrainguinal bypass grafts. Good runoff (2-3 vessels) was present in only 36%, and vein grafts were used in 60% of limbs. OF occurred in 26.7% (IF 6.5%, LF 20.2%) with a mean follow-up of 16.2 months (range 0-63). Major AMP resulted in 17.2% limbs. In 140 limbs with audible Doppler pedal signals, there was no significant difference in AKPR, ABI, or segmental indices between successful and failed grafts. Successful grafts had a higher AKPR (114.8 ± 38.5 vs 100 ± 30.5, p < .05) and BKPR (87.9 ± 30 vs 72.2 ± 23.5, p < .01) compared with failed bypasses. No significant differences in IF, LF, or OF rates were noted in limbs with ABI < 0.2 vs > .02, < .04 vs > .04 or presence/absence of Doppler pedal signals.

Preoperative noninvasive Doppler flow studies are invaluable in the diagno sis, grading, and follow-up of unoperated patients with lower extremity arterial occlusive disease or detection of impending graft failure. They do not reliably predict success/failure of infrainguinal bypass grafts in individual patients. Low ABI or absent Doppler pedal signals do not by themselves preclude successful revascularization.
Unstable Carotid Artery Syndrome: Clinical Management, Risks and Outcome
Authors: Rothrock John F. , Lyden Patrick , Yee John , Wiederholt W.C.
Published: November 2007

Forty-five consecutive patients with unstable carotid artery syndrome were evaluated and treated, 23 surgically and 22 medically. Early cerebral angiogra phy and carotid endarterectomy yielded permanent neurologic morbidity/mor tality incidences of 0% and 8.7%, respectively. Despite a fairly high incidence of stroke acutely and during the follow-up period (24% and 8%, respectively), 80% of the total group continued at their baseline, prepresentation level of daily function at an average follow-up of 22.3 months. Aggressive clinical manage ment of this patient group is generally safe, but the efficacy of such manage ment remains unproven.
Hemodynamic Observations Related to in-Situ By-Pass Arteriovenous Fistulae
Authors: Leopold Peter W. , Kupinski Anna Marie , Corson John D. , Shandall Ahmed A. , Shah Dhiraj M. , Karmody Allastair M. , Leather Robert P.
Published: November 2007

A total of 145 in-situ saphenous vein bypasses were studied postoperatively by Echo Doppler (Duplex) ultrasound scanning. Volumetric blood flow was measured transcutaneously in each case. Five patients did not clinically improve despite patency of their bypasses. Three other patients had persistent edema and arteriovenous fistulae. Surgical ligation of dominant fistulae in these 8 pa tients resulted in significant improvement of distal bypass flow in 7 patients (p < 0.01, Student's paired t-test) with a concomitant decrease in fistula flow and resolution of symptoms in all patients.

An occasional patient undergoing in-situ bypass may have a hemodynamic compromise postoperatively that is correctable by fistula ligation.
Chylous Ascites Following Abdominal Aortic Transplantation—A Case Report
Authors: Denck H.
Published: November 2007

A seventy-year-old patient developed chylous ascites as a complication after surgery for abdominal aortic aneurysm. After failure of conservative treatment a peritoneovenous shunt (Denver) was placed, which functioned immediately. The patient died four weeks later of massive coronary ischemia. The shunt had been functioning until the patient's death. No chylous fistula was found by au topsy.
Response of Cutaneous Laser Velocimetry to a Temperature Change: Normal and Dysvascular Patients Compared
Authors: Neufeld Gordon R. , Reilly Cheryl A. , Galante Stephen R. , Roberts Andrew B. , Baumgardner James E. , Graves David J. , Quinn John A.
Published: November 2007

In previous studies of skin blood flow using a helium flux technique, we found a linear relationship between blood flow and skin temperature. In this paper we compared the helium flux method to laser Doppler velocimetry (LDV) over a range of temperatures in 5 normal healthy volunteers. In a separate normal group we measured the increase in LDV signal to a temperature change in both the volar aspect of the forearm and the dorsum of the foot. We then compared the LDV temperature response data from the normal subjects with data from a group of 20 patients with known peripheral vascular disease of the lower extremities and found a highly significant reduction in LDV output vs temperature in the patient groups. We concluded that the LDV temperature response data provide a convenient method for comparison of LDV data be tween patients and between sites on the same patient.
Healing Pattern of Collagen-Impregnated and Preclotted Vascular Grafts in Dogs
Authors: Noishiki Yasuharu , Chvapil Milos
Published: November 2007

To eliminate the need for preclotting dacron fabric vascular grafts, collagen- impregnated microvel double velour vascular grafts were used. Twelve mongrel dogs were implanted in the thoracic aorta with collagen-impregnated pros theses, in the form of a loop, 28 to 38 cm long and 8 mm in diameter. Four identical prostheses were preclotted and served as controls. The prostheses were harvested from two to 216 days postoperatively and the healing pattern was determined by histology and scanning electron micrograph methods. At the time of implantation, none of the collagen-impregnated prostheses bled through the wall and all remained patent. The authors established that the collagen- impregnated prostheses healed markedly faster, as documented by the signifi cantly larger area covered by neoendothelial cells and the significantly greater incidence of vasa vasorum along the grafts implanted for a period ranging from eighty-one to ninety-nine days. The study documents the close association be tween the rate of neoendothelialization and the number of microvessels in the healing prosthesis. The authors conclude that collagen-impregnated microvel double velour vascular grafts prevent bleeding through the wall and enhance the rate of the healing without induction of fibrotic changes.
The Nature of the Endothelial Lining in the Expanded Polytetrafluoroethylene Vascular Graft: An Experimental Immunofluorescent Study
Authors: Yeng Yang  , Takenaka Kenji , Kholoussy A. Mohsen , Emara Medhat , Kodellas Lambros , DuPree John J. , Matsumoto Teruo
Published: November 2007

Indirect immunofluorescent technique directed at factor VIII-related anti gen was used to examine the cellular lining of short PTFE vascular grafts re placing a portion of common iliac artery in dogs. The innermost cellular monolayer was determined as true endothelium. The pannus developed from both anastomotic ends of the host artery and strongly supported the overlying endothelium. Endothelial damage occurred in the areas without tissue support underneath. Complete endothelialization played an important role in maintain ing graft patency.
Limited Dissection of the Aorta
Authors: Ueyama Takeshi
Published: November 2007

Typical dissecting aneurysms of the aorta are recognized as having two or more tears, entry and reentry in the intimal layer, and a longitudinally dissect ing lumen in the medial layer. Atypical dissecting aneurysms, with only a single tear and a narrow dissecting lumen, also occur. Persistent hypertension and severe back and/or abdominal pain are usually the presenting symptoms. This paper discusses 7 atypical cases of aortic dissection. There were 6 males and 1 female, between the ages of forty-nine and seventy years of age, with the mean age of 61.8 years. The sites of the aortic dissection varied. One was found in the aortic arch, two in the descending thoracic aorta, two across a portion of the diaphragm, and two at the celiac axis origin. All 7 patients were treated with antihypertensive medication soon after the onset of symptoms. Five of the pa tients were then treated surgically, 2 with resection and graft replacement, and 3 with direct suture repair of the dissection. The 2 remaining patients were managed conservatively on antihypertensive medication.
Ruptured Carotid Mycotic Pseudoaneurysm After Simple Carotid Endarterectomy: Case Report and Brief Literature Review
Authors: Bonta Marco J. , Blackford James M.
Published: November 2007

Carotid pseudoaneurysm is an uncommon but serious complication of carotid endarterectomy. A case is presented in which the lesion occurred four weeks after combined aortocoronary bypass and carotid endarterectomy without patch angioplasty. The English surgical literature concerning this lesion is re viewed and reported.
Takayasu's Arteritis: Case Reports
Authors: De Toledo Francisco Victor , Pereira De Araújo Adalberto , Beer Alberto , Mino Garces Patricio , Baptista Ronaldo
Published: November 2007

This article reports 5 cases of young females with "Takayasu's arteritis" who underwent successful vascular operation during the period from February, 1978, to May, 1983. The operations were performed at the Vascular Service of Marcilio Dias Naval Hospital. Analysis of the blood tests revealed that the erythrocyte sedimentation rate was elevated in 3 patients. Arteriography pro vided the definitive diagnosis. The patients have been asymptomatic since then.
Hospital-Incurred Vascular Trauma: Management of Brachial Artery Thrombosis Following Cardiac Catheterization
Authors: Woodham James W. , Brigham Robert A.
Published: November 2007

This study reviews the authors' experience with 13 cases of brachial artery thrombosis following cardiac catheterization. Eleven patients underwent bra chial artery exploration with complete restoration of normal distal pulses and excellent long-term results. There was no morbidity or mortality. The 2 patients who did not undergo surgical repair complained of exercise-induced hand ische mia. The etiology of the thrombosis and alternatives in surgical management are discussed. An aggressive approach toward vascular injury associated with retrograde brachial artery catheterization is warranted.
New Directions in the Use of Carbon as Vascular Graft Material
Authors: Ratto Giovanni B. , Di Primio R. , Romano P. , Truini M. , Badini A. , Zaccheo D. , Motta G.
Published: November 2007

Carbon has been used to improve the thromboresistance of synthetic vascular prostheses, and for this pur pose, dacron grafts have been coated with carbon. Owing to the contradic tory results reported in the literature, a new kind of vascular conduit, ex clusively textured from carbon fi bers, has been developed. The pres ent research study was undertaken to compare carbon and expanded poly tetrafluoroethylene (e-PTFE) grafts when used as vascular substitutes. Fifty-six experimental animals were divided into four equal groups and underwent substitution of segments of infrarenal aorta or inferior vena cava (IVC), through use of either carbon or e-PTFE grafts. Prosthetic segments were removed fifteen sec onds, or sixty minutes, or seven, fif teen, thirty, sixty, or one hundred twenty days after implantation. Spec imens were examined by light and scanning electron microscopy. Cumu lative patency rates, calculated by the life-table method at 120 days after surgery, were 72% for aortic carbon grafts, 41 % for aortic e-PTFE grafts, and 0% for both carbon and e-PTFE grafts implanted on the IVC. Carbon conduits performed significantly bet ter than e-PTFE conduits when used as small-caliber arterial substitutes (p < 0.05). Fifteen seconds after blood contact, the inner surface of carbon prostheses, regardless of the implantation site, was covered with a thin proteinaceous layer, whereas e- PTFE grafts appeared almost com pletely free from hematic deposits.

One hour after implantation, a red thrombus was found to overlay the luminal surface of both carbon and e- PTFE prostheses. This layer ap peared to be thicker on the e-PTFE grafts than on the carbon grafts and thicker on the venous grafts than on the arterial. The endothelialization process of the blood-prosthesis inter face seemed to be slightly more rapid on the carbon than on the e-PTFE aortic grafts. In conclusion, this new carbon graft would appear to possess promising specifications, making it suitable for small-caliber arterial (but not venous) replacement.
Reharvesting of Saphenous Vein Arterial Bypasses— Two Case Reports
Authors: Martin Kevin D. , Sherman Mark M.
Published: November 2007

Patients who require bypass grafts to the distal vessels of the lower extremity represent a significant problem if autogenous saphenous vein is not available, since saphenous vein has a higher patency rate than any other prosthetic mate rial for distal bypasses. Presented here are two case reports of reharvesting saphenous vein that has been previously used in femoropopliteal bypasses. Composite grafts were then constructed with polytetraflouroethylene (PTFE) so the portion of the bypass going below the knee was still saphenous vein graft.
Late Vascular Complications of Lumbar Disc Surgery — Case Reports
Authors: Onursal Ertan , Sonmez Bingur , Mehmet Ali Bedirhan  , Kargi Aydin , Cesmeci Suat , Nilgun Ulusoy Bozboga  , Barlas Cemil
Published: November 2007

Many reports have been published describing different vascular lesions after lumbar disc surgery but the actual incidence is probably higher than has been published. Lesions of vascular structures (aorta, iliac arteries, and veins) close to the spine can arise as a consequence of the removal of disc fragments.

In emergency cases, general surgeons are usually called upon to deal with these in the absence of more qualified vascular surgeons. But for an elective case, an experienced vascular surgeon's knowledge of the pathogenesis and ap propriate management of these lesions is mandatory for the proper care of the patients. Herein, 3 additional cases of late vascular complications of lumbar disc surgery, their diagnostic features, and correct treatments are presented.
Iliofemoral Crossover Bypass in High-Risk Patients: Management and Results
Authors: Wandschneider W. , Hauck H. , Denck H.
Published: November 2007

Between 1982 and 1986, 65 high-risk patients underwent iliofemoral cross over bypass (COBP) for unilateral iliac occlusion or stenosis; 53.8% complained of rest pain, 27.6% showed beginning gangrene, and 13.8% were operated on because of acute iliac occlusion. The proximal anastomosis was placed on the external iliac artery in 76.9%, the distal anastomosis on the profound femoral artery in 89.2%. The authors usually used PTFE grafts placed in the retrorec tal-preperitoneal space.

Doppler index rose by 0.3, flow improvement averaged 3 mL/100 mg tis sue/min; no steal phenomenon was observed. Perioperative mortality was 7.6%, limb salvage rate was 93.4%. After a mean interval of 31.3 months, 31.6% had died, and 8 patients had had to undergo major amputations. Cumulative pat ency rate after one year was 81 %, after two years 71 %, and after three years 60%.

The authors conclude that COBP is a valid alternative to anatomic iliac re construction in high-risk patients with unilateral iliac artery occlusion or steno sis.
Ruptured Abdominal Aortic Aneurysm Presenting as Incarcerated Epigastric Hernia—A Case Report
Authors: Falgout Howard J. , Fendley Steven M. , Walker Howard , Ferrara John J.
Published: November 2007

Reduction in mortality from ruptured abdominal aortic aneurysm can be achieved by prompt recognition of established clinical manifestations. In addi tion to the classic symptoms and signs, incarceration of a previously reducible groin hernia has occasionally led to the diagnosis of aneurysmal rupture. This report details the first known case of acute incarceration of an epigastric (inci sional) hernia secondary to ruptured abdominal aortic aneurysm. It serves to underscore the necessity of maintaining a high index of suspicion for occult aneurysmal rupture when a patient presents with incarceration of any previ ously reducible abdominal wall hernia.
Dissecting Aneurysm of the Infrarenal Abdominal Aorta — A Case Report
Authors: Jørgensen Lisbeth , Lindewald Helle , Lorentzen Jørgen E.
Published: November 2007

One case of primary dissecting aneurysm of the infrarenal abdominal aorta, diagnosed by ultrasound scanning, computed tomography, and angiography, is presented. Etiology, incidence, and diagnosis of abdominal aortic dissection are discussed, and a survey of the literature is included.
Effect of Endothelial Seeding and Graft Material on the Patency Rate of Venous Grafts
Authors: Vo Nghia M. , Arbogast Loretta , Friedlander Ed , Stanton Paul E.
Published: November 2007

Because prosthetic grafting to the venous system has a low patency rate, endothelial cell seeding has been used to enhance this rate. The effects of heterologous (porcine) or homolo gous (canine omental) endothelial seeding and of graft material (dacron or polytetrafluoroethylene—PTFE) on the patency rate of venous grafts were evaluated in this study.

Fifty-three grafts (10 cm x 8 mm ID) were inserted in dogs' vena cava. All animals were treated with aspi rin. Patency rate was evaluated at day 4 (cavography) or at day 32 (his tology).

The authors found that: (1) da cron grafts provided a poor venous conduit for seeding purposes; (2) PTFE grafts, whether seeded with omental canine or porcine endothelial cells, had a consistently high patency rate; and (3) although further studies would be needed, heterologous and homologous cell seeding might repre sent acceptable alternatives to autolo gous seeding.
Surgical Treatment of an Isolated Dissection of the Internal Carotid Artery—A Case Report
Authors: Lutz Barbara , De Vleeschauwer Philippe , Ktenidis Kiriakos , Horsch Svante
Published: November 2007

A forty-four-year-old man was seen because of transient ischemic at tacks in the vascular laboratory. In vestigations indicated a high-degree stenosis of the internal carotid artery (ICA). In the intravenous digital sub traction angiography it seemed to be a case of fibromuscular dysplasia. At operation the authors found an iso lated dissection of the ICA, which was responsible for the stenosis. This was confirmed by histologic findings. The ICA was anastomosed to the ex ternal carotid artery in end-to-end technique. The dissected part of the ICA was resected. This proceeding was possible, because an anastomosis free of tension could be performed owing to a poststenotic coiling of the ICA. The postoperative course was uncomplicated. The follow-up six months later showed a patent ICA in Doppler ultrasound examination and intravenous digital subtraction angi ography.
Mesenteric Vascular Injury: An Appraisal of Current Management
Authors: Vitenas Povilas , Kerstein Morris D.
Published: November 2007

Injury to the visceral vasculature has a high mortality rate. A retrospective evaluation identified 11 men and 4 women (sixteen to thirty-three years) who sustained nine gunshot injuries, four stab wounds, and two cases of blunt trauma. Eight patients had associated organ trauma. Seven patients arrived in the Emergency Department with a systolic blood pressure < 90 mm Hg; 6 died. Blood loss varied from 2,000 to 15,000 mL. All vascular injuries except one (saphenous vein patch) underwent direct repair; no synthetic material was used. Nine survivors (three stab wounds, six gunshot injuries) and six deaths (three gunshot wounds, two blunt traumas, one stab wound) were reported, for a 40% mortality rate. Second-look procedures were undertaken during the latter part of the series with seemingly better results.
Recent Gross Intramural Plaque Hemorrhage in Asymptomatic High-Grade Carotid Stenosis
Authors: Archie Joseph P.
Published: November 2007

The plaques of 124 consecutive primary carotid endarterectomies in 111 pa tients performed for asymptomatic 75% or greater diameter internal carotid stenosis were examined for gross intramural plaque hemorrhage. There were 74 endarterectomies in 61 asymptomatic patients (13 bilateral). Nineteen addi tional patients underwent unilateral carotid endarterectomy for asymptomatic stenosis prior to or concomitant with coronary artery bypass or abdominal aor tic operations, and another 31 patients had endarterectomy for asymptomatic stenosis after contralateral carotid endarterectomy for symptomatic carotid dis ease. Gross intramural plaque hemorrhage was present in 29 of the 124 plaques (23.4%). Of these, 15 were in the 31 (48.4%) patients who had a prior contralat eral carotid endarterectomy for symptomatic carotid disease (p < 0.001 by chi square), and 6 were in the 19 (31.6%) who had symptomatic aortic or coronary disease. Eight of the 74 (10.8%) plaques in 61 asymptomatic patients had hem orrhage. Patients taking aspirin, dipyridamole, or warfarin did not have an increased incidence of plaque hemorrhage. These findings indicate that patients with asymptomatic 75% or greater diameter carotid stenosis and either contra lateral symptomatic carotid disease or symptomatic coronary or abdominal aor tic disease may be at increased risk for neurologic events.
Polydioxanone and Polypropylene Suture Materials in Experimental Coronary Artery Surgery with Free Internal Mammary Artery
Authors: Aarnio P. , Harjula A. , Lehtola A. , Sariola H. , Merikallio E. , Huusari H. , Mattila S.
Published: November 2007

Some experimental and clinical reports have showed the feasibility of polydioxanone in vascular surgery. In this study, polydioxanone and poly propylene suture materials were used in free internal mammary artery (IMA) graft anastomoses, which were made in 8 dogs from the left IMA to the left anterior descending coronary artery one free graft after another. Nine polydioxanone and nine polypropylene anastomoses were studied at six months with light mi croscopy and scanning electron mi croscopy (SEM). The leading feature in light microscopy was the intimal thickening, which was seen in 7 of 9 cases in both groups. Polypropylene suture material was seen and there was foreign body reaction around it, whereas polydioxanone had disap peared and no foreign body reaction could be seen. In the SEM study the endothelial line covered the anasto motic site. The polydioxanone anas tomoses were smoother than polypro pylene anastomoses, in which the su ture material was seen bulging up from the flow surface. According to this experimental study polydiox anone is as reliable as polypropylene and has some superior features over polypropylene in small luminal vas cular anastomoses.
Alteration in Collagen and Elastin Content in Varicose Veins
Authors: Chello Massimo , Mastroroberto Pasquale , Romano Rossana , Cirillo Francesco , Cusano Tullio , Marchese Antonietta R.
Published: November 2007

The nature and distribution of venous disease surrounding the development of varicose veins is controversial. Collagen and elastin are important components of the vein walls that affect their function. Collagen provides tensile strength, and elastin provides tissue elasticity

The amount of collagen and elastin was studied biochemically and histologically in two groups of human normal and varicose veins. The collagen content was higher in both dilatated and morphologically normal segments of varicose veins when compared with normal veins, whereas the elastin content was markedly decreased only in the dilatated segments of varicose veins. The ratio of thick to thin collagen fibers was almost invariable. These findings were consistent with the morphologic fibrosis that has regularly been described in varicose veins and emphasize the important role of elastin in providing the retractive force that opposes the development of dilatation and tortuosity of the vein wall.
Extensive Iatrogenic Dissection of the Aorta. Complications of Retrograde Arterial Catheterization
Authors: Rangel Alberto , Gutierrez Samuel , Chavez Eduardo , Gonzalez Guadalupe , Badui Elias
Published: November 2007

The authors report a case of a forty-three-year-old woman with an extensive iatrogenic dissection of the aorta, from the iliac artery to the ascending aorta, not associated with atherosclerosis or previous aortic dissection, as a complication of retrograde arterial catheterization. The authors emphasize the need to take all cautions in performing this procedure to avoid serious complications such as the present one.
Administration of Heparin by Continuous Intravenous Infusion in the Treatment of Deep Venous Thrombosis
Authors: Erdem Erhan , Uncu Hakan
Published: November 2007

In this prospective study the authors compared two approaches to heparin therapy, in the treatment of deep venous thrombosis—continuous infusion heparin and intermittent heparin therapy.

Each group was comparable with respect to age, gender, risk factors, and etiologic factors. The continuous infusion group (n=60) received a heparin bolus of 150 U/kg followed by continuous intravenous infusion of 750 U/kg/twenty-four hours. The intermittent group (n=60) received a bolus of 5000 U in every four hour period. In the infusion therapy group, the resolution of clinical symptoms was more rapid, so the hospitalization time was shorter, and the hemorrhagic complications and relapses were fewer than with intermittent therapy.

The authors conclude that administration of heparin by continuous infusion appears to be effective and safer than intermittent injection therapy.
Outcome Following Below-Knee Amputation for Limb Ischemia: A Multivariate Odds Ratio Analysis of Clinical Variables
Authors: Marelli Daniel , Sampalis John , Shum-Tim Dominique , Scott Henry J. , Chiu Ray C.-J.
Published: November 2007

One hundred and eleven consecutive patients undergoing below-knee amputation for end-stage limb ischemia were reviewed. Decision on the level of amputation was made mainly on clinical grounds. Univariate and multivariate analyses of the outcomes, including revision to above-knee amputation and ability to walk, were carried out for seven preoperative clinical variables related to history alone. Median age was seventy-one years old and there were 74 men. Fifty percent of the patients were diabetic, 14% had neurologic dysfunction, 17% had undergone remote revascularization, 25% had undergone contralateral lower extremity amputation, and 23% underwent unsuccessful attempt at foot salvage prior to amputation. Operative mortality was 10% and morbidity excluding wound complications was 14.5%. Wound complications not requiring further surgery occurred in 10 patients who all eventually walked with a prosthesis. Incidence of revision to above-knee amputation was 19%. Diabetics had less occurrence of this event (odds ratio 0.3, p=0.011). Twenty-five patients were lost at one-year follow-up. Sixty-two % of patients were alive at greater than one year postoperatively and 49% were able to walk with a prosthesis. Potential for rehabilitation among patients with below-knee amputation was adversely affected by preoperative neurologic dysfunction (odds ratio 11.8, p=0.003) and favored by remote lower extremity revascularization (odds ratio 0.3, p=0.04). In patients who required revision to above-knee amputations (n=21), only 38% were able to walk with a prosthesis as compared with 51% for those who did not require stump revisions (p=0.065). Interestingly, there was no effect of age detected on either survival or rehabilitation to walk. Ability to identify high-risk patients will facilitate their selection for primary above-knee amputations.
Valvular Surgery During Infective Endocarditis
Authors: Balthazar Jacob José Luiz , Menezes Lorga Adalberto , da Silveira Luiz Carlos , Parro Adelino , Ardito Roberto Vito , Nicolau José Carlos
Published: November 2007

Between 1984 and 1991, 76 patients with mean age 36.3 ± 15.4 years were operated on at the authors' institute for active infective endocarditis (IE). In 47.3%, blood cultures were negative. Indications for surgery were progressive heart failure, uncontrolled infections, and embolisms. The surgical mortality rate was 23.7%, which is higher than that in patients without IE operated on during the same interval in this center (P < 0.0001). Actuarial survival was 80.8 ±5.9% over nine years of follow-up. Fifty-six patients had native valve endocarditis with a surgical mortality of 14.2%, which is higher than that in patients without IE in the authors' experience (P < 0.05). Actuarial survival in patients operated on for native valve IE was 87.3 ±5.4% over nine years. The aortic valve involvement increased the surgical mortality. Twenty patients had pros thetic valve endocarditis (5 early and 15 late) with an overall surgical mortality of 50% and actuarial survival of 52.5 ± 17.5% over nine years. The surgical deaths were caused by sepsis (61.1%), heart failure (22.2%), bleeding (11.1%), and acute renal failure (5.5%). In the 76 patients, the actuarial curve showed 79.7 ± 6.3% event-free patients (continued on next page) over nine years. The events analyzed were reoperation, recurrence of IE, thromboem bolism, and perivalvular leak. The group operated on with native valve IE had 79.5 ±6.7% event-free patients over nine years. Bioprostheses were employed in 75.7% of the patients with native valve IE and in all patients with prosthetic valve IE. The authors' experience shows the following: (1) Active IE increases significantly the surgical mortality in valvular heart disease. (2) Aortic valve involvement worsens the prognosis. (3) Because of the good long-term survival and the low rate of complication, bioprostheses may be safely employed.
Traumatic Abdominal Aortocaval Fistula Caused by Induced Abortion
Authors: Liu Jia-Qi , Lu Quan-Shu , Shen Kang-Nian , Chen Xiao-Hua , Yew Kee-Lu , Lin Chen
Published: November 2007

A case of traumatic abdominal aortocaval fistula resulting from an induced abortion during the second trimester of pregnancy is presented. This case raises attention to a rare, but potentially fatal, complication of an elective abortion.
Cardiomyoplasty
Authors: Chekanov V.S. , Krakovsky A.A. , Bushlenko N.S. , Riabinina L.G. , Andreev D.B. , Shatalov K.V. , Dubrovsky I.A. , Pekarsky V.V. , Akhmedov Sh. D. , Trehan N. , Shetty K.
Published: November 2007

The authors present their experience with cardiomyoplasty in 25 patients. They describe the early and late results, control of hemodynamic changes, and the optimal regimen for stimulation of the muscular graft.