bluuebunny/crossref_metadata_2025 huggingface dataset:
Ascending Aorta To Bilateral Femoral Artery Graft
Authors: Chang John B. , Rao Gattu N. , Thomson Norman B.
Published: November 2007

This report presents a safe, simple method of bypassing the abdominal aorta in a patient in whom the infrare nal portion of the aorta is unusable for proximal grafting and in whom axillo femoral bypass grafting is contraindi cated. In our patient the standard aor tofemoral bypass was considered un wise because of previous abdominal surgery and an occluded infrarenal aorta. A left axillofemoral with femo rofemoral was ruled out in view of his left hemiparesis and probable need for subsequent left nephrectomy. A right axillofemoral grafting was not possible because of right subclavian artery ste nosis.
Conservative Management of Arterial Injuries in Infants and Young Children: A Preliminary Report
Authors: Samson I.D. , Schneider K.M. , Pasternak B.M.
Published: November 2007

This is a preliminary report of conservative management of iatrogenic arterial injuries in infants and children. Nonsurgical management was elected regardless of the initial presentation and degree of ischemia of the extremi ties, and the outcome was good in all patients. This approach is different from the management of such injuries in adults.
Autoregulation of Blood Viscosity in Health and Disease
Authors: Dintenfass L.
Published: November 2007

It is suggested that blood viscosity remains constant through the action of an autoregulatory mechanism. The sensors and control loops correspond to two types of viscoreceptors, one sensing blood viscosity in large vessels, and another red cell rigidity in small vessels. The presence of rigid cells leads to a decrease of hematocrit to a level corresponding to below-normal blood viscosity in order to compensate for the increased peripheral vascular resistance caused by rigid cells. A malfunction of the beta system will lead to, or contribute to essential hypertension. The structure of the sensors is unknown and one can only specu late on the possible modes of function.
Popliteal Artery Entrapment Syndrome: Report of 29 Cases
Authors: Bouhoutsos John
Published: November 2007

Twenty-nine cases of popliteal entrapment seen in 19 young adult males are reported. One case was iatrogenic in origin. The cases were divided into four groups according to pathology. Group A was associated with an abnor mal medial head of the gastrocnemius, Group B with an abnormal soleus or plantaris, and Group C with excessive hypertrophy of both heads of the gastrocnemius. The complex abnormality in Group D was associated with hypertrophied semimembranosus, with a lateral attachment of the medial head of the gastrocnemius, and with a low origin of the plantaris. In five cases the artery was thrombosed, whereas the remaining were diagnosed early. In the majority, diagnosis had to be confirmed by arteriography with the leg in a state of stress. It is suggested that the condition is more common than the few published cases would indicate.
Venous Thromboembolism Prophylaxis in the Surgical Patient
Authors: Conti Sebastian
Published: November 2007

A questionnaire designed to assess actual practice with regard to venous thromboembolism prophylaxis (VTEP) was mailed to 100 general surgeons. Although a majority (78%) of the respondents (n = 65) indicated that they used some form of VTEP, the methods used were inadequate to protect high-risk and moderate-risk patients from thromboembolic complications. Furthermore, pulmonary embolism was not perceived as a significant prob lem by most (64%) of the respondents who did not use prophylaxis.
Vasculogenic Impotence: A Review of 92 Cases With 54 Surgical Operations
Authors: Virag R. , Zwang G. , Dermange H. , Legman M.
Published: November 2007

A 2-year study of 92 cases of impotence involved 69 arteriographic confer ences and 54 attempts at revascularization. The authors emphasize the importance of studying organic impotency by noninvasive methods. Leakage of arterial filling of the cavernous bodies is the main disorder (76%), and it can be well assessed by Doppler ultrasonography and arteriography. The syndrome of unstable erection as a result of venous insufficiency is reviewed and a new operative procedure is proposed to re-establish sustained erections. The various procedures to revascularize the penis and their results are discussed. In 60% of the 54 impotent men who underwent surgery, the results were good.
A New Self-Anchoring Endocardial Electrode
Authors: Robicsek Francis , Tarjan Peter , Harbold Norris B. , Masters Thomas N. , Robicsek Steven A. , Ferrari Herbert A.
Published: November 2007

We describe a new electrode which uses the self-anchoring property of an ejectable dart to remain in permanent contact with the right ventricular myocardium. In longrange animal experiments, there were neither disloca tions nor mechanical failures. Both acute and chronic threshold measure ments, as well as sensing characteristics, remained acceptable. The experi mental lead was applied in a clinical case refractory to treatment by other electrodes.

The application of this dart-electrode appears to be indicated when elec trode instability occurs. Further well-controlled clinical trials appear to be necessary before it could be recommended for routine clinical use for all patients requiring transvenous pacemaker implants.
Pseudoaneurysm Formation in a Gore-Tex Graft Used for Hemodialysis
Authors: Wolfson Philip J. , Haimov Moshe , Slifkin Robert , Kaynan Arieh
Published: November 2007

Gore-Tex has become the graft material of choice for angioaccess in hemodialysis patients. We present the first report of a pseudoaneurysm arising at the puncture site of a Gore-Tex prosthesis.
Surgical Management of Patients in a Periodic Hemodialysis Program and Subjected to Cardiopulmonary Bypass
Authors: Burgos Raul J. , Rufilanchas Juan J. , Alvarez Lourdes , Montero Carlos G. , Campdera Francisco G. , Botella Julio , Figuera Diego
Published: November 2007

The surgical management of patients who were in a periodic hemodialysis program and were to be subjected to cardiopulmonary bypass is complex and requires special care.1, 2 We have managed 2 patients in the final stages of chronic renal failure who had to undergo surgical correction of cardiac disease. In both cases there had been previous cardiac surgery. The peculiar problems presented by these patients are discussed, as well as the surgical procedure used to prevent potential complications.
Limb Salvage after Massive Soft Tissue, Bone, and Vascular Injury from an Airplane Propeller—3-Year Survival with a Popliteo-Peroneal Saphenous Vein Graft
Authors: Taricco Alfred
Published: November 2007

A 33-year-old male pilot instructor was injured by an airplane propeller which resulted in massive injury to his right lower lateral leg, leaving in its wake a destroyed peroneal nerve, macerated muscle, open fractures of the tibia and fibula, and severe vascular injury. The latter involved complete transsection and destruction of the anterior tibial artery and the tibiopero neal trunk plus a laceration of the distal popliteal and proximal posterior tibial veins. After his arrival to the hospital he was treated for shock, underwent arteriography and reconstructive vascular surgery which resulted in limb salvage. Further surgery for skin grafting was required and he was discharged from the hospital six weeks after he was admitted and he was ambulating without aid.

Two years later his popliteo-peroneal saphenous vein graft continues to function and he performs all activities including sports with little difficulty. He requires no foot or leg brace and has no limp.

Leg injuries as a result of automobile, motorcycle, and hunting accidents along with war-related injuries are well known to all surgeons who deal with injuries of the extremities. However, an injury to an extremity from a rotating airplane propeller is most unusual as the following case report will reveal. Even more so is the fact that the leg was not traumatically amputated but had all of its vital arterial supply destroyed. Without reconstruction he would have had to go on to complete amputation by normal surgical means. The psychologic impact of such an injury is almost as severe as the physical injury and requires treatment as well.
FemoroPopliteal and FemoroTibial Arterial Bypasses for Limb Salvage
Authors: Chang John B.
Published: November 2007

Personal experiences with femoropopliteal and tibial artery bypasses to save limbs are reviewed. There were 315 consecutive bypass procedures in 249 patients over a period of 5 years and 6 months. Femoropopliteal bypasses were done with autogenous greater saphenous vein grafts in 102 cases and with PTFE (expanded polytetrafluoroethylene, Gore-Tex) grafts in 100 cases.

Femoropopliteal artery bypasses were done with superficial femoral vein grafts in three cases, with bank veins in two cases, and with arm veins in three. In two cases proximal bypasses were made above the inguinal ligament, and these were included in the series of femoropopliteal artery bypasses. There were 70 cases of femorotibial artery bypasses with autogenous greater saphenous vein grafts, two cases with arm veins, and 19 cases with PTFE grafts.

In seven cases sequential bypasses were done (femoropoplitealtibial arte rial bypasses) with autogenous greater saphenous vein grafts. In 15 cases popliteal-distal tibial artery bypasses were done with autogenous greater saphenous vein grafts. In 15 cases popliteal-distal tibial artery bypasses were done with autogenous greater saphenous vein grafts.

Accumulated patency rates at 5 years were 83% and 68.7% in femoropopli teal and femorotibial artery bypasses with autogenous greater saphenous vein grafts. The accumulated patency rates at 3 years were 83% and 22% in femoropopliteal and femorotibial artery bypasses with PTFE grafts.
Endarterectomy in the Absence of External Carotid Artery
Authors: Adar R. , Zweig A.
Published: November 2007

Carotid artery endarterectomy was performed in a patient with a rare anomaly of the carotid bifurcation. The external carotid artery was absent, and 3 branches originated from the internal carotid artery. Two other branches emerged from the area of transition of common to internal carotid artery. The arteriographic and surgical implications are briefly discussed.
Use of the Doppler Ultrasonic Flowmeter in Extracranial-Intracranial Arterial Bypass Surgery
Authors: Lichti Edgar L. , Watts Clark , Pulliam Morris
Published: November 2007

The Doppler ultrasonic flowmeter is a useful tool in extracranial-intracra nial bypass surgery for cerebrovascular disease. Its use in the pre-operative, intra-operative, and post-operative phases of treatment is described.
External Carotid Endarterectomy for Cerebral and Ocular Ischemia
Authors: Sekhar Laligam N. , Heros Roberto C. , Dujovny Manuel , Wolfson Sidney K. , Segal Ricardo
Published: November 2007

We are reporting a series of 8 patients in whom external carotid endarterec tomy was performed for ocular or cerebral ischemia or embolism. High quality cerebral angiography and noninvasive cerebrovascular studies were useful in the evaluation and the follow up of this group. These included 133Xenon cerebral blood flow measurements, ocular pneumoplethysmography, periorbi tal doppler ultrasonography and carotid phonoangiography. The follow up ranged from 3 months to 2 years. The complications included 2 postoperative common carotid artery occlusions, one of which was surgically reopened. There were no strokes or ischemic symptoms in the follow up period. Anatom ical, physiological, pathological and clinical data supporting the value of this operation are reviewed. The indications for external carotid artery endarterec tomy and the operative technique are discussed.
Arterial Dysplasia and Splenic Artery Aneurysms
Authors: Lie J.T.
Published: November 2007

The hazard of rupture of asymptomatic splenic artery aneurysms in preg nancy is well known. Arterial dysplasia is an important etiologic basis of splenic artery aneurysms in women of child-bearing age, as exemplified by the two cases described. In one patient, multiple splenic artery aneurysms oc curred in association with hypoplasia of the aorta and visceral arteries. In another patient, a false aneurysm of the splenic artery occurred with coexisting fibromuscular dysplasia of the renal arteries.
Myocardial Protection of the Homograft
Authors: Chartrand Claude , Parent Robert , Stanley Paul
Published: November 2007

Because of profound heart failure immediately after orthotopic transplanta tion, experiments were designed to evaluate the effect of induced ventricular fibrillation and initial cold coronary perfusion followed by the use of a cooling bag on the protection of the homograft during implantation and the subsequent improvement of its performance. Group I: 7 dog hearts immediately immersed in cold saline after resection were transplanted orthotopically. Group II: in 5 donors, after induced ventricular fibrillation and initial hypothermic coronary perfusion, the graft was isolated in a cooling bag until completion of surgical anastomosis. Both groups were prepared for hemodynamic studies which were carried out in the resting state 3, 24 and 48 hours postoperatively. In group I, myocardial temperature decreased to 12.5 within 13 minutes; afterward it rose rapidly to 25°C. In group II induced hypothermia was more rapid and more profound (11°C in 10 min); it was then maintained between 12° and 16.5°C with the cooling bag. Three hours post-op cardiac performance in group II was much higher than in group I as demonstrated by increases in CI (+69%), SVI (+98%), MSERI (+57%), PVI (+54%), MxAccI (+38%), SPI (+79%), SWI (+ 130%). Twenty-four hours after surgery, cardiac function had improved in both groups but remained superior in group II (CI + 44%), (SVI + 39%), (MSERI + 31%), (PVI + 27%), (SPI + 27%), (SWI + 39%). Forty-eight hours postoperatively, some of the data remained slightly superior in group II (CI + 20%), (SVI + 26%), (MSERI + 23%).
New Shunt for Carotid Endarterectomy
Authors: Rao Gopal
Published: November 2007

Carotid endarterectomy to prevent stroke in extracranial occlusive disease is an accepted mode of therapy. Although surgery for a totally occluded vessel is unsuccessful, for subtotal occlusion is very rewarding. There is a lot of controversy for the exact technique of surgery. Whether to use a local or general anesthesia is debated. The enthusiasm for adjuvant therapy to protect the brain during surgery with hypercarbia or normocarbia is equal among their proponents. There are equally good results by both usages of shunt and no shunters. 2 There are many kinds of shunts that are used, proponents of each claiming good results. My purpose is to report our experience with a new shunt that is used routinely and describing its advantages.
Femoral Blood Flow Determination with a Multichannel Digital Pulsed Doppler: An Experimental Study on Anesthetized Dogs
Authors: Marquis C. , Meister J.J. , Mirkovitch V. , Depeursinge C. , Mooser E. , Mosimann R.
Published: November 2007

Since Satomura first described an ultrasonic device using the Doppler effect to detect blood flow in 1959, more recent advances in medical engineer ing have met the need for non-invasive, quantitative measurement of blood flow in peripheral arteries.1 This goal can now be achieved with the use of a pulsed Doppler combined with an A-mode scan to estimate the angle of the ultrasound beam and the dimensions of the vessel.

Although several authors have already published data concerning blood flow volume obtained by continuous wave or pulsed Doppler devices in human peripheral arteries2,3,4 or in animal experiments,5,6,7 the accuracy of their meas urements was only correlated with indirect blood flow determinations such as electromagnetic flowmetry or venous occlusion plethysmography.

The present study compares the values of blood flow volume obtained by a Multichannel Digital Pulsed Doppler (MDPD) and by direct timed blood collec tion (DTBC) in the canine common femoral artery.
Effect of Vein Bypass Graft Diameter on Patency and Flow
Authors: Morishita Yasuo , Taira Akira , Poirier Robert A. , Terzian James A.
Published: November 2007

The purpose of this study was to examine the effects of vein graft diameter on graft patency and flow. In both legs of 12 dogs the (large) femoral vein and (small) lateral saphenous vein were bypassed onto their respective femoral arteries at identical levels. Graft flows and diameters were recorded, and early (10 days) and late (6 or 12 months) angiograms were performed. All 24 vein grafts were patent on both early and late studies. There was no statistically significant difference between large and small graft flows intraoperatively or at sacrifice (6 or 12 months). This study suggests that there is no advantage to the use of small calf veins over larger thigh veins for coronary artery bypass grafting.
Pulmonary Sequestration with Aneurysmal Anomalous Systemic Artery
Authors: Shuman Robert L. , Libby Glenn , Riker Jeffrey
Published: November 2007

Although pulmonary sequestrations are usually supplied by a large anomalous systemic artery, no previous report of aneurysmal change in this artery has been described. Our patient demonstrated a large aneurysm of the distal systemic artery which was filled with organized thrombus. Although both trauma and cystic medial necrosis could have been causative agents, both were ruled out and the etiology of this aneurysm formation remains speculative.
PTFE Prostheses in Leg Arteries Reconstruction
Authors: Cavallaro Antonino , Gallo Pietro , Sciacca Vincenzo , Garofalo Mariano , Sterpetti Antonio , Stipa Sergio
Published: November 2007

The authors report their experience of 67 consecutive patients submitted to reconstruction of the below-the-knee arteries by means of expanded PTFE (Gore-Tex) prostheses.

Results in terms of patency and limb salvage are not of absolute value owing to the lack of selection of patients, most of whom were at very high risk. However, a lower performance in comparison to autologous vein graft was evident.

A pathologic study of patent, occluded and infected grafts is presented: the high level of "biocompatibility" of such grafts is confirmed.

A high incidence of infection both of patent and occluded grafts was a relevant feature of the casuistic.
Intraluminal Application of Fibrinogen Adhesive by the Example of the Endarterectomised Pig Aorta
Authors: Rendl K.H. , Waldstein N. , Waclawiczek H.W.
Published: November 2007

The gluing of tissue with highly concentrated fibrinogen, designated in the following briefly as fibrin gluing, is a relatively old technique. Bergel already reported in 1909 on first trials of hemostasis with fibrin powder.1 In 1915, Grey used a fibrin solution prepared from sheep blood for hemostasis in intracranial operations.2 In 1944, Cronkite fixed skin transplants with a fibrinogen-thrombin mixture. Difficulties occurred with the adhesivity, probably in consequence of low fibrinogen concentrations.3 Since the ex perimental and clinical investigations of Spängler et al.,4,3 a large number of possible applications of fibrin gluing has been described.6-12
Papillary Endocardial Tumor: A Case Report
Authors: Vallejo José L. , Alvarez-Fernandez Emilio
Published: November 2007

A case of papillary endocardial tumor is reported. It was located in the proximity of the tricuspid valve ring and was diagnosed at surgery. The incidence and its different locations are pointed out. The origin of this type of tumor is discussed, as well as the surgical problems that its location and multiplicity present. Clamping of the aorta and mitral valve occlusion is recommended in order to prevent migration and embolization of tumor fragment.
Exclusion Bypass in Peripheral Vascular Surgery
Authors: Molina J. Ernesto
Published: November 2007

Although the technique of end-to-end proximal aortic anastomosis for peripheral bypass surgery has been widely accepted, the distal exclusion of the proximal native circulation has not been given much attention. Experimentally it has been shown that an end-to-end anastomosis at the distal end of the bypass graft has better hemodynamics and flows than an end-to-side. A group of 20 patients are reported here in whom a total exclusion bypass was carried out proximal and distally. One single case of aorto bifemoral is reported, 6 ileo-femoral, 12 femoro-popliteal, and 1 femoro-femoral bypass. Gortex grafts were used in all instances. Blood flows measured beyond the distal anastomosis show an increase in flow after the proximal native vessel is excluded completely at the distal anastomotic site. This technique, therefore, is advocated and recommended over the classic proximal and distal end-to-side anastomosis for ileo- femoral and femoro-popliteal bypass reconstructions.
The Effects of Adenosine Upon the Coronary Circulation Studied by Thermography. An Experimental Study
Authors: Robiscek Francis , Masters Thomas N. , Niesluchowski Witold , Born Gustav V. R.
Published: November 2007

If blood passes through extracorporeal circuits, platelets are activated even if the patient is fully heparinized.1 These activated thrombocytes begin to adhere, cluster, release their granular constituents, and within minutes of the institution of cardio pulmonary bypass a sheath of platelet and fibrin aggregates will line all components of the extracorporeal circuit.2,3,4 This process endangers the patient in two ways: (1) The lining of aggregates on the "down side" to the arterial filter may fragment and cause a shower of microemboli. (2) Intra-bypass platelet aggregation depletes the number of circulating thrombocytes, thus increases the possibility of post-operative bleeding.5,6,7
Evaluation of the Benefits of Intra-Operative Pre-Reconstructive Angiography
Authors: McAnena Oliver J. , Kiely Eamonn A. , O'Donnell Joseph A.
Published: November 2007

Intraoperative Pre-reconstructive Angiography (IPA) was performed on 32 extremities of patients with rest pain and/or gangrene. In all cases I.P.A. pro vided better visualisation of the distal arterial system. In 19 extremities (59%) the I.P.A. resulted in major changes in the proposed patient treatment and operation. We advocate I.P.A. in extremities requiring lower extremity bypass in whom pre-operative angiography fails to opacify or inadequately opacifies vessels below the knee.
Left Hand Hemiplegia Following Right Carotid Endarterectomy
Authors: Borrero Edgar , Chang John B.
Published: November 2007

The incidence of stroke in the perioperative period following carotid throm boendarterectomy has been reported to be 1% to 10%. 1,2,3 It is generally ac cepted that neurologic deficits result from temporary cerebral ischemia during carotid occlusion, reperfusion, emboli or carotid artery thrombosis. Contralat eral extremity weakness and parathesis have been reported lasting from one hour to a few days postoperatively. We would like to report a case of complete paralysis of the left hand following right carotid endarterectomy.
Extraluminal Varicose Vein Stripping with Endarterectomy Stripper
Authors: Al-Fallouji M.A.R.
Published: November 2007

A new technique of Extraluminal Varicose Vein Stripping using Martin En darterectomy Stripper is described. The procedure was performed as part of triple saphenectomy on 20 legs in 15 patients and proved to be safe, easy to perform and less time consuming.
Asymptomatic Carotid Bruits: Non-Invasive Screening A Five-Year Follow-up
Authors: Fritch Charles D. , Raskind Robert
Published: November 2007

Non-invasive procedures to screen patients with asymptomatic carotid ar tery bruits for angiography and surgery are now available. The use of Oculople tysmography (OPG) and Phonoangiography (PA) in 1120 arteries in 560 patients is reviewed; 101 patients (18%) had positive findings. Eighty five of these patients were available for 5 year follow up. None of these patients had surgery or other treatment. In this group there were 27 (32%) major cerebro vascular accidents (CVA) and 22 deaths. In this group of patients, screening and further work up and surgery where indicated in advised.
Management of Infection Associated with Prosthetic Graft Exposure in Angioaccess
Authors: Tanchajja Supoj , Hassan Mohaideen A. , Avram M.M. , Eisenberg M. Michael
Published: November 2007

New experience in management of infection associated with PTFE graft ex posure in angioaccess is presented. Primary closure or rotating skin flap of these open wounds usually fail. Simple local wound care and systemic antibiotic administration are the first step to control and localize the infection. A mature PTFE graft can tolerate exposure for an indeterminate period of time. Once the infection is clinically controlled, salvage of the infected graft can be achieved by revision and removal of the infected portion of graft.
Disseminated Intravascular Coagulation and the Mobin-Uddin Vena Cava Umbrella Filter in a Patient with a Hypercoagulable State
Authors: Mizock Barry A. , Shah Prabodh C.
Published: November 2007

The association of certain malignancies with a hypercoagulable state is well described. The occurrence of pulmonary emboli in this patient population is relatively common. The management is frequently complicated by recurrent emboli while on anticoagulation or by significant contraindications to anti coagulation. Mechanical interruption of the vena cava in these patients is poten tially life-saving. This report describes the case of a patient with an underlying hypercoagulable state in whom the insertion of a Mobin-Uddin vena caval um brella filter lead to clinically significant bleeding secondary to disseminated in travascular coagulation.
Complex Renal Artery Reconstruction: Surgical Techniques
Authors: Garcia-Rinaldi Raul , Revuelta Jose M. , Johnston Robert H. , Vaughan G. Dennis
Published: November 2007

We analized the techniques and results of 28 complex renal artery recon structions. The techniques employed for reconstruction included patch angio plasty of renal artery aneurysms, right iliac to right renal artery bypass for redo revascularization, renal artery reimplantation and renal artery bypass simulta neous with the surgical treatment of associated aortic, visceral or peripheral arterial lesions. Of the 28 reconstructions, 2 (7%) failed requiring revision. There was no hospital mortality and only 1 late death. With proper patient selection, operative exposure, renal protection and ingenuity, most complex re nal lesions can be treated successfully in situ and concomitant with other associ ated arterial problems.
Brachial Artery Transsection after Closed Elbow Dislocation A Case Report and Review of the Literature
Authors: Urse John S. , Auwers Frederick J. , Posevitz Laszlo
Published: November 2007

The 15th case in the English speaking literature of brachial artery transsec tion after closed elbow dislocation is presented. A review of the literature with particular attention to vascular repair techniques is correlated with sequelae of this injury. Data from Armed Forces statistics of major actions support the contention that arterial repair utilizing end-to-end anastomosis or vein grafting does diminish vascular related sequelae.
Pitfalls in the Application of Residual Coronary Pressure Gradient (RCPG) as an Indicator of Success or Failure of Transluminal Coronary Balloon Angioplasty
Authors: Robicsek Francis
Published: November 2007

While the measurement of residual trans-stenotic coronary pressure gradi ent (CPRG) in the course of balloon angioplasty is a procedure of practical value in both estimating the severity of the stenosis and the degree of improve ment achieved, its application, however, has also several and serious sources of error; therefore, its value is limited and it should never be accepted as an out-of- context single indicator to either the degree of the stricture or of the anatomic improvement induced by angioplasty.
Occult Penetrating Injury to the Suprarenal Aorta: A Case Report
Authors: Heslov Steven F. , Abu Dalu Joseph , Humphrey Robert W.
Published: November 2007

A thirty-three year old white male presented with a single gunshot wound to the body of T10-11 with resultant paraplegia. Vascular examination was unre markable. In the work up of the paraplegia, the patient was found to have suprarenal aortic traumatic pseudoaneurysm, successfully repaired with tube graft replacement. This represents a rare presentation of an occult suprarenal penetrating aorta injury.
Simple Method to Stabilize the Blood Pressure in the Aortic Arch During Distal Crossclamping. An Experimental Study
Authors: Robicsek Francis , Vajtai Peter , Masters Thomas N. , Wilkinson Henry A.
Published: November 2007

A method is presented to stabilize the blood pressure on the aortic arch during crossclamping. The procedure consists of inserting a cannula into the proximal aorta and connecting it to a plastic buffer-bag suspended above the operating table at a level corresponding to the desired blood pressure in the aortic arch. Experimentally the method proved to be highly effective to protect the heart from acute hypertension and from overdistention injury regardless of the level of aortic crossclamping.
Spinal Cord Injury Following Abdominal Aortic Surgery: A Case Report
Authors: Borrero Edgar , Chang John B.
Published: November 2007

The incidence of spinal cord injury following abdominal aortic surgery is 0.25%.8 Szilagyi's world literature search yielded 36 case reports, and he added 8 case reports to that number. In Szilagy's series, all of the postoperative cases of spinal cord injury were observed after abdominal aortic aneurysm surgery. The incidence in cases of ruptured aneurysms was ten times greater (5 of 247 or 2%) than that noted in cases of unruptured aneurysms (3 of 1,477 or 0.2%) . No spinal cord injury occurred in the patients operated on for aorto-iliac occlusive disease, and the rarity of occurrence of this complication in aorto-iliac occlusive disease is reflected in the number of cases reported in the literature. 2,3,5,6,9

The lower extremity neurologic deficit may occur with or without bowel and bladder paralysis, and may be temporary or permanent. The object of this paper is to present a case report of spinal cord injury following surgery for aorto-iliac occlusive disease, and a discussion of the pathophysiology of this complication.
Management of Peripheral Arterial Injuries at Ibadan: Case Report
Authors: Adebo Oluwole A. , Osinowo Olugbenro
Published: November 2007

Seventeen patients were treated for major peripheral injuries at the Univer sity College Hospital, Ibadan from May 1977 to April 1984. Stab wounds and blunt trauma were the commonest modes of injury. Diagnosis was based on clinical features with arteriography in 10 patients. Arterial transection was found in 8 patients, thrombosis in 4, arteriovenous fistulae in 3 and aneurysm in 2. The ischaemic time in the acute cases averaged 53.5 hours. Arterial repair was performed in 11 cases, embolectomy in 2, ligation in 2, primary amputation and non-operative treatment in 1 case each. Repair failed in 2 cases of popliteal injuries grafted after 48 hours of ischaemia; both were amputated. Functional results were excellent in 13 patients. One patient died from a delayed rupture from the distal end of an ilio-femoral dacron graft. The need for early presenta tion of cases and avoidance of prosthetic graft is reconfirmed.
An Unusual Foreign Body in Pulmonary Artery — A Case Report
Authors: Barlas Cemil , Kalayci Göksel , Onursal Ertan , Bedirhan Mehmet Ali
Published: November 2007

An unusual case of pulmonary foreign body is reported. The foreign body, Kirschner wire, was used for clavicular fixation. It was found free in the middle part of mediastinum one and a half years after fixation in a control chest roent genogram. We discussed by which tract such a rigid substance had arrived in the pulmonary artery. We also reviewed the diagnostic techniques and surgical difficulties in removing foreign bodies from the pulmonary circulation.
False Aneurysm with Delayed Hemorrhage after Carotid Artery Endarterectomy: A Case Report
Authors: Ramadas H.S. , Abbasi K. , Welling Richard E.
Published: November 2007

False aneurysm following carotid endarterectomy seldom occurs when the arteriotomy is closed primarily with durable polyester suture material. A case of pseudoaneurysm caused by infection is reported. The patient required re- exploration for acute hematoma postoperatively with insertion of a Penrose drain. Resection of the aneurysm and interposition of a saphenous vein graft resulted in no neurological complications.
Rationale and Efficacy of the Substitute "Valve" Operation by Technique II in Deep Venous Insufficiency of the Lower Limb
Authors: Psathakis Nikolaos D. , Psathakis Dimitrios N.
Published: November 2007

The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 105 patients (119 limbs) with deep venous incompetence of the lower limb. There was a five-year follow-up on 101 of them (115 limbs) after operation by Technique II. Results were assessed clinically, by Doppler ultrasound, by venous pressure measurements, and by phlebography. Clinical improvement in 108 of 115 limbs was associated with a decrease in ambulatory venous pressure and prolongation of refilling time with interruption of the popliteal reflux by Doppler (96 limbs) and with phlebographic evidence of a functioning substitute "valve."
Intra-Arterial Infusion of Papaverine to Relieve Superior Mesenteric Artery Vasoconstriction in a Neonate with Midgut Volvulus
Authors: Williamson Susan L. , Tisnado Jaime , Cook Doug E. , Barnhardt Glen , Salzberg Arnold M.
Published: November 2007

The use of intra-arterial papaverine in an attempt to decrease superior mesenteric artery vasoconstriction in a neonate with surgically reduced midgut volvulus is presented.
Can Aortography Precipitate Mesenteric Infarction in Patients With Chronic Intestinal Ischemia? Case Studies
Authors: Collier P.E. , Ryan J.J. , Fazi B. , Diamond D.L.
Published: November 2007

Three patients with symptoms suggesting chronic mesenteric ischemia underwent diagnostic aortography. All three patients were well-hydrated before, during and after the procedure, and no technical or physiologic mishaps occurred during the performance of the aortogram. The arteriograms demonstrated occlusion of two mesenteric vessels and severe stenosis of the remaining vessel in each patient. Bowel infarction occurred shortly after the radiographic procedure in all three patients.

Angiographic contrast agents are hyperosmolar and can induce both localized and systemic hypovolemic states. These dyes also induce changes in the blood cells and vessel walls, especially in areas distal to critical stenoses, that tend to shift the ratio of prostacyclin to thromboxane in favor of thromboxane. It is recommended that operative intervention be planned soon after arteriographic confirmation of the diagnosis of chronic mesenteric ischemia because the radiographic contrast agent may induce changes that cause bowel infarction. Otherwise, the patient should be anticoagulated with heparin or volume expanded with low molecular weight dextran until operative intervention is undertaken.
Atrial Myxoma Producing Acute Aortic Occlusion with Anuria and Paraplegia: A Case Study
Authors: Abu-Nema Taiseer , Francis Issam
Published: November 2007

This report describes a successful aortic embolectomy performed in an adult male admitted with sudden, complete aortic occlusion. The removed embolus disclosed histologic features of a cardiac myxoma. Repeated two-dimensional echocardiography did not show any intracavitary cardiac tumor. To our knowledge, this is only the sixth reported survival of a patient with this condition.
Stab Wounds of the Heart. Report of Two Consecutive Survivors Involving Heroic Measures and Seemingly Fatal Acidemia
Authors: Velez Augustine , Pizzi Walter F. , Sze Kenneth C. , Nambisan Ramachandran , Hovaguimian Hagop , Jacobowitz Israel J. , Richman Howard
Published: November 2007

There are four major considerations in the effective resuscitation of the patient with penetrating wounds of the heart. Prehospital care and transport must be appropriate and rapid, using a modified load-and-go approach. Emergency Department thoracotomy must be considered and performed immediately upon the patient's arrival at the hospital. Descending thoracic aortic occlusion is the most useful maneuver in maintaining perfusion of the heart and brain until hypoperfusion can be corrected. The severe acidemia frequently exhibited by agonal patients was corrected in both cases presented (in our first case, the pH was initially 6.47, the lowest ever recorded in a deficit-free survivor) by application of the above-mentioned modalities.

In conclusion, we found that the use of these heroic measures in treating two victims of stab wound of the heart, despite the discouraging results published by some other centers, achieved deficit-free survival for both patients.

We believe that in cases of penetrating chest trauma, it is inappropriate to base the use of Emergency Department thoracotomy solely on the observance of signs of life in transit to the hospital. Mandatory thoracotomy should be applied in these cases.
Noninvasive Technique of Intraoperative Autologous Blood Transfusion in Abdominal Vascular Accidents
Authors: Efem Spencer E. E.
Published: November 2007

A simple, noninvasive method of intraoperative autologous blood transfu sion in abdominal vascular accidents is described. Twelve patients, all males whose ages ranged from three to sixty years, received from 300 ml to 2,500 ml of autologous blood intraoperatively. All patients received powerful antibiotics pe rioperatively and for five days postoperatively because the transfused blood was considered to be potentially contaminated. Up to 70% of spilled blood was sal vaged. No deaths or major postoperative complications wre encountered. Hepa torenal function and hematologic indices that had shown initial minor departures from normal returned to normal within seven days postoperatively. Autologous intraoperative blood transfusion has a definite place in tropical sur gery, even though major vascular and cardiac surgery are not routinely done at the present time.
Experimental Evaluation of Tissue Reactivity to Vascular Sutures: Dacron, Polypropylene, PTFE
Authors: Cavallaro Antonino , Sciacca Vincenzo , Cisternino Silvestro , Di Marzo Luca , Mingoli Andrea , Allegrucci Paola , Gallo Piero
Published: November 2007

Three currently available cardiovascular suture materials (braided dacron, polypropylene, PTFE) were compared in a series of abdominal aortic grafting in the beagle dog, aiming at the definition of tissue response. Optimal accept ance by tissues was demonstrated for monofilaments (PTFE, polypropylene); braided dacron was shown to cause a heavy and prolonged tissue reaction.
Hereditary Angioneurotic Edema: Report of a Case Undergoing Open-Heart Surgery— A Case Report
Authors: Umebayashi Yusuke , Morishita Yasuo , Arikawa Kazuhiro , Sakamoto Hiroto , Taira Akira , Sano Yuji
Published: November 2007

Hereditary angioneurotic edema is a familial disease due to the absence or to the functional deficiency of the inhibitor of the activated first component of complement. It is characterized by recurrent attacks of localized edema affect ing skin and mucosal membranes; edema of the laryngeal mucosa may be fatal. Because trauma and surgical intervention may become a trigger of attacks, a pitfall for surgeons or physicians is always present. We recently encountered a patient with hereditary angioneurotic edema who successfully underwent open- heart surgery following short-term prophylaxis with danazol and fresh frozen plasma transfusion.
Surgical Treatment of Infected Aortofemoral Grafts: A Fifteen-Year Experience
Authors: di Marzo Luca , Feldhaus Richard J. , Schultz Richard D.
Published: November 2007

During the last fifteen years, we performed a total of 855 aortofemoral re constructions. Fifteen (1.75%) grafts were surgically removed (completely or partially) owing to a severe infection (Szilagyi: Grade 3) at a mean of 66.3 months (SD ± 37.9) after their implantation. Diagnosis was always clinically evident. In 10 patients, the graft was partially removed (one or two limbs). In 3 of the 10, graft infection progressed requiring complete graft removal after a mean of 18.6 days. In the other 5 patients, the graft was removed "in toto" at the time of the first operation. In 9 cases, revascularization was accomplished by means of a "remote" takeoff reconstruction (thoracic aorta or axillary ar tery), whereas in 8 cases (3 recurred) reconstruction was performed with a "local" takeoff reconstruction (stump or aortoiliofemoral arteries). One patient was not revascularized, because the limb was already amputated.

Recurrence of infection was higher in the patients treated by partial removal of the graft (p < 0.05), even though the stump sterility was always evaluated by means of intraoperative culture. The mortality of patients with recurrence of infection was 66.6%.

Multiple operations of the femoral site were considered a factor in causing aortofemoral graft infection (p < 0.01). Diabetes was not considered a factor in causing infection (p n.s.).

Grafts with remote takeoff reconstruction have better long-term results in terms of limb salvage and survival when compared with local takeoff recon struction (p < 0.05).
Use of the Right Mammary Artery for Coronary Bypass
Authors: Singh Ram N. , Taylor Paul C.
Published: November 2007

As the utilization of internal mammary arteries (IMAs) for coronary bypass is expanded, more distal dissection becomes necessary to obtain longer pedicles to reach various sites in the coronary arterial tree. Preoperative arteriography precisely delineates the distal IMA anatomy and is particularly useful when the right IMA is being utilized.
An Alternative Technique for the Surgical Correction of Kinked or Redundant Carotid Arteries
Authors: Young James R. , Khoury Rajai T. , Rahbar Ahmad
Published: November 2007

Twenty patients with kinked and coiled arteries are presented, and their successful surgical management is described. In most of the patients, the redun dant artery was reimplanted into the common carotid artery, along with resec tion, if needed, to correct extreme redundancy. Alternatively, the authors used resection of the redundant posterior wall with insertion of a dacron velour patch anteriorly with equal success. Advantages of the latter technique are discussed.
Venous Obstruction Due to Tibial Exostosis—A Case Report
Authors: Gorenstein Arkadi , Katz Schmuel
Published: November 2007

A twelve-year-old boy with significant obstruction of the calf veins is de scribed. Ascending functional phlebography demonstrated venous obstruction at the level of a tibial exostosis. Following excision of this abnormal bony struc ture, the venous drainage was markedly improved.
Effect of Graded Aortic Occlusion on the Reticuloendothelial System
Authors: Vo Nghia M. , Chi David S. , Stanton Paul E.
Published: November 2007

To evaluate the effect of graded aortic occlusion on the reticuloendothelial system (RES), 21 Sprague Dawley rats were subjected to fifteen (GI), thirty (GII), or sixty (GIII) minutes of distal aortic occlusion or to a sixty-minute sham operation (GIV) under general anesthesia. Chromium 51-labeled sheep red blood cells (SRBC) were injected twenty-four hours later, and SRBC half-life (T½) was measured as an index of RES function.

Decreased RES function was (1) dependent upon the duration of clamping time, (2) most pronounced at sixty minutes' clamping time, (3) characterized by a marked increase in SRBC half-life, along with a decreased radioactive uptake by the spleen and liver.
Is the Problem of the Postthrombotic Syndrome Reality or Myth?
Authors: Psathakis Nikolaos D. , Psathakis Dimitrios N.
Published: November 2007

The substitute "valve" operation by Technique II designed to overcome re flux in the popliteal vein was performed on 145 patients (162 limbs) with deep venous incompetence of the lower limbs, primary or postthrombotic. Results were assessed clinically, by Doppler ultrasound, by venous pressure measure ments, and partially by phlebography. Clinical improvement in 154 of 162 limbs was associated with a reduction of ambulatory venous pressure and prolonga tion of refilling time with interruption of the popliteal reflux by Doppler (134 limbs) and with phlebographic evidence of a valve-like effect of the silastic ten don.
Postischemic Transcutaneous Oxygen Tension Response in Assessment of Peripheral Atherosclerosis
Authors: Slagsvold Carl-Erik , Kvernebo Knut , Stranden Einar , Kroese Andries
Published: November 2007

The applicability of transcutaneous oxygen tension measurements (TCpO2) at rest and after a postischemic response test was investigated in a control group and in patients with peripheral atherosclerosis. Three parameters were evalu ated : oxygen reappearance time (ORT), oxygen recovery index (ORI), and rest ing oxygen tension (ROT). ORT distinguished controls and patients, as well as patient groups. An ORT ≥ twenty seconds is indicative of peripheral circulatory insufficiency and seemed to be dependent on the postischemic reappearance of blood flow. ORI did not separate the groups as well as ORT and was signifi cantly reduced only in patients with critical ischemia. It is concluded that mea surement of ORT, ORI, and ROT are easily performed, assessing oxygenation of the skin. ORT probably indicates the function of supplying arteries. ORI is related to compensatory mechanisms and changes in the microcirculation.
Bilateral Common Femoral Artery Stenosis Mimicking Aortic Stenosis—Case Report
Authors: Cohen Jon R. , Shay Peter , Pillari George , Chang John B.
Published: November 2007

Isolated bilateral common femoral artery stenoses or occlusions are an ex tremely rare arterial lesion and have not been previously reported. Herein the authors report 2 patients with this lesion with remarkable similarities. Both are similarly aged women, diabetic, hypertensive, and cigarette smokers. Both pa tients had thigh and calf claudication, diminished or absent femoral pulses, and diminished Doppler pressures from the thigh down. Common femoral endar terectomy and patch angioplasty with and without distal bypass was successful in the management of these 2 patients. The signs and symptoms of this lesion are identical to those of patients with aortic stenosis or bilateral iliac artery stenoses.
Long-term Intraarterial Infusion Therapy with Prostaglandin E1 in Patients with Ischemic Ulcer of the Extremities
Authors: Nakata Y. , Sakurai T. , Yamada I.
Published: November 2007

There is confusion about blood flow of the foot during intraarterial infusion of prostaglandin E 1. The authors studied blood flow in the dorsalis pedis arter ies of patients with ischemic ulcer during the infusion and report the results in this paper.

Prostaglandin E1 was continuously infused intraarterially for a mean of 30.9 ±14.5 days in 17 lower extremities of 11 patients with intractable ischemic ulcers. Thirteen of the 17 cases responded to the treatment—especially the cases in which peripheral arteries near the foot joint were patent. In the dorsalis pedis artery, the blood flow increased by 266.3% during the arterial infusion, but no differences were seen in the peak frequency or the percent window denoting the degree of spectral broadening in the infused lower limb. On the other hand, there was no statistically significant difference between the blood flow, peak frequency, or percent window of the contralateral lower limb before, and those parameters during, the infusion. The authors observed complications in 9 of 17 cases, which necessitated the discontinuation of the infusion.
Aneurysm of the Internal Jugular Vein — A Case Report
Authors: Regina G. , Cardia G. , Squeo M.A. , Lillo A. , Latorre M. , Odero A.
Published: November 2007

Venous aneurysms unrelated to arteriovenous fistulas are uncom mon. This case report describes clini cal findings and data obtained by echo Doppler examination in a young girl with a venous aneurysm of the right internal jugular vein and a tho racic outlet syndrome. An etiologic correlation between the aneurysm and the thoracic outlet might be sus pected.