bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute and long-term outcome of silverhawk assisted atherectomy for femoro-popliteal lesions according the TASC II classification: a single-center experience
Authors: Sixt  , Rastan  , Beschorner  , Noory  , Schwarzwälder  , Bürgelin  , Schwarz  , Müller  , Hauk  , Brantner  , Möhrle  , Linnemann  , Macharzina  , Neumann  , Zeller
Published: February 2013

Background: Directional atherectomy (DA) has become popular in some centers to remove atherosclerotic plaques in femoro-popliteal lesions. Although immediate and also short - term outcome data are promising, solid long-term data are warranted to justify the widespread use in daily practice. Patients and methods: In this prospective study de novo and restenotic lesions of the femoro-popliteal segments were treated with the Silverhawk™ device. 161 consecutive patients (164 lesions) with peripheral artery disease (PAD) Rutherford classes 2 to 5 were included from June 2002 to October 2004 and October 2006 to June 2007 (59 % male, mean age 67 ± 11 years, range 40 to 88) and the outcome analyzed according to the TASC II classification. Results: DA alone was performed successfully in 28 % (n = 46), adjunctive balloon angioplasty in 65 % (n = 107) and stenting in 7 % (n = 11). The overall technical success rate was 76 % (124 / 164) and the procedural success rate 95 % (154 / 164). At 12 months primary patency rate was 61 % (85 / 140) and the secondary patency rate was 75 % (105 / 140) in the entire cohort, being less favourable in TASC D compared to TASC A to C lesions (p = 0.034 and p < 0.001, respectively). Furthermore the restenosis rate differed trendwise (p = 0.06) between de novo and restenotic lesions. Changes in the ABI and the Rutherford classes were significantly in favour of TASC A to C lesions compared to TASC D after 12 months (p = 0.004). The event free survival (MI, TIA, or restenosis) was 48 % at 12 months and 38.5 % at 24 months. Predictor for restenosis in the multivariable analysis was only male gender (p=0.04). Conclusions: The results in TASC D lesions are inferior to those in the lesser stages. DA of femoro-popliteal arteries leads shows a trend to better long-term technical and clinical outcome in de novo lesions compared to restenotic lesions.
Endovascular treatment of mycotic pseudoaneurysms
Authors: Vávrova  , Jonszta  , Czerný  , Hrbac  , Lipina  , Klement  , Procházka
Published: February 2013

The surgical correction of ruptured intracranial infectious pseudoaneurysms is associated with high morbidity and mortality. An endovascular therapeutic approach has been introduced recently. This treatment is, compared to surgical intervention, less invasive, faster, more effective and safer, thus making it a gentler option, particularly for pediatric patients. Lower morbidity and mortality have been achieved thanks to the combination of prolonged administration of antibiotics, coil embolization, and parent artery occlusion. Two pediatric cases of bleeding mycotic pseudoaneurysm treated successfully with fibered coil embolization and long-term antibiotics are dealt with in this manuscript.
Aortobifemoral embolism in an 18-year old patient following cisplatin and 5-fluorouracil chemotherapy for nasopharyngeal carcinoma
Authors: Heinrich  , Born  , Hoebert  , Verrel  , Simon  , Bode  , Fleischhack
Published: February 2013

After cisplatin / 5-fluorouracil chemotherapy for nasopharyngeal carcinoma, an 18-year female patient developed aortobifemoral embolism. Besides chemotherapy, additional risk factors for arterial thromboembolic events were smoking, contraceptive medication and adjuvant antiemetic treatment with dexamethasone. Thrombophilia screening was negative. Thromboembolic complications during or after cisplatin have been reported in a frequency of 17.6 % in lung cancer patients, and in 8.4 % of patients with germ cell tumors. The incidence of arterial thromboembolic events was 9.3 % and 1.7 %, respectively. The pathogenesis of cisplatin induced thromboembolism is thought to be caused by endothelial damage leading to endothelial cell dysfunction, increased von Willebrand factor plasma levels, and hypomagnesaemia.
Pseudoaneurysm of the popliteal artery due to osteochondroma of the distal femur
Authors: Sadeghi-Azandaryani  , Mendl  , Rademacher  , Hoffmann  , Steckmeier  , Heyn
Published: February 2013

Osteochondroma is the most common type of benign bone tumour, and is most often found in the knee region. The lesion is usually clinically silent although it may cause different complications such as fractures of the tumour, bone deformities, neurological disorders, malignant transformation and in rare cases vascular disorders. Vascular disorders include stenosis, occlusions, thrombosis, arteriovenous fistula and in rare cases pseudoaneurysm formation. A delay in diagnosis especially of pseudoaneurysm formation may result in life-threatening situations, extensive operations and lengthy hospital stays. We report the case of a 22-year-old woman with an osteochondroma of the distal femur which caused pseudoaneurysm of the popliteal artery.
Transforming growth factor-beta signaling pathway in Marfans syndrome: a preliminary histopathological study
Authors: Yuan  , Ma  , Zhang  , Jing
Published: February 2013

Background: Marfans syndrome is an inherited disorder that affects the connective tissue. It has been proposed that mutations of FBN1 gene or of transforming growth factor (TGF)-beta type II receptor may be responsible for its pathogenesis. However, the role of TGF-beta signaling pathway in the development of Marfans syndrome has not been comprehensively investigated. Materials and methods: Surgical specimens of the aorta were obtained from two female Marfan patients, and the control aortic tissue was taken from an autopsy of a healthy individual. The aortic specimens were examined with hematoxylin-eosin, Massons trichrome, von Gieson/victoria blue-van Gieson bichrome, and immunohistochemical stainings of TGF-beta1, TGF-beta type I receptor, Smad2/3, Smad4 and Smad7. Results: Hematoxylin-eosin staining demonstrated severe elastic lamellar disruption and patchy vascular smooth muscle dissolution in the aortic media of the Marfan patients. Collagen deposition, interlamilar elastic fiber fragmentation, loss or proliferation, and acid mucopolysaccharide accumulation were observed in the disarrayed aortic wall structures of Marfan patients by Massons trichrome, victoria blue-van Gieson bichrome, and Alcian blue and periodic schiffs (AB-PAS) stainings, respectively. By immunohistochemistry, structural disruptions with enhanced TGF-beta;1 in the cytoplasm, Smad2/3 in the interstices, Smad4 in the cytoplasm, nuclei or interstices, and OOO Smad7, in the nucleus along with attenuated TGF-beta type I receptor in the aortic tissues of Marfan patients in comparison to the healthy control. Conclusions: Marfan patients may have aberrant TGF-beta signaling pathway associated with increased collagen deposition, interlamilar elastic fiber degenerative changes, and acid mucopolysaccharide accumulation. The signaling dysregulation may play an important role in the pathogenesis of this genetic disorder.
Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?
Authors: Maras  , Tzormpatzoglou  , Papas  , Papanas  , Kotsikoris  , Kotsiou  , Maltezos
Published: February 2013

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.
EkoSonicSV endovascular system for recanalization of the basilar artery occlusion
Authors: Jonszta  , Czerný  , Skoloudík  , Böhm  , Klement  , Procházka
Published: February 2013

The interventional management of stroke may consist of the use of angioplasty, stenting or mechanical thrombus removal technique. For this purpose several retrieval devices are being used. Recently the new alternative device - EkoSonicSV has been introduced, which is particularly suitable for recanalization of the occluded basilar artery (BA). Here we are presenting a complete recanalization of BA using this device in two patients with stroke over a short period of time together with the intra-arterial use of recombinant tissue plasminogen activator and application of intravascular ultrasound.
Vascular anomalies in children
Authors: Weibel
Published: February 2013

Vascular anomalies are divided in two major categories: tumours (such as infantile hemangiomas) and malformations. Hemangiomas are common benign neoplasms that undergo a proliferative phase followed by stabilization and eventual spontaneous involution, whereas vascular malformations are rare structural anomalies representing morphogenetic errors of developing blood vessels and lymphatics. It is important to properly diagnose vascular anomalies early in childhood because of their distinct differences in morbidity, prognosis and need for a multidisciplinary management. We discuss a number of characteristic clinical features as clues for early diagnosis and identification of associated syndromes.
Intramural delivery of bortezomib inhibits restenosis following arterial injury
Authors: Gong  , Zhou
Published: February 2013

Background: Several studies have demonstrated that the proteasome inhibitors prevent restenosis following arterial injury. The proteasome inhibitor bortezomib shows anti-inflammatory and antiproliferative effects. Here, we evaluate the efficacy of bortezomib in inhibiting the restenosis following arterial injury and the effect on nuclear factor kappa B (NF-kappaB) and p27. Methods: An injured iliac artery rabbit model was established by balloon over-stretching. Rabbits were intramurally infused with bortezomib or normal saline by a transport coronary dilatation catheter in the bortezomib (n = 20) or control (n = 20) groups, respectively, and they were sacrificed on the 7th or 21th day following the arterial injury. Neointimal area was measured by computer analysis of photomicrographs, while expression of NF-kappaB and of p27 on day 7 were evaluated by Western blotting and immunohistochemistry, respectively. Results: Expression of p27 (56.10 ± 3.03% vs. 10.24 ± 0.60%, p < 0.05) was significantly higher while that of NF-kappaB (0.44 ± 0.02 vs. 0.70 ± 0.03, p < 0.05) was significantly lower in the bortezomib group than in control group on day 7 after arterial injury. Neointimal formation was significantly lower in the bortezomib group on day 21 after arterial injury (0.67 ± 0.03 vs. 1.30 ± 0.05 intima/media ratio, p < 0.05). Conclusions: Intramural delivery of bortezomib reduces neointimal formation, possibly via a mechanism involving upregulation of the p27 and downregulation of the NF-kappaB. Bortezomib therefore may be an alternative therapeutic approach for preventing restenosis.
Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years
Authors: Radak  , Babic  , Ilijevski  , Jocic  , Aleksic  , Gajin  , Tanaskovic  , Lozuk  , Otasevic
Published: February 2013

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.
Percutaneous transluminal angioplasty versus primary stenting in infrapopliteal arteries in critical limb ischemia
Authors: Brodmann  , Froehlich  , Dorr  , Gary  , Portugaller  , Deutschmann  , Pilger
Published: February 2013

Background: In endovascular recanalisation of infrapopliteal arteries, studies have already pointed out the value of balloon angioplasty, but for stent implantation very few randomized controlled data exist so far. Patients and methods: We conducted a randomized controlled prospective trial in patients with critical limb ischemia (CLI) comparing the effect of percutaneous transluminal ballon angioplasty (PTA) versus primary stenting in infrapopliteal arteries, concerning 1-year clinical benefit and reobstruction rate. Results: 54 patients were either randomized for primary stenting (balloon expandable stent) or PTA alone, 33 patients were assigned to the PTA group, 21 patients to the stent group. The whole follow up period of 12 months was completed by 46 patients. Improvement by at least one Rutherford classification was reached by a total of 33 (75.0 %) of patients at month 12, 22 (81.5 %) in the PTA group and 11 (64.7 %) in the stent group. A complete ulcer healing at month 12 showed 21 (63.6 %) of all patients, with a higher percentage in patients treated with PTA alone 16 (80.0 %) vs 5 (38.5 %). 50.0 % of all patients showed re-obstruction over the follow-up period, 39.4 % of the PTA and 66.7 % of the stent group. At month 3 primary patency rate was nearly equal in both groups (76.7 % PTA vs 75.0 % stent), but drifted apart with the duration of the follow-up period, with a primary patency at month 12 in the PTA group of 48,1 % vs 35,3 % in the stent group. As for secondary patency at month 12 the PTA group showed a patency rate of 70.4 %, vs 52.9 % in the stent group. Conclusions: Primary stenting with balloon expandable stents in the infrapopliteal arteries does not outway the benefit of PTA alone with the application of modern hydrophilic balloon catheters in patients with CLI.
Revascularization of carotid artery stenosis - a brief update on current evidence
Authors: Koennecke
Published: February 2013

Major and long-awaited trials comparing carotid endarterectomy (CEA) with carotid stenting (CAS) were published in recent years. Both, ICSS and CREST, documented a higher rate of periprocedural stroke and death in CAS, in particular in elderly patients, thereby confirming the results of prior trials and meta-analyses. In CREST, the composite endpoint included myocardial infarction (MI), which led to statistical equipoise between the treatment arms due to a higher rate of MI with CEA. However, whether MI is a relevant endpoint in trials for stroke prevention remains debatable. The stroke preventive benefit seems equally sustained after CEA and CAS, although the significance of restenoses, whose frequency is twice as high after CAS compared to CEA, is unclear in the long range. Emergent CEA in patients with clinically unstable carotid stenosis is associated with a very high complication risk, but the optimal treatment strategy for these patients remains to be elucidated. Recent evidence indicates a very low stroke risk of asymptomatic stenoses with intensive medical treatment, rendering revascularization almost unnecessary. The detection of microembolic signals on transcranial Doppler and rapid stenosis progression by duplex sonography might help to identify patients with higher stroke risk in whom revascularization is warranted.
Clinical application and technique of 64-slice spiral CT subtraction angiography in head and neck
Authors: Yang  , Huang  , Duan
Published: February 2013

Background: To discuss the technique of 64-slice spiral CT subtraction angiography (64-SCTSA) in head and neck, and evaluate its clinical application. Patients and methods: 84 patients suspected of head-neck vascular diseases were examined with 64-SCTSA. The examination techniques, image quality and clinical application were retrospectively analyzed, and the diagnoses of 64-SCTSA were compared with those of surgery or DSA. Results: Eighty-four subjects were successfully examined with 64-SCTSA, whose scanning and imaging parameters are effective. Image quality was excellent in 51 cases (60.7 %), good in 29 (34.5 %) and acceptable in 4 (4.8 %). In the 84 subjects, 79 cases were found abnormal in blood vessel (58 in head and 21 in neck), of which 57 were confirmed by surgical operation or digital subtraction angiography (DSA). Conclusions: 64-SCTSA is a feasible technique with satisfactory image quality and has the advantages of showing the lesions of vasculature without shelter from bone. It can improve the diagnostic accuracy in head-neck vascular diseases.
Arterial stiffness, inflammatory and pro-atherogenic markers in gestational diabetes mellitus
Authors: Salmi A. , Zaki M.N. , Zakaria  , Nor Aliza G. , Rasool H.G.
Published: February 2013

Background: This study aims to determine whether gestational diabetes mellitus (GDM) is associated with increased arterial stiffness, inflammatory and pro-atherogenic markers compared to age matched controls. Patients and methods: This is a cross-sectional study involving 53 pregnant women in the early third trimester of pregnancy consisting of 31 women with normal pregnancy and 22 women with GDM. Subjects were grouped into GDM and control groups based on modified oral glucose tolerance test results; they were considered GDM if fasting blood glucose (FBG) was >= 6.1 mmol/L and/or the two hours post-glucose intake was >= 7.8 mmol/L. Arterial stiffness was assessed non-invasively using the parameters augmentation index (AIx) obtained via pulse wave analysis and carotid femoral pulse wave velocity (PWV). Tumor necrosis factor alpha (TNF-alpha), high sensitivity C- reactive protein (hsCRP) and plasminogen activator inhibitor-1 (PAI-1) were measured using enzyme linked immunoassay technique (ELISA). Aortic and brachial blood pressure (BP) indices were also recorded. Results: Mean ages and gestational ages (GA) for the control and GDM groups showed no significant differences (31.1 ± 5.68 vs. 32.9 ± 8.46 years; 29.0 ± 2.43 vs. 29.6 ± 1.54 weeks respectively). FBG and 2 hour post-glucose levels were significantly higher in GDM; (5.27 ± 1.19 vs. 3.94 ± 0.44 mmol/L, p < 0.001; 9.66 ± 1.76 vs. 5.68 ± 1.10 mmol/L, p < 0.001). TNF-alpha, PAI-1 and hsCRP levels were significantly higher in GDM compared to controls (0.81 ± 0.15 vs. 0.72 ± 0.13 pg/ml, 54.48 ± 13.07 vs. 36.16 ± 15.58 cm/ml, 7.91 ± 1.16 vs. 6.70 ± 1.45 mg/l respectively). PWV (8.28 ± 1.48 vs. 7.97 ± 1.12) and AIx (16.73 ± 10.98 vs. 16.13 ± 9.64 %) were not significantly different between the two groups. No significant differences were seen for aortic and brachial BP, mean arterial pressure and body mass index. Conclusions: The inflammatory markers TNF-alpha and hsCRP, and the pro-atherogenic marker PAI-1 were elevated in GDM compared to age matched controls. No significant difference was seen between the two groups in their arterial stiffness.
Doppler-Ultrasound measurements in renal allografts depend on the patients body position
Authors: Steubl  , Papachristou  , Wolf  , Roos  , Lutz  , Heemann  , Stock F.
Published: February 2013

Background: Due to anatomical reasons a position-dependent renal allograft artery stenosis is being discussed (e.g. only in patients upright position). The tortuous course of the allograft artery complicates the direct, angle-dependent measurement of maximum systolic flow velocities (vmax). So indirect signs such as intraparenchymal vmax and resistance index might be helpful, but it is unknown how these values change physiologically when patients body position changes. Patients and methods: We examined renal allografts of 60 patients (38 male, 22 female) with stable graft function using B-Mode-, colour-coded duplex-sonography and pulsed-wave-Doppler. We measured vmax and RI-values of three interlobar arteries in the cortex and allograft artery in the hilus in patients standing upright and in horizontal position. Corresponding values were analyzed for significant differences. Results: Intraparenchymal RI-values and vmax were significantly reduced in patients upright compared to the horizontal position (16 %, MW=0.59 vs. MW=0.70, p < 0.001 resp. 6 %, MW=30.18 cm/s vs. MW=32.17 cm/s, p = 0.045). Similar results could be detected in the renal hilus. Conclusions: Patients with stable graft-function show significant, position-dependent differences of the intraparenchymal and hilar RI-values and maximal systolic flow velocities. These changes of Doppler parameters has to be kept in mind for the correct diagnosis of a position dependent allograft artery stenosis.
Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence
Authors: Asciutto  , Lindblad
Published: February 2013

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.
Management of thoracic aortic lesions - the future is endovascular
Authors: Weidenhagen  , Bombien  , Meimarakis  , Geisler  , Koeppel A.
Published: February 2013

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the state-of-the-art treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.
Novel oral anticoagulants - key messages for the angiologist
Authors: Haas  , Spannagl  , Schellong M.
Published: February 2013

Novel oral anticoagulants (NOACs) have become available for different clinical indications such as the prevention of venous thromboembolism (VTE) after major orthopaedic surgery, for the treatment of VTE and stroke prevention in patients with atrial fibrillation (AF). One thrombin inhibitor (dabigatran etexilate) and two factor Xa-inhibitors (rivaroxaban and apixaban) are the most advanced NOACs and therefore, up-to-date information on their evidence and use in clinical practice appears timely. In this review we give a concise overview of the pharmacology and clinical evidence derived from phase 3 clinical trials. Then the meaningfulness of laboratory testing is discussed and recommendations are given for clinical scenarios that may necessitate adjustment of their use. We conclude that NOACs are valuable alternatives to heparins or vitamin K antagonists (VKA) in the prevention and treatment of VTE and for the prevention of stroke in patients with AF. Prescribers should however be aware of special situations and patient populations where the manufacturers instructions need to be carefully followed. In particular, patients with comorbidities and co-medications may require individual decision making in order to prevent bleeding complications.
Recurrent syncope caused by compression of internal carotid artery by an anomalous hyoid bone
Authors: Janczak  , Skora  , Rucinski  , Szuba
Published: February 2013

In rare cases a syncope can be caused by compression or irritation of the carotid artery and the carotid sinus due to congenital anatomical anomalies of cervical structures like the hyoid bone. We present the case a of 36 year old man with recurrent syncopes when turning his head. Clinical investigations revealed a hyoid bone anomaly with elongated lesser cornua, especially on the right symptomatic side. Surgical resection of the right lesser cornu led to complete resolution of symptoms over a two year follow-up. Syncope especially in younger subjects may be caused by congenital anomalies of the musculoskeletal system in the cervical region and should be considered in the differential diagnosis of syncope, transient cerebral ischemia and stroke.
Thrombembolic occlusion of crural arteries following transcatheter aortic valve implantation - successful endovascular recanalization using a thrombus aspiration device
Authors: Malyar M. , Kaleschke  , Reinecke
Published: February 2013

Transcatheter aortic valve implantation (TAVI) has become an increasingly used alternative to conventional surgical valve replacement in patients with severe aortic valve stenosis (AS) and high operative risk. We here describe a case of a TAVI performed in local anesthesia causing intraprocedural thromboembolic occlusion of non-stenotic crural arteries and its immediate successful therapeutic management by means of endovascular recanalization using a thrombus aspiration device.
Popliteal entrapment syndrome and age
Authors: Schweizer  , Hügli  , Koella  , Jeanneret
Published: February 2013

On the occasion of diagnosing a popliteal entrapment syndrome in a 59-year old man with no cardiovascular risk factors, who developed acute ischemic leg pain during long distance running, we give an overview on this entity with emphasis on patientsage. The different types of the popliteal artery compression syndrome are summarized. The diagnostic and therapeutic approaches are discussed. The most important clinical sign of a popliteal entrapment syndrome is the lack of atherosclerotic risk factors in patients with limited walking distance. Not only in young athletes but also in patients more than 50 years old the popliteal entrapment syndrome has to be taken into account.
Ventilatory threshold is related to walking tolerance in patients with intermittent claudication
Authors: da Rocha Chehuen  , Cucato G. , dos Anjos Souza Barbosa P. , Costa A. R. , Ritti-Dias M. , Wolosker  , de Moraes Forjaz L.
Published: February 2013

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.
Bailout directional atherectomy for side branch salvage following subintimal recanalization of infragenicular arteries
Authors: Airoldi  , Faglia  , Clerici  , Latib
Published: February 2013

A 64-year old diabetic male presenting with critical limb ischemia was treated with percutaneous angioplasty for occlusion of the infragenicular popliteal artery and crural vessels. Directional atherectomy was uncommonly used in the false lumen created by following subintimal angioplasty of the infrapopliteal vessels for re-access into the true lumen. The positive clinical and angiographic results indicate that atherectomy can be considered a useful tool for rescue interventions to reopen large side branches unintentionally occluded during subintimal angioplasty.
The chimney graft technique for preserving renal arteries in stent-graft sealing zones
Authors: Moulakakis G. , Papapetrou  , Giannakopoulos G. , Avgerinos D. , Kakisis  , Brountzos N. , Liapis D.
Published: February 2013

Patients with juxtarenal aneurysms require complex surgical open repair, which is associated with increased mortality and morbidity. An alternative procedure that can be used is the chimney graft technique. Three cases of abdominal aortic aneurysms were successfully treated in our department with this technique. One type-Ia endoleak occurred which was successfully treated with coiling and biological glue infusion. All of the chimney grafts have remained patent for the period of observation. The chimney technique has good results as a bail out procedure in complex EVAR or in well planned difficult cases. Long-term data is necessary to determine the efficacy of this technique.
The relationship between vitamin D deficiency and thoracic aortic dilatation
Authors: Demir  , Uyan  , Melek
Published: February 2013

Background: Vitamin D deficiency can play a role in cardiovascular conditions, such as coronary artery disease, heart failure and hypertension. Vitamin D deficiency can activate the renin-angiotensin-aldosterone system, which in turn affects the cardiovascular system. Thus, a relationship between vitamin D deficiency and thoracic aortic dilatation (TAD) and aneurysm could be postulated. In this study, we compared 25-OH vitamin D levels between TAD and control groups. Patients and methods: This study included 87 patients with TAD who were 40 - 70 years old. The control group consisted of 93 patients who were 40 - 70 years old and did not have TAD. A transthoracic echocardiography was performed on each patient. Along with routine tests, the 25-OH vitamin D and parathormone (PTH) levels were analyzed. Results: No statistically significant difference was found between the two groups regarding their basic characteristics. The average PTH level of the TAD group was higher than that of the control group (94.87 ± 44.96 and 66.39 ± 30.58 pg/ml, respectively; p < 0.001). The average 25-OH vitamin D level of the TAD group was lower than that of the control group (11.89 ± 7.54 and 15.98 ± 4.98 ng/ml, respectively; p = 0.001). The initial conventional echocardiographic parameters of both groups were comparable. Logistic regression analysis revealed that the PTH and 25-OH vitamin D levels were independent predictors of TAD. Conclusions: Vitamin D deficiency was found as an independent factor associated with TAD.
A case of upper extremity deep vein thrombosis due to Kikuchi Fujimoto disease
Authors: Belaj  , Gary  , Eller  , Deutschmann  , Beham-Schmid  , Gorkiewicz  , Brodmann
Published: February 2013

Kikuchi Fujimoto disease (KFD) is a rare form of lymphadeopathy with systemic symptoms. We present a case of a 31-year-old female farmer who was admitted to the emergency ward because of swelling of the left arm. Upper extremity venous thrombosis due to local compression of lymph nodes was diagnosed. The histological workup of lymph node biopsy showed histiocytic necrotizing lymphadenitis which is a typical sign of KFD. Anticoagulant treatment for the venous thrombosis was initiated. As KFD is often associated with a transition to systemic lupus erythematosus follow up visits are scheduled in our outpatient clinic.
Differences in patterns of peripheral arterial occlusive disease and eligibility for endovascular treatment
Authors: Zimmermann  , Arzt  , Wildgruber  , Schuster  , Wendorff  , Eckstein
Published: February 2013

Background: To analyze differences in morphological changes in the vascular tree among patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). In addition, suitability for endovascular treatment was evaluated. Patients and methods: Our study included 690 lower extremities with IC or CLI in 500 consecutive patients who were assessed by magnetic resonance angiography (MRA) according to the TASC II classification and in terms of the below the knee run-off status. Multivariable logistic regressions models adjusted for cardiovascular risk factors were used to evaluate differences in arteriosclerotic lesion patterns and eligibility for endovascular treatment. Results: Multivariable analysis showed that compared with IC extremities, CLI extremities have significantly more severe arteriosclerotic lesions at the aortoiliac (p < 0.001), femoropopliteal (p < 0.001), and crural levels (p < 0.001), with a greater risk of multilevel disease (odds ratio [OR], 1.71; 95 % confidence interval [CI] 1.10 - 2.66; p = 0.018). More than 80 % of extremities with IC and more than 50 % of extremities with CLI appeared to be eligible for endovascular treatment in an isolated evaluation of the aortoiliac and femoropopliteal axis. For combined evaluation of the aortoiliac and femoropopliteal axis, the proportion of endovascular suitability (TASC A+B lesions) decreased to 65 % (IC) and 41 % (CLI). For TASC A+B+C lesions, the proportions were 79 % (IC) and 41 % (CLI). Conclusions: Lower extremities with IC and CLI significantly differ in terms of arteriosclerotic lesion morphology and patterns of lesion localization. The majority of IC and CLI extremities appear to be eligible for endovascular treatment. Because of further improvement in endovascular equipment, even more patients will be eligible for treatment.
Entwicklung der Rolle der Advanced Practice Nurse in der stationären Langzeitpflege älterer Menschen in der Schweiz
Authors: Zúñiga Franziska , Jenni Giovanna , Wiesli Ursula , Schwendimann René
Published: February 2013

Durch die demografische Entwicklung mit einer zunehmend höheren Lebenserwartung steigt auch die Anzahl der pflegebedürftigen, älteren Menschen in den nächsten Jahren an. Diese Menschen sind oft von mehreren chronischen Erkrankungen sowie von altersbedingten Gesundheitsproblemen betroffen und bedürfen der Unterstützung durch professionelle Pflegedienste. Während die Anforderung an die pflegerische Expertise im Langzeitbereich steigt, besteht ein zunehmender Mangel an qualifizierten Pflegenden. Erfahrungen in anderen Ländern zeigen, dass auf Masterniveau ausgebildete Advanced Practice Nurses (APNs) in der stationären Pflege älterer Menschen eine Qualitätsverbesserung der Pflege ermöglichen. Ihre interdisziplinäre Ausrichtung und Orientierung an klinischen Ergebnissen tragen zur Weiterentwicklung ganzer Institutionen und der gerontologischen Pflege im Allgemeinen bei. Am Beispiel von pflegegeleiteten Praxisentwicklungsprojekten zur Verbesserung der Schmerzerfassung und -linderung wird die Entwicklung einer Advanced Nursing Practice in drei Pflegeheimen der deutschsprachigen Schweiz aufgezeigt. Anhand definierter Kompetenzen der APN wird ihre Rollenumsetzung beschrieben. Ihre Tätigkeit fokussiert dabei auf die direkte klinische Praxis, die Entwicklung einer evidenzbasierten Pflege, die Beratung von Pflegenden und die Förderung der interdisziplinären Zusammenarbeit. Die Aufgabenbereiche und Rollen von APN in der stationären Langzeitpflege lassen sich in Zukunft noch deutlich weiter entwickeln.
Advanced Nursing Practice (ANP) im direkten Pflegealltag: Die pflegerische Praxisentwicklung eines akutgeriatrischen ANP-Teams
Authors: Ulrich Anja , Hellstern Peter , Kressig Reto W. , Eze Germaine , Spirig Rebecca
Published: February 2013

Im Jahr 2000 startete das Institut für Pflegewissenschaft in Basel mit einem klinisch ausgerichteten Masterprogramm in Advanced Nursing Practice (ANP). Die mit einem Masterabschluss erlangte Pflegeexpertise beinhaltet vertieftes Wissen und Know-how in einem Spezialgebiet. Zusammen mit anderen Pflegefachpersonen entwickeln diese klinisch tätigen, wissenschaftlich- und praxisorientierten Advanced Practice Nurses (APNs) die Pflegepraxis in der Schweiz weiter, insbesondere für chronisch kranke oder geriatrische Patienten. Bis zu 25 % der über 80-jährigen Menschen erfahren jährlich mindestens einen Spitalaufenthalt. Neben dem akuten Einlieferungsgrund leiden sie oft an zusätzlichen chronischen Erkrankungen, welche gleichzeitig exazerbieren. Diese fragilen Patienten benötigen Unterstützung durch Pflegende, welche erweiterte gerontologische Pflege anbieten können. In der akutgeriatrischen Universitätsklinik Basel findet unter der Leitung einer APN eine systematische, kontinuierliche und effektive Praxisentwicklung statt, welche eine personenorientierte und geriatrisch-spezialisierte Pflege fördert. Die Prinzipien der Aktionsforschung leiten das Praxisentwicklungsprojekt. Der zyklische Prozess «Look-Think-Act» fördert die kritische Auseinandersetzung mit der Praxis. Erste Resultate zeigen eine kürzere Aufenthaltsdauer und verbesserte Betreuungsresultate bei den Patienten sowie eine erhöhte Arbeitszufriedenheit und Selbstwirksamkeit aus Sicht der Pflegenden. Mit dem vorliegenden Artikel wird die Geschichte von ANP kurz eingeführt und anschließend werden die Entwicklung und Einführung des Projekts sowie erste Resultate der Evaluation dargestellt.
Wie Angehörige von Patientinnen mit Demenz deren Aufenthalt auf einer Akutstation und ihre eigene Zusammenarbeit mit Fachpersonen erleben: Eine qualitative Studie
Authors: Nufer Theres Walther , Spichiger Elisabeth
Published: February 2013

Rund ein Drittel der geriatrischen Patientinnen im Spital leiden unter Demenz als Zweitdiagnose. Ein Spitalaufenthalt kann für solche Patientinnen negative gesundheitsbezogene Auswirkungen haben und für Angehörige zusätzliche Belastungen mit sich bringen, denn strukturelle und organisatorische Bedingungen erschweren oft eine demenzgerechte Pflege. Diese qualitative Forschungsarbeit untersuchte, wie Angehörige den Aufenthalt von Patientinnen mit Demenz auf einer akutgeriatrischen Station erlebten. Mit 12 Angehörigen wurden Interviews durchgeführt und mittels Inhaltsanalyse ausgewertet. Die Ergebnisse zeigten, dass sich Angehörige unabhängig vom Schweregrad der demenziellen Symptome um die Patientin sorgten: Findet sie sich zurecht? Trägt man ihren Bedürfnissen Rechnung? Angehörige fühlten sich in besonderem Maße verantwortlich. Sie schätzten das rehabilitative und pflegerische Betreuungsangebot, konnten dadurch meist Verantwortung abgeben und fühlten sich temporär entlastet. Die Zusammenarbeit mit Fachpersonen erlebten sie unterschiedlich: Erleichterung, wenn sie einbezogen und wertgeschätzt wurden, aber Ernüchterung beziehungsweise Enttäuschung, wenn sie sich nicht verstanden und übergangen fühlten. Für manche Angehörige hing die Qualität von Pflege und Zusammenarbeit von Einzelpersonen ab. Es empfiehlt sich, Maßnahmen, die von Angehörigen positiv erfahren werden, zu verstärken und für ganze Teams eine Kultur der bewussten Beziehungspflege und Zusammenarbeit mit den Angehörigen von Patientinnen mit Demenz zu entwickeln.
Bedarfslagen und Interventionsnotwendigkeiten für die betriebliche Gesundheitsförderung in der stationären Altenpflege
Authors: Faller Gudrun , Reinboth Christian
Published: February 2013

Der demografische Wandel führt nicht nur zu einem zunehmenden Bedarf an Altenpflegerinnen und -pflegern, sondern senkt gleichzeitig auch die personelle Verfügbarkeit von Arbeitskräften in dieser Branche. Anstrengungen mit dem Ziel, Gesundheit und Motivation des bestehenden Arbeitskräftepotenzials aufrecht zu erhalten, sind unumgänglich. Auswahl und Gestaltung von Interventionen setzen neben einschlägigem Wissen über subjektives Gesundheits- und gesundheitsrelevantes Belastungserleben auch Einsicht in organisationsbezogene Bedingungen und Einflussfaktoren voraus. Die vorliegende Studie analysiert am Beispiel eines Verbunds von sechs stationären Altenpflegeeinrichtungen und einer Seniorenwohnanlage entsprechende Zusammenhänge mittels einer Fragebogenerhebung. Als aussagekräftigster Gesundheitsindikator erwies sich Burnout. Der stärkste Prädiktor für Burnout bestand in einem konflikthaften Verhältnis von Arbeit und Privatleben. Zwischen verschiedenen Beschäftigtengruppen zeigten sich signifikante Unterschiede hinsichtlich der subjektiven Gesundheit. Vor diesem Hintergrund wird ein organisationsbezogenes Verständnis von Betrieblicher Gesundheitsförderung vertreten.
«Vom Interesse an vernünftigen Zuständen...» Bedeutung und konstitutive Elemente einer kritischen Theorie der Pflegewissenschaft
Authors: Friesacher Heiner
Published: February 2013

Pflegerisches Handeln bedarf einer theoretischen Grundlegung. Wie in jeder anderen Disziplin gehören Theorien zum Kernbestand der Wissenschaft. Sie ermöglichen die Bestimmung des Gegenstandsbereichs und die Entwicklung der Domäne der Pflege. Je nach Abstraktionsgrad, Reichweite und Art der Theorien haben sie sowohl handlungsleitende als auch orientierende und kritische Funktionen. Neben innerwissenschaftlichen Gründen dienen Theorien der Pflege, aber auch der Begründung und Legitimation nach «außen». Dieses ist umso wichtiger, je stärker auch von politischer und gesellschaftlicher Seite Forderungen und Erwartungen an die Pflege herangetragen werden. Der in dieser Arbeit vorgelegte Entwurf einer kritischen Theorie der Pflegewissenschaft versteht sich als partikulare gesellschaftskritische Theorie zum Aufzeigen von Repressionen und Defiziten in der pflegerischen Praxis (1). Er dient gleichzeitig der Begründung zur Erreichung vernünftiger Zustände. Die Theorie ist somit emanzipatorisch und normativ gehaltvoll. Eine kritische Theorie der Pflegewissenschaft lässt sich im Anschluss an Foucaults Machtanalytik und die Kritische Theorie der Frankfurter Schule als eine Kritik der Arbeits-, Verständigungs-, Anerkennungs-, Selbst- und Sozial-, Zeit- und der Naturverhältnisse explizieren.
Editorial
Authors: Käppeli Silvia , Meier Martha
Published: February 2013

(Aus Pflege Heft 1, April 1988)
Schulgesundheitspflege in Deutschland? - Eine Übersichtsarbeit zu Aufgaben und Rollen von School Nurses
Authors: Schmitt  , Görres
Published: February 2013

Seit vielen Jahrzehnten sind vor allem in angloamerikanischen und skandinavischen Ländern spezialisierte Pflegekräfte in Schulen tätig, die als sogenannte «School (Health) Nurses» die Kinder und Jugendlichen in allen gesundheitlichen Angelegenheiten betreuen. Diese Übersichtsarbeit widmet sich der Frage, welche konkreten Aufgaben und Rollen School Nurses im internationalen Kontext übernehmen und welche davon auch in Deutschland von entsprechend qualifizierten Pflegefachkräften ausgeführt werden könnten. Mithilfe einer systematischen Literaturrecherche wurden 34 Publikationen gefunden, die allgemeine Rollen- und Aufgabenbeschreibungen von School Nurses fokussieren. Insgesamt ließen sich elf zentrale Aufgabenbereiche identifizieren. Diese umfassen unter anderem die direkte pflegerische Versorgung bei Verletzungen, Notfällen, akuten oder chronischen Erkrankungen, präventive und gesundheitsförderliche Tätigkeiten, Information, Schulung und Beratung, die Erhebung gesundheitsbezogener Probleme und Bedarfe sowie die Entwicklung und Durchführung entsprechender Angebote und die Bereiche Kommunikation, Kooperation und Vermittlung. Mit Blick auf die positiven internationalen Erfahrungen erscheint die Einführung von School Nurses in Deutschland als vielversprechender Ansatz zur Förderung von Gesundheits- und Unterstützung von Bildungszielen. Das dazu benötigte Kompetenzprofil erfordert eine Zusatzqualifikation «Schulgesundheitspflege», die - basierend auf vorhandenen internationalen Curricula - auf Hochschulniveau angesiedelt sein sollte.
Die WHO-Pilotstudie zur Family Health Nurse in Deutschland: Sichtweisen von Familien zur Familiengesundheitspflege - Eine qualitative Untersuchung
Authors: Krüger  , Eberl  , Schnepp
Published: February 2013

In der vorliegenden Studie wurden Familien zu ihren Erfahrungen mit den ersten, in Deutschland nach dem WHO-Konzept der Family Health Nurse weitergebildeten, Familiengesundheitspflegenden und -hebammen (FGP/FGH) befragt. Die Weiterbildung befähigt dazu, Familien und Einzelpersonen niederschwellige pflege- und gesundheitsbezogene Angebote zu unterbreiten. Ziel war es herauszuarbeiten, inwieweit diese Fachpersonen die Familien unterstützen und ob das Curriculum der Weiterbildung Familiengesundheit auf die Bedarfe der Familien ausgerichtet ist. Im Rahmen der Evaluation wurden acht Familien, die aus unterschiedlichen Gründen Angehörige zuhause versorgen, mittels qualitativer Interviews befragt. Die Datenauswertung folgte der Methode von Burnard. Die Familien beschreiben unterschiedliche Unterstützungen der FGP/FGH wie «Pflege- und gesundheitsbezogene Tätigkeiten», Hilfen im «Alltagsmanagement» und Aktivitäten in Verbindung mit «Case-Management». Die Betreuung der FGP/FGH trägt zur Stabilisierung der Situation innerhalb der Familie bei. Die Analyse zeigt zudem, dass die Inhalte der Weiterbildung von den FGP/FGH berücksichtigt und angewendet werden. Insgesamt wird deutlich, dass Familien mit sehr unterschiedlichen pflegerischen, gesundheitlichen und sozialen Bedarfen von der Betreuung durch die FGP/FGH profitieren. Die familiäre und pflegerische Situation wird entlastet. Die Familien werden dazu befähigt, ihren Alltag zu bewältigen und neue Strategien zu entwickeln.