bluuebunny/crossref_metadata_2025 huggingface dataset:
Complications of Laser-Assisted Angioplasty: Recognition, Classification and Treatment
Authors: Diethrich Edward B. , Timbadia Ela , Bahadir Ilhan
Published: August 2008

No adequate reports from signifi cant patient populations exist on the nature and extent of complications from peripheral laser-assisted angio plasty. To define and enumerate these adverse reactions, data were col lected from 770 procedures per formed on 400 patients in a sixteen- month period. Arteries treated were: 133 iliac (17%), 418 femoral (54%), 121 popliteal (16%), 73 tibial/pero neal (9%), and 25 grafts (3%).

Complications, similar to those of standard angioplasty, were identified and classified according to cause: la ser, access method, or the angioplasty procedure with its attendant equip ment (balloons, etc). The types of morbidity observed were: perfora tion/dissection (54 cases, 7%), acute thrombosis (38, 5%), spasm (5, 0.7%), false aneurysm at the punc ture site (15, 2%), embolism (1, 0.1%), and hematoma (115, 15%).

Because perforation is the most significant intraoperative complica tion, a standardized system has been devised to bring uniformity to its doc umentation and reporting. The three-part classification is based on the arterial pathology producing the probe's deviation and on the ramifi cations of the aberrancy.

In addition to recognition and classification, prudent treatment of an evolving complication can often salvage the procedure. Treatment modalities for the common complica tions and preventive measures to avert them have been identified and incorporated into the treatment pro tocol.
Retained Foreign Bodies, The Cause of Postmidsternotomy Sinuses: Case Reports
Authors: Weiss Jerry , Herman Oscar , Siegman-Igra Yardena , Shafir Raphael
Published: August 2008

Postmidsternotomy chronic si nuses have received little attention in the literature. They are usually not a life-threatening complication but may sometimes lead to grave condi tions such as acute mediastinitis, in fection of prosthetic valves or vascu lar grafts, and sternal osteomyelitis.

Most patients suffering from this problem usually undergo several un successful surgical interventions ow ing to failure to recognize the under lying cause in the first place. The cause of the sinus is nearly always a foreign body situated deep within the tissues from the time of the original operation. The authors believe that it is of utmost importance that the ex tent of the sinus be demonstrated prior to surgery by sinogram or other imaging techniques. Unless the for eign object is identified and removed, the sinus will recur.

Over the last four years, they treated 70 patients with postmid sternotomy complications; 14 of them had sternal sinuses. In each of the 14, some grade of wound infection oc curred at the immediate postopera tive period following the original op eration. In all cases, a foreign body was identified prior to or during ex ploration and removed. These in cluded wires, pacemaker electrodes, silk sutures, a Teflon pledget, and a piece of steridrape. Follow-up, rang ing up to twenty-seven months, shows no recurrence of the sinuses.
Revascularization of Severely Ischemic Limbs by Staged Arteriovenous Reversal
Authors: Sun Jian-Min , Zhang Pei-Hua
Published: August 2008

Having succeeded in salvaging severely ischemic canine hindlimbs by staged arteriovenous reversal, the authors then successfully treated, from January, 1984, to June, 1986, 33 patients with a total of 39 lower extremities by this approach, except for 1 limb. According to the different levels of the extensive and diffuse arterial occlusion, the arteriovenous reversal was formed on three different sites: (1) high-deep reversal, produced between the external iliac, com mon femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal, made between the distal popliteal artery and the tibiopero neal venous trunk; and (3) superficial reversal, established between the distal popliteal artery and the distal portion of the long saphenous vein.

As of April, 1988, these limbs have been followed up for twenty-three to fifty-five months. Except for 1, the postoperative results of the patients in this series are excellent or good.

The authors suggest that the staged arteriovenous reversal is a new and ef fective approach in the treatment of extensive arterial occlusive disease of the limb.
Emergency Surgery in an Acutely 111 Hypotensive Patient with a Large, Mobile, Echogenic Right Sided, Intracavitary Cardiac Mass—A Case Report
Authors: Sheldon Murray I. , Gong Henry P. , Del Rio Gerry , Sweezer William , Parsons Nils , Lee Garrett
Published: August 2008

An acutely ill hypotensive man was evaluated and found to have a large, mobile, right-sided intracardiac mass on two-dimensional echocardiography; the latter aids in differentiating thromboemboli, tumor, and vegetation. Owing to a severe drop in blood pressure, the patient underwent emergency surgery with cardiopulmonary bypass wherein large masses of organized clots were re moved from the right atrium, right ventricle, and left and right pulmonary arteries. Pulmonary embolectomy with exploration of all right-sided cardiac chambers in this patient who had deteriorated clinically proved life-saving.
Vascular Rereconstruction and Major Amputations A Case Report
Authors: Berger Alan
Published: August 2008

In an effort to increase the probability of primary below-knee amputation healing the author converted a common femoral artery to dorsalis pedis artery vein bypass to a common femoral artery to below-knee popliteal bypass to a blind popliteal segment along with a below-knee amputation in a patient with an osteomyelitic Chopart amputation. The patient was rapidly and successfully rehabilitated with a prosthesis and the bypass remained patent. This case report illustrates that preservation of the important functional aspect of the knee joint in the elderly population is justification for vascular reconstruction since the probability of primary below-knee amputation healing is enhanced.
Morphologic Analysis of Artificial Blood Conduits in the Short-Term Carotid Artery Test
Authors: Kogel H. , Vollmar J.F. , Stenzenberger G. , Mohr W. , Frösch D. , Marx U.
Published: August 2008

Different analyses (SEM (scanning electron microscopy), light microscopy, nuclear medical investigations) must be added to short-term carotid artery test, in order to allow a real prediction of the behavior of suitable vascular grafts in the in-vivo long-term test. Comparing 60 experimental implantations (5 differ ent prosthetic materials) in carotid artery position with more than 150 vascular grafts in long-term in-vivo tests led to a new point system to appraise the various parameters of the short-term method numerically. An initial thrombogenicity of the prosthetic wall and the formation of an intramural thrombogenic matrix were found to be prerequisites for the ingrowth of connective tissue, trans- prosthetic microvascularization, and multifocal spontaneous endothelial lining.
An Investigation of Cutaneous Penile Blood Flow Using Laser Doppler Flowmetry
Authors: Pielet Rodger W. , Pielet Rodger W. , Ross Edward V. , Rice Janet C. , Kerstein Morris D. , Lewis Ronald W.
Published: August 2008

A capillary perfusion monitor was used to determine the flaccid and erect cutaneous penile blood flow in 19 healthy men. A mean value of 41.95 mV was observed from readings in the flaccid state, whereas the mean value in the erec tile state was 306.63 mV in readings at one minute of tumescence. Recordings were also obtained at two, three, and four minutes in 6 subjects, during which a plateau was reached.
Aortopopliteal Bypass: A Case Report
Authors: Sfeir Roger E. , Hussein Maher K.
Published: August 2008

Extraanatomic bypasses were introduced by Blaisdell more than twenty-five years ago. A wide variety of such bypasses have been used in various conditions. The authors report a case of aortopopliteal bypass done for limb salvage.
Situs Inversus Totalis and an Infrarenal Abdominal Aortic Aneurysm: Case Report
Authors: Huston Jan , Nicholas Gary
Published: August 2008

Situs inversus totalis is a rare clinical finding. A patient with a 7 cm in frarenal abdominal aortic aneurysm and situs inversus totalis is presented. The patient underwent routine and uneventful operative management of his aneu rysm. This case demonstrates the relative ease of aneurysm resection in this setting if the anomaly is recognized preoperatively.
Laser-Assisted Balloon Angioplasty: Analysis of 132 Clinical Cases
Authors: Posevitz Laszlo , Greer Stephen , Kovacs Peter
Published: August 2008

From September, 1987, to September, 1988, 132 laser endarterectomies with or without balloon angioplasty were performed on 113 patients who presented with lower limb occlusive disease. Overall success rate as determined by intra operative angiogram and Doppler measurements signifying a patent lumen was 80% (106 laser-assisted procedures). In 26 procedures (20%), laser-assisted balloon angioplasty was unsuccessful. Complications associated with 132 laser thromboendarterectomies were arterial spasm (9.1%), perforation requiring surgery (3.0%), and thrombosis in the first forty-eight hours (1.5%) following the procedure. There was no limb loss, stroke, myocardial infarction, or death associated with this procedure.
Infrapopliteal Bypass Grafting for Limb Salvage In Diabetic Patients
Authors: Agnes S. , Serino F. , Magalini S.C. , Vulpio C. , Iannace C. , Ghirlanda G. , Mingrone G. , Borzone A. , Castagneto M.
Published: August 2008

A four-year prospective study of distal revascularization in diabetics with trophic damage of the limbs is presented. Thirty-two infrapopliteal bypasses in 32 limbs of 31 diabetic patients were performed. One-year and three-year graft patency rates were 68% and 59% respectively. Limb salvage was obtained in every case of surgical success.
Familial Dissecting Aortic Aneurysm in the Absence of Marfan's Syndrome with Review of the Literature: Case Report
Authors: Kerstein Morris D. , Kiev Jonathan , Levelo Barry M.
Published: August 2008

This is a report of familial aortic dissection in a mother and son with no evidence of Marfan's syndrome in either patient. The mother, a fifty-three—year-old nurse, was evaluated initially for a four-year history of untreated hypertension and heart murmurs. Multiple cardiac complaints, including shortness of breath and chest pain on exertion, with a strong smoking history associated with an Austin-Flint murmur were noted. Subsequent laboratory studies, including electrocardiogram and cardiac catheterization, confirmed the diagnosis of dissection in the ascending aorta with free communication with an aneurysmal sac. Operative intervention included a Dacron prosthesis and porcine xenograft for aortic valve replacement. The postoperative course is unremarkable and the patient remains well after eleven years. Her twenty- eight-yearold son had a heart murmur identified on an office visit for a recurrent upper respiratory infection. Increased symptoms of shortness of breath, pulsus bisferiens, and an Austin-Flint murmur, along with findings on electrocardiogram and subsequent cardiac catheterization, confirmed the diagnosis of dissecting aortic aneurysm. The patient did not tolerate surgical intervention and a supraventricular tachycardia resulted in his death. Autopsy confirmed the extent of dissection, a 630-g heart with biventricular dilatation, hypertrophy, and dilatation of the atria; there was extensive cystic medial necrosis in the aorta. Marfan's syndrome is excluded because of the genetic predisposition to dissecting aortic aneurysm and no other findings of the Marfan's syndrome were identified. This report is to document the genetic predisposition and identification of 2 cases of congenital aortic dissection and its consequences.
Post Traumatic Occlusion of the Aortic Isthmus—Case Report
Authors: Antoine Ph. , Defraigne J.O. , Grenade Th. , Limet R.
Published: August 2008

A case of occlusion of the thoracic aorta after traumatic rupture of the aortic isthmus is presented.

Despite successful operation with restoration of distal pulses, death occurred because of the prolonged preoperative period of ischemia, with severe postoper ative uncontrolled acidosis, hepatic and mesenteric ischemia, and paraplegia.

Death following traumatic rupture of the thoracic aorta is usally related to rapid exsanguination but rarely to ischemia after aortic occlusion by the peri- aortic hematoma.
Repair of Abdominal Aortic Aneurysm After Renal Transplantation Without Renal Protection—A Case Report 4
Authors: Hopkins N.F.G. , Hughes S.J. , Scott-Coombes D. , Mansfield Averil O.
Published: August 2008

A sixty-three-year-old man was found to have a 6.5 cm abdominal aortic aneurysm on routine follow-up six months after renal transplantation. Renal function did not deteriorate over the operative period. In such circumstances, the operation should be designed to minimize the period of renal ischemia, but specific techniques to maintain normotensive renal perfusion are not required.
Hickman Catheter Perforation of the Superior vena Cava with 5-FU Extravasation into the Anterior Mediastinum A Case Report
Authors: Carr Marcus E. , Wampler Galen L.
Published: August 2008

Hickman catheter perforation of the superior vena cava with erosion of the catheter tip into soft tissues and extravasation of 5-fluorouracil into the anterior mediastinum is reported. Symptoms included progressive hoarseness and inter mittent right chest pain. Chest x-ray revealed migration of the catheter tip out of the vessel and extravasation of fluid. Risk factors for this complication in clude left subclavian vein cannulation, positioning of the catheter tip in the upper portion of the superior vena cava, and impingement of the catheter tip against the vessel wall. Good catheter position should be confirmed and tenting of the lateral wall of the superior vena cava excluded by careful examination of a postinsertional chest x-ray.
Operative Management of Symptomatic MB
Authors: Yee Edward S.
Published: August 2008

The relationships between coronary myocardial bridging (MB) and clinical symptoms have been controversial. Five young male patients underwent testing for symptomatic MB, manifested as angina with evidence of ischemia or sudden death. Preoperative testing included atrial stimulation studies for evidence of lactate extraction and serial cardiac catheterization. Positive lactate production and/or extensive milking (>90%) of the proximal left anerior descending artery (LAD) were documented in 4 patients, who were, therefore, treated surgically by supra-arterial myotomy. Associated intraoperative mapping and endocardial resection were required for significant anterior aneurysm and scars. Postopera tive studies demonstrated resolution of the milking and/or intracoronary gradi ents. The remaining patient had recurrent sudden death, but negative lactate study, and was treated by automatic internal cardiac defibrillator (AICD).

Symptomatic young patients can present with pathologic compression of the proximal LAD from extensive MB. Complete supra-arterial myotomies were successful treatments. Other adjunctive surgical procedures: (1) mapping, (2) endocardial resection, and/or (3) AICD, were based on their preoperative stress testing and intraoperative findings.
Spermatic Vein Doppler Examination in the Investigation of Male Infertility
Authors: Sfeir Roger E.
Published: August 2008

Clinical and laboratory studies have provided convincing evidence that varicoceles are detrimental to spermatogenesis and that this effect is unrelated to their size. Doppler ultrasound was used to evaluate 364 infertile men: 241 (66%) of them had a clinically palpable varicocele and the Doppler detected a subclinical varicocele in 167 patients. Fifty-five percent of patients with a clinical left varicocele were found to have a right varicocole too on ultrasound examina tion. The pregnancy rate after variococelectomy was high for the female partners of patients who had a positive Doppler examination for varicocele whether the varicocele was clinically evident or not. The high percentage of subclinical varicoceles and the good results of surgery show the importance of this exami nation in the investigation of male infertility.
Tibial Artery Revascularization Utilizing Microscopic Vascular Technique
Authors: Tomikawa Masaki , Ueyama Takeshi , Yokokawa Masayasu , Hashimoto Hideki , Yamamoto Keiichi
Published: August 2008

During the past six years and nine months, tibial artery revasculariza tion was performed for 42 cases (47 limbs) utilizing the transmicroscopic vascular technique. The operations for limb salvage of the clinical stages III and IV accounted for 89.4% of all operations.

Fifty-two operations were per formed in all, including 3 secondary and 1 tertiary operative procedures. Each distal anastomosis on a tibial artery was completed with a continu ous polypropylene 7-0 suture with the aid of an operative microscope, mag nifying by 5 to 10 times. The greater saphenous vein was used as bypass and patch materials in all cases. Of 37 bypasses, classical reversed graft was adopted for 33 bypasses, includ ing 7 sequential bypasses, while 4 by passes were the in situ graft. Com bined revascularization was per formed simultaneously for 6 limbs and secondarily for 7 limbs for the purpose of improving the inflow.

Forty-two cases were successfully followed up for one to eighty-one months postoperatively (24.1 months in average). There was neither opera tive death nor hospital death, but late death due to malignant tumor and thrombotic disease occurred in 5 cases. Early bypass occlusion was ob served in 1 limb and late occlusion in 9 limbs. In 4 limbs with late occlu sion, blood flow was restored satis factorily by additional operation. Amputation was performed on 1 limb with late occlusion. The primary cu mulative patency rate by Kaplan- Meier curve was 95.6% for six months, 85.0% for one year, and 65.0% for five years. The secondary rate was 95.6%, 87.7%, and 84.2% respectively.

The transmicroscopic surgical technique can positively reduce anas tomotic troubles during revascular ization of infrapopliteal vessels, and it appears that this technique is a use ful means of maintaining the long term patency of the bypass to infra popliteal vessels and, together with sequential bypass or the combined operation, to the inflow.
Hemodynamic Evaluation of an Implantable Pneumatic Left Ventricular Assist Device in the Calf
Authors: Withington Peter Stuart , Graham Timothy Robin , Ooi Laureen , White David , Colvin Michael Peter , Lewis Christopher Terence
Published: August 2008

Left ventricular assist systems are being developed for permanent clinical implantation. An understanding of the interactions of these devices with the native circulation is required. Hemodynamic evaluation up to two weeks following implantation of a prototype permanent circulatory support device in the calf model is presented. Data obtained suggest that adequate cardiovascular support is provided in the two weeks following insertion of the device. Implantation of the device involves coring and cannulation of the apex of the left ventricle.
Performance of the Tilt-Disc Valve in the Inferior Vena Cava: An Animal Study
Authors: Phifer Travis J. , Price David T. , Thomas Mary B. , Grafton Warren D.
Published: August 2008

The authors' laboratory recently reported long-term patency of valvular xenografts in the canine inferior vena cava. Valve fibrosis, however, followed early nonocclusive perileaflet thrombosis. A potential design flaw in the tricus pid prototype with open leaflets juxtaposed to the vascular wall possibly caused flow stagnation in valve cusps and initiated thrombus formation. The authors evaluated this hypothesis by design modification to a tilt-disc mechanical proto type with no valve cusps and continuous washing of the open midlumenal disc.

The study included 12 metal alloy, tilt-disc valves placed in the canine infe rior vena cava. Daily aspirin (80 mg) and dipyridamole (50 mg) were begun on the day before implantation, with a single bolus of intravenous heparin (100 units/kg) administered prior to vascular occlusion. Angiography followed by complete autopsy was performed at two weeks in 6 animals, and at four weeks in 4 animals. Two animals underwent valve explantation fifteen minutes after reflow with examination of the vena cava at the site of valve placement by scan ning electron microscopy.

Five valves were patent at two weeks. Four valves were patent at four weeks. Thrombus formed on the surface of the disc and supporting structure in all 9 patent valves, however, and underwent progressive organization with eventual valve fibrosis. A small, asymptomatic pulmonary embolus was discovered upon autopsy at four weeks in 1 animal. Scanning electron microscopy showed leuko cyte adherence to the lumenal surface within fifteen minutes after reflow.

This study, as well as previous work, shows feasibility for maintenance of prosthetic valve patency in the vena cava. Correction of a potential design flaw in the tricuspid tissue valve by elimination of the sinus with continuous leaflet washing in a tilt-disc mechanical prototype failed, however, to prevent peri leaflet thrombosis.
Successful Repair of Left Ventricular Aneurysm Associated with Mitral Regurgitation Secondary to Spasm-Induced Myocardial Infarction—A Case Report
Authors: Mizutani Tetsuo , Kusagawa Minoru , Yuasa Hiroshi , Yada Isao , Shikano Kazuhisa , Tanaka Kuniyoshi , Tani Kazuhiro , Hayashi Takashi
Published: August 2008

A sixty-four-year-old man was admitted with a severe feeling of chest oppres sion and loss of consciousness. An echocardiogram and a left ventriculogram revealed a left ventricular aneurysm with severe mitral regurgitation, and a selective coronary angiogram demonstrated normal coronary arteries. Spasm- induced posterior myocardial infarction was diagnosed, and the patient under went combined left ventricular aneurysmectomy and mitral valve replacement. Six years after the surgery the patient remains well, without angina or heart failure.
Lethal Vascular Rupture in a Previously Undiagnosed Case of the Ehlers-Danlos Syndrome: A Case Report
Authors: Lidang Jensen Marianne , Balslev Thomas
Published: August 2008

Fatal spontaneous rupture of an iliac artery in a previously healthy twenty- year-old man with Ehlers-Danlos syndrome type IV is reported. Etiology and clinical findings are mentioned and the high risk of lethal complications in type IV is emphasized. Despite the application of special techniques, mortality fol lowing vessel rupture in such patients remains exceedingly high.
Upper Limb Ischemia Following Accidental Intraarterial Heroin Injection: A Case Report
Authors: Ferrante Angela M. R. , Cina Gregorio
Published: August 2008

Acute ischemia of the upper limb is a complication of intravenous drug abuse due to accidental puncture of the arterial tree. The authors report a suc cessfully treated case of hand ischemia in a heroin addict. Anticoagulant and fibrinolytic therapy appeared to be effective treatment of this type of arterial thrombosis.
Paraprosthetic Abscess and Gangrenous Left Colon: A Unique Late Complication of Abdominal Aortic
Authors: Dickson Christopher S. , Kupferschmid John P. , Cobb Charles F. , Benckart Daniel H.
Published: August 2008

Many complications related to the use of prosthetic aortic grafts in the treatment of aneurysmal and occlusive disease of the abdominal aorta have been reported. Early complications include bleeding, thrombosis, embolization, and infarction of the left colon. Late complications may be more difficult to diagnose and include graft infection, pseudoaneurysm formation, and aortoenteric fistula. We describe here a unique late complication following aortic reconstruction for aortofemoral occlusive disease. A brief review of the literature is presented.
Arterial Thrombosis Due to Idiopathic Superficial Femoral Arteriovenous Fistula: Case Report
Authors: Almgren Bo , Karacagil Sadettin , Nybacka Olof
Published: August 2008

The authors report a case of idiopathic arteriovenous fistula between the superficial femoral artery and vein resulting in acute thrombosis of the popliteal artery. This complication of an arteriovenous fistula has not been described before.
Migration of a Fractured Acetabular Socket Wire Into the Femoral Vein: Indication for Urgent Removal by Venous Thrombectomy: A Case Report
Authors: Hake Ulrich , Reichel Klaus , Mayer Eckart , Oelert Hellmut
Published: August 2008

The migration of a foreign body into a great vein is a rare occurrence that requires urgent surgical intervention. In our patient one fragment of a circular acetabular socket wire marker had entered the femoral vein. Exact topographic location of the wire was achieved by computerized tomography. Urgent surgery revealed a floating wire within the venous lumen with associated thrombosis.
Factors Influencing Patency of Bypass Grafts for Ischemia of the Upper Limb
Authors: Farina Carlo , Schultz Richard D. , Feldhaus Richard J. , Cistemino Silvestro , Mingoli Andra
Published: August 2008

In order to determine factors influencing operative and long-term patency of bypass grafting for upper extremity ischemia, a fifteen-year experience with 39 bypass grafts was reviewed. Etiology of the lesions included atherosclerosis in 17 limbs, thoracic outlet syndrome in 7 cases, violent or iatrogenic trauma in 12 cases, and arteritis in 3. Primary lesions affected the innominate, subclavian, axillary, and brachial artery in 2, 19, 8, and 10 cases respectively. All patients had a complete follow up (mean seventy-one ± forty-four months). The thirty- day, one-year, and five-year patency rates were 92%, 81%, and 78%, respec tively. Indications for operation and type of onset of ischemic symptoms significantly influenced graft patency (p<0.05). Although early results of bypass grafting were better in patients with chronic symptoms (p<0.05), these grafts had a higher incidence of late occlusion (p = NS). Late patency rate was also signifi cantly affected by the site of distal anastomosis, grafts inserted above the elbow achieving the best results (p<0.05). The nature of the graft itself was not a good determinant for bypass patency (p = NS). Finally, better results were obtained in patients with innominate and subclavian artery disease compared with those affected by a more distal arterial lesion (p<0.05).
Application of Indwelling Double-Balloon Shunt in Endarterectomy of the Innominate Artery
Authors: Furui Tomoo , Ogawa Yutaka , Yamada Hiroshi
Published: August 2008

The authors describe a new operative technique utilizing a double-balloon shunt tube to ensure carotid flow during innominate endarterectomy. (See copy for running head instructions.)
Dye-Enhanced Tissue Welding Using Fibrinogen and Continuous-Wave Argon Lasers
Authors: Libutti Steven K. , Oz Mehmet C. , Chuck Roy S. , Treat Michael R. , Nowygrod Roman
Published: August 2008

Despite their theoretical advan tages, laser-welded anastomoses ini tially appear prone to rupture. Furthermore, the repair of defects seen in the weld following laser energy expo sure is often hindered by thermal in jury to the tissue edges. In this study, the immediate strength of these welds has been increased by the application of fibrinogen combined with a laser-en ergy-absorbing dye, fluorescein isothiocyanate (FITC, maximum absorbance 490 nm), to the anasto motic site prior to continuous-wave argon laser exposure (488-514 nm, 5.66 watts/cm2). A rabbit abdominal aorto tomy model was employed. Data ob tained immediately after welding demonstrated that the mean bursting pressure of welds created without fi brinogen (184 ± 65 mm Hg, n = 12) was significantly less than that of re pairs with fibrinogen (407 ± 72 mm Hg, n = 11) (p<.001). Defects seen in the weld immediately after laser expo sure could be easily repaired by addi tional application of fibrinogen and repeated laser treatment. Histologi cally, aortotomies repaired with fibrin ogen demonstrate less thermal injury to host tissues than nonsolder repairs do.

Laser soldering with exogenous fi brinogen significantly improves the bursting strength of primary laser- welded anastomoses and mitigates technical difficulties with laser tissue welding.
Noninvasive Measurement of Cardiac Output by Esophageal Doppler Method During Anesthesia
Authors: Kemmotsu Osamu , Ueda Mitsuo , Nakata Fusazo , Hanaoka Yukari , Morimoto Yuji , Okamura Atsushi , Harada Koji , Yamamura Takeyasu
Published: August 2008

The authors evaluated the effi ciency and reproducibility of cardiac output measurement by esophageal continuous-wave Doppler ultra sonography (ECO). A total of 114 si multaneous measurements of ECO and thermodilution cardiac output (TDCO) were compared in 25 surgi cal patients undergoing general anes thesia in the supine position. ECO could be obtained easily with mini mal experience by means of a com mercially available Doppler cardiac output monitor. There was a signifi cant correlation between ECO and TDCO (<0.001). The regression equation obtained was Y = 0.992X- 0.029, and the correlation coefficient was 0.935. ECO was more reproduc ible than TDCO, because the aver aged value for coefficient of variation (CV) was 5.2% for ECO and 8.3% for TDCO, and these values were sta tistically significant. Their results in dicate that the esophageal Doppler method provides noninvasive, safe, and continuous cardiac output moni toring in patients during anesthesia in the supine position. This method is more useful in patients for whom in vasive cardiac output monitoring is considered inappropriate.
Subclavian Steal Syndrome with Occluded Aberrant Right Subclavian Artery—A Case Report
Authors: Swersky Robert B. , Barek Lowell Bryant
Published: August 2008

A forty-five-year-old man with significant right upper limb claudication on exertion and associated episodes of dizziness is presented. The patient was found to have occlusion of an aberrant right subclavian artery with a right subclavian steal syndrome. The vascular reconstructive alternatives are discussed in view of this unusual anatomy.
Fatal Paradoxical Embolus Due to a Central Venous Pressure Catheter: Case Report
Authors: Raffa Hassan , Mosieri Jackmerry , Fageeh Nizar
Published: August 2008

A case of paradoxical embolus that caused initial ischemic changes on the electrocardiogram monitor and later a massive myocardial infarction and cardiac arrest with death is presented. This occurred during a pulmonary wedge biopsy to determine the operability in a twenty-eight-year-old patient with ventricular septal defect and high pulmonary artery pressure diagnosed by catheterization. Autopsy revealed a long blood clot measuring 6 cm in length and 0.5 cm in width sitting and completely blocking the orifice of the left coronary artery. This caused the coronary insufficiency. A similar clot was found on the tip of the central venous pressure catheter when the right atrium was opened.

The causes of and means of preventing this fatal complication in patients with left and right-heart communications are discussed in detail.
Use of a Flexor Carpi Ulnaris Muscle Flap To Cover an Exposed Hemodialysis Access—A Case Report
Authors: Kshettry Vibhu R. , Ponamgi Suri B.
Published: August 2008

Exposed vascular grafts rapidly become infected, and these infections are difficult to eradicate. Salvage of exposed vascular grafts can be achieved by muscle flap, since the potential increase in local blood supply can help to control the infection. The authors report a case in which an exposed hemodialysis graft was covered with a flap created from the flexor carpi ulnaris muscle. Because this muscle is a wrist flexor and adductor, its use in a flap may weaken the wrist. However, tenodesing the flexor carpi ulnaris tendon to the flexor carpi radialis tendon, as was done in this case, can help preserve the function of the flexor carpi uinaris muscle.
Varicose Veins: A Clinical and Biochemical Correlation
Authors: Saroyan R. Mark , Kerstein Morris D. , Haynes Daniel F. , Dyslin David C. , Senkowsky Jon , Kadowitz Phillip J. , McNamara Dennis B.
Published: August 2008

Prostaglandin (PG) metabolism in chronic venous disease can be assessed by quantitative analysis of prostacyclin (PGI2, an antiaggregatory vasodilator) and thromboxane A2 (TXA2, a proaggregatory vasoconstrictor). The authors corre lated the biochemical and noninvasive evaluation (Doppler ultrasound, pho toplethysmography [PRG], and phleborheography [PRG]) of 20 patients with normal and varicose veins, using operative specimens for biochemical analysis. Ten-mg segments of vein were incubated with 10 μM 14C-PGH2 and separated by thin-layer chromatography. Formation of 6-keto-PGF1a and TXB2 was in creased in varicose vein compared with normal vein: 157 ± 11 vs 230 ± 19 picograms 6-keto-PGF1a (p <.05) and 23 ± 2 vs 34 ± 4 picograms TXB2 (p <.05). All patients with varicose veins displayed evidence of venous insufficiency by all examinations. Of 13 patients with clinically normal veins, 8 were normal by all noninvasive criteria. Five were abnormal by two or more noninvasive critera, yet had normal biochemical findings. Increased PGI2 formation in patients with varicose veins indicated increased activity of PGI 2 synthase, possibly associated with chronic venous insufficiency . Noninvasive testing may indicate those patients at risk for developing chronic venous disease before clinical or biochemical changes occur.
A Unique Presentation of an Anastomotic Pseudoaneurysm-Case Report
Authors: Schweitzer Eugene J. , Matas Arthur J.
Published: August 2008

A patient with end-stage renal disease treated with peritoneal dialysis had two old, thrombosed hemodialysis access grafts in her upper limb. She presented with the puzzling problem of a slowly recurring hematoma over the venous anastomo sis of the upper arm graft . When the hematoma was explored surgically, its source was not immediately apparent; however, when the arterial anastomosis of the upper arm graft was subsequently explored, a small anastomotic pseudoaneurysm was encountered. Blood from the pseudoaneurysm had been dissecting between the graft and its fibrous tunnel and slowly accumulating at the venous anastomosis. Pseudoaneurysms occur in less than 5% of dialysis access grafts. They almost invariably present as a pulsatile hematoma over the arterial anastomosis or over a needle hole in a patent graft. The case described herein is interesting because of its unique presentation.
Bilateral Persistent Sciatic Artery Associated with Dissecting Aortic Aneurysm: Case Report
Authors: Matsuda Naruto , Ohgi Shigetsugu , Ito Katsuaki , Hara Hiroshi , Mori Tohru
Published: August 2008

A case of bilateral persistence of the sciatic artery in association with a DeBakey type III dissecting aortic aneurysm is presented. Arteriography demon strated a patent persistent left sciatic artery with an aneurysm, and this artery connected to the popliteal artery. The sciatic artery was also present on the right side but had been occluded in the pelvis, so the hypoplastic superficial femoral artery provided the main route to the popliteal artery. Aneurysm or occlusion of a sciatic artery is common. However, the combination of a dissecting aortic aneurysm and a persistent sciatic artery has never been reported previously. When a persistent sciatic artery provides the main blood supply to the lower limb, anticoagulant therapy is recommended to prevent its occlusion.
Multiple Venous Aneurysms of the Saphenous Vein: Report of an Uncommon Case
Authors: Gruber H.P. , Amiri M.A. , Fraedrich G. , Schlosser V.
Published: August 2008

Venous aneurysms are rare entities. They may cause serious complications like thrombosis or pulmonary embolism. An uncommon case of multiple large aneurysms of the saphenous vein of a forty-one-year old woman is reported. The literature is reviewed and etiology, potential complications, diagnosis, and treat ment are discussed.
Usefulness of Angioscope in Angioplastic Procedures for Arteriosclerotic Obstructions of the Femoral Artery
Authors: Inoue Kiyoshi , Kitamura Soichiro , Fukutomi Masaaki , Kaneda Kozo , Kawachi Kanji
Published: August 2008

In patients with arterial occlusion or stenosis of the lower extremity due to arteriosclerosis obliterans (ASO), vascular lumen was angioscopically observed immediately after transluminal balloon angioplasty (TBA). Five major findings were observed and classified: (1) abrasion of the intima, (2) irregularity of the lumen due to poor expansion, (3) laceration of the wall, (4) mural thrombus, and (5) intraluminally protruding calcification. The degree of each finding was scored with a 3-grade scale (0, 1, or 2). In analysis of the relationship between angioscopic scoring and long-term vascular patency, when initial scores were high, decreased patency was seen in the early (within six months) and late (after six months) (p<0.05) postoperative periods (p<0.01). In patients in whom total scores were over 5, the vascular patency rate was markedly low (11 % and 0% in the early and late postoperative periods, respectively) (ρ<0.01). These results indicate the usefulness of angioscopic observation of the vascular lumen immediately after TBA in predicting postoperative patency.
Changes in Femoral Artery Blood Flow and Supersensitivity of Arteries to Norepinephrine After Lumbar Sympathectomy in Dogs
Authors: Iwahashi Kanji , Hiratani Katsuhiko , Tsunekawa Kengo
Published: August 2008

Blood flow of the femoral arteries of both sides was measured, and changes in sensitivity of the arteries to norepinephrine were studied in unilateral sym pathectomized canine hindlimbs, in order to demonstrate the presence of super sensitivity of arteries to norepinephrine after sympathectomy.

Before injections of norepinephrine into the vein, the ratio of blood flow in the femoral artery on the sympathectomized side to that on the opposite side increased in L3-L5 and in L3-L7 sympathectomized hindlimbs. This ratio of blood flow decreased in inverse proportion to the increase of doses of norepinephrine admin istered into the vein in both groups, and finally the flow on the sympathectomised side became lower than that on the nonsympathectomized side.

The dorsal pedal arteries on the L3-L5 sympathectomized side, which are subject to decentralization but not denervation, had a slight degree of supersen sitivity to norepinephrine. The saphenous arteries on the L3-L5 sym pathectomized side were incompletely denervated and showed a moderate degree of supersensitivity to norepinephrine. The saphenous and the dorsal pedal arteries on the L3-L7 sympathectomized side were denervated almost completely and showed a significant increase in sensitity to norepinephrine.

These results provide evidence that supersensitivity to norepinephrine does occur in the arteries of sympathectomized canine hindlimbs.
Diabetes Mellitus and Coronary Artery Bypass Surgery
Authors: Berki Thran , Kocak Tuncer , Balkanay Mehmet , Isik Ömer , Yakut Cevat
Published: August 2008

Two hundred diabetic coronary artery heart disease patients were operated during a fifty-four-month period. The total number of coronary artery bypass grafting (CABG) operations performed in this period was 1300. Emergency CABG operations were excluded from this study. The diabetic patient population was subclassified as having latent diabetes, diabetes regulated with diet or oral antidiabetic agents, and insulin-dependent diabetes mellitus (IDDM). Congestive heart failure and left ventricular hypertrophy seen in the diabetic population was a significant clinical feature as compared with the nondiabetic patients. An giographically the distribution of localized coronary artery lesions was similar, but a diffuse atherosclerotic vessel disease pattern was prominent in the diabetic group. Segmental wall motion in diabetic patients revealed severe ventricular dysfunction as compared with the nondiabetic group. Hospital mortality was 6.8% to 8.5 % in favor of the nondiabetic group. Low cardiac output, renal complications, mediastinitis, and wound infections were encountered more fre quently in the diabetic patients. The distal coronary artery anastomosis rates in nondiabetic and diabetic patients were 2.8 and 3.1 respectively.

The high rate of vascular and metabolic complications seen in this systemic disease has led the authors to accept diabetes mellitus as a risk factor in CABG surgery.
Consequences of Groin Lymphatic Fistulae After Vascular Reconstruction
Authors: Kalman Peter G. , Walker Paul M. , Johnston K. Wayne
Published: August 2008

Division of lymphatics during femoral arterial exposure may result in a lymphatic fistula. The management of this problem may be conservative or operative, both aimed at stopping the leak of lymphatic fluid and preventing graft contamination. The authors' purpose was to review their groin lymphatic fistulae over the last ten years to assess their approach and determine long-term outcome. Forty-five patients during the past ten years had an identified lymphatic fistula following vascular reconstruction involving the femoral artery. Sixty-seven per cent had underlying prosthetic grafts at risk. Twenty-three patients were man aged conservatively (bed rest, pressure dressing, antibiotics) with an average of thirteen days of lymphatic fistula and all resolved. In 22 patients the lymphatic fistula was stopped by exploration and simple closure after an average of fourteen days. The average length of stay after vascular surgery was sixteen days in patients treated conservatively, and twenty-four days in those treated surgically. There were 3 groin infections in the group treated conservatively. Follow-up of all patients averaged fifty-three months (range three to one hundred thirty-one months), and there was no evidence of false aneurysm formation or graft infec tion. Both conservative and operative approaches are effective in the management of the lymphatic leak, and the decision between the two methods of treatment depends upon drainage volume and duration.
A New Syndrome: The Popliteal Pseudo-Entrapment
Authors: Psathakis Dimitrios N.
Published: August 2008

The pseudo-entrapment syndrome is caused by kinking of the popliteal artery and vein, and/or of the common tibial nerve, and occsionally of the common fibular nerve. The clinical symptoms are similar to the symptoms found in the entrapment syndrome. The kinking in pseudo-entrapment syndrome is caused by a transverse fibrous band, resulting in calf pain and distress. Pathogenesis, diagnosis, and operative treatment of this new and common syndrome are described.

In 66 lower limbs of 49 patients a popliteal pseudo-entrapment syndrome was confirmed by Doppler ultrasound. It was caused by kinking of the popliteal vessels and nerves on one or more fibrous bands transversing the popliteal fossa from the lateral to the medial head of the gastrocnemius muscle. Of the 49 patients (66 limbs), 32 patients, mostly women, (41 limbs) were opperated on by dividing the fibrous bands. Results after operation were assessed by Doppler ultrasound. Pulsation in the pedal arteries was present in spite of maximal knee flexion and tiptoeing. Postoperatively the patients were without symptoms and complaints. The results achieved by operation were still maintained five years later.
Occluded Infrainguinal Vein Bypass Grafts. Are Secondary Alloplastic Procedures Worthwhile?
Authors: Függer Reinhold , Böhner Hinrich , Schemper Michael , Kretschmer Georg , Polterauer Peter
Published: August 2008

Occlusion of an infrainguinal saphenous vein bypass presents an unresolved problem of further treatment in patients with threatened limbs. The implantation of alloplastic grafts is an attempt to possibly avoid amputation. The authors report 56 patients who were treated by secondary alloplastic grafts after occlusion of their vein bypass. All secondary procedures were performed for limb salvage. The median time of patency of sequential combined saphenous vein plus an additional alloplastic bypass was sixteen months. Following a reocclusion of the secondary grafts, 45 % required major amputation. Nevertheless, the median period of limb salvage was fifty-four months. Therefore, secondary alloplastic grafts seem to be a reasonable procedure in the treatment of threatened limbs after occlusion of an infraginguinal saphenous vein bypass, if one takes the limited life expectancy of sixty-four months into account for these patients.
Leiomyosarcoma of the Inferior Vena Cava—A Case Report
Authors: Wicky B.N. , Sege D.G. , Amgwerd R.
Published: August 2008

The authors report a rare case of leiomyosarcoma of the inferior vena cava (IVC) with an unusually long survival time of more than five years without signs of local or systemic tumor recurrence up to today. The diagnostic and therapeutic problems are discussed and the relevant literature is considered. The diagnosis was assessed by computed tomographic scan. The surgical treatment consisted of resection of the tumor (located in the inferior and middle third of the IVC), together with the right kidney. After proximal ligature of the left kidney vein no reconstruction of the resected segment of the IVC was performed.

Owing to an adequate collateral venous drainage the kidney function remained normal. The prognosis of this rare tumor is reported to be quite poor with a resectability rate of about 60% and a mean survival time of two to three years after surgery. Alternative treatment modalities such as irradiation or chemotherapy are considered to be of no additional benefit.
Results of 300 Bileaflet Mechanical Valve Implanatations
Authors: Işik Örner , Balkanay Mehmet , Kisacikoglu Bülent , Tanugur Hüseyin , Bayezid Omer , Yakut Cevat
Published: August 2008

Three hundred bileaflet mitral or aortic mechanical prosthetic heart valves were implanted in 250 patients over a four-year period at Kosuyolu Heart and Research Center: 96 patients underwent mitral valve replacement (MVR), 81 aortic valve replacement (AVR), and 73 AVR + MVR. Seven of the mitral, 8 of the aortic, and 2 of the double valve replacements involved additional cardiac proce dures. Sex ratio was 63% females, 37% males. The youngest patient was nine, the oldest was seventy-six, and the average age was thirty-nine years; 59% of the patients had atrial fibrillation, 66% were in NYHA functional Class III-IV, and 61% were in congestive heart failure.

Hospital mortality was 9.6% and late mortality was 4%. The predictors of survival were evaluated. Preoperatively and postoperatively 17 variables were studied by statistical analysis. Factors identified as influencing survival were: female sex, advanced age, NYHA Class more than III, increased cardiothoracic ratio, congestive heart failure, diabetes mellitus, giant left atrium, and prosthet ic valve endocarditis. Eleven patients developed endocarditis, and 21 had throm boembolic episodes.

The authors conclude that the bileaflet mechanical prosthetic heart valve is a good candidate for mechanical valve replacement among the currently availa ble choices.
Should HIV Endocarditis Patients Be Operated On? A Case Presentation
Authors: Yee Edward S.
Published: August 2008

Emergency valve replacement for left-sided endocarditis in intravenous drug abusers with a poor long-term prognosis makes the operative decision a difficult one, especially when they are also at risk for HIV infection. The influence of cardiopulmonary bypass on 2 patients may have accelerated the clinical manifes tations of their underlying infections, including a marked acceleration and death in one. These cases suggest that cardiopulmonary bypass perturbs the immune system. The safety of cardiopulmonary bypass in these settings is questioned and a nonoperative approach may be justified in this high-risk group of endocarditis patients.