bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular Thoracic Outlet Syndrome: Successful Outcomes with Multimodal Therapy
Authors: Coletta Joelle M. , Murray James D. , Reeves T. Roland , Veiling Thomas E. , Brennan Frank J. , Hemp James R. , Hall Lee D.
Published: September 2024

Purpose:

Vascular thoracic outlet syndrome (TOS) can present with signs of arterial impingement or, more commonly, as venous obstruction. In an effort to decrease morbidity associated with vascular thoracic outlet syndrome, we have used an aggressive multimodal treatment approach.

Methods:

Since November 1992, we have evaluated 29 patients with vascular thoracic outlet syndrome. Nine of ten patients with arterial thoracic outlet syndrome had first rib resections. Eighteen of 19 patients with venous occlusion underwent anticoagulation, thrombolysis, and first rib resection. Eight patients required additional endovascular therapy for persistent stenoses, either venous angioplasty alone (2) or angioplasty plus stent placement (6).

Results:

Follow up extends to 75 months with a mean of 24 months. Patients with stents have been followed for a mean of 38 months. Twenty-five of 28 patients managed with multimodal therapy were essentially asymptomatic at last follow up.

Conclusion:

Thrombolysis, anticoagulation, surgical decompression, and endovascular procedures act synergistically to improve results of therapy in patients with vascular thoracic outlet syndrome.
Preoperative Lipid Control with Simvastatin Reduces the Risk for Graft Failure Already 1 Year after Myocardial Revascularization
Authors: Christenson J.T.
Published: September 2024

Hypercholesterolemia is a recognized risk factor for development of atherosclerosis in both native coronary arteries and bypass grafts. Lipid-lowering therapy with statins is effective. Few data are available for studies on bypass grafts. The influence of hypercholesterolemia on development of bypass graft disease was studied.

Clinical and angiographic follow up 1 yr after CABG of patients with a preoperative cholesterol > 6.2 mmol/l, with a preoperative lipid control (group 2) or controls (group 1) and patients with cholesterol < 4.7 mmol/1 (group 3) were studied. Patient demographics, angiography and operation data were the same in all the groups.

Group 1 patients had significantly higher incidence of graft lesions, requiring more interventions than Group 2. Sequential vein bypass grafts showed superior features compared to single vein grafts.

Preoperative lipid control with statins is strongly recommended, since uncontrolled hypercholesterolemia has a direct impact on the outcome of CABG procedure. It significantly reduces the development of vein graft obstructive disease.
A Cheaper Substitute for Skin Closure in Open Sternum Technique
Authors: Metin Kivanç , Oto Öztekin
Published: September 2024

Delayed sternal closure is a life saving method in pediatric open heart surgery. We have used a sterile PVC bag sutured to two pieces of chest tubes to close the sternal defect. This is used as a cheaper substitute, which is available in every operating room which can be used as an alternative to PTFE or bovine patch closure.
Initial Results of Ultrasound Screening for Aneurysm of the Abdominal Aorta in Western Australia: Relevance for Endoluminal Treatment of Aneurysm Disease
Authors: Lawrence-Brown Michael M.D. , Norman Paul E. , Jamrozik Konrad , Semmens James B. , Donnelly Neil J. , Spencer Carole , Tuohy Raywin
Published: September 2024

Background.

Increased life expectancy in men during the last thirty years is largely due to the decrease in mortality from cardiovascular disease in the age group 29–69 yr. This change has resulted in a change in the disease profile of the population with conditions such as aneurysm of the abdominal aorta (AAA) becoming more prevalent. The advent of endoluminal treatment for AAA has encouraged prophylactic intervention and fuelled the argument to screen for the disease. The feasibility of inserting an endoluminal graft is dependent on the morphology and growth characteristics of the aneurysm. This study used data from a randomized controlled trial of ultrasound screening for AAA in men aged 65–83 yr in Western Australia for the purpose of determining the norms of the living anatomy in the pressurized infrarenal aorta.

Aims.

To examine (1) the diameters of the infra-renal aorta in aneurysmal and non-aneurysmal cases, (2) the implications for treatment modalities, with particular reference to endoluminal grafting, which is most dependent on normal and aneurysmal morphology, and (3) any evidence to support the notion that northern Europeans are predisposed to aneurysmal disease.

Methods.

Using ultrasound, a randomized control trial was established in Western Australia to assess the value of a screening program in males aged 65–83 yr. The infra-renal aorta was defined as aneurysmal if the maximum diameter was 30 mm or more. Aortic diameter was modelled both as a continuous (in mm) and as a binary outcome variable, for those men who had an infra-renal diameter of 30 mm or more. ANOVA and linear regression were used for modelling aortic diameter as a continuum, while chi-square analysis and logistic regression were used in comparing men with and without the diagnosis of AAA.

Findings.

By December 1998. of 19,583 men had been invited to undergo ultrasound screening for AAA, 12,203 accepted the invitation (corrected response fraction 70.8%). The prevalence of AAA increased with age from 4.8% at 65 yr to 10.8% at 80 yr (χ2 = 77.9, df = 3, P<0.001). The median (IQR) diameter for the non-aneurysmal group was 21.4 mm (3.3 mm) and there was an increase (χ2 = 76.0, df = 1. P<0.001) in the diameter of the infra-renal aorta with age. Since 27 mm is the 95th centile for the non-aneurysmal infra-renal aorta, a diameter of 30 mm or more is justified as defining an aneurysm. The risk of AAA was higher in men of Australian (OR = 1.0) and northern European origin (OR = 1.0, 95%CL: 0.9. 1.2) compared with those of Mediterranean origin (OR = 0.5, 95%CL: 0.4. 0.7).

Conclusion.

Although screening has not yet been shown to reduce mortality from AAA, these population-based data assist the understanding of aneurysmal disease and the further development and use of endoluminal grafts for this condition.
Results of 256 Consecutive Abdominal Aortic Aneurysm Repairs Using Extraperitoneal Approach
Authors: Igari T. , Hoshino S. , Iwaya F. , Satokawa H. , Midorikawa H. , Takase S. , Hoshino Y.
Published: September 2024

Two hundred and fifty-six consecutive abdominal aortic aneurysms were repaired using three approaches for extraperitoneal exposure of the aorta and iliac vessels from February 1990 through September 1998. The perioperative mortality rate was 3.1% in 228 elective repairs and 14.3% in 28 ruptured cases. The initial 23 cases were repaired using Sicard's method. The duration of endotracheal intubation was 1.0±2.8 h, alimentation initiation was 2.7±1.6 days, and narcotic requirements were 1.2±1.1 times. Following these initial cases, we employed Williams' method for 192 abdominal aneurysms, however; repeated incisional pain and three cases of deforming bulge led us to avoid dividing muscles. In the last 13 cases, our approach was performed without muscle dividing. The narcotic requirements decreased to 0.3±0.7 times. As for postoperative complications, the larger skin incision approach had no shower embolism. However, the shorter skin incision had four cases of shower embolisms, one lymphorrhea and one vascular trauma by the aortic clamp. The extraperitoneal approach offers certain physiologic advantages with minimal disturbance of gastrointestinal and respiratory function. We believe that this method is useful for rapid approach to the proximal aorta in case of emergency. Postoperative wound complications could be prevented via an oblique incision without muscle dividing.
Using Postoperative Cardiac Troponin-I (cTi) Levels to Detect Myocardial Ischaemia in Patients Undergoing Vascular Surgery
Authors: Andrews N. , Jenkins J. , Andrews G. , Walker P.
Published: September 2024

Background.

Cardiac complications occur commonly in vascular surgery patients. Diagnosis of cardiac complications is difficult because of the inaccuracies associated with traditional cardiac enzyme measurements. CTi. a highly sensitive and specific marker of myocardial injury, may be able to detect cardiac complications with greater ease and accuracy.

Methods.

The study prospectively examined 100 consecutive patients who underwent major vascular surgery between 6/7/98 and 31/12/98 at the Royal Brisbane Hospital. Daily measurements of cTi, creatine kinase (CK), creatine kinase MB (CKMB), CKMB index, renal function and haemoglobin were taken for three postoperative days. One postoperative electrocardiograph (ECG) was taken. An extensive cardiac history was taken. Intraoperative and postoperative events were recorded.

Findings.

There were 100 patients. 18 patients (18%) had a cTi elevation. On the basis of classical diagnostic criteria, 15 patients (15%) suffered one or more cardiac complication (either myocardial infarction, congestive cardiac failure, unstable angina or atrial fibrillation). One patient (1%) who had a cTi elevation died. CTi elevation occurred in five patients (5%) who were not diagnosed with cardiac complications based on traditional criteria. Despite not meeting specific diagnostic criteria for cardiac complications, all patients showed signs and symptoms that could be attributed to myocardial ischaemia. Every patient who developed congestive cardiac failure or atrial fibrillation had a cTi elevation. A Chi-square analysis revealed a significant association between cTi elevation and postoperative cardiac complications. Four variables contributed small but significant amounts of unique variance to the prediction of peak cTi on linear regression analysis. These were peak CKMB index, postoperative congestive cardiac failure, postoperative chest pain and postoperative cardiac complications.

Conclusions.

Routine cTi monitoring of postoperative vascular patients would be an effective and inexpensive way to detect patients with cardiac complications. The relationship between postoperative cTi elevation and significant coronary artery disease remains to be shown.
Surgical Repair of Anomalous Origin of the Coronary Artery from the Pulmonary Artery in Children
Authors: Malec Edward , Zając Andrzej , Mikuta Mirostaw
Published: September 2024

Objective:

To evaluate surgical management of children with coronary artery anomalies, including patients with rare abnormalities (left anterior descending artery or right coronary artery originating from the pulmonary artery).

Methods:

A retrospective review of eight patients (aged 2 months-10 yr; median 3.5 yr), treated for coronary artery anomalies between 1989 and 1999. Coronary vessels were reimplanted to the aorta in four children, while the remaining four were subjected to the Takeuchi procedure.

Results:

All children survived. None required mechanical circulatory support. In six patients significant mitral valve insufficiency developed, nevertheless, no intraoperative mitral valvuloplasty was performed. Follow-up was 2 months-10 yr. All patients developed normally and are currently in NYHA class I. Echocardiography revealed normal FS and EF values within 1–17 months postoperatively.

Conclusions:

In children with coronary artery anomalies, the best results are achieved with an early diagnosis and aggressive management. In our opinion coronary vessel reimplantation and the Takeuchi procedure yields comparable results.
Carotid Endarterectomy in Awake Patients with Contralateral Carotid Artery Occlusion
Authors: Karmeli R. , Lubezky N. , Halak M. , Loberman Z. , Weller B. , Fajer S.
Published: September 2024

Objectives:

Patients with severe stenosis of an internal carotid artery with contralateral occlusion (ICO) are at an increased risk for stroke, and therefore surgical treatment is usually recommended. Carotid endarterectomy (CEA) under regional anesthesia enables constant monitoring of neurologic status and selective shunting in cases of clinically evident cerebral ischemia. In this study, we assess the selective use of shunts based solely on changes in neurological status in awake patients with ICO undergoing CEA as well as their complication rates.

Methods:

During 1996–1998, we studied intraoperative findings and results of CEA under regional anesthesia with clinical monitoring of neurological status in two groups: (1) patients with stenosis (>70% by NASCET) and contralateral occlusion ( n = 50) and (2) patients with stenosis and no contralateral occlusion ( n = 94).

Results:

Shunt insertion was required in 42% of group 1, and 6% in group 2. All of the patients in group 1 requiring shunts had stump pressures <50 torr. The average stump pressure of group 1 (40 torr) was significantly lower than that of group 2 (75 torr), and was also lower than that of patients with severe contralateral stenosis (35 patients, 76 torr). Perioperative stroke rates were identical in both groups (2.1%).

Conclusion:

Since ICO patients are at a high risk for brain ischemia during ICA clamping, they require shunt insertion frequently. Patients with no contralateral occlusion require shunting at a much lower rate — even in the presence of severe contralateral stenosis. Regional anesthesia allows for early detection of brain ischemia and therefore, the perioperative results in both groups are similar.
Effect of Ischaemic Preconditioning, Cardiopulmonary Bypass and Myocardial Ischaemic/Reperfusion on Free Radical Generation in CABG Patients
Authors: Wu Zhong-Kai , Tarkka Matti R. , Eloranta Jussi , Pehkonen Erkki , Laurikka Jari , Kaukinen Liisa , Honkonen Eva L. , Vuolle Mikko , Kaukinen Seppo
Published: September 2024

Objective:

To investigate the free radicals (FR) generation after ischaemic preconditioning and cardiopulmonary bypass and during reperfusion in CABG patients, and the role of ischaemic preconditioning.

Methods:

Forty-three CABG patients were randomised into an ischaemic preconditioning and a control group. The protocol for ischaemic preconditioning was two cycles of 2-min ischaemia followed by 3-min reperfusion. Free radicals were measured using electron spin resonance spectroscopy. Global and right heart functions were collected.

Results:

The free radicals generation in coronary sinus blood in the ischaemic preconditioning group was 9.7 and 16.6% after the ischaemic preconditioning protocol and 10 min after declamping, 6.8 and 13.3% in the controls. The free radicals in arterial samples were, respectively, 21, 14, 10 and 9% at 10 min, 1, 2 and 24 h after reperfusion. Cardiac index (CI) and right ventricular ejection fraction (RVEF) were improved by ischaemic preconditioning.

Conclusion:

Both ischaemic preconditioning and cardiopulmonary bypass induced free radicals generation. Although ischaemic preconditioning had no effect on free radicals generation after the operation, it protected against postoperative stunning.
Tricuspid Regurgitation Secondary to Mitral Valve Disease: Tricuspid Annulus Function as Guide to Tricuspid Valve Repair
Authors: Colombo Tiziano , Russo Claudio , Ciliberto Guglielma Rita , Lanfranconi Marco , Bruschi Giuseppe , Agati Salvatore , Vitali Ettore
Published: September 2024

Methods.

A prospective analysis was performed on 50 patients (pts) with rheumatic mitral disease and associate secondary tricuspid insufficiency who underwent mitral valve replacement from January 1995 to December 1998. Surgical indication to tricuspid annuloplasty was considered in patients with echocardiographic tricuspid annulus diameter >21 mm/m2, regardless semiquantitative evaluation of tricuspid insufficiency. De Vega annuloplasty was performed in 33 out of 50 patients.

Results.

Hospital mortality was 2.0% (CL 0.3–3.6). The follow up of the discharged patients ranged from 3 to 48 months (mean 25±15.9). Three late deaths occurred (6.1% CL 2.8–9.2). Forty-two patients out of the 46 followed up (91.3% CL 84.9–93.8) were in I or II NYHA class. In eight patients (16.3% of discharged patients) the obtained result has been considered as ‘negative late results’: persisting moderate (three cases) or moderate-severe (five cases) Trl, together with congestive heart failure requiring a furosemide intake of >25 mg/day. No patients had severe Trl at follow up. The statistics analysis demonstrated the ‘preoperative fraction shortening of the tricuspid annulus’ ( P = 0.038) as factor predictive of late negative result. The incidence of late negative result was 57.1 % among patients with fractional shortening lower than 25% and 0% among those patients with fractional shortening greater than 25% ( P = 0.0001).

Conclusions.

The choice to treat the tricuspid insufficiency according to indexed tricuspid annulus dimension (>21 mm/m2) has been effective in terms of clinical efficacy and of late functional result. Fractional shortening of the tricuspid annulus, expression of right ventricular cardiomyopathy in patients with poorest prognosis, affects the postoperative evolution of tricuspid insufficiency.
Aortic Arch and Proximal Supraaortic Arterial Repair under Continuous Antegrade Cerebral Perfusion and Moderate Hypothermia
Authors: Jacobs Michael J. , de Mol Bas A. , Veldman Dirk J.
Published: September 2024

Purpose:

In this prospective study the clinical and neurological outcome of continuous antegrade cerebral perfusion (ACP) and moderate hypothermia was evaluated in patients undergoing ascending and aortic arch repair including reconstruction of the proximal supraaortic arteries.

Methods:

In 50 consecutive patients (mean age 47 yr, range 22–70) aortic arch and supraaortic arterial repair was performed: ascending aorta and aortic arch ( n = 34) and aortic arch and Bentall procedure ( n= 16). In 12 patients the distal anastomosis was performed using the elephant trunk technique. Test-clamping of the innominate artery for 3 min was performed under EEG-monitoring followed by the same procedure for the left carotid artery. Cardiopulmonary bypass was instituted and the innominate artery replaced by a polyester graft before antegrade perfusion was carried out through the graft. While cooling to 28–30°C, the left carotid artery was similarly treated with subsequent antegrade cerebral perfusion. The distal anastomosis was made at or beyond the left subclavian artery under circulatory arrest. During rewarming the innominate and carotid polyester grafts as well as the subclavian artery were anastomosed to the main graft, while antegrade cerebral perfusion was continued.

Results:

In 46 patients antegrade cerebral perfusion was achieved with a mean volume flow of 12 ml/kg/min and a mean arterial pressure of 54 mmHg. EEG-monitoring delineated stable and symmetrical recordings. In four patients antegrade flow (mean 15 ml/kg/min) and pressure (mean 65 mmHg) had to be increased to establish baseline EEG-recordings. The mean time of circulatory arrest was 18 min. The overall hospital mortality was 6%: two patients died from cerebral infarction and one patient suffered from a ruptured abdominal aortic aneurysm. Three patients (6%) developed a temporary neurological deficit which resolved spontaneously. Two patients (4%) developed renal failure requiring temporary hemodialysis. Pulmonary complications occurred in 12 patients (25%).

Conclusion:

Continuous antegrade cerebral perfusion via selective grafts to the innominate and carotid arteries offers adequate protection in patients undergoing replacement of the ascending aorta or aortic arch and great vessels. This technique allows radical repair and optimal vascular reconstruction without time restrains and avoids the necessity for profound hypothermia.
Aprotinin Reduces the IL-8 after Coronary Artery Bypass Grafting
Authors: Isbir C. Selim , Doǧan Riza , Demircin Metin , Yaylim Ilhan , Paşaoǧlu Ilhan
Published: September 2024

The effect of aprotinin, a protease inhibitor, on myocardial interleukin-8 (IL-8) production after ischemia-reperfusion injury was investigated. Twenty patients who had elective coronary artery bypass grafting were included in this study. Patients were randomly divided into two groups ( n = 10 in each). Group A patients received high dose aprotinin (20,000 IU/kg as pretreatment followed by 7500 IU/kg for 6 h) and Group B patients received normal saline as a control. Serum IL-8 levels after the termination of cardiopulmonary bypass (CPB) showed a significant improvement in aprotinin treated group compared to control group (70±42.6 vs 360.71±87.9 ng/ml) ( P<0.005). Levels were also significantly higher at post-operative 24th hour in patients who did not received aprotinin (340.16±92.10 vs 96.13±34.33 ng/ml). However at post-operative 48th hour levels were again higher in control (untreated) group, but the difference was not statistically significant (78.8±34.4 vs 42.8±9.29 ng/ml).

Aprotinin prevented the IL-8 release from myocytes in ischemia-reperfusion injury. The mechanism is highly dependent on anti-protease activity of aprotinin.
Sutureless Vascular Anastomosis: The VCS® Clip
Authors: Kirsch W. M. , Gupta S. , Zhu Y. H.
Published: September 2024

Non-penetrating, arcuate-legged clips facilitate vascular reconstructions and significantly reduce the incidence of anastomotic neointimal hyperplasia. Though originally developed as a microvascular-approximating instrument, by far the largest application has been for hemodialysis vascular access. Long-term studies comparing suture to clip for access creation have demonstrated the clear technical and biological superiority of the clip for this procedure. This “sutureless” vascular anastomotic technique is more demanding than conventional suturing, requiring precise vessel preparation and supervised training.
Endovascular AAA Repair in Patients with Renal Insufficiency: Strategies for Reducing Adverse Renal Events
Authors: Carpenter Jeffrey P. , Fairman Ronald M. , Barker Clyde F. , Golden Michael A. , Velazquez Omaida C. , Mitchell Marc E. , Baum Richard A.
Published: September 2024

Vascular imaging, usually employing nephrotoxic contrast agents is relied upon for all aspects of endovascular AAA repair causing some to consider renal insufficiency a relative contraindication. We sought to determine if endovascular AAA evaluation and repair could be successfully accomplished by minimally or non-nephrotoxic modalities.

Records and results for 98 consecutive patients undergoing endovascular AAA repair were reviewed. Patients requiring dialysis preoperatively were excluded ( N =3).

The average volume of iodinated contrast agent employed for intraoperative imaging was 152 cc (35–420 cc). Twenty patients (20%) had baseline renal insufficiency (serum creatinine ≥1.3 mg/dl). A rise in serum creatinine above baseline was observed in 23 (24%) patients following repair: for 15 (16%) this was permanent. Creatinine rise occurred in patients with both normal (15) and abnormal (8) baseline values ( P=0.09). Rise in creatinine was independent of contrast volume employed and of the use of infrarenal vs suprarenal device fixation ( P>0.05). Two (2%) patients required permanent dialysis, one of which had a normal baseline creatinine and unclear etiology for renal failure, the other had a baseline creatinine of 2 and required device placement over an accessory renal artery. Strategies to minimize the use of nephrotoxic contrast for patients with renal insufficiency included the use of MRA, rather than contrast-CT for pre and postoperative imaging (7. 35%) and use of Gadolinium rather than iodinated contrast for performance of intraoperative arteriography (5. 25%). Endovascular grafts were successfully designed and implanted based upon MRA as the sole preoperative imaging modality in every case in which it was attempted (7). Mortality was not significantly different between those with and without abnormal baseline renal function ( P>0.05). Adverse events (access failures, arterial injuries, blood loss, endoleaks) were not significantly correlated with baseline renal insufficiency, rise in creatinine from baseline, use of MRA or intraoperative Gadolinium angiography ( P>0.05).

Pre- and postoperative evaluation and performance of endovascular AAA repair can be accomplished in patients with renal insufficiency without increasing the rate of mortality or adverse events employing a strategy which minimizes the use of nephrotoxic contrast agents, relying upon Gadolinium arteriography and MRA. Endovascular grafts can be successfully planned and followed employing MRA as the sole imaging modality.
Wet Gangrene in Hemodialysis Patients with Calciphylaxisis is Associated with a Poor Prognosis
Authors: Davis Catharina A. , Valentine R. James
Published: September 2024

Calciphylaxis is a rare syndrome characterized by progressive vascular calcification and ischemic tissue loss in patients with chronic renal failure. We report our five-year experience with five patients who developed foot gangrene due to calciphylaxis. All five patients had characteristic clinical, laboratory, and radiologic findings of the disorder, but no diagnostic variable was uniformly present. All five had progressed to advanced gangrene at the time of surgical consultation. Despite aggressive local attempts to control infection, all five patients died of septic complications. Parathyroidectomy was performed in three patients but did not alter the course in any case. This small experience suggests that the outcome of foot gangrene associated with calciphylaxis is predicated on the degree of tissue loss. Aggressive local wound care does not appear to be adequate to control infection in patients who have already developed gangrene. Although parathyroidectomy may have important long-term advantages in patients with calciphylaxis, it does not appear to affect outcome in these advanced cases.
Effect of Retroviral Transduction of Canine Microvascular Endothelial Cells on β1Integrin Subunit Expression and Cell Retention to PTFE Grafts
Authors: Grandas Oscar H. , Costanza Michael J. , Donnell Robert L. , Reddick Tonya T. , Carroll Roger C. , Stevens Scott L. , Freeman Michael B. , Goldman Mitchell H.
Published: September 2024

This study evaluated the effect of retroviral transduction on canine microvascular endothelial cell (CMVEC) detachment from fibrin glue coated expanded polytetrafluoroethylene (ePTFE) graft material. CMVEC were isolated from adipose tissue by fluorescent activated cell sorting (FACS). Three treatment groups were evaluated: G-I, transduced CMVEC, selected in antibiotic G418 for 10 days ( n=5); G-II, CMVEC selected in G418 and recovered from selection for 4 days ( n=5): and G-III, control group of naive CMVEC ( n=6). 3H-thymidine labeled endothelial cells were seeded on fibrin glue coated four-mm diameter PTFE. Grafts were exposed to physiologic shear stresses of 16 dyn/cm2. Cell detachment was determined by 3H-thymidine counts in the circuit effluent. β1 integrin subunit expression was measured by flow cytometry. After 2 hours of flow exposure, G-I and G-II demonstrated significantly greater cell detachment rates compared with the control seeded grafts. Median peak channel β1 integrin subunit value for G-III CMVEC was 2311±481.7 vs. 31.5±4.51 and 26.3±2.0 in the transduced cell groups ( p=0.00043). Low β1 integrin expression correlated with flow induced high detachment rates of retrovirally-transduced CMVEC.
Beating Heart Myocardial Revascularization on Extracorporeal Circulation in Patients with End-Stage Coronary Artery Disease
Authors: Prifti Edvin , Bonacchi Massimo , Frati Giacomo , Giunti Gabriele , Proietti Piero , Leacche Marzia , Massetti Massimo , Babatasi Gerard , Sani Guido
Published: September 2024

Objectives:

To evaluate in a cohort of ESCAD patients (pts) the effects of on-pump/beating-heart versus conventional CABG in terms of early and mid-term survival and morbidity and LV function improvement.

Methods:

Between January 1993 and December 2000, 78 (Group I) ESCAD pts underwent on-pump/beating-heart surgery. Mean age in Group I was 66.2±6 (58–79), NYHA and CCS class were 3.2±0.6 and 3.3±0.4 respectively, Myocardial viability index 0.69±0.1 (%), LVEF (%) 24.8±4, LVEDP (mmHg) 28.1±5.8 and LVEDD(mm) 69.5±6. Group II consisted in 78 ESCAD patients undergoing conventional CABG selected in a randomized fashion from an age, sex, and LVEF corrected group of patients. Mean age in Group II was 65.7±5 (57–78). NYHA 3.1±0.7, CCS 3.4±0.8, LVEF(%) 25±5, LVEDP(mmHg) 27.9±4.4 and LVEDD(mm) 69.2±7.2.

Results:

Postoperatively, 5(7.7%) patients died in Group I versus 7(11.5%) patients in Group II ( P>0.1). CPB time resulted to be in Group II patients ( P=0.001) and the mean distal anastomoses per patient was similar between groups ( P=Ns). Perioperative AMI ( P=0.039), LCOS ( P= 0.002), necessity for ultrafiltration ( P=0.018) and bleeding>1000 ml ( P=0.029) were significantly higher in Group II. None of the Group I patients underwent surgical revision for bleeding versus 8(10.3%) patients in Group II ( P=0.011). At 6 months after surgery, the LV function improved significantly in Group I patients, demonstrated by an increased LVEF = 27.2±4(%)( P=0.001), lower LVEDP = 26.4±3(mmHg)( P=0.029) and LVEDD = 67±4(mm) ( P=0.004) instead of a lower LVEDD = 66.8±6(mm)( P=0.032) versus the preoperative data in Group II. The actuarial survival at 1, 3 and 5 yr were 90, 82 and 71% in Group I and 89, 83 and 74% in Group II ( P=Ns).

Conclusion:

In ESCAD patients who may poorly tolerate cardioplegic arrest, on-pump/beating-heart CABG may be an acceptable alternative associated with lower postoperative mortality and morbidity. Such a technique offers a better myocardial and renal protection associated with lower postoperative complications due to intraoperative hypoperfusion.
Autologous Fibrin Glue for Sealing Vascular Prostheses of High Porosity
Authors: Kjaergard H. K. , Weis-Fogh U. S.
Published: September 2024

Thirty high-porosity double-Velour vascular prostheses were sealed with fibrin glue, the fibrinogen in the glue being prepared from citrated plasma by ethanol precipitation. After such preparation the prostheses were blood-tight at a pressure > 300 mmHg. Using a fibrin concentration of 13 mg/ml (obtained by dilution of the fibrinogen solution) the prostheses were blood-tight at a minimum pressure of 150 mmHg, which is suitable for clinical use. Sufficient fibrin glue can be prepared from 44–88ml of the patient's blood to seal most types of high-porosity vascular prosthesis used clinically. The fibrin-sealed grafts have good handling characteristics because they are soft, pliable and non-sticky. The use of autologous fibrin glue has obvious safety advantages by preventing both transmission of viral diseases and immunological reactions.
Human Greater Saphenous Vein: Histologic and Ultrastructural Variation
Authors: Marin M. L. , Gordon R. E. , Veith F. J. , Panetta T. F. , Sales C. M. , Wengerter K. R.
Published: September 2024

This study describes the varied histologic features and ultrastructure of human saphenous veins obtained from patients undergoing infrainguinal arterial reconstruction. Portions of 30 remnant veins were fixed at arterial pressure (100 mmHg). Vein specimens were obtained from 13 men and 17 women, with a mean age of 70.2 years. Ten veins (33%) were from diabetic patients. Samples of fixed veins were prepared for light and electron microscopy. The luminal surface contained valves and redundant intimal folds at the site of ligated side branches. Microvalves were present at the orifices of several 1-mm vein tributaries. The endothelial cells lining the intima were often discontinuous and were aligned in a variable pattern. The thicknesses of the vein walls varied from 20 to 360 μm, with increased connective tissue matrix in the intima and medial layers of thick-walled veins. Some 10% of the veins demonstrated spindle cells in the intima; these cells had a smooth muscle cell phenotype and varied with respect to the degree of cellular differentiation. Regions of vein wall calcification were occasionally seen and were always present in association with a thickened vein intima. Variations in the structure of the saphenous vein from patients undergoing bypass surgery are common. The relationship between altered saphenous vein morphology and subsequent vein graft stenosis needs to be defined.
Recurrent Trichosporon Beigelii Endocarditis after Aortic Valve Replacement
Authors: Miralles A. , Quiroga J. , Farinola T. , Obi C. , Saura E. , Fontanillas C. , Granados J. , Benito M. , Calbet J. , Castells E.
Published: September 2024

Fungal endocarditis of the bioprosthetic heart valve, implanted in a patient without evidence of impaired immunity, is reported. Clinical manifestations of endocarditis appeared 7 years after aortic valve replacement for rheumatic disease and included embolization into the popliteal artery. Trichosporon beigelii was isolated from the cultured fragments of the embolus. Two valve replacements were performed because of recurrent infection during the following 4 years. In spite of prolonged antifungal therapy, the patient died from multiorgan septic involvement.
The Beginning of Stroke Prevention by Surgery
Authors: Eastcott H. H. G.
Published: September 2024

Normal variations in the crossflow capacity of the Circle of Willis, and the effects of disease upon this and on the thromboembolic potential of the cervical carotid, together account for the clinical unpredictability of strokes. These two factors form a recurring theme in the history of stroke studies, from 1664 with the publication of Cerebri Anatome, to the duplex and computer-assisted scanning techniques of today. The path followed by the discoverers is traced from Hippocrates to Moniz and Miller Fisher, to show how their work led directly to the technique of carotid endarterectomy.
Charles Rob, Alfred Nobel and Aphrodite: The Development of Surgery for Venous Thromboembolism
Authors: Eklöf B.
Published: September 2024

Charles Rob and the vascular surgeons at Strong Memorial Hospital have made significant contributions to the development of venology. Their impact on the surgical treatment of venous thromboembolism is emphasized. The technique for thrombectomy with temporary arteriovenous fistula is described. In a prospective randomized study from Sweden iliac vein patency was found in 76% of the operated group and 35% of the conservatively treated group after 6 months, and 77% versus 30%, respectively, after 5 years. A patent femoropopliteal vein with competent valves was found in 52% of the surgically treated patients compared with 26% of those treated conservatively after 6 months, and 36% versus 11%, respectively, after 5 years. Thrombectomy with temporary arteriovenous fistula is the author's method of choice to treat patients with acute iliofemoral venous thrombosis if the history of swelling of the thigh indicating iliac vein obstruction is less than 7 days' duration and the activity expectancy of the patient is more than 10 years.
The Evolution of Surgery for Renovascular Occlusive Disease
Authors: Stanley J. C.
Published: September 2024

Renal artery stenotic disease is the most common form of surgically correctable hypertension. Occlusive lesions of the renal artery are categorized as: arteriosclerotic, fibrodysplastic (intimal fibroplasia, medial fibrodysplasia, perimedial dysplasia) and developmental. The incidence of stroke, heart disease and renal failure has been reduced with contemporary drug management of hypertensive vascular disease, but similar salutary outcomes have not accompanied the medical treatment of renin-mediated renovascular hypertension. Selection of patients for operation implies documentation that a renal artery stenosis is of functional importance. Advances in the surgical management of renovascular hypertension have evolved over the past 50 years, such that carefully performed reconstructions benefit 85–95% of properly selected patients.
Left Main Coronary Artery Patch Plasty with Internal Mammary Artery
Authors: Suma H. , Amano A. , Nabuchi A.
Published: September 2024

Isolated stenosis of the left main coronary artery was surgically enlarged by patch angioplasty using a distal flap of the left internal mammary artery. The remaining proximal mammary artery pedicle was anastomosed to the anterior descending coronary artery as an in situ graft for security. The patient's recovery was uneventful, and postoperative angiography at 2 weeks showed good patency of both the left main trunk and the internal mammary artery graft.
Coronary Disease and Tracheal Stenosis with Tracheo-Oesophageal Fistula: A Combined Surgical Procedure
Authors: Wimmer-Greinecker G. , Gross Ch. , Mair R. , Klima U. , Harringer W. , Brücke P.
Published: September 2024

A patient with coronary disease class III of the New York Heart Association and tracheal stenosis with a tracheo-oesophageal fistula, which developed after long-term intubation, is described. As both conditions were symptomatic, an aortocoronary double bypass was combined with resection of the trachea and closure of the fistula. Postoperative recovery was uneventful and the patient is symptom-free after 3 years.
Lipomatous Hypertrophy of the Interatrial Septum
Authors: Basu S. , Folliguet T. , Anselmo M. , Greengart A. , Sabado M. , Cunningham J. N. , Jacobowitz I. J.
Published: September 2024

Lipomatous hypertrophy of the interatrial septum, a finding associated with obesity and advancing age, consists of accumulation of adipose tissue including fetal adipose tissue in the interatrial septum. It is a rare lesion of the heart and can reach notable size. A case is reported in which the diagnosis of lipomatous hypertrophy of the interatrial septum was established intraoperatively; the large bulk of the lipoma was such that it required major reconstruction of the interatrial septum and right and left atrial walls.
Comparison of Fluoropolymer Passivated Dacron and Polytetrafluoroethylene Grafts in a Sheep Model
Authors: Sardelic F. , Fletcher J. P. , Ao P. Y. , Bilous M.
Published: September 2024

The search for an optimal prosthetic vascular graft suitable for small vessels continues. The aim of this study was to compare a fluoropolymer passivated Dacron graft with a standard polytetrafluoroethylene graft. A sheep animal model was used. Under general anaesthesia a 5-cm length of 5-mm diameter graft was interposed into the left carotid artery. After an interval of 1, 2 or 3 months the sheep were reanaesthetized and a carotid angiogram performed before harvesting the graft. Graft patency was assessed by macroscopic inspection, angiography and histological examination. Overall, four of eight polytetrafluoroethylene grafts and three of ten fluoropolymer passivated Dacron grafts remained patent with similar patency rates at 1, 2 and 3 months. Histological examination of all available grafts showed evidence of fibrointimal hyperplasia. All but one of the occluded grafts had fibrointimal hyperplasia.
Outcome of Patients with Abnormal Ocular Pneuroplethysmographic Measurements Undergoing Coronary Artery Bypass Grafting
Authors: Matano R. , Ascer E. , Gennaro M. , Mohan C. , Acinapura A. J. , Jacobowitz I. , Cunningham J. N.
Published: September 2024

A total of 1780 patients without symptoms of cerebral ischemia undergoing coronary artery bypass grafting (CABG) were screened before surgery for carotid stenosis by pneumophlethysmography. An abnormal test was defined as a difference in ophthalmic artery pressures of ≥ 5 mmHg or ophthalmic-brachial pressure index ≤ 0.69. Some 99 patients (5.6%) had an abnormal ocular pneumoplethysmographic measurement (89 unilateral, ten bilateral). Of these, 26 patients underwent prophylactic carotid endarterectomy before CABG (group 1), while the remaining 73 patients had reconstruction without previous carotid endarterectomy (group 2). A total of 100 patients (group 3) with normal ocular pneumoplethysmographic results were used as controls. The three groups were comparable with respect to age, diabetes, hypertension, smoking and severity of coronary artery disease. Early (30-day) postoperative stroke rates were 0 and 4% ( n = 3) for groups 1 and 2 respectively, and 0% for group 3 ( P> 0.07). Early mortality rates after CABG for groups 1 and 2 were 4% ( n = 1) and 1% (n = 1), respectively and 2% ( n = 2) for group 3 ( P> 0.4). Late follow-up (mean 48 months) demonstrated stroke rates of 0% for group 1, and 10% and 4% for groups 2 and 3 ( P> 0.08). The early mortality and stroke rates in the ten patients with bilateral abnormal ocular pneumoplethysmographic values were 0 and 0%. However, late strokes occurred significantly more often (43%) in patients with bilateral abnormal results compared with those with unilateral abnormal findings when both groups did not undergo carotid endarterectomy ( P< 0.04). Thus, abnormal bilateral ocular pneumoplethysmographic measurements were more predictive of late stroke in patients undergoing CABG than abnormal, unilateral values.
Perfusion Defects in Vibration White Finger: A Clinical Assessment Using Isotope Limb Blood Flow
Authors: Greenstein D. , Parkin A. , Maughan J. , Kester R. C.
Published: September 2024

Vibration white finger is a vasospastic disorder caused by long-term exposure to vibration tools. In an attempt to assess the extent of obliterative vessel disease in this disorder, hyperaemic hand blood flow was measured using technetium-labelled human albumin and a γ camera. This method quantitates blood flow in ml/100ml of tissue per min in addition to providing a perfusion image used to assess vessel disease. A perfusion score is then given to this image to reflect the extent of disease. The results of this study demonstrate that 78% of patients with vibration white finger had evidence of organic vessel disease. Moreover, patients with advanced disease tend to be bilaterally affected. The use of this simple method is advocated to aid in the diagnosis of vibration white finger; this may be particularly important for medicolegal purposes.
Vertebral Arteriovenous Fistulas: A Study of 49 Cases and Review of the Literature
Authors: Vinchon M. , Laurian C. , George B. , D'arrigo G. , Reizine D. , Aymard A. , Riché M.-C. , Merland J.-J. , Cormier J. M.
Published: September 2024

The experience is reported with 50 vertebral fistulas treated by the authors in a joint radiological and surgical team. Of the 28 fistulas that were traumatic, 18 occurred after incidental iatrogenic puncture, and 22 were spontaneous, of which four presented in patients displaying angiographic features of fibromuscular dysplasia. Eleven patients were operated on and 33 had endovascular treatment. In nine patients who were either symptom-free or in poor health, no treatment was advised. The fistula was occluded in 38 (93%) of the treated patients, and the vertebral artery patency was preserved in 32 (78%). A total of 224 published cases were reviewed: 152 were traumatic, most after a penetrating injury; 72 were spontaneous, with three age peaks (at 7.26 and 52 years). Treatment has evolved considerably and endovascular occlusion is now the treatment of choice, surgery being reserved for specific indications.
Role of Bypass, Endarterectomy, Extra-Anatomic Bypass and Endovascular Surgery in Unilateral Iliac Occlusive Disease: A Review of 1257 Cases
Authors: Lorenzi G. , Domanin M. , Costantini A. , Rolli A. , Agrifoglio G.
Published: September 2024

Some 1257 patients who had undergone revascularization procedures for unilateral iliac occlusions were reviewed retrospectively. A total of 824 patients were operated upon using conventional operations, 165 patients had femorofemoral bypass and 268 were treated using endovascular surgery techniques. Revascularization was performed through an extraperitoneal approach by means of iliac thromboendarterectomy (560) or iliac femoral bypass (264) if there was a total occlusion of either the common or external iliac artery (group 1). A femorofemoral crossover bypass was inserted when the operative risk was considered to be high (group 2). Endovascular procedures (percutaneous transluminal angioplasty 234, laser percutaneous transluminal angioplasty 11, stenting 22, atherectomy one) were used in recent years to treat stenoses or occlusions of 3 cm or less (group 3). The indications for operation were severe claudication in 79.7% in group 1 and 92.6% in group 3, whereas in group 2 66.7% of patients presented with symptoms of more advanced ischaemia. The immediate patency rate was 97.0% after extraperitoneal reconstructive surgery. 96.9% in the femorofemoral group and 92.1% in patients having an endovascular procedure. The operative mortality rate was 0.7, 4.2 and 0.3% for groups 1–3. respectively. The 5-year patency rate, analysed by the life-table method, was 77.9% in group 1, 75.3% in group 2 and 73.7% in group 3 ( P= n.s., log rank test) The different revascularization techniques were chosen on the basis of the type of disease present and the patient's general condition. All procedures appeared to be effective when correctly selected.
Angiographic Findings of Silent Ischaemia following Aortocoronary Bypass Surgery
Authors: Lundbom J. , Myhre H. O. , Ystgaard B. , Tromsdal A. , Aakhus S. , Bjørnstad K. , Bolz K.-D. , Levang O. W.
Published: September 2024

Silent ischaemia, defined as ST-depression ≥ 1 mm without chest pain, was found on exercise testing in 22 (10.7%) of 206 patients who underwent aortocoronary bypass surgery in the period from March 1983 to November 1985. Exercise testing was performed 4.9 (range 3.6–6.7) years after operation on an electrically braked bicycle. Sixteen of the 22 patients were free from chest pain, while the remaining six had slight to moderate angina pectoris on exercise. Coronary angiography was performed in 21 patients with silent ischaemia; one of the 22 patients died before this investigation. Some 13 patients had one or more occluded grafts, one a new stenosis in a native vessel and five incomplete myocardial revascularization. For the remaining two patients, no aetiology for the ischaemia was found, and revascularization appeared to be complete. Before surgery, 13 patients had three-vessel disease, six two-vessel disease and three one-vessel disease. At follow-up, two patients had three-vessel disease, ten two-vessel disease and seven one-vessel disease. The value of identifying patients with silent ischaemia after aortocoronary bypass surgery with regard to life expectancy and quality is controversial. Subsets of patients, namely, those with main-stem stenosis and three-vessel disease, may benefit from secondary operation. Identification of these patients may therefore be of clinical importance.
Thoracic Aortic Aneurysmectomy with a Sutureless Intraluminal Ringed Graft
Authors: Tabayashi K. , Sai S. , Yoshida Y. , Akino Y. , Itoh Y. , Uchida N. , Ohmi M. , Mohri H.
Published: September 2024

Forty-two patients underwent replacement of the thoracic aorta with a sutureless intraluminal graft. Early and long-term results were evaluated. The operative mortality rate was 7.1 %. There were two postoperative complications related to a ringed graft. One complication, the formation of a pseudoaneurysm. was caused by insufficient fixation of the graft; the other, a cerebral infarction, was related to the location of the proximal anastomosis with respect to the origin of the left subclavian artery. The 3- and 5-year actuarial survival rates were 86 and 69.5%, respectively. These were similar to survival rates of age-matched controls in the general Japanese population. Replacement of the thoracic aorta using a sutureless Intraluminal graft can be performed with acceptable operative mortality, with good long-term results.