bluuebunny/crossref_metadata_2025 huggingface dataset:
Inferior Vena Cava Interruption for the Prevention of Pulmonary Emboli: Advantages, Disadvantages, and Complications
Authors: Borrero Edgar , Rosenthal David
Published: August 2008

Pulmonary embolism (PE) in high-risk patients is minimized by inferior vena caval interruption by ligation, plication/clipping, intraluminal filters, or intralu minal balloons. Vena caval filter implantation is the least traumatic of all surgi cal implantation is the least traumatic of all surgical methods of preventing PE. These nonocclusive methods are preferred to minimize the possible sequelae of venous insufficiency. The prevention of septic emboli requires complete liga tion of the inferior vena cava (IVC). The transvenous approach to IVC inter ruption by intraluminal filter is particularly useful in severely ill patients.

The Kim-Ray Greenfield filters are at present the most frequently used mo dalities for prevention of fatal PE when intervention is required. In a large ser ies of patients who have had the Greenfield filer implanted, there has been an operative mortality of less than 1%, with an incidence of recurrent emboli of less than 2%, and an incidence of venous stasis sequelae of approximately 20%. In general, this device has greater ease and flexibility of placement with lower mortality and morbidity rates.
Arteriovenous Communications in Patients with Primary Varicose Veins: An Investigation Using Thermography, Blood Oxygen Tension, and Operative Microscopy
Authors: Kimura Tadahiro , Yoshizaki Satoshi , Matsumoto Sumio
Published: August 2008

The presence of arteriovenous communications (AVCs) in the lower extremi ties of patients with primary varicose veins with or without ulcerations was inves tigated by use of thermography, analysis of the blood oxygen tension, and observation under operative microscopy.

Fifty-six subjects, including 20 normal subjects and 26 patients with primary varicose veins, were studied. Subjects maintained a standing position in a quiet room while thermography was performed both before and after exercise. The exercise was performed tiptoeing at a rate of twenty times per minute. After exer cise, hot spots on the lower extremities of the patients with varicose veins were localized by thermography. In the normal subjects, blood samples were aspi rated percutaneously from the femoral artery and vein before and after lumbar anesthesia. In the patients with primary varicose veins, an incision was made in the inguinal region following lumbar anesthesia and samples of blood were aspirated from the femoral artery and vein, the saphenous vein, and the ther mographic hot spots. The venous and arterial blood oxygen tensions were deter mined immediately in the hospital laboratory by means of a blood gas analyzer.

After lumbar anesthesia, there were significant differences between the oxy gen tensions of the hot spots and those of the femoral or saphenous veins in the patients with varicose veins (p < 0.01, p < 0.05). At operation, the hot spots were investigated by operative dissection and microscopy. Small, pulsating arteries were observed at the sites that corresponded to the hot spots. These results strongly suggest that AVCs open up in the dermal capillary bed as the result of a persis tently high venous pressure, and these shunts, by diverting oxygenated blood away from the overlying skin, produce skin ischemia and ulceration.
Laser Vascular Anastomosis—Preliminary Evaluation of a New Anastomotic Technique
Authors: Brooks Stephen G. , Ashley Simon , Gehani Abb A. , Davies G. Alban , Fisher John , Kester Ralph C. , Rees Michael R.
Published: August 2008

Laser vascular anastomosis (laser welding) is a developing technique that em ploys the thermal effect of laser energy to achieve fusion of apposed vessel edges. The authors have attempted to establish a definitive technique by an investiga tion of the physical properties of laser welds. Porcine coronary arteriotomies were repaired in vitro by two different laser wavelengths (Argon [488/514 nm] and Nd:YAG [1064 nm]) and by use of chromophore dyes to enhance energy absorption at the anastomosis. Anastomatic bursting strength was measured directly by means of saline infusion and vessel constriction (caused by diffusion of heat from the weld) assessed by a constant-pressure flow rate model. Histo logic techniques were also employed to estimate the degree of thermal damage to the vessel.

In all these respects optimal results were obtained by the Argon laser and use of the chromophore Basic Fuchsin. These repairs all burst at greater than 200 mmHg and were minimally constricted. Thermal tissue damage was accurately confined to the anastomotic site. This technique will, therefore, be employed in future studies.
Red Cell Deformability Changes as a Prognostic Indicator of Postoperative Morbidity in Cardiac Surgery Using Cariopulmonary Bypass
Authors: Belboul Ali , Al-Kahaja Najib , Bergman Per , Roberts Donald , William-Olsson Göran
Published: August 2008

Preoperative and intraoperative red cell deformability assessed by a standard microfiltration technique was used to study the gross rheologic changes of red cells due to disease and mechanical trauma in relation to postoperative compli cations following the use of cardiopulmonary bypass (CPB) for elective heart surgery in 142 patients in NYHA (New York Heart Association) class III. The red cell filtration rate (RCFR) in μL/s was determined before surgery and grouped rheologically into four functional classes (GTCA = Gothenborg Cardio-Thoracic Association). Compared with their laboratory's normal reference for 200 healthy individuals (mainly blood donors) (61 ± 9 μL/s ± 2 SD), the RCFR was signifi cantly reduced by 21% (p < 0.05) to GCTA class I (1-25% reduction) in 18 pa tients, by 34% (p<0.01) to class II (26-50% reduction) in 99, and by 54% (p<0.001) to class III (51-75% reduction) in 25. Significant RCFR reductions during CPB were seen in all the groups, where the mean reduction was lowest in class I (15% p<0.001) and highest in class III (76% p<0.001) as compared with normal subjects.

The analyses of complications showed that significantly higher frequencies of bleeding, blood transfusion, respirator usage, and arrhythmia were found in class III than in class I (1.5 vs 0.8 L, p<0.05; 3 vs 1.5 units, p < 0.05; 14 vs 6 hours, p<0.05 respectively).

The authors conclude that preoperative red blood cell deformability testing and grading of the patients' microrheologic status of red blood cells can be a complement to the NYHA function classification and can also be useful for study ing the morbid effects of surgical trauma associated with CPB.
Flow Waveform Analysis of Autologous Saphenous Vein Grafts for Reconstruction of Lower Extremity
Authors: Okadome Kenichiro , Komori Kimihiro , Onohara Toshihiro , Yamamura Shinji , Sugimachi Keizo
Published: August 2008

On the basis of the author's previous reports that the outcome of the recon structed lower extremity artery was closely associated with the electromagneti cally determined flow waveform pattern at operation and was an essential factor in determining the patency, the values of T variation—the integral of time differen tial of wall shear stress in one cardiac cycle for 35 consecutive femoropopliteal autologous saphenous vein grafts were reviewed by flow waveform analysis. For grafts with the Type O or I flow waveform pattern, the cumulative patency rate, calculated by the life-table method, was 94% at one and three years and 57% at five years. In contrast, for grafts with the Type II flow waveform pattern, the patency rate was 70% at one year, 43% at three and five years (p < 0.05, at one and three years). To assess the correlation between T variation values, and outcome of the grafts, 35 grafts were grouped into three, according to the value of T variation: grafts with T variation lower than 30 dyne/cm2 , those with T variation ranging from 30 to 70 dyne/cm2, and those with T variations higher than 70 dyne/cm 2 . The grafts with T variation higher than 70 dyne/cm2 showed the most favorable long-term patency and the grafts with T variation lower than 30 dyne/cm2 showed poor results; the results were intermediate in grafts with a T variation ranging from 30 to 70 dyne/cm2. Thus, flow waveform analysis is useful for predicting the outcome of femoropopliteal saphenous vein grafts. In particular, the T variation is a reliable indicator of the outcome of these grafts.
Screening for Abdominal Aortic Aneurysm in 295 Outpatients with Intermittent Claudication
Authors: Andersson Anders P. , Ellitsgaard Niels , Jorgensen Bo , Fallentin Eva , Kollerup Gina B. , Holtveg Helle , Holstein Per
Published: August 2008

In an attempt to establish the prevalence of abdominal aortic aneurysm (AAA) in outpatients with intermittent claudication (IC), 295 patients had ultrasonic screening of their abdominal aorta. There were 123 women and 172 men, median age sixty-eight years range from thirty-eight to eighty-six years. Prevalence of AAA was 5.5% (16/291 patients; examination was inconclusive in 4). All of the AAAs except 1 were found in patients older than sixty years. The prevalence in women was high and there was no significant difference between the sexes in number of AAAs: men, 12/172; women, 4/123 (p > 0.16). Of all patients, 71% were smokers and 13 AAAs were in smokers. No AAAs were found in nons mokers. 3 AAAs were found among 27 patients with unknown smoking status. The percentage of smokers was about equal in the two sexes. Because only one third of the AAAs were identified by abdominal palpation, it was insufficient as a screening procedure. The authors conclude that patients of both sexes and more than sixty years old with IC should be offered ultrasonic screening for AAA.
Unusual Internal Iliac Artery Aneurysm- A Case Report
Authors: King Brian J.
Published: August 2008

This paper describes a very unusual internal iliac artery aneurysm that was unrecognized when it first ruptured but was successfully treated by incontinuity ligation, exploration, and evacuation.
Rupture of an Iliac Artery Aneurysm into the Rectum: A Case Report
Authors: Ravi Rajagopalan
Published: August 2008

Arterioenteric fistulas are uncommon, particularly when involving the colon and rectum, and death often ensues from multisystem failure.

A seventy-eight-year-old man was admitted to the hospital within a few hours after the onset of profuse rectal bleeding. The preoperative diagnosis was perfo rated diverticulitis, but exploratory laparotomy uncovered a ruptured right iliac artery aneurysm that had eroded into the rectum. A diverting sigmoid colosto my and cross femoral grafting were performed, and the patient recovered. Ear ly, aggressive surgical intervention and medical management were essential to the successful outcome of this case.
Coronary Sinus Pressure: A Condition per Se of Return Volume via the Coronary Sinus in the Healthy Animal? Surgical Considerations in Atriopulmonary Anastomosis Procedures
Authors: Fentidis P. , Fernández Ruiz Ma , Madero Jarabo R. , Cordovilla Zurdo G.
Published: August 2008

In order to test the hypothesis of the "vascular waterfall" mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume (CRV) via the coronary sinus (CS) was studied in healthy animals.

An experimental model of pressure regulation in the CS was prepared and aortic and left atrial pressures, EKG, and the cardiac output (measured by thermodilution) were recorded. The return volume via the CS was measured at CS pressures of 10 or less, 15, 20, and 25 mm Hg or more, for a total of 36 determinations.

Overall, increased CS pressure did not produce significant changes in aortic and left atrial pressures, heart rate, cardiac index, or CRV via the CS. When CS pressure was 25 mm Hg or more, however, there was a significant decline in the average CRV via the CS. Nevertheless, stepwise variant regression showed that the CS per se does not condition the volume of coronary return via the CS. The authors' results suggest that in healthy animals, the hypothesis of the "vascular waterfall" mechanism in coronary venous circulation is not valid.

Thus, in correcting congenital cardiac malformations by use of atriopulmonary anastomosis procedures, there is no justification for employing techniques that ensure CS drainage into the left atrium in order to avoid the hemodynamic repercussions attributable to the hypothesis of the "vascular waterfall."
Use of Non-Valved Extracardiac Conduits in Complex Congenital Anomalies
Authors: Sarioglu Tayyar , Paker Tufan , Sarioglu Ayse , Bayindir Osman , Köner Ali , Aytaç Aydin
Published: August 2008

Between March, 1986 and September, 1989, nonvalved conduits were used in 9 patients, ages ranging between five and seventeen years. Cardiac pathologies were atrioventricular and ventriculoarterial discordance with ventricular septal defects (VSD) and pulmonary stenoses (PS) in 5, transposition of great arteries (TGA) + VSD + PS in 1, and double-outlet left ventricle (DOLV) + VSD + PS in 3. Pulmonary obstruction was valvular in 1, valvular and infundibular in 7. There was 1 patient with pulmonary atresia.

Valveless conduits 16-22 mm in diameter were used between the pulmonic ventricle and the pulmonary artery. All patients recovered from operation and remained well, except 1 with DOLV who died with severe arrhythmias the third postoperative day. During the mean follow-up of 32 ± 11.8 months 1 patient died of acute cardiac failure in the ninth month and all other patients were asymptomatic without needing reoperations.

These results have been encouraging for the use of nonvalved conduits in complex congenital cardiac anomalies.
Femoral Artery Aneurysms In Behçet's Disease
Authors: Paç M. , Koçak H. , Basoglu A. , Yekeler I.
Published: August 2008

Vascular involvement in Behçet's disease (BD) can include both arteries and veins. Arterial aneurysms in BD have been seen most commonly at the abdominal aorta and femoral arteries. During a seven-year period, 7 aneurysms in 5 patients were surgically treated in the authors' department. Arteriography was performed in the first 2 patients for diagnosis. Pseudoaneurysms occurred at puncture sites in these patients. All patients were treated surgically with saphenous or polytetrafluoroethylene grafts. One patient died of rupture of an abdominal aortic aneurysm. Another patient had above-knee amputation because of the graft's pseudoaneurysm, late septic embolus, and necrosis of the extremity.
Surgical Treatment of Stasis Venous Ulcers of the Lower Limb
Authors: Taheri S.A. , Kulaylat M.N. , Taheri P.A. , Hoover E.
Published: August 2008

Ten patients with severe lower extremity stasis venous ulcer refractory to medical therapy were selected to undergo excision of the ulcer and the underly ing muscle fascia and interruption of the incompetent communicating veins with split thickness skin grafting. All patients had evidence of lipodermatosclerosis. Eight patients had a descending venogram that showed grade IV regurgitation and 2 had an ascending venogram that showed patency of the venous system. All patients had venographic evidence of incompetent communicating veins. Biopsies obtained from calf muscle (4) and sural nerve (2) were consistent with neuromyopathy. Thermodilution study performed in 4 patients showed in creased flow to the affected limb with pooling of venous blood. Follow-up (mean thirteen months) showed healing of all ulcers and no ulcer recurrence. The authors suggest that this procedure be reserved for patients with gross and permanent pathologic changes in and around the ulcer when medical therapy fails.
Factitious Appearance of Aortic Dissection During Portable Cardiopulmonary Bypass—A Case Report
Authors: Drucker Morris H. , Woods Larry A. , Austin Stephen M.
Published: August 2008

The use of percutaneous cardiopulmonary bypass support (PCPS) has in creased as an aggressive resuscitative measure for hemodynamically compromised patients and for support during high-risk coronary angioplasty or valvuloplasty. The authors present a patient with an acute myocardial infarction and shock, in whom aortography during PCPS simulated the appearance of a Type B aor tic dissection, with apparent compression of contrast dye by a nonopacified false channel. The etiology appears to be the competitive flow between the normal forward cardiac ejection and the retrograde cardiopulmonary flow. Low cardi ac output and the differences in density between blood and radiographic dye exaggerate this phenomenon.
Massive Hematuria Due to a Femoroureteric Fistula A Late Complication of Aortofemoral Bypass Grafting —A Case Report
Authors: Hashmonai Moshe , Kaluski Edo , Torem Shlomo
Published: August 2008

A case is reported of a disrupted femoral anastomosis and infected groin hematoma, which presented with massive hematuria and hydroureteronephro sis. This complication occurred nine months after aortofemoral bypass regraft ing, during which the ureter had been transected and repaired. The infected graft was removed, and the ureteric fistula closed spontaneously. The patient was fol lowed up for nine years until his demise from unrelated causes. The pathogenet ic mechanisms of these complications are discussed, and preventive measures are indicated.
Cystic Adventitial Arterial Disease in the Iliofemoral Region — Case Report
Authors: Schiesari Alberto Previato , Miotto Diego , Feltrin Gianpiero , Liessi Guido , Capitanio Giovanni , Blandamura Stella , Costa Francesco Dalla
Published: August 2008

Cystic adventitial arterial disease (CAAD) is a rare vascular disease mainly affecting the popliteal artery in men. The authors present an unusual case of CAAD in the iliofemoral region in a twenty-six-year-old woman. Symptoms com prised rapid onset of claudication, and angiography of the lesion revealed a typical "scimitar" stenosis. Since treatment with transluminal angioplasty is known to be useless and since there is a high percentage of relapses after simple evacua tion of the cysts, the authors resected the affected arterial segment and recon structed the artery using a prosthetic polytetrafluoroethylene (PTFE) graft.
Graft Enteric Fistula: A Report of Two Late Cases and Literature Review
Authors: Lee Brian J. , Lynch Robert D. , Smith John W.
Published: August 2008

Two patients with late graft enteric fistula (GEF) are reported, one at nineteen years (238 months) and the other at nineteen years eleven months after implan tation. In a review of the literature the incidence varies from 0.2% to 4% and also varies for emergent, elective, aneurysmal, and occlusive disease. Mechani cal and infectious factors, alone or in combination, are thought to comprise the etiology of GEF. The diagnosis is based on a high index of suspicion and must be considered in any patient with a previous aortic graft and gastrointestinal bleed ing until proved otherwise. No single diagnostic study is useful in all cases, and exploratory laparotomy may be the final diagnostic procedure in some. Most authors recommend total graft excision and extra-anatomic bypass; however, in situ repair or replacement has been performed in a few selected cases. The 2 cases reported demonstrate that there is no time limit for occurrence of GEF after abdominal aortic reconstruction.
Aneurysm of an Aberrant Celiac Axis: Revascularization of Hepatic and Splenic Arteries—A Case Report
Authors: Kinjo Osamu , Shiroma Hiroshi , Kamada Yoshihiko , Dharma Raj Shrestha  , Koja Kageharu , Kina Morio , Miyagi Kazufumi , Kusaba Akira
Published: August 2008

In a fifty-three-year old Japanese woman, a 3-cm-diameter saccular, calci fied aneurysm was detected beneath the pancreas during surgery for cholelithi asis. She was then referred to the authors' institution, where an aneurysm was detected on the medial wall of an anomalous celiac axis, that is, the hepato splenic trunk as a branch of an anomalous hepatosplenomesenteric trunk. This vascular anomaly was identified as type III in Adachi's classification of the structural variation of the celiac axis. The aneurysm was resected, and revascu larization of the hepatic and splenic arteries was successful following insertion of an autogenous vein graft.
Ten Years of Experience with Aortoiliac Polytetrafluoroethylene Grafts—Effects of Postoperative Anticoagulation on Graft Function and Patient Survival
Authors: Függer Reinhold , Prager Manfred , Sautner Thomas , Magometschnigg Heinz , Kretschmer Georg , Polterauer Peter
Published: August 2008

Between 1980 and 1990, 354 aortoiliac repair procedures were performed with polytetrafluorethylene (PTFE), which had become available in 1980. This retrospective analysis was designed to show whether anticoagulation or antiaggregant treatment had beneficial effects on patient survival and graft function. In patients with unilateral aortoiliac grafts, antithrombotic therapy with phenprocoumone or acetylsalicylic acid (ASA) improved graft function (Breslow, p=0.038; Mantel, p=0.013) and long-term survival (Breslow, p=0.013; Mantel, p = 0.009). However, the results concerning survival are devaluated, because the members of the control group were older (65.9 years vs 61.1 years, Chi square test p=0.01). In patients with PTFE bifurcation grafts, in whom risk factors and age were well balanced, survival was also significantly prolonged by postoperative drug treatment in the early years of the follow-up (Breslow, p=0.038; Mantel, p=0.298), but graft function was unaffected.

These results suggest that postoperative anticoagulant therapy with ASA or phenprocoumone may be of some benefit in patients undergoing iliac PTFE grafting procedures. Based on these retrospective data, a randomized prospective trial was initiated to study the effects of different drugs suppressing coagulation, ie, anticoagulants and antiaggregants, on allogenous grafts.
Prostacyclin—Thromboxane Ratio as a Noninvasive Screening Test for Pulmonary Embolism
Authors: Duran Enver , Karagoz Haldun Y. , Isimer Askin , Dogan Nevzat , Kocailik Ali , Balkanli Kunter , Sungun Mutasim
Published: August 2008

The effect of pulmonary embolism (PE) on prostacyclin (PGI2) and thromboxane A2 (TxA2) levels and PGI2- TxA2 ratio (PTR) was investigated in a series of canine experiments. Group I dogs (n = 8) underwent experimental PE with autologous clot. Group II dogs (n=8) received imidazole (30 mg/kg), five minutes before PE to inhibit thromboxane synthesis and to simulate antiplatelet drug therapy. Group III dogs (n=8) received only imidazole without PE. In Groups I and II, PGI2 levels (measured as the 6-keto PGF1α metabolite) increased significantly after PE (p < 0.05), whereas they were not altered in Group III. PE caused a sharper increase in TxA2 levels (measured as the thromboxane B 2 metabolite) in Group I (p < 0.001). Imidazole decreased TxA 2 levels both in Groups II and III (p < 0.05). The reference values (ie, before PE and before imidazole) of PTR were not significantly different among the three groups: 3.8±0.4 in Group I, 3.6±0.2 in Group II, and 3.8 ±0.1 in Group III (mean 3.7±0.2). In Group I, PE resulted in a decrease in the PTR (p < 0.05), which reached its peak significance at ten minutes (from 3.8±0.4 to 1.8±0.2). Imidazole-treated groups showed a significant increase in the PTR irrespective of PE (p < 0.05) by virtue of the decreased thromboxane B2 values. It is concluded that, a PTR ratio of 2 or less is suggestive of PE in patients who do not receive antiplatelet therapy.
Nonoperative Removal of an Intracardiac Foreign Body in a Child: Case Report
Authors: Mucci Samuel J. , Cardwell Robert J. , Hennessy James R. , Khan Abid H.
Published: August 2008

The authors report a case of a nine-year-old girl whose fractured Hickman catheter embolized to the heart. Because the proximal end of the catheter fragment resided underneath the papillary muscles of the tricuspid valve, biopsy forceps were used to maneuver the fragment from the right ventricle into the inferior vena cava. This fragment was then retrieved with a basket snare without complication.
Hemodynamic Evaluation of Venous Function After Surgical Treatment of Varicose Veins
Authors: Hirai Masafumi , Naiki Kenichi
Published: August 2008

In the present study, venous function was evaluated by simultaneous strain gauge plethysmographic (SGP) and photoplethysmographic (PPG) techniques before and after varicose vein surgery. In plethysmography, expelled volume dur ing five active dorsiflexions of the feet and venous recovery time were calcu lated to evaluate muscle efficiency and valvular competence. This technique was applied in 46 limbs of 31 patients with varicose veins and 40 limbs of 20 normal subjects. Postoperative tests showed an improvement in venous function. In the early stage after operation, however, all parameters were still lower than those in the normal group. This early postoperative venous dysfunction may be due to residual incompetence of the small veins and reduction of the communica tions between the superficial veins or the superficial and deep veins. The parameters improved three and six months after surgery, suggesting a recovery of the tone of the small veins and the development of collaterals. One year postoperatively, however, the venous function worsened again. After applica tion of a tourniquet below the knee, the half-refilling time was prolonged sig nificantly in both the SGP and PPG tracings, indicating that abnormal reflux of the superficial veins had worsened one year after surgery.
A Huge Solitary Aneurysm of the Right Coronary Artery Successfully Treated by Surgery—A Case Report
Authors: Akasaka Tadayoshi , Ogura Yoshimitsu , Anbe Jiro , Nakajima Hiroshi , Ozeki Masayoshi , Mitsuishi Tsuzuki , Suzuki Ryuzo , Ishikawa Yasuro , Tamura Tsutomu , Sato Tomohide , Miyashita Hideo
Published: August 2008

The case of a symptomatic fifty-four-year-old woman with a huge, solitary aneurysm of the right coronary artery is presented. A coronary angiogram did not visualize the aneurysm because of tightly packed thrombi in it, but it was definitely diagnosed intraoperatively after the mass was opened. Excision of the aneusymal wall, removal of thrombi, closure of coronary ostium, and plication of the aneurysmal wall were performed without revascularization. Histologic ex aminations demonstrated cystic medial necrosis with deposition of acid- mucopolysaccharides, suggesting that pathogenesis might be a dissecting aneurysm.
Is Heparin-Induced Platelet Activation an Unrecognized Cause of Thrombosis in Chronic Dialysis Patients?
Authors: Brent Kerns D. , Frymoyer Paul A. , Kopecky Richard T. , Tice Diane , Fillinger Mark F. , Bruch David , Schwartz Robert A.
Published: August 2008

Despite an increase in vaso-occlusive disorders and routine exposures to large quantities of heparin, chronic dialysis (CD) patients have not been studied for the presence of heparin-induced platelet activation (HIPA). Measurement of platelet aggregation and adenosine triphosphate release was performed at hepa rin concentrations of 0.1 U/mL and 100 U/mL using platelet-poor plasma (PPP) from 90 nonthrombocytopenic CD patients; 72 patients received heparin over prolonged periods (108 ±15 weeks); 18 patients received no heparin for two months prior to study.

Results: PPP from 1 hemodialysis (HD) patient stimulated strong ( > 19%) platelet activation at both 0.1 and 100 U/mL heparin concentrations. Four pa tients (4.4%) demonstrated intermediate (10-19%) platelet activation in the presence of 0.1 U/mL but not 100 U/mL heparin concentrations. Eighty-five patients demonstrated no platelet activation ( < 10%) at either heparin concen tration.

Conclusion: (1) None of the 90 dialysis patients met the strict laboratory criteria for HIPA. (2) Despite long-term exposure to large quantities of heparin, the prevalence of HIPA in CD patients appears to be no greater than that of the general patient population receiving heparin. (3) Nonthrombocytopenic HIPA is not a major factor contributing to thrombotic disorders in dialysis patients.
Controversies in the Surgical Treatment of Thoracic Aortic
Authors: Olearchyk Andrew S.
Published: August 2008

The author recommends echocardiography and thoracic aortography com bined with coronary angiography in patients with thoracic aortic aneurysms prior to the operation; resection and replacement of asymptomatic fusiform aneurysms measuring twice or more the size of the normal aorta and of aortic dissections at cardiac operations; and use of active shunts during resection of descending thoracic aneurysms.
Vascular Complications After Total Knee Replacement —
Authors: McKellar Daniel P. , Dutro John A. , Mesghali Homayoun
Published: August 2008

Despite the close association of the popliteal artery to the knee joint, rela tively few cases of arterial injury following total knee replacement have been reported. The authors report 2 patients with total knee prostheses who devel oped hemarthrosis due to pseudoaneurysm formation originating from the ge niculate branches of the popliteal artery. In 1 patient, early arteriography led to a prompt diagnosis and treatment with subsequent good outcome. In the second patient the diagnosis was delayed, for an arteriogram was performed only after recurrent bleeding. This patient had a prolonged course eventually necessitating removal of the total knee prosthesis.

These cases emphasize the need for a high index of suspicion for arterial injury in patients who undergo total knee replacement with subsequent develop ment of hemarthrosis or persistent bleeding. Early arteriography to establish the diagnosis is advocated.
Treatment of Severe Arterial Occlusive Disease by Epidural Spinal Electrical Stimulation
Authors: Steude U. , Abendroth D. , Sunder-Plassmann L.
Published: August 2008

In 10 cases with advanced vascular occlusive disease the effect of epidural spinal electrical stimulation (ESES) on peripheral circulation has been tested by use of transcutaneous oxygen measurement (TcPO2), telethermography, and laser-speckle measurements. The values in all cases increased. Improvement was more pronounced during the first two to three weeks. Indications and limitations of this treatment modality are discussed.
Intramyocardial Coronary Arteries: Dissection During Coronary Artery Bypass Surgery in 70 Patients
Authors: Olearchyk Andrew S.
Published: August 2008

Between October, 1983, and January, 1991, of a total of 395 patients who underwent coronary artery bypass (CAB) surgery, 70 (17.7%) had dissection and vein (65.7%) or internal thoracic artery (ITA; 34.3%) grafting of intramyocardial (IM) coronary arteries for significant proximal coronary artery disease (CAD).

The IM left anterior descending (LAD) artery was dissected and grafted in 58.6%, the IM branches of the circumflex artery (CFA) in 31.4%, the IM posterior descending artery (PDA) in 1.4%, and multiple IM arteries in 8.6% of the patients.

The LAD artery was usually dissected distally at the site of reemergence, and then, the myocardium was transected cephalad, as were the CFA branches, by cutting the overlying myocardium over them. The intracavitary or subendocardial LAD arteries were dissected, grafted, and elevated to permit closure of the opened left ventricle (LV) beneath.

There were no complications related to the dissection of the IM arteries.

The IM arteries are usually of a larger diameter and more often free of atherosclerosis. Therefore, they should be dissected and grafted in patients suffering from significant proximal atherosclerotic disease.
Natural Course of the Amputee's Residual Limb as Followed by Sequential Ultrasound Examinations
Authors: Hyman Stephen , Ellenberg Maury , Pope Sarah , Brown O. William
Published: August 2008

The authors studied 13 amputees (7 below knee, 6 above knee) with sequential ultrasound examinations at weeks 1, 2, 3, and 6 status post amputation to define the natural evolution of stump healing in below- and above-knee amputations. This would permit diagnosis of abnormal conditions such as abscess. In their series, they found striking differences between below- and above-knee amputations. In below-knee amputations the development of fluid collections was rare (2/6) and, when present, small (less than 3 cm) and transient (resolving within two to three weeks). In above-knee amputations, all stumps first developed subcutaneous edema followed by fluid collections (less than 5 cm) all of which resolved within six weeks. They found that ultrasound examinations are a useful technique to define abnormal fluid collections in the amputee's residual limb.
The Effect of Fibrin Glue on the Formation of Perivascular Adhesions
Authors: Dickson Christopher S. , Magovern James A.
Published: August 2008

Fibrin glue is an effective hemostatic agent, but its effect on adhesion forma tion is not known. This study was designed to determine the effect of fibrin glue on perivascular adhesion formation. Arteriotomies were performed on the ca rotid and femoral arteries of 12 dogs. Fibrin glue was used on 24 of the arte riotomies while the other 24 arteriotomies served as controls. Four weeks later the arteries were reexplored. The surgeon assessed the degree of adhesion for mation using four previously defined categories. In addition, color photographs were taken of each site so that adhesion formation could later be evaluated by an unbiased observer. In both categories, there was a slight tendency for fibrin glue to decrease the extent of perivascular adhesion formation, although this difference was not statistically significant.
Recanalization of Coronary Artery Occlusion in Patients with Acute Myocardial Infarction by Use of Brushing Wire—Case Reports
Authors: Hachida Mitsuhiro , Hirai Masaya , Ihashi Kenji , Koyanagi Hitoshi , Chong Young Shi
Published: August 2008

A new coronary intervention using a brushing wire was performed in 11 patients at emergency. All patients were found to have a total obstruction in a coronary artery or a coronary bypass graft. In all patients, thrombolytic ther apy had been performed, without achieving coronary recanalization. Infarct- related arteries on which this technique was used were the left descending artery in 8 patients, right coronary artery in 2 patients, and a bypass graft in 1 patient. The mean ischemic time was 4.18 ±2.59 hours.

Coronary recanalization was obtained in all patients (100%). The residual diameter stenosis was less than 50% in 3 patients, between 50% and 95% in 5 patients, and more than 95% in 3 patients. Preserved left ventricular ejection function was 57.0±12.8%. Ventricular fibrillation occurred in 2 cases owing to thrombolytic therapy. Additional intervention was performed with percuta neous transluminal angioplasty in 3 patients and with coronary artery bypass grafting in 7 patients. One patient underwent CABG following PTCA. Addi tional intervention was not required in 2 patients.
Therapy of Peripheral Arterial Disease: Laser-Assisted Angioplasty Combined with Intravascular Endoprosthetic Stents
Authors: Hundt Cornelia , Berger Hermann , Schmand Jochen , Lauterjung Lutz
Published: August 2008

Percutaneous transluminal laser-assisted angioplasty (PTLA) was combined with percutaneous implantation of vascular endoprostheses to reduce the reoc clusion rate after recanalization of iliac and femoropopliteal occlusions. PTLA (laser recanalization and following balloon dilation) was performed in 56 complete occlusions of iliac (n=9), femoral (n=31), and popliteal (n=16) arteries. Success or failure was defined by clinical criteria (Fontaine's classifica tion), ankle-arm Doppler systolic pressure index, and (if necessary) arteriog raphy. Cumulative long-term patency (mean follow-up time sixteen months) was estimated by the Kaplan-Meier method. The success was also analyzed in corre lation with a couple of variables (localization, length of occlusion, vessel runoff, and the medical treatment).

The initial success rate of PTLA was 83.9%. Reocclusions (4 immediate and 5 at follow-up) occurred only in patients with initially insufficient morphologic result after balloon dilation. In 17 of such cases with residual stenosis after PTLA, stents were implanted. Stent implantation was completed in 88.2%. The overall cumulative success was 68.4%. No difference was observed in this study between the long-term patency rates of treated iliac and femoropopliteal vessels.

The combination of laser recanalization and implantation of vascular stents is a promising method in the management of peripheral arterial occlusive dis ease. It can prevent reocclusions after PTLA and avoids bypass surgery.
New-Generation Glutaraldehyde-Tanned Mandril-Grown Vascular Grafts
Authors: Ratto Giovanni B. , Leprini Arnaldo
Published: August 2008

In order to improve the capability of withstanding mechanical trauma dur ing surgical manipulations, a new generation of tanned ovine collagen vascular grafts with a thicker inner tissue cover has been developed. In spite of such structural refinements, long-term performance of the new grafts, implanted in the inferior vena cava of pigs, was not superior to that of the former grafts.
Fibrinogen and Fibrinogen Degradation Product Levels in Thromboangiitis Obliterans
Authors: Surinder Mohan Gulati  , Chandra Vidhan , Narayan Shashi
Published: August 2008

Fibrinogen and fibrinogen degradation product levels were estimated in 20 patients with thromboangiitis obliterans and compared with those in healthy smokers and patients with other peripheral vascular diseases. The presence of increased fibrinogen levels in patients with thromboangiitis obliterans raises the possibility of its being a risk factor in the pathogenesis of Buerger's disease.
Aneurysm of an Aberrant Right Subclavian Artery—
Authors: Kiev Jonathan , Murray Jay , Cohn Joseph D. , Kerstein Morris D.
Published: August 2008

The authors present a case report of an aberrant subclavian artery aneu rysm recognized on chest x-ray and confirmed with barium swallow and angio gram.
Isolated Gluteal Artery Aneurysm—A Case Report
Authors: Plessas S.T. , Macheras A. , Moiseos M. , Haralbidis N. , Ouranos Z.
Published: August 2008

An interesting case of isolated gluteal artery aneurysm, without an obvious causative factor, is presented.
Long-Term Follow-up of Laser-Assisted Angioplasty: Analysis of Factors Influencing Restenosis and Patency
Authors: Odink Henk F.
Published: August 2008

In a prospective study 24 successful laser recanalizations of femoropopliteal occlusions (mean length, 10.4 cm ± 6.6) were followed up. Before recanaliza tion all patients were classified according to the Rutherford classification and after one year grouped as a clinical success or failure. From the present, the Rutherford classification appears to be useful in predicting long-term patency. The patients classified in the Rutherford categories 1 and 2 showed a long-term patency of 86%. The patients classified in the categories 3, 4, and 5 had a mean patency of only 30%. This difference was statistically significant.

The length of the occlusion influenced neither the patency nor the restenosis rate. The mean occlusion length in the vessels that remained patent was 10.3 cm ± 6.6, compared with a mean occlusion length of 10.5 cm ± 6.7 for the vessels that showed a restenosis.

Directly after the procedure, the mean patency of the successes was 83% and that of the failures was 63%. It is postulated that the influence of the laser and 20% overdilation can contribute to a better long-term patency.
Abdominal Aortic Aneurysm: Age as a Risk Factor Influencing Postoperative Survival
Authors: Perko Mario Jerzy , Olsen Peter Skov , Schroeder Torben Veith , Sørensen Steffen , Lorentzen Jørgen Ewald
Published: August 2008

During a ten-year period 735 patients with abdominal aortic aneurysm were admitted of whom 656 patients were operated on. The perioperative mortality was 18%: 5% in cases electively operated on, 17% in acute not ruptured cases, and 37% in patients presenting with rupture. Age significantly affected peri operative (< 31 days) mortality—both considered alone and assessed together with other risk factors. Further analysis indicated that the perioperative mor tality of octogenarians did not differ from the mortality of septuagenarians, who on the other hand experienced a perioperative mortality rate twice that of patients younger than seventy years. Survival beyond the perioperative period was adversely affected only by age and ischemic heart disease.
Lipid Peroxides in the Mechanism of Ischemia/Reperfusion Injury in Skeletal Muscle—Experimental Studies
Authors: Ikezawa T. , Nishikimi N. , Oba Y.
Published: August 2008

Two sets of experiments were conducted to investigate whether oxygen-de rived free radicals are involved in the mechanism of ischemia/reperfusion (I/R) injury of skeletal muscle and vitamin E is effective in alleviating the injury.

In the first set of experiments, twenty adult mongrel dogs were divided into three groups: group 1 (n=7) control, group 2 (n = 6) I/R, and group 3 (n=7) I/R with 500 mg of vitamin E. Serum creatine phosphokinase (CPK) and lipid per oxides (LPO) were measured as markers of rhabdomyolysis and biomembrane injury due to oxygen-derived free radicals, respectively. CPK increased signifi cantly after reperfusion with a peak value of 38,000 ± 9,800 mU/mL in group 2, when compared with a peak value of 1,060 ± 290 mU/mL in group 3 (p < 0.02). LPO also significantly increased with a peak value of 20.4 ±3.7 nmol/mL in group 2, when compared with a peak value of 9.2 ± 2.2 nmol/mL in group 3 (p < 0.04).

In the second sets of experiments, 13 dogs were divided into two groups: group A (n=5) control and group B (n=8) I/R. Tissue LPO was measured eighteen hours after reperfusion in the gracilis muscle and gastrocnemius mus cle. The mean value of LPO in the gracilis muscle was 0.94 ± 0.46 nmol/mg protein in group A, compared with 1.13 ± 0.67 nmol/mg protein in group B. It was higher in group B, but there was no significant difference. Mean LPO in the gastrocnemius muscle was 0.85 ± 0.34 nmol/mg protein in group A, and 1.83 ± 0.71 nmol/mg protein in group B. There was a significant difference (p < 0.02).

Serum CPK and LPO were significantly higher in group 2 than in groups 1 and 3, and tissue LPO was also high in skeletal muscle after reperfusion. Serum CPK and LPO were effectively suppressed by administration of vitamin E be fore reperfusion.

These results show that oxygen-derived free radicals are involved in the mechanism of I/R injury in skeletal muscle and suggest that vitamin E is effec tive in alleviating the injury.
Lactobacillus Endocarditis Necessitating Combined Mitral and Aortic Valve Replacement—A Case Report
Authors: Olearchyk Andrew S.
Published: August 2008

A sixty-nine-year-old man with previous exposure to radiation and with Heyde's syndrome developed endocarditis caused by Lactobacillus acidophilus, involving the mitral and aortic valves, and resistant to antibiotic treatment.

He underwent mitral and aortic valve replacement (MVR and AVR) with mechanical valves, followed by six weeks of antibiotic therapy with excellent results.
Bilateral Aneurysms of the Pulmonary Artery with Pectus Excavatum—A Case Report
Authors: Özpinar Cevat , Ceran Sami , Yeniterzi Mehmet , Yüksek Tahir , Özergin Ufuk , Solak Hasan
Published: August 2008

An eleven-year-old boy was operated on for a left-sided pulmonary artery aneurysm. The same patient had also been operated three years earlier because of a right sided aneurysm.
Overwhelming Postsplenectomy Infection Presenting as Acute Lower Limb Ischemia—A Case Report
Authors: Hersch M. , Olsha O.
Published: August 2008

This report describes acute ischemia of the right lower extremity as the first sign of overwhelming postsplenectomy infection (OPSI) in a sixty-five-year-old man with known peripheral vascular disease two months after gastrectomy and splenectomy for gastric cancer. While emergency arterial bypass was being con sidered, the patient developed generalized peripheral vasoconstriction together with clinical and laboratory evidence of consumption coagulopathy and meta bolic acidosis. The possibility of OPSI was suggested and he was accordingly managed in the intensive care unit. A blood culture grew Streptococcus pneumo niae. The patient died of overwhelming pneumococcal sepsis with marked hemodynamic instability and multiorgan dysfunction four days after admission.

The onset of acute lower limb ischemia was an early sign of OPSI in this patient with preexisting peripheral vascular disease. This sign has not been pre viously reported.
Interval Gangrene After Femorodistal Bypass: Case Report
Authors: de Nie A.J. , Yo T.I.
Published: August 2008

Interval gangrene is a rare but devastating complication after a successful peripheral revascularization procedure. It represents ischemic necrosis in a seg ment proximal to a functioning distal anastomosis and may develop when a bypassed segment is deprived of good perfusion. The patient here described underwent a femoroperoneal bypass because of severe atherosclerosis, with is chemia in the left lower extremity. Despite a good functioning bypass and a warm foot, she postoperatively developed ischemia of an area in the lower limb proximal to the distal anastomosis and eventually required above-knee amputa tion.

This case emphasizes the need for maintaining good perfusion of the entire lower limb after successful distal extremity bypass, which may require adjunc tive procedures. The authors recommend, therefore, that intraoperative angi ography be performed routinely, not only to judge the anastomosis and the distal perfusion, but also to assess the adequacy of antegrade and retrograde perfusion of the bypassed segment. Thus measures can be taken in time for optimal prevention of interval gangrene.
Autologous Fibrin Glue—Clinical Use and Sealing of High-Porosity Vascular Prostheses
Authors: Kjaergard Henrik K. , Weis-Fogh Ulla S. , Sørensen Henning , Thiis Jens , Hern Jesper , Rygg Inge
Published: August 2008

Autologous fibrin glue was prepared in a new way by means of ethanol. From 42 patients 44 mL of blood with a mean plasma fibrinogen concentration of 3.7 mg/mL was drawn. The product of the preparation was a mean of 2.5 mL of fibrinogen concentrate with a concentration of 28 mg/mL. After addition of 0.3 part of thrombin solution containing calcium chloride and aprotinin, an antifibrinolytic agent, the total volume of two-component fibrin glue was 3.3 mL. The preparation was done in a closed system to ensure sterility and com pleted within ninety minutes. Twenty high-porosity double-velour vascular prostheses were sealed with autologous fibrin glue in the laboratory. The pro stheses were tight for blood up to a pressure higher than 300 mmHg, which was comparable to vascular prostheses impregnated with collagen, but to more than twice the pressure of 130 mmHg, where vascular prostheses preclotted with blood started leaking. Autologous fibrin glue imparts a nice white vascular graft with superior handling characteristics, since it is nonsticky compared with blood-clotted grafts and softer and more pliable than the vascular prostheses impregnated with collagen from the manufacturer. In addition autologous fi brin glue has the obvious advantages of safety from transmission of viral dis eases and from immunologic reactions.