bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Angioplasty For Left Coronary Ostial Stenosis in Takayasu's Disease — A Case Report
Authors: Raffa Hassan , Mimish Laith , Al-Ibrahim Khalid , Rustom Magd
Published: August 2008

Surgical angioplasty of the left main coronary artery for severe ostial stenosis in a thirty-five-year-old oriental woman suffering from Takayasu's disease was performed by use of an onlay autologous pericardial patch through an anterior aortotomy approach. This procedure was performed to reestablish a physiologic antegrade coronary arterial flow and to avoid use of internal mammary arteries, which have little flow in Takayasu's disease, or the saphenous veins, which can also be involved in the inflammatory process. The procedure also avoids a lengthy, time-consuming triple coronary artery bypass procedure and the use of saphenous veins, which are prone to certain slow or rapid attrition.

Total clinical improvement with disappearance of angina and return of the patient to NYHA functional class I with normal treadmill exercise response was immediately obtained. Angiographic restudy six months after the surgical angioplasty revealed excellent results with complete wide patency of the ostium. This represents the first report in the world literature of surgical angioplasty of a left main coronary arterial ostial stenosis in Takayasu's disease.
A New Vascular Procedure: The Axillo-abdominal Aorta Bypass Graft — Case Report
Authors: Mingoli Andrea , Feldhaus Richard J. , Schultz Richard D.
Published: August 2008

An axillodistal abdominal aorta bypass graft is proposed as an alterative procedure for revascularization of the lower limbs when intraabdominal and intrathoracic approaches are not feasible. This simple and safe procedure is proposed instead of the axillobifemoral bypass graft for the treatment of selected patients with abdominal aortic occlusive or aneurysmal disease and aortic graft infection. A case of a patient who underwent axilloabdominal aortic grafting because of a ruptured infrarenal abdominal aortic aneurysm, combined with severe chronic obstructive pulmonary disease, is reported.
Absence of the Inferior Vena Cava with Umbilical Vein Drainage—A Case Report
Authors: Kutsal Ali , Balkanci Ferhun , Akhan Okan , Böke Erkmen
Published: August 2008

This is a case report of a patient classified in the polydysplasias group who has the combination of generalized hemangioma, absent inferior vena cava with umbilical vein drainage of the lower parts of the body, obstruction of the right subclavian vein, and anomalous branching of the hepatic artery.
Superior Mesenteric Artery Mycotic Aneurysms— A Case Report
Authors: Tyrell Jon S. , Humphrey Robert , Dorazio Richard , Ezzet Faik , Abu-Dalu Joseph
Published: August 2008

Mycotic aneurysm of the superior mesenteric artery is an uncommon event usually preceded by a severe infection such as bacterial endocarditis. The authors report one such case successfully treated by resection without need for subsequent revascularization for bowel resection. Previous literature and case reports are reviewed.
Experimental Study of Cerebral Vasospasm Induced by Serotonin and Oxyhemoglobin in Subarachnoid Hemorrhage
Authors: Kun Jiang , Li Shao Hua  , Bao Yao Dong
Published: August 2008

To clarify the mechanism of cerebral vasospasm induced by serotonin (5-HT) and oxyhemoglobin (OxyHb), the authors studied the roles of vasoactive pros taglandins (PGs) and free radicals in the cerebral vascular wall of rabbits. At first, they measured the 5-HT level in whole blood plus cerebrospinal fluid (CSF) and in platelet-rich plasma (PRP) plus CSF by fluorescence following the incubation at 37°C for zero to six days. The 5-HT in whole blood plus CSF did not significantly diminish for up to five days (p < 0.05), but in PRP plus CSF it markedly decreased within twenty-four hours (p < 0.01).

The authors prepared 49 rabbits, divided into four groups: a nontreated (control) group and three groups treated with 5-HT, with OxyHb, and with free radical scavengers plus OxyHb, respectively. After treating the vessels with 5-HT or OxyHb, they measured levels of 6-keto-PGF1α and thromboxane B2 (TXB2), the stable metabolites of prostacyclin (PGI2) and TXA2, respectively, with PGE2 in vessels by radioimmunoassay. Vascular lipid peroxidation (LPO) was also measured by fluorescence. In the nontreated group, the level of 6-keto- PGF1α was significantly higher in the basilar vessels than that of any peripheral vessels (p < 0.01).

In the group treated with 5-HT, 5-HT contracted both basilar and femoral arteries, but there was no significant change in levels of 6-keto-PGF1α, TXB2 , PGE2, and LPO. Vasospasm induced by 5-HT is not specific to the cerebral artery and does not depend on PGs and LPO. In the group treated with OxyHb, however, OxyHb induced severe vasospasm in the basilar vessel alone, where LOP was highly increased (p < 0.01) and 6-keto-PGF1 α markedly decreased

(p < 0.01), but there was no significant change in TXB2 and PGE2. OxyHb did not induce femoral arterial spasm. But the LPO content was increased (p < 0.01), and there was no change in the levels of 6-keto-PGF1α, TXB2, and PGE2. These results disclose that cerebral vasospasm induced by OxyHb may depend on the high level of PGI2, a vasodilator, in the vascular wall.

When various free radical scavengers were mixed with OxyHb, only manni tol, which is a hydroxy radical scavenger, could inhibit cerebral vasospasm in duced by OxyHb and elevate the level of 6-keto-PGF1α in the arterial wall. Therefore, the mechanism of cerebral vasospasm induced by OxyHb depends on the hydroxy radical, which inhibits PGI2 metabolism.
Pathways of Coronary Collateral Circulation
Authors: Wang Shih-Pu , Lin Chwen-Yih
Published: August 2008

To define the specific pathways of coronary collateral circulation, the rec ords of 250 consecutive patients who had significant coronary artery disease as documented with arteriograms were systematically reviewed. All of them were free from valvular disease, and none had had coronary bypass graft when eval uated. Coronary stenosis involved mostly the left anterior descending artery (LAD), then the right coronary artery (RCA), and finally the left circumflex artery (LCX). Coronary collateral circulation was seen only in the artery with more than 90% stenosis; the frequency of collateral circulation was 73.7% in the RCA, 36.6% in the LAD, and 26% in the LCX. Eleven different pathways were noted in patients having stenosis of the RCA; ten different pathways, in patients having stenosis of the LAD; and six different pathways, in patients having stenosis of the LCX. The related clinical significance is discussed.
Hip Claudication—Its Pathophysiology and Treatment
Authors: Iwai Takehisa , Sato Shoji , Sakurazawa Kenichi , Muraoka Yukihiko , Inoue Yoshinori , Endo Mituo
Published: August 2008

Hip claudication (HC) is a comparatively rare symptom in patients with chronic arterial occlusive disease. Although the role of the internal iliac artery (IIA) is important in the occurrence of HC, the relationship between HC and the IIA collateral system with the external iliac artery and the superior rectal artery is not clear and is possibly very complex. During the past three years 15 patients who presented with HC, and 3 patients who presented with bilateral IIA occlusion without HC, were studied. In all patients angiography revealed variable IIA occlusive changes. The pressure in the bilateral profunda penis arteries was measured and was found to correspond well with the angiographic findings. The superior rectal arterial flow was examined transrectally with a Doppler probe developed by the authors. In addition to the main arterial recon struction (bifurcated synthetic grafting 8 cases, femorofemoral crossover or fe moropopliteal bypass 6 cases, etc.), direct IIA reconstruction was performed in 13 IIAs (8 patients) with good results. HC was removed in 2 of the 3 femorofe moral crossover bypass cases.

Their study suggests that many variations of hip claudication exist. The pe nile brachial pressure index in HC patients was 0.3±0.13 or less. Bilateral IIA occlusion cases with no HC were found to be getting blood via the superior rectal artery. It was also observed that there were to a certain extent independ ent supplies to the hip and genitalia, for elevation of the penile pressure was seen on the IIA repair side. In some cases, without IIA repair, the rich blood plexus to the pelvic organs via the iliac circumflex and others provided complete relief from hip claudication.
Postoperative Thrombus Formation in the False Lumen Following Surgical Repair of Aortic Dissection
Authors: Yada Isao , Satoh Tomoaki , Wada Kiyoto , Mizumoto Tohoru , Shimono Takatugu , Takeuchi Yoshihiro , Hiraiwa Takane , Shinpo Hideto , Tanaka Kuniyoshi , Yuasa Hiroshi , Kusagawa Minoru
Published: August 2008

During the period 1980 to 1990, 65 patients with aortic dissection underwent surgical treatment. The authors have mainly been using the entry closure proce dures to enclose the false lumen with thrombus for dissecting aortic aneurysm. The survival rate was 75%. In 36 long-surviving patients who have been able to be followed up postoperatively, angiography and/or computed tomography (CT) with contrast enhancement was used to evaluate the aortic and any resid ual false lumen during a mean follow-up of sixty months.

Complete thrombotic closure of the false lumen was obtained in only 5 cases; 18 of the remaining 31 patients have developed almost complete thrombus for mation, and only local remaining false lumens were noted. In the other 13 pa tients (36%), an extensive residual false lumen was observed, mainly in the patients with an aneurysm of larger diameter where the preoperative CT im ages showed the false lumen to be larger than the true lumen, indicating the requirement for extensive aortic graft replacement or secondary operation.
Aneurysm of the Portal Vein: Case Report and Review of the Literature
Authors: Hiekata Tomizo , Hinata Saburo , Takei Hiroshi , Kamata Satoshi , Shinagawa Toshihito
Published: August 2008

The authors present a case of a sixty-nine-year-old woman who had a saccu lar aneurysm of the extrahepatic portal vein measuring 5 cm in diameter. The aneurysm was excised safely without complications. Microscopically, the aneu rysmal wall showed extremely thin portions with media consisting of only a few layers of muscle bundles. Etiology was considered to be congenital.

Eighty cases have been reported in the world literatures including 40 cases presented in Japanese. Fatal complications such as rupture and perforation have been reported in 1 case, and portacaval shunt has been recommended as a surgical treatment of choice for symptomatic patients to avoid thrombosis in the aneurysm, rupture, or portal hypertension. On the basis of the experience ob tained from the presented case, however, the authors consider that a large sac cular extrahepatic portal vein aneurysm had better be excised to avoid potentially fatal complications.
Fistula Between An Abdominal Aortic Aneurysm and the Transverse Colon: Case Report
Authors: Salman Ergun , Ozeren Murat , Bayraktaroglu Mehmet , Mavioglu Ilhan , Cetingok Ugur , Yucel Ertan
Published: August 2008

Aortoenteric fistula is one of the rare complications of abdominal aortic an eurysm. The segment of intestine most frequently involved in aortoenteric fis tula is the duodenum, whereas the colon is a very rare site of fistula formation. To the author's knowledge, only 13 cases have been reported in the literature to have a primary arteriocolic fistula caused by abdominal aortic aneurysm. Pri mary repair of the fistulization between aorta and transverse colon, resection of aneurysm, and left axillofemoral, femorofemoral bypass were performed on the patient, who represents the fourteenth case in the literature. No important com plication developed and the patient was discharged from the hospital on the fifteenth postoperative day but died on the twenty-fourth postoperative day at another hospital from myocardial infarction.
Transient Ischemic Attacks in Central Nervous System Vasculitis After Delivery: Case Report
Authors: Shintani Shuzo , Tsuruoka Shin , Nagano Nobuhisa , Shiigai Tatsuo
Published: August 2008

A twenty-five-year-old woman with cerebral vasculitis is presented. She had been delivered of her first infant without complications three weeks previously, and after delivery suffered from recurrent severe headaches and a transient right sensory hemiparesis. The diagnosis was based on four-vessels angiography showing segmental narrowing (a "beaded" or "sausaged" appearance) in the arteries of bilateral hemispheres and cerebellum, and on clinical and laboratory investigations excluding other underlying disease. Although the correlation with this rare condition and pregnancy remains unknown, her recurrent severe headaches remarkably improved on treatment with corticosteroid.
The Role of Reconstructive Surgery in the Management of Renal Artery Lesions—Case Reports
Authors: Del Gaudio Antonio , Faenza Alessandro
Published: August 2008

In the past, the management of strictures of the renal arteries relied mainly on reconstructive surgery using prostheses or venous grafts. Today, these meth ods are being shelved in favor of transluminal percutaneous angioplasty, espe cially in high-risk cases or in patients with only one kidney (case report).

After reviewing the long-term results of 75 consecutive patients submitted to surgery for renal artery strictures (30 reconstructed with prostheses and 45 with venous grafts), the authors maintain that there is still a place for this type of surgery in particular situations such as the two long-term complications re ported (case reports).
Severe Mitral Regurgitation Due to Uncommon Cystic Form of Fibroelastoma—A Case Report
Authors: Balthazar Jacob José Luiz , Parro Adelino , Marcolino Braile Domingo , Menezes Lorga Adalberto , Garzon Sergio A.C. , Nicolau José Carlos
Published: August 2008

This is the report of a case of fibroelastoma of the mitral valve, presenting with a cystic image at the echocardiogram, that was confirmed at surgery and by histopathologic examination. Severe mitral valve regurgitation was diag nosed by Doppler study and angiocardiography. Both features, the severe mitral regurgitation and the cystic image, have not been described previously in cases of fibroelastoma.
Variations in Aortic Arch Branch Vessel Anatomy as Seen by Aortography
Authors: Reppert Matthew K. , Lundgren Eric C. , Dibos Luis A. , Deshmukh Narayan
Published: August 2008

Several variations in the anatomy of the aortic arch and its branches have been described in the literature based on cadaveric dissection findings. Many of these variations can also be detected by aortic arch arteriography. This study was undertaken to determine the incidence and pattern of variations in aortic arch branch vessel anatomy as seen by aortography. Seventy-six of 705 (10.8%) arteriograms showed variations from normal. A total of 7 variant patterns was identified. The most common abnormality was common origin of innominate artery and left common carotid artery.
Skin Flux and Histology in Venous Hypertension
Authors: Laurora Giuseppe , Pizzicannella Giuseppe , Cesarone Maria Rosaria , Fisher C. , Belcaro Giovanni , Nicolaides A.N.
Published: August 2008

Skin blood flux and the venoarteriolar response have been studied by laser- Doppler flowmetry (LDF) in 20 postphlebitic limbs and in 20 normal limbs. Histology was also studied with punch biopsy specimens in postphlebitic limbs and in 4 randomly selected, normal volunteers.

Skin flux was increased and the venoarteriolar response decreased in all postphlebitic limbs. Also in all patients an apparent increase in the number of capillaries was observed. They appeared dilated and tortuous, and the thick ened capillary wall was surrounded by a pericapillary halo composed of pro tein, neutral polysaccharides, hemosiderin, and fibrin.

In conclusion, measurements with LDF differentiate between normal and postphlebitic limbs, corresponding to the histologic finding of an altered capil lary system. Therefore, LDF is useful for defining the degree of microan giopathy due to venous hypertension.
Venous Thrombosis: Detection via Magnetic Resonance Imaging
Authors: Rafal Richard B. , Williams Wendalyn M. , Markisz John A.
Published: August 2008

Magnetic resonance imaging (MRI) has been shown to be an effective tool for evaluating the vascular system. MR imaging has proven to be a safe and reliable method for detecting venous thromboses. MRI can be used in place of venography, computed tomography (CT), or sonography as the initial study in almost all patients suspected of having occlusion of a major venous channel.
Correction of Superficial Incompetence with Selective Saphenous Vein Repair (SSVR)
Authors: Belcaro G.
Published: August 2008

The aim of this study was to evaluate, in a prospective, five-year follow-up study, selective saphenous vein repair (SSVR) (combined use of plication of the incompetent saphenofemoral junction [SFJ] and selective ligature of incompe tent veins). The effects of SSVR were evaluated by ambulatory venous pressure measurements refilling time (RT) and color duplex to detect the number of incompetent venous sites. From a group of 400 consecutive patients studied for venous incompetence 54 subjects were randomized in an SSVR and a control group. Criteria of inclusion were SFJ incompetence with presence of valve cusps and incompetence of two to five venous sites in the territory of the long saphenous.

After five years 22 patients in the SSVR group and 21 in the control group completed the study. SSVR increased RT (p < 0.02), and the number of incom petent sites was decreased after five years (p < 0.02). In the control group RT was shorter and the number of incompetent sites increased (p < 0.05) after five years.

In conclusion SSVR appears to be an effective, physiological treatment with good long-term (five-year results) on incompetence and on the prevention of new incompetent sites.
The Effect of Atrial Pressure Changes and Cardiac Nerves on Plasma Atrial Natriuretic Peptide Levels
Authors: Okcu Nihat , Kocak Hikmet , Derya Onuk M. , Gündogdu Mehmet , Bakan Ebubekir , Yilmaz Arif , Basoglu Ahmet , Ates Azman , Ayse Pac F.
Published: August 2008

The authors researched the association between plasma atrial natriuretic peptide (ANP) levels and atrial pressure changes and cardiac nerves in 14 dogs.

The dogs were divided into two groups, each group containing 7 dogs. In the second group, cardiac denervation was performed. Left atrial pressure was in creased by creating partial mitral obstruction in both groups. In the second stage, after atrial pressures were decreased to previous values, the dogs were bled. Eventually, atrial pressures were decreased below the normal value. Plasma ANP levels and right and left atrial pressures were determined in all stages.

It was concluded that ANP was released from the atria by a direct effect of stretching of the atrial wall and that there was no specific effect of cardiac nerves on ANP release.
Full Inferior Vena Cava Agenesis Causing Acute Abdominal Symptoms: Case Report and Literature Review
Authors: Liatas Anastasios Chr. , Dendrinos Soterios , Koundourakis Socrates , Liakakos Theodore
Published: August 2008

Absence of the entire inferior vena cava caused acute abdominal symptoms, and the patient, a twenty-year-old man, was operated on on an emergency ba sis. Subsequent ascending venography, abdominal computed tomographic scan, intraarterial digital subtraction angiography, and intraosseous phlebography revealed full inferior vena cava and iliac venous system agenesis, up to and above the level of the hepatic veins, venous return from the lower limbs and the abdominal viscera being through a series of multiple collateral channels and the azygos-hemiazygos system.
Ruptured Abdominal Aortic Aneurysms: A Retrospective Look at a Ten-Year Interval
Authors: Trotter Michael C. , Ilabaca Pat A.
Published: August 2008

Ruptured abdominal aortic aneurysms (AAAs) remain a lethal entity despite early recognition, prompt intervention, and technological advances in critical care. Elective resection of AAAs offers the best survival. Two distinct experi ences, 1977 to 1980 (Group I) and 1989 to 1990 (Group II), were retrospectively reviewed. Major postoperative complications were renal and respiratory failure in both time periods. Acute renal failure was seen in 38% of patients in both groups. Respiratory failure was seen in 29% of patients in Group I and 48% of patients in Group II. Overall mortality was 44% in Group I and 48% in Group II. Hemodynamic instability upon presentation continues to be an ominous prognostic indicator (54% mortality in Group I and 80% mortality in Group II). Morbidity and mortality for surgery for ruptured AAA remain very high and largely unchanged over the years. If no contraindication to surgery exists, the authors recommend elective resection of AAA at diagnosis.
Cryopreserved Allografts for Limb Salvage
Authors: Trotter Michael C. , Painter Max W. , Casini Michael P. , Ilabaca Patricio A.
Published: August 2008

Over a nineteen-month period, 17 patients (8 men, 9 women) underwent revascularization for limb salvage with cryopreserved saphenous vein allografts when autogenous saphenous vein was not available and prosthetic material was felt to be inappropriate. Their mean age was sixty-seven years. Risk factors included hypertension (88%), diabetes mellitus (63%), cigarette smoking (44%), and hypercholesterolemia (44%). All patients had multiple previous vascular operations including coronary artery bypass grafting (3.9 procedures per pa tient). Indications for operations were rest pain (8), ischemic necrosis (3), or both (6).

All cryopreserved allografts were obtained from the same procurement source and prepared by a standardized protocol. Combinations of prosthetic material and cryopreserved allograft were used to make composite grafts (5 cases) when adequate length of autogenous saphenous vein was not available. Upper limb veins were not utilized. All patients received antiplatelet therapy or were anticoagulated postoperatively.

Current follow-up is two to fifteen months. There were 1 death and 3 major amputations (including the 1 patient who died) in the postoperative period. Fol low-up noninvasive vascular studies were obtainable in 13 patients whose limb was salvaged; 71 % of assessable grafts were patent. Cryopreserved saphenous vein allografts provide a viable option for a selected group of patients when autogenous saphenous vein is not available.
Application of Sulfur Hexafluoride into Pleural Space Reduced Pulmonary Shunt in Chronically Atelectatic Lobe After Sleeve Resection—A Case Report
Authors: Uyama Tadashi , Sumitomo Masayuki , Kondo Kazuya , Sakiyama Shoji , Tanida Nobuyuki , Monden Yasumasa
Published: August 2008

A seventy-three-year-old man had undergone right sleeve upper lobectomy. The bronchial anastomotic site occluded because of granulation that had been treated with yttrium aluminum garnet (YAG) laser initially. He refused reopera tion or YAG laser surgery at the time of reocclusion of the anastomotic site. He complained of exertional dyspnea, and his blood gas analysis showed hypoxe mia. The authors injected sulfur hexafluoride into pleural space of the patient to reduce pulmonary shunt in chronically atelectatic lobes. Blood gas analysis just after injection of sulfur hexafluoride gas into pleural space showed increase of oxygen tension, suggesting decrease in shunting. With the management of pleu ral space through use of sulfur hexafluoride, he leads a normal daily life without exertional dyspnea.
Ruptured Abdominal Aortic Aneurysm Due to Behçet's Disease—A Case Report
Authors: Yörükoğlu Yavuz , Zengin Mustafa , Paşaoğlu Eşref , Nazliel Kemal , Salman Ergun , Yücel Ertan
Published: August 2008

Behçet's disease, originally described as a triad of orogenital ulcerations and uveitis, is a chronic, multisystem disorder involving the skin, mucous mem branes, gastrointestinal tract, eyes, joints, central nervous system, and blood vessels. Vascular manifestations of Behçet's disease (vasculo-Behçet's disease) consists of venous and arterial forms. The arterial form is rare but carries a grave prognosis. The authors present a case of Behçet's disease that manifested itself with a rupture of an abdominal aortic aneurysm. The outcome, although successful in this case, poses a prognostic dilemma for the surgical team in volved. The world literature in respect to complications and prognosis of vascu lar reconstruction in Behçet's disease is reviewed and discussed.
Early Graft-Sigmoid Erosion in a Patient with Prior Sigmoid Resection—A Case Report
Authors: Schwartz Myron E. , Jacobson Julius H.
Published: August 2008

Aortobifemoral graft-sigmoid colon erosion occurred one week postopera tively in a patient with prior sigmoid resection. A brief review of the literature and a surgical option for prevention of this complication are presented.
Peripheral Pseudoaneurysms in a Third World Country
Authors: Babar S.M.A.
Published: August 2008

This preliminary report of an ongoing prospective trial that began in 1986 describes 95 peripheral pseudoaneurysms excluding intracranial and cardiac aneurysms.

The majority of these aneurysms were located in the upper limbs. Firearm injury was the main cause, and the author found a high incidence of concomi tant neurological lesions. Relevant investigations included Doppler flow studies, arteriography, and electrophysiologic assessment for neurologic lesions. Where neurologic involvement, such as brachial plexus (BP) lesion, was present, a rad ical one-stage neurovascular reconstruction, after excision of the aneurysm, was undertaken. This usually involved sural nerve grafting for nerve defects. Long saphenous vein (LSV) was the most common vascular conduit used, but the author has also used cephalic vein and synthetic grafts in selected cases.

The early results have been very good with respect to revascularization and amelioration of symptoms, but the reattendance rate of the patients under fol low-up was very poor. Although the limited early review of the results of both vascular and nerve grafts has been very satisfactory, these findings cannot be statistically generalized. The author found lack of patient education, peer bias, and poverty to be the main reasons for the poor follow-ups and delayed refer rals. His approach has been surgically aggressive to provide reliable improve ment within a short period of time.
Beneficial Effects of Prostacyclin on Pulmonary Function During Heparin Reversal with Protamine
Authors: Küçükaksu Deniz Süha , Katircioğlu Salih Fehmi , Saydam Gül , Bozdayi Mithat , Mavitas Binali , Tasdemir Oguz , Bayazit Kemal
Published: August 2008

This study was planned to show the beneficial effects of prostacyclin (PGI2) on pulmonary function after heparin reversal with protamine. Twenty-eight patients entered the study. Half of these patients received prostacyclin, whereas the other patients did not.

N-acetyl glucosaminidase (NAG) level was 37.6 ± 4.7 pmoL/mL in the con trol group and 19.7 ± 3.8 pmoL/mL in the PGI2 group (p < 0.001) five minutes after protamine administration. Leukotriene B 4 (LTB4) level was 118 ±13.7 pmoL/mL in the control group and 56 ± 13.8 pmoL/mL in the PGI2 group (p < 0.001). Alveolar-arterial oxygen difference was 69± 15 mmHg in the con trol group and 58 ± 11 mmHg in the PGI2 group (p < 0.05).

As a result of this study it was concluded that PGI2 reduced the toxic mani festations of heparin-protamine complex and improved the pulmonary gas ex change.
Surgical Management of Evolving Capillary Hemangiomas in Childhood
Authors: Seccia Antonio , Salgarello Marzia
Published: August 2008

On the basis of a large series of cases, the authors define and illustrate the characteristics of evolving capillary hemangiomas (ie, congenital vascular capil lary lesions that do not undergo spontaneous regression after the first eight to ten months of life), focusing on how they evolve and the ensuing need for early treatment.

The progressive growth and expansion in the cutaneous-subcutaneous (and at times muscular) district is due to the dilation and confluence of capillaries and progressive formation of confluent cavities resulting from the breaking of the interlacunar septa and from endothelial proliferation.

The authors point out the sites most frequently involved: lips, eyelids, and cheeks, with considerable repercussions on the cosmetic-functional unit. The clinical aspects are also discussed, especially in relation to the location and de velopment of a single lesion, as well as the diagnostic and therapeutic aspects of the disorder.

Special attention is paid to surgical treatment, which must obviously be con servative and must be designed as a multistep procedure so as to avoid useless mutilation and make sure that the scar tissue due to the surgical sclerosis will contribute to the reduction of the angiomatous lesion.
Percutaneous Antegrade Popliteal Artery Approach for Infrapopliteal Angioplasty: Case Report and Technical Note
Authors: Oliva Vincent , Blais Christian , Echave Vincent , Abdulnour Elias
Published: August 2008

Infrapopliteal angioplasty was performed using percutaneous antegrade catheterization via the popliteal artery; this was done in a sixty-five-year-old patient suffering from lower limb ischemia, with an occluded superficial femo ral artery.

The purpose of the procedure was to improve the distal runoff, prior to femoropopliteal bypass surgery. The technique is fully described.
Aortic Aneurysm Repair in Patients with Coronary Heart Disease: Strategy for Diagnosis and Treatment
Authors: Schlosser Volker , Fraedrich Gustav , Schindler Michael , Fasol Roland
Published: August 2008

Coronary heart disease, specifically myocardial infarction, represents the major risk factor for patients undergoing surgical repair of their abdominal aortic aneurysm.

About 75% of all patients in the series of 285 cases were without any signs or symptoms of coronary heart disease. Nevertheless, 21.8% of these patients required additional cardiologic screening in order to assess a possible suspected coronary heart disease, which made urgent coronary angiography necessary in 4.6% of all the patients. Furthermore, 7.3% of all the patients required percutaneous transluminal coronary angioplasty (9=3.15%) or coronary artery bypass grafting (12=4.2%) prior to their scheduled aneurysm operation.

Owing to this concept of careful preoperative assessment of adjacent coronary risk factors in patients with aortic aneurysms, the overall morbidity and mortality has dropped from 7.6% to 3.1% over the last ten years.
Comparison of Duplex Ultrasonography and Ascending Contrast Venography in the Diagnosis of Venous Thrombosis
Authors: Montefusco-von Kleist Cheryl M. , Bakal Curtis , Sprayregen Seymour , Rhodes Barbara A. , Veith Frank J.
Published: August 2008

The application of duplex ultrasonography to the diagnosis of venous thrombosis requires validation by comparison of the duplex findings with the results of ascending contrast venography. In this study, 2534 veins were examined by both methods with contrast venography results serving as the standard for comparison. In this setting, duplex ultrasonography proved to be 100% sensitive and 99% specific for venous thrombosis. Duplex ultrasonography is as reliable as venography in the diagnosis of venous thrombosis and has no associated risks or known complication. In addition, duplex ultrasonography provides information regarding pathologic anatomy that is comparable to the detail provided by high-quality venography. The authors conclude that duplex ultrasonography should be the diagnostic method of choice for evaluating patients with suspected venous thrombosis.
Noninvasive Preoperative Evaluation of Carotid Atheroma: Echo-Color-Doppler Versus Duplex Scanning
Authors: Rizzo Salvatore , Cardia Giuseppe , Fullone Martinella , Regina Guido
Published: August 2008

Seventy-two internal carotid arteries in 36 patients (33 men and 3 women) were examined by echo-color-Doppler with and without the insertion of the color function. Subsequently, within one month of the ultrasound evaluation, the 36 patients underwent digitalized angiography of the epiaortic truncus by arterial catheterization.

Eight endarterectomies (EAs) of the internal carotid artery were performed on 7 patients (1 patient had surgery on both sides) who presented stenosis greater then 70% during angiography, and 2 patches of external carotid artery were performed.

The authors have found no significant different (t test) between the perfect agreement of the echo-color-Doppler (87.5%) and the perfect agreement of the duplex scanning (79.1 %) (P=0.079).

The difference between the two methods in underreading (P=0.144) or over-reading (P=0.160) the stenosis was insignificant.

If only the third class of stenosis is considered (50-80%), the class where all the internal carotid arteries that underwent EA surgery are concentrated, the perfect agreement is significantly greater for echo-color-Doppler (79.4%) than for duplex scanning (67,65%) (P= 0.021).

The authors believe that echo-color-Doppler facilitates the diagnosis of the lesion by means of the immediate identification of even minimal turbulence even though it offers the same possibility as duplex scanning for morphologic and structural study of the atherosclerotic plaque.
Effect of Renal Ischemia on Blood Cell Rheology
Authors: Bratell Stefan , Belboul Ali , Al-Khaja Najib , Per Bergman , Haraldsson Gudjon , Jonsson Olof , Pettersson Silas , Roberts Donald
Published: August 2008

In an effort to understand how ischemia and reperfusion might affect blood cell rheology, erythrocyte and leukocyte filterability was measured in blood samples collected from the renal vein from rabbits without previous ischemia or during reperfusion after sixty minutes of ischemia. A gradual decline in blood cell filterability was observed during continuous sampling in both circumstances. However, during reperfusion after ischemia, the filterability of erythrocytes and leukocytes was even more reduced as compared with that of control animals. This ischemia-induced reduction in filterability could be partly prevented by pretreatment with superoxide dismutase and catalase. An impaired cellular filterability induced by oxygen free radicals produced during recirculation after ischemia might contribute to the local erythrostasis found in such kidneys.
Predictive Value of Manual ECG-Monitored Exercise Test Before Abdominal Aortic or Peripheral Vascular Surgery
Authors: Kaaja Risto , Sell Henrik , Erkola Olli , Harjula Ari
Published: August 2008

The value of manual ECG-monitored exercise test was studied in 58 patients (39 men and 19 women) with intermittent claudication scheduled for abdominal or peripheral vascular surgery. There was a high incidence of well-known risk factors (hypercholesterolemia, smoking, and hypertension) in men and women. History of coronary artery disease (CAD) was present in 29.3% of the patients. No correlation was found between patients with single or multiple stenoses in lower extremity arteries (angiography) and CAD. Ischemic response (ECG) to manual exercise testing was positive in 14 patients (24.1%), of whom 2 (14.3%) had major cardiovascular postoperative complications. Both died of acute myocardial infarction within fourteen days. They had slow recovery (thirty to sixty minutes) of the ST segment (0.3-0.6 mV).

The authors conclude that manual exercise testing might reveal serious CAD in patients with severe occlusive peripheral arterial disease of the lower extremities. In cases with slow recovery of ischemic response to exercise, coronary bypass or angioplasty could be advantageous before major vascular surgery.
Rupture of an Aneurysm of the Internal Iliac Artery into the Rectum. Report on a Case with Favorable Outcome
Authors: Del Gaudio Giovanni-Alberto , Berardi Monica , Del Gaudio Antonio
Published: August 2008

Although internal iliac artery aneurysms are uncommon, their timely recognition and surgical treatment are important since, like all other abdominal aneurysms, they tend to enlarge and rupture, often without warning, and the outcome is usually fatal.

An aneurysm of the left internal iliac artery, in a seventy-six-year-old obese man, which ruptured into the rectum, was successfully treated by partial removal, distal aneurysmorrhaphy, and positioning of an aortofemoral prosthetic bypass.
Intra-abdominal Bleeding as a Result of Segmental Mediolytic Arteritis of an Omental Artery: Case Report
Authors: Ohwada Susumu , Joshita Takashi , Kawade Susumu , Tanahashi Yoshifumi , Takeyoshi Izumi , lino Yuichi , Nakamura Seiji , Miyamoto Yukio , Morishita Yasuo
Published: August 2008

A seventy-three-year-old woman with intra-abdominal bleeding secondary to a ruptured omental artery was operated on successfully. Preoperatively an emergency angiogram showed patchy areas of narrowing and beading in the affected artery. The pathologic finding in the ruptured omental artery was segmental mediolytic arteritis, characterized by segmental disruption of the medial smooth muscle cells and the initiation of mediolysis. The authors report this rare case of spontaneous intra-abdominal hemorrhage.
Occlusion of the External Iliac Artery—A Rare Complication of Long-Distance Running: Case Report
Authors: Bartels Claus , Nigbur Helmut , Claeys Luc , Horsch Svante
Published: August 2008

Stenosis or complete occlusion of the iliac artery is extremely rare in long-distance runners. When pain in the thigh and buttocks develops, the diagnosis of arterial occlusive disease is often delayed in these patients, for degenerative changes in the skeletal and muscle system are more prevalent.

Herein the authors present the case of a young female long-distance runner in whom the external iliac artery became occluded at the end of a 100 km course, although claudication had developed one year before. The temporal relationship between the onset of claudication and the complete arterial occlusion at the end of the last race may give further insight into the underlying pathological mechanism.
Splenic Artery Aneurysms—Case Reports
Authors: Gupta Ashish K. , Ghani Abdul , Wegener Michael E.
Published: August 2008

Three patients with large splenic artery aneurysms (SAA) are presented, together with a review of the possible etiologies and the clinical and therapeutic aspects. SAA should be suspected in any patient with left upper quadrant pain and unexplained blood loss, especially if the patient is pregnant, and should be aggressively treated as outlined here.
Absorbable Suture in Vascular Surgery
Authors: Storck Martin , Orend Karl-Heinz , Schmitz-Rixen Thomas
Published: August 2008

The choice of suture material in surgery is often individual and a result of personal experience. Cardiovascular surgeons have always been reluctant to use absorbable suture material for direct arterial or venous anastomoses for differ ent reasons, mainly because of suspected anastomotic dilatation or even rupture during or after the absorption phase. More than ten years ago, a new class of synthetic, monofilament, flexible, biodegradable suture material was intro duced for clinical use. Since then, much experimental and clinical work has been carried out to evaluate physical and biological characteristics of this class of suture material (polydioxanone/polydimethylsiloxane = [PDS] and polytri methylene-carbonate = [PTMC]) in many different tissues, including vascular tissue. There is increasing evidence that slow-absorbable sutures will gain clini cal importance for cardiovascular and peripheral vascular surgery in the fu ture, since many experimental and clinical studies during the last forty years have proven histologic superiority over nonabsorbable materials. Descriptions of healing processes in blood vessels after surgical anastomoses lead to the con clusion that persisting foreign suture material results in persistent cellular reac tions and chronic inflammatory responses and may consequently disturb physi ologic functions such as compliance at the anastomotic site. It is the purpose of this article to give a review of the literature. Implications are discussed for surgery of growing vessels, transplantation surgery, microsurgery, and surgery in infected anastomoses. Nonabsorbable suture material should no longer be used for direct vascular anastomoses.
Combined Myocardial and Peripheral Revascularization of the Lower Limbs
Authors: Massimo Carlo G. , Favi Piero P. , Presenti Luigi F. , Manca Giuseppe
Published: August 2008

In a series of 2,786 patients submitted to operation for peripheral arterial disease of the lower limbs from 1964 to 1986, the overall mortality rate was 6.9%, and 69% of these died of acute myocardial infarction (AMI). In order to reduce the incidence of AMI, from 1979 to 1990, 258 patients with lower limb ischemia were investigated for coronary artery disease (CAD). All of them had clinical signs of myocardial ischemia and were submitted to coronary arteriog raphy after previous evaluation with dipyridamole thallium scanning and echo cardiography. Severe CAD was shown in 137 patients, and combined myocardial and peripheral revascularization was planned: coronary artery by pass grafting (CABG) was performed first on 61 patients followed by peripheral operation after an average of three weeks; simultaneous procedure was per formed on 76 patients upon intraoperative decision. The overall mortality rate was 3.6%: 3.3% for staged and 3.9% for simultaneous procedure. No myocar dial infarction was registered in the early postoperative period, but peripheral graft occlusion in 5.8% (8/137) was the main complication. The actuarial five- year survival rate was 87%; the actuarial five-year patency of the peripheral grafts was 61.9%.

The authors conclude that combined myocardial and peripheral revascular ization prevents early death from myocardial infarction and improves late sur vival without increasing surgical risks; with proper judgment simultaneous operations can be performed.
Functional Benefits of Peripheral Vascular Bypass Surgery for Patients with Intermittent Claudication
Authors: Regensteiner Judith G. , Hargarten Melanie E. , Rutherford Robert B. , Hiatt William R.
Published: August 2008

Many patients with peripheral arterial disease (PAD) undergo peripheral bypass surgery to relieve the symptom of intermittent claudication. However, measurement of graft patency alone, assessed by change in ankle blood pres sure, may not adequately reflect the improvement in functional status following the operation. Fourteen patients with moderately severe intermittent claudica tion were evaluated before and after bypass surgery to assess changes in hemo dynamics (by resting ankle-brachial indices-ABIs), exercise performance (by a graded treadmill protocol), and community-based walking ability (by a ques tionnaire that characterizes self-reported walking speed and distance). Six weeks after surgery, resting ABIs improved in surgical patients (from 0.56 ± 0.09 to 0.93 ± 0.16, P < 0.05). Peak treadmill walking time improved from 6.2 ± 5.9 to 11.8 ± 7.1 min (90%), peak oxygen consumption from 15.5 ± 6.5 to 19.1 ± 8.5 mL/kg/min (23%), and pain-free walking time from 1.5 ± 0.4 to 6.0 5.5 min (290%). Questionnaire scores for walking distance improved by 203% and for walking speed by 130% (all P < 0.05). After twelve weeks, improve ments other than pain-free walking time were maintained. Changes in peak treadmill performance or questionnaire scores were not correlated with the ini tial ABI, changes in ABI six or twelve weeks after surgery, or the type or extent of bypass surgery. The results demonstrate that surgical treatment of PAD, indi cated for the relief of intermittent claudication, improves exercise performance and self-reported community-based walking ability. The change in functional status of the patient is an important outcome of surgery that cannot be pre dicted from routine noninvasive testing alone and should be measured directly.
Girdled Arteriotomy: A. Method to Increase the Arterial Lumen
Authors: Sotelo Julio , Perez Rodolfo
Published: August 2008

Arterial stenosis is a common consequence of several vascular pathologies; surgical arterioplasty produces improvement of blood flow, but recurrent stenosis is frequent. A method of increasing the arterial lumen consists of a longitudinal arteriotomy left opened within a wrapping membrane of glu taraldehyde-tanned bovine pericardium, avoiding sutures in the arterial wall. Girdled arteriotomy was performed in the common carotid artery of 12 dogs; four months later, 3 of them were studied by angiography, Doppler ultrasound, magnetic resonance, and histology. The inner area of the arterial lumen had increased 96% when compared with the contralateral artery, immune tolerance to the foreign membrane was optimal, a newly formed endothelium covered the space between the edges of the arteriotomy, and the blood flow had increased as measured by Doppler ultrasound. Most causes of postsurgical arterial resteno sis seem to be prevented. Girdled arteriotomy is a fast and simple surgical pro cedure that could be used in the treatment of arterial stenosis.
Aortocaval Fistula Due to Stabbing Injury: A Case Report
Authors: Salman Ergun , Ozeren Murat , Yucel Ertan , Yörukoglu Yavuz
Published: August 2008

Traumatic aortocaval fistula due to stabbing injury by knife is a rare entity. The authors present a case of aortocaval fistula due to stabbing injury and its successful surgical treatment by bifurcated Dacron graft interposition between the aorta and both common iliac arteries. No complication occurred in the post operative course.
Experimental Study of Cardiac Lymph in Myocardial Stunning
Authors: Masuda Hiroshi , Furuzono Kohji , Kamimura Ryozo , Taira Akira
Published: August 2008

To clarify the pathophysiology of myocardial "stunning" from the viewpoint of the cardiac lymphatic system, lymph dynamics were studied in a fifteen-minute ischemic dog model. The influences of two interventions were evaluated: active lymph drainage by hyaluronidase (500 units/kg intravenously given on occlusion) and lymph stasis (loading 10 cmH2O of hydrostatic pressure on the cardiac lymphatic system on and after occlusion).

Lymph flow of the control group did not significantly change despite remarkable decreases of both regional myocardial contractility (systolic strain) and regional myocardial blood flow (RBF). Meanwhile, active lymph drainage effectively improved systolic strain from the early reperfusion period (from 62 ± 4% to 77 ± 4% of baseline for control versus lymph drainage group, respectively, P < 0.05). Significant improvement of RBF was also noted within the endocardial side. Lymph stasis gradually deteriorated systolic strain (from 65 ± 5% to 45 ± 7% for control versus lymph stasis group at 240-minute reperfusion, respectively, P < 0.05) and was accompanied by an increase of myocardial water content. In pooling and analyzing the results obtained from these groups, a positive correlation was found between lymph flow and systolic strain, and it tended to be better during the early reperfusion period (r= 0.63, P < 0.01 at fifteen-minute reperfusion r=0.49, P < 0.05 at 240-minute reperfusion).

The authors conclude that the process of myocardial "stunning" can be influenced by regulating lymph flow.