bluuebunny/crossref_metadata_2025 huggingface dataset:
The Experience of Simultaneous Carotid Endarterectomy and Myocardial Revascularization
Authors: Lai Shiau-Ting , Wan Jih-Shiuan , Yu Tarn-Jenn , Huang Cheng-Hsiung , Shih Chun-Tse
Published: November 2007

Between January 1988 and April 1994, simultaneous carotid endarterectomy and myocardial revascularization were performed in 20 patients (16 men and 4 women) with a mean age of 67.38 ± 11 years (range: fifty-six to seventy-eight years). The neurologic presentations included asymptomatic carotid bruit in 4 patients (20%), history of transient ischemic attack (TIA) in 11 (55%), and previous stroke with recent history of TIA in 5 (25%). Preoperatively, 14 patients (70%) were in New York Heart Association functional class III, with the remainder in either class I (5%) or class II (25%). Coronary arteriography demonstrated severe coronary atherosclerosis involving a double-vessel disease in 4 patients (20%), and triple-vessel disease in 16 (80%). Two patients (10%) had left main coronary artery stenosis, and 4 had previous recent myocardial infarction. All patients received unilateral carotid endarterectomy and a mean number of 3.5 distal anastomoses of coronary arteries. No patient died within thirty days after simulta neous operation, and operative mortality rate was zero. The late mortality rate was 20%, with only 1 death related to myocardial infarction and 1 attributable to contralateral stroke. According to a proposed guideline, the long-term outcome is determined by the extent and severity of the cardiovascular disease. Simultaneous operation is appropriate for a subgroup of patients with coexisting carotid and coronary artery disease.
Long-Term Comparison of in Situ and Nonreversed Saphenous vein Grafts for Infrapopliteal Reconstruction
Authors: Albers Maximiano , De Luccia Nelson , Aun Ricardo , Presti Calógero
Published: November 2007

The nonreversed saphenous vein bypass graft has become a reasonable alternative to the standard in situ technique for infrainguinal arterial reconstruction. The objective of this study was to compare the long-term results obtained with these techniques in patients with severe limb ischemia. Fifty-five in situ and 57 nonreversed saphenous vein bypass grafts to the infrapopliteal arteries were compared for secondary graft function, preser vation of the foot, and patient survival. The crude relative risk of secondary failure for nonreversed grafts was 1.03 (95% confidence interval [95%CI] 0.62-1.69). Stratified analysis showed a stable relative risk of 1.04 (95%CI 0.58-1.86) in the stratum of 33 nonreversed and 47 in situ grafts done with both a good vein and a high origin. Conflicting results were found in the other strata as a result of small stratum size. The relative risks for major amputation and death were 0.60 (95%CI 0.35-1.05) and 0.44 (95%CI 0.25-0.79), respectively.
A Corticosteroid-Responsive Inflammatory Abdominal Aortic Aneurysm Developing from an Atherosclerotic Aneurysm
Authors: Kobayashi Yoshio , Matsuo Hiroshi , Homma Satoshi , Hayashi Tokio , Tsushima Nobuko , Takamoto Shinichi
Published: November 2007

An uncomplicated atherosclerotic abdominal aortic aneurysm in a seventy-one-year-old woman was found to have increased substantially in size. Abdominal computed tomog raphy (CT) demonstrated an abdominal aortic aneurysm with a thick mantle of material having the density of soft tissue abutting its anterior and lateral walls and hydronephrosis of the right kidney due to an encased ureter. Low-dose corticosteroid therapy was given for forty days. On subsequent CT scanning, most of the thick soft- tissue mass surrounding the dilatated aorta and the hydronephrosis had disappeared, which simplified the surgical repair that was then performed. Pathologic examination of the mass showed inflammatory tissue.
Large Intracranial Aneurysm Growing Dorsally on the Internal Carotid Artery
Authors: Furui Tomoo
Published: November 2007

A case of a large intracranial aneurysm is presented in which the dome distended dorsally to the internal carotid artery (ICA) but the neck was adjacent to the origin of the posterior communicating artery (PcomA). This case illustrates that aneurysms located on the dorsal ICA wall at the level of the PcomA include not only types occurring without relation to arterial divisions, as previously reported, but also rarer types growing from the PcomA junction.
Effect on Thrombolysis and its Complication of Graft Occlusion and Specific Risk Factors
Authors: Ikeda Yasuharu , Wada Hiroya , Rummel Mark C. , Field Charles K. , Bhatnagar Pankaj K. , Khoury Paul A. , Wilson Audrey R. , Kerstein Morris D. , Matsumoto Teruo
Published: November 2007

The objective of this study was to correlate the initial outcome of thrombolytic therapy in patients with specific risk factors who presented with an occluded synthetic graft. Seventy-seven angiographically documented occluded synthetic grafts were treated with urokinase. All patients presented within thirty days of occlusion. The cases were investi gated according to specific risk factors: smoking (SM), hypertension (HT), coronary artery disease (CAD), and diabetes mellitus (DM). A high number of occlusions occurred in patients had a history of heavy smoking (84.4%). Complete thrombolysis was achieved in 46 of 77 (59.7%) graft occlusions. Thirty-eight of 65 (58.5%) occlusions in patients who smoked, 29 of 47 (61.7%) occlusions in patients with HT, 22 of 36 (61.1%) occlu sions in patients with CAD, and 18 of 25 (72.0%) occlusions in patients with DM were completely lysed. When comparison was made between the specific risk factors, no signif icant difference was found in complete lysis. Forty-seven complications occurred in 31 (40.3%) of 77 cases. One patient (1.3%) suffered from a fatal intracranial hemorrhage. No significant increase in complications was seen when the various risk factors were compared.

In conclusion, no relation was observed between the initial success rate with throm bolytic therapy and multiple risk factors in patients with arterial graft occlusion.
Hypercoagulable States in Vascular Surgery
Authors: Paty Philip S. K. , Darling R. Clement , Chang Benjamin B. , Leather Robert P. , Shah Dhiraj M.
Published: November 2007

The purpose of this study was to identify patients with predisposing risk factors signaling further workup for the presence of hypercoagulable states before performance of arterial reconstruction. In patients so identified, specific methods were used to promote the patency of the arterial reconstruction during the postoperative period. Fourteen patients were identified with 16 coagulation defects, and in them, 19 arterial reconstructions (some bilateral) were performed. Most of the reconstructions have remained patent with or without revision.
Carotid Endarterectomy: A Nine-Year Review of Procedures Performed in a Community Hospital
Authors: Holliday H. Joseph
Published: November 2007

This review was conducted to compare the results of carotid endarterectomy in a community hospital with those of the same surgery performed in larger medical centers.

In all, 166 carotid surgeries were performed over a nine-year period by the same surgeon. There were no operative or perioperative deaths. The operative stroke rate was 1.2%. No other significant complications were noted. Recurrence requiring a second surgery was noted in 1 patient.

These results compare favorably with those of larger institutions and support carotid endarterectomy in a smaller community hospital. ,
Inferior Vena Caval Filter Placement Without Preoperative Venacavography
Authors: Mirande Raul A. , Mirande Karri K. , Liu Terrence , Baker William H.
Published: November 2007

Despite the emergence of noninvasive studies as the gold standard of venous diagnosis, many authors still insist upon formal preoperative venacavograms prior to insertion of an inferior vena cava (IVC) filter. Conversely, the authors employed only preoperative nonin vasive venous examinations and intraoperative fluoroscopy in 123 consecutive (IVC) filter placements of either the Greenfield filter (n=66) or the LGM (Vena Tech) device (n=57) by the surgical service. They reviewed the patients' intraoperative and postop erative hospital courses to identify complications that could have been avoided by obtaining preoperative contrast venacavograms.

Twenty-one intraoperative complications or untoward events occurred in 17 patients, 1 of which could definitely have been prevented by preoperative venograms. These included: unrecognized internal jugular thrombus or web (3), neck hematoma (2), partial filter opening (2), obliquely placed filters (2), requirement of multiple venous insertion sites (5) or conversion to an open procedure (2), premature filter discharge into iliac veins (2), unrecognized IVC thrombus requiring a suprarenal filter (1), placement of a Vena Tech filter inverted (1), and development of hemodynamic instability requiring inotropic support (1). Two patients (1.6%) suffered clinically apparent inferior vena caval occlusion and 4 (3.3%) had recurrent pulmonary emboli after filter placement. There were 18 deaths (14.6%), 14 of these within the thirty-day postoperative period (11.4%). None had evidence that the IVC filter or recurrent thromboembolic events led to their demise.

In this retrospective review, the authors identified 1 intraoperative (unrecognized IVC thrombus) and no postoperative complications that could have been prevented by obtaining a preoperative contrast venacavogram. They conclude that noninvasive preop erative venous evaluation coupled with intraoperative fluoroscopy is adequate for the safe placement of inferior vena caval filters.
Extracranial and Transcranial Color-Coded Sonography Reduce the Need for Angiography Prior to Carotid Endarterectomy
Authors: Martin P.J. , Gaunt M.E. , Bell P.R.F. , Naylor A.R.
Published: November 2007

The growing need for carotid endarterectomy must be accompanied by safe and reliable methods of imaging the cerebral circulation. The authors used extracranial and tran scranial color-coded sonography to evaluate the cervical carotid arteries and the basal cerebral circulation in 76 patients prior to surgery, aiming to reduce the need for preop erative angiography. In 3 patients (proximal and distal carotid disease; subtotal occlusion) carotid ultrasound failed to define the nature and extent of stenosis adequately, and thus conventional angiography was performed. Transcranial imaging identified intracranial stenotic disease in 4 patients and interhemispheric collateral flow in 29 patients. All patients underwent carotid endarterectomy without any complications due to inadequate preoperative imaging. An ultrasound-based approach eliminated the need for angiography in the majority of patients with significant implications for risk reduction and financial expenditure.
Early Diagnosis and Repair of Popliteal Artery and Vein Injuries Occurring During Arthroscopy of the Knee
Authors: Fogerty Mary D. , Hines George L. , Sutaria Maganlal
Published: November 2007

Injuries to the popliteal vessels during arthroscopic procedures of the knee are rare but may lead to amputation of the extremity. Early recognition and repair of such injuries is essential to avoid this complication.

Two cases of patients who sustained injuries to the popliteal artery and vein during arthroscopy and were diagnosed and definitively treated within hours of the injury are reported. Both patients underwent urgent repair of the lacerated artery and vein and had good perfusion and function of the lower limb postoperatively.

When the possibility of arthroscopic injury to the popliteal vessels exists, the diagnosis and treatment are straightforward. Early repair may avoid the disastrous complication of amputation of the affected leg.
Management of Radiation-Induced Extracranial Arterial Occlusions at Multiple levels
Authors: Ligush John , Criado Enrique , Marston William A. , Keagy Blair A.
Published: November 2007

Extracranial arterial occlusion can occur secondary to external beam irradiation of the cervical region. The authors present a case of radiation-induced occlusion of bilateral common carotid, bilateral internal carotid, and unilateral vertebral arteries. Management issues are discussed, with particular focus on radiation-induced arterial injury and the external carotid artery as a means to cerebral revascularization.
Inferior Pancreaticoduodenal Artery Aneurysm
Authors: Thurlow J.P. , Muto P.M. , Namyslowski J. , Benotti P.N.
Published: November 2007

Visceral artery aneurysms are well described in the surgical literature. Specifically, inferior pancreaticoduodenal artery aneurysms are exceedingly rare and only minimal data are available to guide management decisions. In the majority of published case reports surgical therapy or angiographic intervention is recommended. This is a case report of a ruptured inferior pancreaticoduodenal artery aneurysm associated with complete occlusion of the superior mesenteric artery, precluding surgical or angiographic intervention. A review of the literature and the rationale for nonoperative, medical management of this uncommon surgical entity is the subject of this article.
Utility of MR Angiography and Radionuclide Procedures in Evaluation of Intramuscular Hemangioma
Authors: Bhatnagar Aseem , Chakravarty Kantilal , Tyagi Sanjay , Jena Amarnath , Krishen Swaroop
Published: November 2007

A girl with a large intramuscular hemangioma of the thigh was examined by use of various imaging techniques. Two relatively new modalities, magnetic resonance angiog raphy and "radionuclide hemangiography," were also performed to discern the vascular communications of the lesion. Their relevance in deciding therapeutic options for intra muscular angiomatosis is discussed.
Infrarenal Abdominal Aortic Dissections
Authors: Raymond Julie T. , Skalina Stefan M. , Kerstein Morris D. , Dupont Jean-René
Published: November 2007

Two cases of limited infrarenal abdominal aortic dissection are reported. One patient was treated successfully with medical therapy alone, which resulted in complete resolu tion of symptoms and obliteration of the dissection. The second patient continued to have pain and eventually required aortic graft replacement. Abdominal aortic dissection may be an entity different from thoracic aortic dissection.
Alteration of Arterial Vasomotor Function in Vitro by Gene Transfer with a Replication-Deficient Adenovirus
Authors: Davies Mark G. , Annex Brian H. , Fulton Gregory J. , Denning Steve M. , Taylor Doris A. , Blazing Michael A. , Peters Kevin G. , Channon Keith M. , George Samuel E. , Hagen Per-Otto
Published: November 2007

Gene transfer technologies offer great potential both to investigate and alter the course of vessel wall pathophysiology. Replication-deficient adenovirus vectors appear particu larly useful for the transfection of blood vessels, because of their ability to accommodate large cDNA inserts and to rapidly and efficiently infect mammalian endothelial and smooth muscle cells. The potential effects of transfection with a replication-deficient adenovirus on vasomotor function have not, however, been described. This study reports gene transfer experiments with a replication-deficient adenovirus containing a cytome galovirus promotor and a nuclear localizing variant of the bacterial β-galactosidase gene. Excised carotid artery segments from 6 rabbits were divided into four segments and infected in pairs for thirty minutes with four viral titers (control [0], 2.5×109, 5×109, and 1×1010 pfu/mL) at 37°C in serum-free culture media (M199). Expression of β-galac tosidase and in vitro vasomotor function were determined after seventy-two hours' incu bation. Isometric tension studies were performed to examine the response of the vessel segments to the contractile agonist norepinephrine. β-galactosidase was expressed in all vessel segments exposed to the adenovirus. There was a significant difference in the sensitivity to norepinephrine (P < 0.04) of the segments treated with the highest and lowest viral titers (mean ±sem, -log10 [EC50] of 5.98 ±0.09, 5.77 ±0.11, 5.68 ±0.14, and 5.52 ±0.13 for the control, 2.5×109, 5×109, and 1×1010 plaque-forming units (pfu)/mL groups respectively). Replication-deficient adenovirus vectors can rapidly and efficiently infect rabbit carotid vessels, but there is, however, a dose-dependent alteration of in vitro vessel vasomotor function that may be mediated by a cytotoxic effect of the viral vector. Although further in vivo work is required to verify these results, this effect needs to be taken into account in studies involving adenoviral gene transfer.
Hemodynamically Significant Carotid Disease and Prophylactic Carotid Endarterectomy in CABG Patients—Impact on Perioperative Neurologic Events
Authors: Hines George L. , Scott William C. , Schubach Scott L. , Tyd Donna , Wehbe Ulla
Published: November 2007

Perioperative neurologic deficits occur in 2-5% of patients undergoing isolated coronary artery bypass grafting (CABG). The effect of preexisting high-grade carotid artery stenosis, as determined by (1) the presence of a cervical bruit, (2) ocular plethysmog raphy (OPG), and (3) duplex scan, and the value of prophylactic carotid endarterectomy in preventing stroke, are uncertain. The hospital courses of 427 patients who underwent pre-CABG carotid duplex scan and coronary artery bypass (CAB) as the only cardiac procedure between April 1992 and June 1994 were reviewed (1) to evaluate the rela tionship between carotid stenosis and perioperative neurologic events and (2) to determine whether endarterectomy for high-grade lesions (80-99%) decreases the risk of perioperative cerebrovascular accident (CVA). There were 11 strokes (2.58%) in 427 patients, 4 CVAs occurred in 389 patients without significant carotid disease; 12 patients had total occlusion of one carotid artery and 4 of them developed a CVA (33.3%); 26 patients had a high-grade stenosis (80-99%) of one carotid artery. Twelve of these patients underwent either a pre-CABG carotid endarterectomy (CE) (5 patients) or simul taneous CE + CABG (7 patients). There were no neurologic events in this group. The 14 other patients with 80-99% stenosis did not undergo a CE. There were 3 CVAs and 1 transient ischemic attack (TIA) in this group. Seven of 11 CVAs (64%) occurred in 34 patients with either total or high-grade carotid disease (P < .0001 by Fisher Exact Test and Wilcoxin Rank Sum).

Conclusions: (1) high-grade or total occlusion of a carotid artery is associated with significantly increased risk or perioperative neurologic events. (2) Carotid endarterec tomy appears to be protective. (3) A significant number (4 of 11) of neurologic events are due to causes other than carotid stenosis.
Iatrogenic Arteriovenous Fistula as a Complication of a Polytetrafluoroethylene (PTFE) Graft for Hemodialysis
Authors: Esterl Robert M. , Garvin Paul J.
Published: November 2007

The authors describe 2 patients who developed an iatrogenic arteriovenous fistula between a straight forearm polytetrafluoroethylene (PTFE) graft and an in situ cephalic vein after posterior puncture of the graft with a hemodialysis cannula. Diagnosis of this iatrogenic fistula was by careful inspection of the PTFE graft. The distal PTFE graft was functional, but the proximal graft was thrombosed at the ill-placed puncture site. Superficial veins on the anterior forearm exhibited a thrill and bruit. Treatment was simple ligation of the fistula and revascularization of the thrombosed segment of the PTFE graft. When the fistula occurred with a pseudoaneurysm, treatment was ligation of the fistula, exclusion of the pseudoaneurysm, and interposition graft to maintain vascular continuity. This complication of vascular access is not documented in the literature.
Successful Surgical Embolectomy Under Transesophageal Echocardiographic Guidance in Pulmonary Embolism
Authors: Okura Hiroyuki , Yoshida Kiyoshi , Shomura Toyo , Yoshikawa Junichi
Published: November 2007

The authors present 2 cases of acute pulmonary embolism in which intraoperative trans esophageal echocardiography guided successful surgical embolectomy. In their experi ences, transesophageal echocardiography was a safe and useful method of visualizing and detecting mobile thrombi in the operating room. Thus, it should be used as an intra operative guidance for surgical embolectomy.
Descending Aortic Dissection in an Elderly Weight Lifter
Authors: Ciocca Rocco G. , Costibile Joseph P. , Graham Alan M.
Published: November 2007

Acute aortic dissections are rare but not uncommon. The etiology of aortic dissections has been attributed to collagen abnormalities or systemic hypertension. Prognosis is predi cated on a timely diagnosis, location of the dissection, and appropriate intervention. Dissections of the aorta associated with weight lifting have been described and tend to involve the ascending aorta in young male weight lifters. This report describes the second reported descending aortic dissection associated with weight lifting.

Aortic dissections associated with weight lifting are exceedingly rare; however, this entity may become more prevalent with an increase in exercise and cardiovascular condi tioning among all age groups.
Profound Hypothermia and Total Circulatory Arrest in the Management of a Massive False Aneurysm of the Subclavian Artery
Authors: Fulton J.O. , Louwrens H.D. , Marr J. , Hewitson J.
Published: November 2007

The surgical management of a massive traumatic false aneurysm of the junction of the right subclavian artery with the innominate artery following a stab wound four months earlier is described. Surgical alternatives are discussed.
Duplex Surveillance of Superficial Thrombophlebitis
Authors: Wasserman Dean , Bonner Kathleen , Devereaux Colleen , Tusa Peter
Published: November 2007

Clinical management of superficial thrombophlebitis has been guided by the assumption that this lesion is self-limited and rarely progresses to serious sequelae. This study eluci dates the fact that this lesion is frequently associated with deep venous thrombosis and potential pulmonary embolism. Accurate diagnosis requires the use of duplex scanning, and an appreciation of the natural history of this problem is essential to recommend treatment.
Operative Repair of Enlarging Hilar Renal Artery Aneurysm
Authors: Eze Augustine R. , Singh Sunnanda , Newman Paul G. , Cisek Paul L. , Comerota Anthony J.
Published: November 2007

Repair of distal renal artery aneurysms poses a significant threat to kidney salvage despite improved operative techniques described over the past decades. The authors describe the case of a seventy-one-year-old woman who presented with an enlarging right renal artery aneurysm located at the renal hilum involving the lobar arteries. Operative repair was accomplished by excision of the saccular posterior wall and reconstruction with a saphenous vein patch. The ischemia time was thirty-three minutes and her postoperative course was uneventful. She was discharged home on the fifth postoperative day with normal renal function, and the renal arteriogram demonstrated a technically successful operation. They review the current literature, and this case is put into perspective with the natural history, clinical course, and present treatment of renal artery aneurysms.
Aberrant Supply of the Common Penile Artery from an Inferior Epigastric/External Pudendal Artery Trunk: Radiological and Urological Implications
Authors: Vrachliotis Thomas G. , Rosen Max P. , Morgentaler Abraham , Kim Ducksoo
Published: November 2007

In cases of arteriogenic impotence, penile angiography is often performed before penile revascularization. Evaluation of the inferior epigastric arteries is critical for preoperative planning, for use of the dominant vessel is preferred. Performance of penile angiography requires knowledge of the extensive variations of the penile arterial system. This case report describes an anatomical variation of both the inferior epigastric artery and the penile arteries. Failure to recognize this variation could have resulted in a failed penile revascularization if surgery had been performed.
Can the Main Trunk of Greater Saphenous Vein be Spared in Patients with Varicose Veins?
Authors: Labropoulos Nicos , Belcaro Gianni , Giannoukas Athanasios D. , Delis Kostas , Ashraf Mansour M. , Kang Steven S. , Nicolaides Andrew N. , Baker William H.
Published: November 2007

Greater saphenous vein (GSV) is the first-choice venous conduit used for bypass grafting. However, GSV is more often varicosed than any other vein. The purpose of this study was to identify how often the main trunk of GSV could be spared during varicose vein oper ations. Two hundred fifty limbs from 187 consecutive patients with GSV reflux on contin uous-wave Doppler were subsequently examined with color flow duplex imaging. The main trunk of GSV was divided into saphenofemoral junction (SFJ), thigh, knee, and below-the-knee (BK) segments. Reflux and varicosities at all levels were noted. Limbs with previous venous surgery involving GSV were excluded from the study.

Reflux throughout the length of GSV was the most common pattern (n=122, 49%). The prevalence of reflux at the SFJ was 78% (n=196); thigh segment, 84% (n=210); knee, 92% (n=229); and BK segment, 74% (n=186). Of the segments with reflux, vari cosities were found in 71% at the thigh, 77% at the knee, and 28% (P<0.0001) at the BK segment. Despite the presence of reflux, the entire length of GSV was free of varicosities in 46 (18%) limbs. Because the main trunk of GSV most often lies deeper than its tribu- taries, in 79 (32%) limbs it was not possible to clinically detect the presence of GSV vari cosities. Those varicosities that were clinically evident most often involved the tributaries of GSV (n=232, 93%) that pierce the superficial fascia and come closer to the skin. One hundred thirty-two incompetent perforating veins were found in 71 limbs, of which 27 were connected with the thigh segment, 5 with the knee segment, and the remaining 100 with the tributaries of the BK segment. No perforating vein was found to be connected with the BK GSV.

The main GSV trunk at the BK level frequently had reflux, but it was rarely varicosed. Because this segment of GSV is not connected to perforating veins, and owing to its intimate anatomic relationship with the saphenous nerve, it may be spared if not varicosed. In about a fifth of the occasions, the entire length of GSV was free of vari cosities, and at least in high-risk patients for arterial disease this vein need not be excised.
Mycotic Aneurysm of the Common Iliac Artery and Distal Aorta Following Stent Placement
Authors: McIntyre Kenneth E. , Walser Eric , Hagman Joseph , Schaper Diann
Published: November 2007

A 43-year-old man was evaluated for disabling left leg claudication. Aortography demon strated occlusion of the left common and external iliac arteries with reconstitution of the left common femoral artery. During this procedure a 10 mm x 9.4 cm Wallstent was placed from the proximal common iliac to the mid-external iliac artery followed by a 10 mm Palmaz stent placed proximal to the Wallstent. He returned after 2 weeks with recurrent symptoms and an absent left femoral pulse. Repeat aortography confirmed that the stented iliac artery was thrombosed. Following thrombolysis, a stenosis distal to the Wallstent was identified and another 8 mm x 4 cm Wallstent was inserted to dilate the stenotic lesion. He did well until the following week when he returned complaining of fever, anorexia, and low back pain. Staphylococcus aureus was cultured from the blood. An initial computed tomography (CT) scan demonstrated only inflammation around the distal aorta, but owing to unremitting fever and symptoms, he underwent another CT scan 4 days later, which demonstrated a large aneurysm of the distal aorta and left common iliac artery. The patient was taken to the operating room where a right-to-left femorofemoral bypass was performed. After the groin wounds were closed, an exploratory laparotomy disclosed a large mycotic aneurysm of the distal aorta and proximal left common iliac artery. The aorta was oversewn below the level of the inferior mesenteric artery (IMA) and the Palmaz and proximal Wallstent were removed. An IMA thrombec tomy was performed because no Doppler flow was present in the sigmoid mesentery. Following abdominal closure, a right axillofemoral graft and thrombectomy of the femo rofemoral graft were performed. On postoperative day 12, he developed an ileus and signs of sepsis. Upon reexploration, a sigmoid perforation was discovered and a sigmoid resection and colostomy were performed. He was treated with parenteral antibiotics and enteral nutrition and was transferred for continued rehabilitation 8 weeks later.
Endoscopic Perforator Ligation for Venous Stasis Disease: Value of Intraoperative Ultrasound Guidance
Authors: Ibrahim Ibrahim M. , Wengerter Kurt R. , Silvestri Fred , Kahn Mark , Wolodiger Fred , Sussman Barry , Dardik Herbert
Published: November 2007

Videoscopic perforator ligation (VPL) is emerging as a safe and viable alternative to open techniques. Complete ligation of all perforators is crucial to reversal of venous stasis consequences. A review of the authors' experience with 19 VPLs revealed six missed perforators when completeness was evaluated by intraoperative duplex scanning. Two were paratibial, three were in the distal part of the compartment, and one was outside the compartment. Three were ligated videoscopically and three by direct subfascial ligation. Nonhealed ulcers proved to have retained perforators requiring direct ulcer excision and perforator ligation. The authors conclude that intraoperative duplex scanning allows more thorough perforator ligation and eliminates retained perforator problems.
Ultrasound-Guided Compression Repair of Catheter-Related Femoral Artery Pseudoaneurysms is Impaired by Anticoagulation
Authors: Hodgett David A. , Kang Steven S. , Baker William H.
Published: November 2007

Ultrasound-guided compression repair (UGCR) of catheter-related femoral artery pseudo aneurysms (CFAP) was retrospectively reviewed. Variables including etiology, size, location, age of pseudoaneurysm, depth and length of neck, coagulation status, number of attempts at compression, and total time of compression were studied. Five of 15 pseudoaneurysms were successfully occluded by use of UGCR. Reasons for failure included compression without occlusion (7), inability to arrest flow in the pseudoaneu rysm during compression (2), and inability of the patient to tolerate compression (1). Two patients who had pseudoaneurysms that we were unable to occlude on initial compression thrombosed their pseudoaneurysms spontaneously on follow-up examina tion. No patient (0/9) who was anticoagulated at the time of compression had a successful occlusion. All five patients with a normal coagulation profile at the time of compression were successfully occluded. One of these pseudoaneurysms recurred, however, after heparin was resumed. Size of pseudoaneurysm, depth or length of neck, time to presentation, or total time of compression did not predict success of UGCR. There were no complications in our series. UGCR is a safe, cost-effective treatment for patients with catheter-related femoral pseudoaneurysms and a normal coagulation profile.
Hemodynamic and Histopathologic Effects of Hydroxyethyl Starch and Superoxide Dismutase Following Splanchnic Arterial Occlusion in a Murine Model
Authors: Simonian Gregory T. , Dardik Herbert , Hallac David , Mazziotta Robert , Ibrahim Ibrahim , Stahl Roslyn
Published: November 2007

The purpose of this study was to examine biophysical and biochemical approaches that would reduce circulatory collapse produced in a splanchnic artery occlusion (SAO) shock rat model. Sprague-Dawley rats were divided into six groups: (1) control (Ctl) rats—no infusions, n=5; (2) control rats receiving 10 mg/kg superoxide dismutase (SOD), n=7; (3) SAO shock rats—no infusion, n=7; (4) SAO shock rats receiving 1.75 mL of normal saline (Sal), n=7; (5) SAO shock rats receiving 1.75 mL of hydroxyethyl starch (HES), n=7; (6) SAO shock rats receiving SOD, n=7. All animals, except controls, underwent clamping of the celiac and superior mesenteric arteries for fifty minutes. Intravenous heparin (500 units/kg) was administered twenty minutes prior to clamping. Following release of the clamps mean arterial blood pressure (MABP) was monitored for an addi tional one hundred minutes. Animals whose MABP could not be maintained above 50 mmHg at one hundred minutes after reperfusion was initiated were considered nonsur vivors. Blood chemistries and serum osmolarity were measured at the end of each exper iment. HES was conjugated to 10 nm gold particles prior to infusion to allow HES location in electron micrographic (EM) studies. The following results were obtained:

The group 4 (HES) MABP was significantly higher than that in groups 2, 3, and 5 (P<.05), but not when compared with that in group 1 (controls). No significant differ ences were found in serum osmolarity. EM studies showed the HES-gold conjugate localized to the intravascular and interendothelial spaces of capillaries and postcapillary venules as compared with interstitial sites.

The authors conclude that HES can maintain MABP at significantly higher levels in an SAO shock rat model, unlike the results following infusions of normal saline or SOD. HES may act as both a capillary sealant and source of oncotic pressure. The lack of efficacy of SOD in this investigation may be due to the severity of the shock model and an inadequate dosing regimen. Further studies are needed to evaluate the rode of phar macologic agents along with fluid resuscitation and capillary sealants. Their combined use may in fact ultimately prove to be the optimal means to treat SAO shock.
A Vitronectin Receptor Antagonist Inhibits Neointimal Formation After Balloon Arterial Injury in Rabbits in Vivo
Authors: Lundgren Craig , Vinogradsky Boris , Guala Amy , Fujii Satoshi
Published: November 2007

The authors have previously shown that cell-matrix interactions mediated via the matrix protein ligand vitronectin derived from serum and its cell surface αVβ3 integrin receptor regulate migration of human aortic smooth muscle cells (SMC) in vitro. Arginine-glycine- aspartic acid (RGD) sequence of vitronectin (residues 45 to 47) is the critical domain for interactions. In this study the authors sought to determine whether interference with vitronectin-receptor interaction in the arterial wall would alter development of neoin timal hyperplasia in a rabbit model.

After balloon-induced injury of the carotid artery (2 fr Fogarty, three times) vitronectin was observed in the intima and upper third of the media (immunostaining, n= 3). In 6 rabbits the vitronectin receptor antagonist cyclic RGD peptide (1 mM) was locally applied to the injured artery by use of ethylene vinyl acetate copolymers (25%). RAD peptide (1 mM, n=6) and ethylene vinyl acetate copolymer without peptide (n=6) served as an inactive control. At twenty-eight days rabbits were killed, carotid arteries were fixed, and mean intima and media area was determined by computer-assisted planimetry. (continued on next page) (Abstract continued) The mean intima/media ratio in control balloon-injured arteries without peptide was 0.43 ±0.08 (SD). In injured RAD peptide-treated arteries the ratio was 0.39 ±0.09 (P= NS). In injured, cyclic RGD peptide-treated arteries the intima/media ration was 0.14 ±0.02 (P < 0.05). There was no significant difference in media area in the two groups.

These results suggest that (1) vitronectin-vitronectin receptor interaction mediates SMC migration in vivo, and (2) localized application of a vitronectin receptor antagonist to the arterial wall after balloon injury modifies this process and results in a significant reduction in the development of neointimal hyperplasia. Vitronectin-vitronectin receptor interaction may be an additional attractive target for pharmacologic manipulations aimed at limiting restenosis after vascular injury.
Pancreaticoduodenal Artery Aneurysms
Authors: Eldar Samuel , Fajer Simone , Kunin Joshua , Naschitz Johanan , Nash Ernest , Karmeli Ron
Published: November 2007

Pancreaticoduodenal artery aneurysms are rare but challenging surgical problems. While physical examination, ultrasound, and computed tomography scans may suggest the diagnosis, more definitive information may be achieved noninvasively by scintiangiog raphy. Angiography is the diagnostic gold standard and remains crucial for rational planning of operative strategy. Surgical repair is usually achieved by exclusion or endoa neurysmorrhaphy. Through use of modern diagnostic and surgical approaches, mortality rates have been reduced from as high as 22% to 6%. The authors herein describe 2 patients with pancreaticoduodenal artery aneurysms and review the management strate gies of this challenging problem.
Detection of an Arterial-Bypass-Graft-Threatening Lesion by Use of Duplex Ultrasonography and Magnetic Resonance Angiography in an Asymptomatic Patient
Authors: Jaff Michael R. , Breger Robert , Deshur William , Pipia Jan
Published: November 2007

The authors describe a unique case in which Doppler ultrasonography and magnetic resonance angiography were used to detect a graft-threatening lesion in an asympto matic patient.
Surgical Therapy of Thoracoabdominal Aortic Coarctation A Literature Review
Authors: Mickley Volker
Published: November 2007

Nonarteritic and nonarteriosclerotic atypical thoracoabdominal aortic coarctation (ATAC) is a rare, often inherited malformation. If the abdominal aorta is involved, additional stenoses of visceral arteries may occur, making surgical correction difficult. A literature review was done to accumulate information on the etiology, epidemiology, and surgical therapy of ATAC.

Detailed reports on the surgical management of 228 ATAC patients were found in world literature between 1951 and 1996. Most patients were operated on during their first two decades of life. In only about 10% of them could associated diseases (neurofi bromatosis in 7%) be identified, leaving a 90% rate of probably inborn malformations. Main preoperative symptom was renovascular hypertension due to suprarenal or inter renal coarctation, often combined with renal arterial stenoses.

Although most of the patients had complex procedures for complete revasculariza tion, perioperative mortality was only 5%. More than 90% of the patients were completely free of symptoms after their operation. Aortic patch angioplasty seems to be burdened with a higher rate of long-term complications than aorto-aortic bypass. Consequent follow-up of all of the young patients is recommended.
Activity of Exoglycosidases in the Aneurysmal Aortic Wall
Authors: Gacko Marek , Zwierz Krzysztof , Arciuch Leszek , Glowinski Stanislaw , Worowska Anna , Omasta Anita
Published: November 2007

The mechanical properties of the arterial wall depend not only on collagen and elastin, but also on proteoglycans. The quantity and quality of proteoglycans depend on the rate of their synthesis and degradation. Proteoglycans are degraded by exoglycosidases and proteases. In the wall of an aortic aneurysm, we found an increase in the activity of exoglycosidases (beta-hexosaminidase, beta-galactosidase and alpha-mannosidase) in comparison with normal and atheromatous aortas, which may indicate a participation of exoglycosidases in decreasing the concentration of proteoglycans in an aneurysmatic arterial wall.
Experience with Greenfield Filters in Pregnant Women for Deep Venous Thrombosis and Pulmonary Embolism Case Reports
Authors: Noel Audra A. , Pappas Peter J. , Haser Paul B. , Silva Michael B. , Hobson Robert W.
Published: November 2007

The indications for inferior vena caval filter placement in the gravid female are ill defined. During pregnancy, however, pulmonary embolism (PE) secondary to venous thrombosis is the most common cause of maternal mortality. Pregnant women are at risk for deep venous thrombosis (DVT) due to hypercoagulability caused by increased levels of coagulation factors and decreased fibrinolytic activity. In addition, decreased venous tone and velocity of blood flow in the lower extremities lead to venous stasis. Although heparin is the treatment of choice for DVT associated with pregnancy, propagation of thrombus or development of bleeding diathesis mandates discontinuation of anticoagulant therapy and consideration for caval interruption. In this review, two patients are presented who required vena caval filters during pregnancy, and indications for their usage in this patient population are defined. Filter placement is recommended during pregnancy in the presence of extensive iliofemoral thrombus, free-floating thrombus, bleeding complications, or pulmonary embolism despite adequate anticoagulation.
A Free-Floating Thrombus in the Inferior Vena Cava Associated with Lung Cancer: Complete Thrombectomy Using a Simple Clamping Procedure A Case Report
Authors: Kawashima Osamu , Hirai Toshikazu , Kamiyoshihara Mitsuhiro , Kurihara Terumasa , Ishikawa Susumu , Morishita Yasuo
Published: November 2007

A 62-year-old woman with inoperable lung cancer received systemic combined chemotherapy with cisplatin and vindesine sulfate. Lower extremity edema occurred after chemotherapy and an iliocavagram revealed a large intraluminal solitary thrombus, which was floating in the inferior vena cava (IVC) and extending up to the level of the renal vein. A thrombectomy using the simple IVC clamping procedure was successfully performed. Primary thrombosis of the IVC is rare, and this is the first reported case associated with lung cancer. A thrombectomy using the simple clamping of the IVC is considered to be a safe and effective procedure for the treatment of a free-floating thrombus in the IVC even in the case of a lung cancer patient.
Radial Artery Reconstruction at the Wrist for Hand Claudication Using the Nondissection Method A Case Report
Authors: Shindo Shunya , Kojima Atsuo , Iyori Keiji , Ishimoto Tadao , Kobayashi Masahiro , Suzuki Osamu , Kamiya Kihachiro , Tada Yusuke
Published: November 2007

Arterial reconstructions in the upper extremity are reported less frequently than those in the lower extremity. In most cases, the operative indications are to save the hand that has severe ischemia. The authors present a case of radial artery reconstruction performed for hand claudication that was disturbing the patient's work as a carpenter. By using the nondissection method, the anastomotic procedure of the small artery was easily performed. The successful result highlights a flexible determination of operative indication for the arterial reconstruction in the upper extremity.
Semaphorin and neuropilin co-expression in motoneurons sets axon sensitivity to environmental semaphorin sources during motor axon pathfinding
Authors: Moret Frédéric , Renaudot Christelle , Bozon Muriel , Castellani Valérie
Published: November 2007

Class III semaphorins (SemaIIIs) are intercellular cues secreted by surrounding tissues to guide migrating cells and axons in the developing organism. This chemotropic activity is crucial for the formation of nerves and vasculature. Intriguingly, SemaIIIs are also synthesized by neurons during axon pathfinding, but their function as intrinsic cues remains unknown. We have explored the role of Sema3A expression in motoneurons during spinal nerve development. Loss- and gain-of-function in the neural tube of the chick embryo were undertaken to target Sema3A expression in motoneurons while preserving Sema3A sources localized in peripheral tissues, known to provide important repulsive information for delineating the routes of motor axons towards their ventral or dorsal targets. Strikingly, Sema3A overexpression induced defasciculation and exuberant growth of motor axon projections into these normally non-permissive territories. Moreover, knockdown studies showed that motoneuronal Sema3A is required for correct spinal nerve compaction and dorsal motor axon extension. Further analysis of Sema3A gain- and loss-of-function in ex vivo models revealed that Sema3A in motoneurons sets the level of sensitivity of their growth cones to exogenous Sema3A exposure. This regulation is associated with post-transcriptional and local control of the availability of the Sema3A receptor neuropilin 1 at the growth cone surface. Thus, by modulating the strength of Sema3A-mediated environmental repulsive constraints, Sema3A in motoneurons enables axons to extend more or less far away from these repulsive sources. Such interplay between intrinsic and extrinsic Sema3A may represent a fundamental mechanism in the accurate specification of axon pathways.
Decommissioning of the Inmarsat 2F3 satellite
Authors: Hope D R
Published: November 2007

The current paper describes the detailed operational planning process required for the decommissioning of the Inmarsat 2F3 satellite. The background to events which lead to the decision to decommission this satellite is presented and descriptions of the methods used to monitor the onboard propellant reserves are included in order to explain their role in determining the date of service termination. Orbital and operational factors are elaborated and then folded into a baseline plan for executing a sequence of orbit raising manoeuvres that would be necessary to increase the satellite altitude above the busy geostationary arc. Subsystem passivation activities to be performed on arrival at the final graveyard orbit are discussed and the paper concludes with the story of what actually happened with the first ever Inmarsat satellite decommissioning.
Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women
Authors: Högdahl M , Kihlström E
Published: November 2007

Leucocyte esterase (LE) in first-voided urine (FVU) and presence of leucocytes in urethral and cervical smears were evaluated to identify Mycoplasma genitalium infection in 416 men and 417 women attending Department of Genitourinary Medicine. M. genitalium was diagnosed in FVU specimens by realtime polymerase chain reaction. The prevalence of M. genitalium was 6.5% in women and 6.7% in men. In total, 88.5% (23/26) of M. genitalium-infected men were identified by a combination of urethral smear and the LE test. In women, the combination of urethral and/or cervical smears and/or a positive LE test identified 91.3% (21/23) of M. genitalium-infected patients. Organism load in FVU correlated significantly with presence of urethritis (≥4 leucocytes per high-power field) in men. A combination of LE testing of urine and urethral and/or cervical smears can be used as screening tests to select patients for specific M. genitalium testing. By this strategy, about 10% of infected individuals will remain undetected.
Factors affecting time to treatment following diagnosis of genital Chlamydia trachomatis infection in Scottish genitourinary medicine clinics
Authors: Fernando I , Oroz C , Steedman N , Baguley S
Published: November 2007

Early treatment of genital Chlamydia trachomatis can reduce complications and transmission. Guidelines have proposed standards for how soon people should be treated following a test. Data from an audit of Scottish genitourinary (GU) medicine clinics was analysed to identify factors associated with a short interval to treatment of chlamydia. A sample of 538 cases of chlamydia diagnosed at 12 Scottish GU medicine clinics between 1 April 2005 and 30 June 2005 was studied. Variables assessed included: age, sex, sexuality, whether a contact, symptoms, whether microscopy was performed, time to lab result and how the result was given. Earlier treatment was associated with: being a contact, having symptoms, being male, performing microscopy (male patients only) and giving the result at a follow-up appointment. Most of these variables (sex, symptoms, etc.) are without the influence of clinic policies and the ones which can be influenced (microscopy and follow-up appointments) are becoming less common. Time to treatment of genital chlamydia might therefore increase in the future.