bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with an Alternate Prosthesis for Chronic Vascular Access
Authors: Sanfelippo Peter M.
Published: November 2007

Although chronic hemodialysis has been employed for more than twenty-five years, the perfect ap proach to chronic vascular access has yet to be realized. The standard ra dial-cephalic fistulae, although suc cessful in a majority of patients, may not provide suitable vascular access. Their failure may be due to paucity of forearm veins, patient's obesity, or lack of patent veins.

Among the alternatives is the car bon transcutaneous access device (CTAD). This paper discusses the four-year experience of one surgeon with the CTAD.

Over a four-year period, the CTAD was utilized in 13 selected pa tients. The selection of these patients was based on the failure of many other access techniques. Prior to CTAD, the patients had had from two to fourteen access procedures. The CTADs have provided four to fifty months of satisfactory access.

Of the 13 patients, 6 have expired with functional CTADS. Four pa tients have had the CTADs removed. One was removed at thirty-two months when it was decided to con vert this patient to peritoneal dialysis after satisfactory access with the CTAD. Another was removed after four months in a patient who opted to switch to peritoneal dialysis. One was removed at nineteen months after failed function, and one was removed after eight months because of Can dida sepsis.

The other 3 patients are living with functional CTADs in use, the longest being in operation fifty months.

The major problem has been the formation of a ball-valve thrombus at the base of the port. A nonoperative approach has been successful in re moval of this thrombus.

The selection of site for the CTAD is of importance for patient conven ience and for longevity of function. The experience in this pilot group of patients with the CTAD followed up to fifty months on dialysis has proved the CTAD to be a significant tool in the armamentarium of the vascular access surgeon.
Intraoperative Coronary Laser Recanalization: Evaluation of Safety in Ten Patients
Authors: Diethrich Edward B. , Timbadia Ela , Bahadir Ilhan , Carroll Susan , Zenzen Sharon , Coburn Kathy
Published: November 2007

Ten coronary artery bypass candi dates were selected to participate in a phase I evaluation of the safety of a 1.7-mm argon-powered, metal- tipped, fiberoptic laser probe for re canalization of the coronary arteries.

Eleven arteries were selected for lasing based on their inability to jeop ardize the scheduled revasculariza tion procedure. Through an arteriotomy distal to the lesion (or through the distal anastomosis of the bypass graft), the laser probe, at power levels of 10-12 watts, was visu ally monitored for passage across the lesion. Single or multiple pulses of energy were delivered to the tip for from 3- to 23-second intervals, with total lasing times of 9 to 173 seconds.

The probe traversed the lesions in 7 (64%) arteries; the remaining 4 (36%) were totally occluded lesions that blocked entry of the probe in 1 and allowed only minimal penetra tion in 3 others. In 1, the distal tip fractured after becoming lodged in the plaque. There was no perfora tion, dissection, or other complica tion to the lasing procedure in this series. One patient died from an un related acute myocardial infarction occurring four days postoperatively.

Calcified plaques pose a major problem for this probe design, but it appears to safely open channels in less mature plaques. Phase II of the study will investigate the efficacy of laser-assisted myocardial revascular ization.
Combined Effect of Transfusion and Blood Groups on the Survival of Patients With Breast Cancer. A Clinical Study of 901 Patients †
Authors: Bufalino Rosaria , Morabito Alberto
Published: November 2007

Previous reports by the authors and by others have shown that trans fusion adversely affects the survival of cancer patients. To delineate fur ther the mechanism of action of blood transfusion on biological behavior of cancer, the authors studied the role of the major blood groups ABO in 901 patients who had all undergone radi cal surgery for operable primary breast cancer and among whom 294 had received at least one unit of whole blood perioperatively.

Multivariate analysis using Cox's regression models on life tables was used. It was found that the adverse effect of transfusion on survival was a blood group-related phenomenon manifesting its action in patients with blood groups A and B (P = 0.0006 and P = 0.006 respectively). The most im pressive effect of transfusion was seen in patients whose age was be tween forty-one and fifty (51.9% ten- year actuarial survival in 47 transfused patients compared with 73.9% in 70 nontransfused ones).

A hypothesis is presented suggest ing that transfusion exerts its effect on the hemostatic system, promoting clotting in group A and B patients and fibrinolysis in group O and AB patients, and thus affects metastatic cascade, with results that have been presented in this series.
Early Postoperative Inferior Mesenteric Arteriovenous Fistula—A Case Report
Authors: Slutski S. , Peer A. , Abramsohn R. , Weitz E. , Bogokowsky H.
Published: November 2007

A case of early postoperative inferior mesenteric arteriovenous fistula is de scribed in a sixty-three-year-old man who underwent an anterior resection of the rectum for carcinoma.

Six weeks after surgery, he developed increasingly severe rectal bleeding. A single incident of copious bleeding caused him to go into shock and require resuscitation. A selective angiography revealed an arteriovenous fistula of the inferior mesenteric artery, which was managed by embolization of the artery by three spring steel coils.

These rare postoperative arteriovenous fistulae are probably caused by the incorporation of an artery and vein in a single stitch or ligature and usually present many years after surgery.
Congenital Iliac Aneurysm—Case Report
Authors: Hvass U. , Khoury W. , Pansard Y. , Legoff J.Y.
Published: November 2007

Isolated congenital aneurysms of the iliac artery are unusual. This report describes such a case, revealed by acute rupture and successfully operated on.
Coronary Endarterectomy in Patients with Diffuse Coronary Disease
Authors: Scheld Hans H. , Moosdorf Rainer , Görlach Gerold , Ewers Jochen , Hehrlein Friedrich W.
Published: November 2007

Diffuse multivessel disease can limit a complete revascularization in patients undergoing coronary bypass surgery. It is considered that coro nary endarterectomy (CEA) offers a reasonable chance for this special group of patients.

Among 2415 patients undergoing coronary bypass surgery, a CEA of the right and/or left coronary system had to be performed in 397 patients with diffuse multivessel disease. Completeness of the procedure was controlled intraoperatively by dye perfusion and angioscopy. One hun dred one patients gave informed con sent to be reinvestigated clinically and by angiography at an average of forty-three months after surgery.

The thirty days mortality after additional CEA was slightly in creased at 3.8%. Also the periopera tive infarction rate increased at 9.3 % . The long-term analysis re vealed a late mortality of 5.5%. Cor onary angiography showed a patency rate of the endarterectomized vessels of 81.2 %; 91% of the patients being reinvestigated showed an improved or asymptomatic clinical status.

Despite a slightly increased risk, CEA proved to be a feasible therapy in this strictly limited group of pa tients, in whom conventional bypass surgery offers poor chances and who otherwise would even be candidates for transplantation.
Intracaval Adrenocortical Carcinoma: A Case Report and a Review of the Operative Strategies
Authors: Barone Gary W. , Soracco Charisse A. , Tribble Curtis G.
Published: November 2007

Adrenocortical carcinomas are rarely encountered tumors that have a ten dency to invade the inferior vena cava. The only effective therapy is complete surgical resection including the extraction of any intracaval tumor thrombus. A case of adrenal tumor with inferior vena caval involvement that manifested early as a pulmonary embolus is presented. The operative approach to intra caval extension is discussed, and operative maneuvers are illustrated.
Carotid Endarterectomy in a Patient With Ankylosing Spondylitis—A Case Report
Authors: Dahn Michael S. , Plezia Richard A. , Diebel Larry , Jacobs Lloyd A.
Published: November 2007

Access to the cervical internal carotid artery may occasionally be limited by the mandible. Management of symptomatic carotid occlusive disease in a pa tient suffering from ankylosing spondylitis is described in which the carotid bifurcation is obscured by the vertical mandibular ramus. The application of technique usually reserved for high internal carotid artery lesions to this situa tion is discussed. In the case reported here, the preferred approach of mandibu lar subluxation allowed successful carotid endarterectomy.
Wrapping and Replacement of Thoracic Aorta: Morphologic and Mechanical Properties
Authors: Symbas P.N. , Pfaender L. , Chen H. , Gravanis M.B.
Published: November 2007

The histologic and mechanical properties of the aorta following its segmental wrapping or replacement was investigated in two groups of dogs.

In Group I (5 dogs) a 3- to 4-cm segment of the ascending and of the descending aorta were wrapped with prosthetic graft (2 dogs with woven and 3 with knitted Dacron). In Group II (5 dogs), a 3-cm segment of the de scending aorta was replaced with prosthetic graft. After an average stay of eight months, the dogs were sacrificed and the aorta was submit ted for histologic and tensile strength studies. There was no change in rup ture strength in either the wrapped or the replaced aortas in comparison with normal control aortas. However, the incidence of rupture at the suture line in Group II was significantly greater. The incidence of rupture site in Group I was 43.5% at the normal aortic segment, 17.4% at the junction between wrapped and nonwrapped aortic segment, and 39.1 % at the wrapped aortic segment. The inci dence of rupture site in group II was 28.9% at the normal aortic segment, 68.9% at the suture line, and 2.2% at the grafted segment. In Group I dogs the outer one third to one half of the media of the wrapped aortic segment was replaced with fibrous tissue.
The Dacron EXS Graft for Femoropopliteal Arterial Reconstruction
Authors: Matsubara Junichi , Nagasue Masami , Hosaka Hiroshi , Shimizu Takeshi
Published: November 2007

The purpose of this study is to clarify the efficacy of the knitted Da cron Velour Externally Supported (EXS) graft in the patency of femoro popliteal, especially below-the-knee femoropopliteal, arterial revascular ization.

Through the end of March, 1988, 62 EXS grafts had been implanted for 43 anatomic and 19 extraana tomic bypasses. Of these, 34 grafts in 28 patients were for femoropopliteal surgery. They were 25 men and 3 women with a mean age of 67.4 years. The location of distal anasto mosis was as follows: 17 grafts were to the popliteal artery above the knee and 17 were below the knee.

Cumulative patency rates, calcu lated by the life table method, were as follows: 93.1% and 77.8% at one year, for above and below the knee, respectively; 64.4% and 77.8%, re spectively, at two and a half years; and 64.4% at four years for above the knee. The longest case of BK is three and a half years. Therefore, there is no 4-year patency rate for BKs. There were no statistical differences between above- and below-the-knee popliteal anastomosis. Postoperative angiograms show no kinking or ste nosis at the anastomosis site of a be low-the-knee popliteal artery in bending position.

These results suggest that the da cron EXS graft is suitable even for below-the-knee femoropopliteal arte rial surgery, showing results similar to those with autologous vein grafts. A longer follow-up period and a larger number of grafts are necessary for firmer conclusions.
Proximal Dissection Originating in Atherosclerotic Thoracic Aneurysms: Diagnostic and Therapeutic Implications—Case Studies
Authors: Hines George L. , Hamdani Mohamed , Epstein Heywood
Published: November 2007

Three patients with atherosclerotic thoracic or thoracoabdominal aneurysms with extensive intramural dissection originating from the aneurysm and extend ing proximally are described. All patients presented with severe back pain sug gesting an acute change in the status of the atherosclerotic aneurysm. In retrospect, the pain was probably secondary to acute dissection. The proximal dissection was not recognized preoperatively in 2 patients and this led to signifi cant intraoperative problems. A combination of computerized axial tomo graphy and angiography should allow accurate preoperative diagnosis. An awareness that these two processes (atherosclerotic aneurysm and proximal dis section) can coexist should allow such a preoperative diagnosis to be considered and help prevent intraoperative difficulties.
Bronchiolar Morphology After Systemic Arterial Interruption
Authors: Closset Jean , Vanderhoeft Patrick J. , Delcour Christian
Published: November 2007

To assess ischemic lesions as a fac tor in obliterative bronchiolitis after lung transplantation, the authors sev ered the left bronchial arteries of 15 dogs, together with the left stem bronchus, the latter being immedi ately reanostomosed. They examined the bronchioles at weekly intervals up to three and a half months. On the week chosen each dog was anesthe tized, totally heparinized, and exsan guino-perfused with saline. Just after heart arrest, the thoracic aorta was injected with a barium solution until this white medium appeared in the bronchial arteries. The heart-lung blocs were excised en bloc, submitted to soft-tissue x ray, fixed, and then sliced to 1 cm. Corresponding right and left 5-mm-thick samples of these slices were prepared for contact mi croradiography followed by histo logic 5-to-20-micron-thick, stained, correlated specimens. For two weeks the left bronchial arteries remained empty, but there was no necrosis or edema. Between two and four weeks barium solution appeared in the bronchial arteries, and the bronchio lar epithelium had become multi stratified. Later the left bronchian giogram became similar to the right, but there were more folds of the mu cosa and a little submucosal fibrosis. These studies provide proof that no significant ischemic lesions occurred during repermeation of the bronchio lar vascular bed. Ischemia, if exist ent, is not a significant factor in obliterative bronchiolitis.
Spontaneous Rupture of the Nonaneurysmal Aorta—A Case Report
Authors: Konigsberg Stephen F. , Finkelstein Norman M. , Shindelman Larry E.
Published: November 2007

Small size is frequently cited as an indication for nonoperative management of aneurysms of the abdominal aorta, particularly in the poor-risk patient. The rationale for this approach is based upon the low risk of rupture in aneurysms of small size and the well-known relationship between tension in the vessel wall and pressure within the aneurysm described by Laplace's law. A case is pre sented here of spontaneous rupture of an abdominal aorta that is most appro priately described as ectatic, rather than aneurysmal. The diagnosis of rupture could not be made on computerized tomographic scan of the aneurysm but was confirmed at autopsy.
Neovascularization in Recurrence of Varices of the Great Saphenous Vein in the Groin: Surgical Anatomy and Morphology
Authors: Glass Gerard M.
Published: November 2007

The hypothesis that recurrence of varicose veins in the groin develops through preexisting tributaries of the great saphenous vein as a result of failure to ligate this vein at the saphenofemoral junction has greatly influenced surgical treatment. The results of an investigation, in 152 limbs, of the role of neovascu larization in recurrence of varices of the great saphenous vein in the groin are presented. A newly formed vessel or complex of vessels was found that was continuous proximally with a residual unresected portion of great saphenous vein or with the saphenofemoral junction and distally with this vein or with other varicose veins in the superficial venous network. The presence of several lumens in an irregular mass of vein tissue and of cords or bands traversing the lumen showed that the vessel was newly formed, not preexisting. Neovascular ization may therefore result in recurrence even where the criterion of correctly performed saphenofemoral ligation has been observed.
One-Stage Reconstruction of Peripheral Neurovascular Gunshot Injuries in a Third World Country
Authors: Babar S.M.A.
Published: November 2007

This study describes 45 young (mean age 38.5 years) male patients with firearm injuries who presented with vascular and neurologic lesions. A synchronous one-stage neurovas cular reconstruction was undertaken in these patients; 75.5% of the traumas involved the clavioaxillary region, producing 32 regional aneurysms (71.1%), 2 major vascular lacer ations (4.4%), and a high degree of neurotmesis (48.8%) and axonotmesis (26.7%) in the brachial plexus (BP). Lower limb vascular lesions included 5 aneurysms associated with significant regional neurotmesis. The follow-up rate was poor and declined from 100% at six weeks to 70.5% at one year and 22.7% at five years. Initial vascular patency rate of 95.5% at six weeks persisted throughout in a similar manner, but the declining reatten dance rate drastically reduced statistical reliability. Recovery to grade III or better was observed in 75% of nerve grafts in the BP region, with 89% of the neurolyzed nerves showing this improvement. The results in the lower limb were comparable. The main idea of presenting this study is to show a pattern that is typical of a third-world country with lack of financial resources, a poor patient-compliance, and peer bias.
Hepatic Artery-to-Bile Duct Fistula Following Wallstent Placement: A Rare Cause of Hemobilia
Authors: LaPlante Jon S. , Khoury Maroon B. , Kiproff Paul M.
Published: November 2007

The authors report the occurrence of severe hemobilia due to hepatic artery-biliary fistula after percutaneous transhepatic placement and dilatation of a Wallstent for obstruction of the biliary confluence due to metastatic colon cancer. The bleeding was controlled by hepatic artery embolization.
The Role of Blood Perfusion and Tissue Oxygenation in the Postischemic Transcutaneous pO2 Response
Authors: Slagsvold Carl-Erik , Stranden Einar , Rosén Leif , Kroese Andries J.
Published: November 2007

The transcutaneous pO 2 (TCpO2) response following release of tourniquet cuff occlusion is expressed as oxygen reappearance time (ORT) and oxygen recovery index (ORI). In the present study the effects of blood perfusion and tissue oxygenation on ORT and ORI in healthy control subjects and two patient groups with peripheral arterial insufficiency were assessed.

In control subjects, ORT reflects diffusion time for O2 molecules from capillaries to the TCpO2 sensor. In patients with claudication, ORT was prolonged probably because of delayed postischemic reperfusion and reduced tissue oxygenation. In patients with critical ischemia, prolonged ORT seems to be attributed more to reduced tissue oxygenation than to delayed postischemic reperfusion.

ORI in control subjects and patients with claudication apparently depends more on capillary pO 2 than on magnitude and duration of the postischemic reperfusion. In patients with critical ischemia, ORI is more related to decreased O 2 delivery subsequent to reduced or absent reactive hyperemia response.

In addition, increased O2 extraction ("O2 steal") and extensive countercurrent O2 exchange during low flow states may reduce ORT and ORI in severely ischemic skin.
Arterial Occlusive Disease in Systemic Lupus Erythematosus
Authors: Erkmen Böke M. , Atasoy Sevket , Dogan Riza
Published: November 2007

The lesions of middle- and large-sized arteries due to systemic lupus erythematosus have been infrequently reported, but vasculitis of small arterioles has been seen more commonly. Herein, a forty-four-year-old woman with lower extremity arterial occlusive disease secondary to systemic lupus erythematosus is presented, and the results of sympathectomy are described.
Sheared Pulmonary Artery Catheter: Transesophageal Echocardiography-Guided Removal
Authors: Tatar Harun , Çiçek Sertaç , Demirkilic Ufuk , Süer Hikmet , Ozal Ertugrul , Kuralay Erkan , Öztürk Ömer Y. , Narbay Dündar
Published: November 2007

Shearing of the pulmonary artery catheter is a rare complication. Intraoperative transesophageal echocardiography was used to localize the catheter in the heart and the catheter was successfully removed. Easy mobility of the pulmonary artery catheters should be tested prior to sternotomy closure in patients having open cardiotomy
Superiority of Internal Jugular Venipuncture to Subclavian Venipuncture as a Central Venous Catheterization
Authors: Hirano Tetsuya , Yoshioka Hidenori
Published: November 2007

Superiority of internal jugular venipuncture to subclavian venipuncture as a central venous catheterization was evaluated in parameters such as duration of procedures, incidence of catheter misposition, and incidence of other complications. In internal jugular venipuncture, the duration of procedure was significantly shorter than that in subclavian venipuncture, and the incidence of catheter misposition was also significantly lower. Moreover, no major complications such as pneumothorax were observed in internal jugular venipuncture, although these complications occurred in small percentages in the subclavian venipuncture group. These results indicate a superiority of internal jugular venipuncture to subclavian venipuncture as a central catheterization owing to its safety and cost efficacy
Aneurysmal Right Coronary Artery to Left Ventricle Fistula Associated with Atrial Septal Defect and Aortic Insufficiency: Surgical Considerations
Authors: Nikas Dimitris J. , Mukerji Vaskar , Concannon Milton D. , Massey Clara V. , Moran Thea C. , Alpert Martin A.
Published: November 2007

A sixty-seven-year-old woman with effort intolerance and presyncope was noted to have a congenital aneurysmal right coronary artery to left ventricular fistula, an ostium secundum atrial septal defect, and severe aortic insufficiency. This is the first case reported with this combination of cardiac anomalies. The diagnosis was confirmed by cardiac catheterization, coronary angiography, and aortography. Aortic valve replace ment, closure of the atrial septal defect, and ligation of the right coronary artery to left ventricle fistula were performed without incident. The patient has remained asympto matic since surgery.
Ruptured Large Abdominal Aortic Aneurysm in a Centenarian
Authors: Shafei Hussein , Attar Abdullah , Al-Ebrahim Khalid
Published: November 2007

Rupture of abdominal aortic aneurysm (AAA) in elderly patients carries a high mortality rate. The decision to operate on a patient more than a hundred ten years of age is contro versial and will depend on many factors. In this case report, the authors describe a successful repair of a ruptured giant (15 cm in diameter) AAA eroding into the vertebral column in a one-hundred-ten-year-old patient. This is likely to be the oldest case reported in the literature with successful outcome.
Long-Term Clinical and Duplex Follow-up After Proximal Vertebral Artery Reconstruction
Authors: Van Schil Paul E. Y. , Ackerstaff Robert G. A. , Vermeulen Freddy E. E. , Eikelboom Bert C. , Schepens Marc A. A.
Published: November 2007

From 1977 to 1989, 28 patients, 18 men and 10 women, underwent 29 proximal vertebral artery reconstructions. Indications were vertebrobasilar insufficiency in 17 patients and TIA or stroke in 6. Five were asymptomatic. Procedures performed were endarterectomy in 20, reimplantation in 5, venous bypass in 3, and decompression in 1 case. Concomitant procedures were coronary artery bypass grafting (6) and carotid, subclavian, or innominate artery revascularization (14).

There was no operative mortality. There were 3 early reoperations for occlusion, bleeding, and lymph fistula, respectively.

Except for 1 foreign patient recent clinical follow-up was complete. Mean follow-up was 85.6 months (range 17-146). During follow-up 10 patients died. Causes were mainly cardiac (3), carcinoma (3), and stroke (2). Seventeen patients were alive, 13 had no cerebrovascular symptoms, 2 sustained a hemispherical stroke, 1 was only slightly improved, and 1 had a drop attack 131 months after operation. Five and ten-year actuarial survival rates were 85% and 51% respectively.

Follow-up with duplex scan was available in 26 patients and was complete in 24. Mean duplex follow-up was 78.6 months (range 3-146). Significant abnormalities were noted in 6 but with symptoms in only 1 patient. Mean time to restenosis was 77.3 months. Late angiographic control in 10 patients correlated well with duplex findings.

Proximal vertebral artery reconstruction yields good clinical long-term results, and duplex scan is a useful tool in the follow-up of these patients.
PTA Plus Stent Implantation Versus PTA Alone for Central Venous Stenoses
Authors: Mickley Volker , Friedrich Jean M. , Rilinger Norbert , Storck Martin , Abendroth Dietmar
Published: November 2007

From 1990 through 1992, 17 severely stenosed central venous segments were diagnosed in 13 patients. In 9 patients, 11 stenoses were detected during follow-up after trans- femoral venous thrombectomy. The other 6 stenoses occurred in the venous outflow tract of 4 hemodialysis shunts. Six stenoses were treated by percutaneous transvenous angio plasty (PTA) alone, and 11 stenoses by PTA plus stent implantation (PTA+S). For PTA+S, a flexible, self-expanding stent was used.

Acute procedure-related complications were not observed. After a median follow-up time of eighteen months (three to thirty-six months), all patients were examined clinically, duplex-sonographically, and angiographically. Following PTA alone (n = 6), there was only 1 excellent result, and 5 patients developed high-grade restenoses. Two of these patients had to be reoperated on, and 1 patient underwent another PTA with stent placement. PTA+S (n = 11) for initial treatment of central venous stenoses gave excellent results in 8 cases, a good result in 1 case, and 2 insufficient results caused by intimal hyperplasia within the stent. These restenoses were successfully treated by another PTA.
Determinants of Failure in Superficial Femoral Artery Angioplasty
Authors: El-Bayar H. , Roberts A. , Hye R. , Davis G. , Freischlag J.
Published: November 2007

Although results of iliac artery balloon angioplasty have been shown to be good, there are much less data regarding initial success and durability of superficial femoral artery (SFA) dilation. The authors retrospectively reviewed the results of 22 patients treated for 27 SFA lesions between 1981 and 1986. Mean age was 64.5 years (fifty-five to seventy-six). Results were analyzed with respect to initial, early ( < twelve months), and late ( > twelve months) angiographic and clinical success. Indications were claudication (22), nonhealing ulcer (3), and rest pain (2). Mean follow-up was 30.9 months; 100% at one year and 92% at two years. Initial failure occurred in 9 (33%) lesions. There were 2 early and 2 late failures for a cumulative patency rate of 90.3% and 78% at one and two years, respectively. Predictors of clinical failure were: (1) initial—age, SFA occlusion, and angio plasty rating; (2) early—age, SFA occlusion, degree of atherosclerosis, and angioplasty rating; (3) late—angioplasty rating. There were 3 complications (11%).

The authors conclude that: (1) 33% of attempted SFA angioplasties were initially unsuccessful and that the cumulative patency rate was 78% at two years. (2) Age is predictive of initial and early failure; SFA occlusion, of initial and early failure; degree of atherosclerosis, of early failure; and angioplasty appearance, of initial, early, and late failures. (3) Complications did not result in limb loss or require surgery.
Isolated Endarterectomy and Patch Angioplasty for Common Femoral Artery Occlusive Lesions
Authors: Hines George L. , Vatsia Sheel
Published: November 2007

Eleven patients underwent isolated common femoral artery endarterectomy and vein patch angioplasty over a five-year period. All patients had claudication. In addition 7 had rest pain and 2 had ischemic ulcerations. Mean age was 67.8 ± 11.2 years. The mean preoperative ankle/arm (a/a) index was 0.48 ±0.14. The operations were performed under local or regional anesthesia. There was no perioperative mortality or morbidity. The mean postoperative a/a index increased to 0.76 ±0.19 at 30.75 months. One reconstruction thrombosed at sixteen months. Two patients died of unrelated causes with patent grafts at six months. The increase in a/a index was the same irre spective of whether the presenting symptoms were claudication alone (0.29), rest pain (0.21), or ischemic ulceration (0.35). This study indicates that femoral endarterec tomy and patch angioplasty is a safe and durable procedure for focal common femoral artery stenosis or occlusion.
The Extrinsic Inguinal Venous Compression Syndrome
Authors: Schimmer R.C. , Hoffmann R. , Enzler M.A. , Flury R. , Brunner U.
Published: November 2007

Seven cases of extrinsic inguinal venous compression syndrome were seen at the University Hospital of Zurich over the past fifteen years. The syndrome can be subdi vided into nontraumatic and posttraumatic compression, both producing the severe clinical picture of venous stasis of the entire lower extremity. In all patients, however, no deep venous thrombosis was observed despite high-grade stenosis of the common femoral vein. Proper diagnosis must be done in all cases of swelling of a lower limb to rule out extrinsic inguinal venous compression. Blind anticoagulation therapy might even be hazardous, whereas exact diagnosis with mostly surgical decompression provides good results regarding patency and thrombosis rate.
One-Stage Repair of Salmonella enteritidis-Infected Infrarenal Aortic Aneurysm
Authors: Onoda Koji , Hayashi Takashi , Mizumoto Toru , Shimpo Hideto , Tanaka Kuniyoshi , Katayama Yoshihiko , Yuasa Uhito , Shomura Yu , Maruyama Kazuo , Takeuchi Masaki , Higashi Shunsaku , Yuasa Hiroshi , Yada Isao
Published: November 2007

A sixty-three-year-old man was admitted with systemic sepsis, but he was in a hemody namically stable situation and found to have a contained rupture of an infrarenal aortic aneurysm, which was infected with Salmonella enteritidis. An abdominal plain film revealed a gas shadow forming a ring in the midabdomen. Computed tomography (CT) showed a contained rupture of an infrarenal aortic aneurysm with a gas formation in the retroperitoneum. An emergent extra-anatomic bypass from the ascending aorta to ( continued on next page) ( Abstract continued) the femoral arteries was performed. The retroperitoneal phlegmon and hematoma that contained a large pseudoaneurysm were removed through a separate incision. A CT obtained after surgery showed gas-containing fluid collections in the retroperitoneum and these were followed up by means of CT. Eight months after surgery, the fluid collec tions had resolved. Aggressive surgical treatment and antibiotic therapy have resulted in a successful outcome.
Aortoiliac Endarterectomy: Long-Term Follow-up and Surgical Reinterventions
Authors: Schiesari Alberto Previato , Rossato Domenico , Morelli Irene , Costa Francesco Dalla
Published: November 2007

The techniques for surgical revascularizations in aortoiliac arteriopathy have evolved remarkably in recent years. The authors have examined their personal experience of 47 selected endarterectomies performed between 1973 and 1992. The favorable results of this type of revascularization are highlighted, together with the significant amount of medium- and long-term redo procedures and the ever-narrowing field of application of such a technique.
Assessment of Laser Doppler Flowmetry During Abdominal Aortic Aneurysmectomy
Authors: Kouchi Yasuhiro , Esato Kensuke , Fujioka Kentaro , Toyota Syuji , Seyama Atsushi , Zempo Nobuya
Published: November 2007

The purpose of the present study was to assess the diagnostic utility of blood flow measurements at the sigmoid colon by laser Doppler flowmetry.

Methods: A laser-Doppler flow probe was placed in contact with the serosa of the sigmoid colon in 41 patients undergoing resection of infrarenal abdominal aortic aneurysms. Blood flows were measured before aortic clamping, after reconstruction, and after inferior mesenteric artery revascularization.

Results: The authors observed a colonic blood flow greater than 18 mL/minute/100 g in all the patients who did not develop postoperative ischemic colitis.

Conclusions: The colonic blood flow needed to prevent postoperative ischemic colitis is greater than 18 mL/minute/100 g. The assessment of blood flow at the sigmoid colon by laser Doppler flowmetry is useful for predicting postoperative ischemic colitis.
Retroperitoneal "Mini" Approach for Aortoiliac Reconstructive Surgery
Authors: Weber G. , Jako G.J.
Published: November 2007

The large vertical midline or transverse transperitoneal approaches used in the conven tional aortoiliac reconstruction are accompanied with a relatively high postoperative morbidity and mortality rate (2% to 5%), even in patients who are good risks under going aortic surgery. The purpose of this study was develop a new technique for aorto bifemoral bypass operation to minimize the operative stress on these patients.

Methods: The recommended left paramedian or transmuscular retroperitoneal approach, using 5-6 cm skin incision and a special retractor with three-dimensional vision and with modified surgical instruments directly under eye control, offers the possibility of decreasing the operative stress significantly and of sufficiently controlling the serious bleeding that might occur. If necessary, this exposure can be immediately converted to a conventional approach by simple enlargement of the incision.

Results: In the authors' first cases the functional results were very good, and conse quently, hospitalization time and the convalescence period were short.

Conclusion: This minimal access approach appears to diminish the catabolic response, and it is hoped that it will be associated with accelerated recovery and virtual abolition of large wound-related complications. It could become the procedure of choice for selected patients with obstructive or aneurysmal aortoiliac disease.
Development of a Transfemorally Delivered Endovascular Graft for Treatment of Aortic Aneurysms in a Canine Model
Authors: Gillespie David L. , Arbid Elias J. , Faxon David P. , Cody Colleen , Menzoian James O.
Published: November 2007

Advances in the treatment of atherosclerotic disease by transluminal angioplasty and intra-arterial stenting have led to the development of a transfemoral endovascular approach to the treatment of aortic aneurysmal disease. The authors investigated this technique using an endovascular graft employing self-expanding anchors for the exclusion of infrarenal aortic aneurysms.

They investigated the technique of transfemoral endovascular aortic grafting in 13 male mongrel dogs weighing an average of 30 kg. Eleven animals had fusiform infrarenal aortic aneurysm models created. One week to three months after surgery all animals underwent midstream aortography under general anesthesia to examine aneurysm morphology. A 14 French catheter was introduced through the right common femoral artery, and under fluoroscopic guidance the endovascular graft was delivered in an infrarenal aortic position. Completion aortography was then performed to confirm placement.

They tested two endovascular graft prototypes. The first employed a proximal anchor attached to the graft and a separately delivered distal anchor. Successful graft delivery was achieved in five of six attempts. Unsuccessful graft delivery occurred in 1 case because of an inability to negotiate aneurysm tortuosity. After delivery graft twisting occurred in 1 case and graft invagination occurred in 2 others upon the attempt to deliver the distal anchor. Successful exclusion was achieved in 3 of 4 remaining cases with an aneurysm model using this prototype. The second prototype employing proximal and distal anchors attached to the graft was successfully deployed in seven of seven attempts. Successful aneurysm exclusion was achieved in 5 of these 7 cases. Failure to exclude the aneurysm neck occurred in 2 cases.

In this preliminary study the authors found the concept of endovascular delivery of a self-anchoring tube graft to be feasible. The optimal delivery system is flexible and possesses a small outer diameter to allow a transfemoral approach through moder ately tortuous iliac arteries. Accurate delivery is aided by intermittent fluoroscopic examination. Doubly anchored grafts are necessary to ensure aneurysm exclusion and prevent graft twisting. Self expanding anchors allow simple endovascular graft deploy ment in a single pass. Continued animal investigation into the fate of aortic side branches, distal embolization, and graft migration is necessary to ensure the eventual success of this technique.
Prospective Study by Ultrasonography of Abdominal Aortic Diameter in Atherosclerosis of the Lower Limbs—The Role of Atheromatous Disease
Authors: Brivady André , Normand Bernadette , Fabry Régine , Pochon Philippe , Cheynel Jean
Published: November 2007

The diameter of the infrarenal abdominal aorta was measured by ultrasonography B- mode scan in 1,413 surgically intact patients with atherosclerosis of the lower limbs. There was a similar increase in abdominal aortic diameter with age in both sexes. Pathologic diameter in men patients was recorded mainly after sixty years of age: in women patients it was observed after the age of seventy. The major risk factors for aortic aneurysm in atherosclerosis obliterans of the lower limbs are smoking, hyperlipidemia with elevated levels of cholesterol, and all three factors combined in association with hypertension. Abdominal aortic diameter was only significantly affected by iliac stenosis.
Vertebrobasilar Dissection in a Duplicated Cervical Vertebral Artery: A Possible Pathoetiologic Association?
Authors: Dare Amos O. , Chaloupka John C. , Putman Christopher M. , Mayer Peter L. , Schneck Michael J. , Fayad Pierre B.
Published: November 2007

A thirty-eight-year-old man with extensive spontaneous vertebrobasilar dissection in asso ciation with duplication of the ipsilateral proximal vertebral artery is described. He had no relevant medical history. The development of a spontaneous arterial dissection in a duplicated arterial system suggests a pathoetiologic association that may further expand the list of cerebrovascular pathology occurring with fenestration/duplications.
Lumbosacral Plexopathy: A Complication of Ruptured Aortoiliac Aneurysms
Authors: Robinson Kevin D. , Gregory Roger T. , Gayle Robert G. , Parent F. Noel , Demasi Richard J. , Wheeler Jock R.
Published: November 2007

Although rare, neurologic injuries associated with infrarenal aortic and iliac artery surgery are devastating and associated with high mortality and morbidity. The authors reviewed their ten-year experience with 738 infrarenal aortic and iliac artery aneurysm repairs, 341 aortoiliac bypasses for occlusive disease, and 15 reoperations for infected aortic prosthesis to identify patients who suffered lower extremity neurologic deficits. Three patients, all following ruptured aneurysms, suffered injuries to the lumbosacral plexus during the study period. No injuries to the spinal cord were diagnosed. These cases are described, and the diagnosis, prognosis, and potential etiologies and prevention are discussed.
Minimally Invasive Vein Harvesting: A Comparison of Endoscopic Versus Traditional Open Saphenectomy
Authors: Matsuura John H. , Dattilo Jeffery B. , Poletti Lawrence F. , Cohen I. Kelman , Posner Marc P. , Makhoul Raymond G.
Published: November 2007

The greater saphenous vein (SV) is the conduit of choice for coronary and infrapopliteal revascularization procedures. Unfortunately, to harvest an SV it is often necessary to make an incision the length of the leg, and this is associated with a significant incidence of wound complications. Minimally invasive procedures have several advantages including reduced incidence of wound complications, decreased hospital length of stay, and, therefore, health-care savings. Currently, little information is available that compares traditional open saphenectomy (OS) versus a minimally invasive procedure, endoscopic saphenectomy (ES). The purpose of this study was to compare SV harvest time, incision length, and harvested vein quality between the OS and ES techniques in six nonpreserved cadavers.

Each limb was randomly selected for either OS or ES. The length of incision, number of SV leaks after harvest, length of SV, and time required for harvest were recorded for each technique. (continued on next page)

The table summarizes the findings of the cadaver dissections.

Per limb, no difference was noted in vein harvest length or number of leaks between OS and ES. A significant reduction was found in incision length for ES (14.4 ±1.4 cm per limb), but the time required for OS was significantly shorter (P=0.01).

This study suggests an equivalent length of SV can be harvested with either OS or ES techniques; however, with the ES technique there is a reduction in incision length and, therefore, a less morbid operative technique.
Evaluation of Pressure Gradients and Variability Following Unna Boot Application
Authors: Molina Hector G. , Chung Jiyearn , Cabellon Paul C. , Simsir Sinan A. , Kohlman-Trigoboff Debra , Smith Bruce M.
Published: November 2007

The authors evaluated subbandage pressures generated by a standardized compression bandaging technique. Subbandage pressure was determined following paste-gauze appli cation to an artificial leg by use of air-filled bladders coupled to a pressure transducer. Mean pressures and ankle-to-knee pressure gradients were calculated. The mean vari ability in pressure at each position was also determined.

Mean pressures in torr (±SD) along the leg are shown in the table (n=27). Mean knee pressures were significantly less than those at the ankle on the medial and lateral sides of the leg (P<0.004 and P<0.02, respectively). Variations in pressure generated by each wrapper over three trials were not significant.

A three-layered compression bandaging technique was used to create a moderate pressure gradient from ankle to knee. The effectiveness of compression bandaging does not necessarily depend on the generation of high subbandage pressures.
Banking and Distribution of Large Cryopreserved Arterial Homografts in Brussels: Assessment of 4 Years of Activity by the European Homograft Bank (EHB) with Reference to Implantation Results in Reconstruction of Infected Infrarenal Arterial Prostheses and Mycotic Aneurysms
Authors: Goffin Y.A. , Grandmougin D. , Wozniak G. , Keppenne V. , Nevelsteen A. , Vogt P. , Van Damme H. , Stankowiak C. , Dapper F. , De Geest R. , Deuvaert Fr. , Van Hoeck B.
Published: November 2007

In 1991 European Homograft Bank (EHB) initiated a program of cryopreservation and distribution of large arteries to meet a new demand for quality-controlled arterial homo grafts of various sizes. From May 1991 to June 1995, 308 arteries have been registered from 136 donors: 122 brain death cases and 14 cadavers (mean age 34 years, male/female ratio 1.52/1); 263 arteries were cryopreserved (113 aortas, 64 aortic bifur cations, and 86 femoral); 19 were discarded for atherosclerosis (6.7%); 10 batches of arteries were partially or totally discarded because of persistent contamination and further eight batches for positive or doubtful viral serology. One hundred patients were treated in nine European centers with one (N = 69) or more EHB homografts. Indications were: infected prosthesis 70 (17 with aortoenteric fistula); mycotic aneurysm 19 (four ascending aortas, two with bronchial fistula); neoplastic infiltration of subrenal aorta one; extracardiac reconstructions/shunts 10. (continued on next page) (Abstract continued) Results from homograft reconstructions in infected prosthesis or mycotic aneurysm were available in 90 patients. There were 19 early deaths and 24 early complications, three were directly graft-related and included a fatal case of homograft rupture. Sixty- seven vascular cases were followed up from 1 month onward (mean: 16 months): 50 were uneventful; there were nine late deaths, of which two resulted from graft-related digestive hemorrhage; there were eight cases of late complications; three arteries were partly explanted as a result of focal thrombosis. Four patients were lost to follow-up. In the cases of aortoenteric fistula, however, the results were disappointing with only five late survivors of the 16 treated patients. Finally, these results show that cryopreserved arteries seem to perform as well in the midterm as the fresh ones.

Both the banking activity of cryopreserved homografts and the short- to mid-term performances of the implants in cases of prosthetic or native arterial infection are very satisfactory, provided no aortoenteric fistula is present. Cryopreserved arteries can also be used for extracardiac shunts and reconstructions.
Generalized Dilatative and Occlusive Vascular Disease: Inflammatory Arteritis or Juvenile Arteriosclerosis?
Authors: Bruns Ch. , Wolfgarten B. , Erasmi H. , Landwehr P.
Published: November 2007

In addition to generalized arteriosclerosis, connective tissue diseases, systemic necrotic arteritis, large-vessel vasculitis, and genetic metabolic diseases have been described as the cause of stenotic and aneurysmal vessel wall alterations. Although unusual, these must be considered in the diagnosis of a generalized vascular disease with arterial occlusion and aneurysm formation in order to determine the appropriate treatment procedure for the individual patient. Operative treatment should be avoided as long as possible for patients with Behçet's disease or Marfan's syndrome but is indicated for any kind of juvenile arteriosclerosis combined with arterial stenosis and dilatation. The patient described in this case report could be successfully treated surgically even though the cause of juvenile arteriosclerosis was inexplicable, and the local complications accompa nying the threatening rupture of the aneurysm could be controlled.
Surgical Correction of Innominate and Brachiocephalic Vein Occlusion from Radiation Therapy and Multiple Indwelling Portacatheters A Case Report
Authors: Sottiurai V.S. , Cooper Michael
Published: November 2007

Radiation-induced arteriopathy is more commonly encountered than venopathy. Total upper extremity venous tributaries' occlusion to the superior vena cava is extremely uncommon. This communication describes a simplified surgical management to enhance upper extremity venous return to the superior vena cava to resolve the incapacitating arm swelling and introduces the concept of a direct arteriovenous graft to a nonexpansive polytetrafluoroethylene (PTFE) graft to create a nonprogressive fistula requiring no future ligation and providing the Venturi effect. The direct arteriovenous fistula in central venous bypass has been proven efficacious and durable in previous studies.