bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-Channeled Aortic Dissection in Marfan Syndrome
Authors: Ando M. , Okita Y. , Tagusari O. , Morota T. , Kitamura S.
Published: September 2024

Among the various types of aortic dissection, three-channeled aortic dissection, in which two adjacent false lumens are present, is rarely observed. The authors surgically treated 20 Marfan syndrome patients with this type of dissection, who accounted for 29.4% of 68 patients with aortic dissection in Marfan syndrome and who were surgically treated in the authors' institution prior to July 1999. Patient age ranged from 24 to 51 years (mean of 40 years). The male:female ratio was 13:7. Valved conduit procedure had been performed previously in 14 patients. Pain was observed at various times in 13 patients. Computed tomography scanning and magnetic resonance imaging were useful for preoperative diagnosis. The morphology of the first and second false lumens was Stanford type A + type B in 10 patients and type B + type B in 10 patients. Re-entry of the second false lumen was observed in five patients. The descending aorta was replaced in 13 patients, thoracoabdominal aortic replacement was performed in five, extra-anatomic bypass in one patient and iliac artery-superior mesenteric artery bypass in one. Four patients died in hospital. There were three late deaths during a follow-up of 1–208 months (mean of 51 months). When pain recurs in Marfan patients with aortic dissection, three-channeled dissection should be suspected and subsequent surgery is required. The incidence of this dissection is high in patients with Marfan syndrome.
Congenital Division of the Left Atrium: The Influence of Associated Congenital Lesions on the Timing and Mode of Presentation
Authors: Alkhulaifi Abdul M. , Serraf Alain , Lacour-Gayet François , Belli Emre , Planché Claude
Published: September 2024

Purpose of study:

Congenital division of an atrium is commonly associated with other cardiac malformations, which may influence presentation.

Basic methods:

Cases diagnosed at our institution between 1980 and 1997 were reviewed, to determine whether associated lesions influence presentation.

Principle findings:

52 patients were diagnosed with atrial division (49 left. 3 right), mean age 4.8 yr. Patients could be divided according to age at diagnosis.

Group 1:

32 patients aged ≤ 1 yr. 14 patients had associated cardiac malformations other than atrial septat defect (ASD). Presentation was with pulmonary oedema.

Group 2:

20 patients > 1 yr. 5 patients had associated major malformations other than ASD Commonest presentation — Isolated shortness of breath. Fifty patients underwent membrane resection and correction of associated anomalies (4% mortality) At follow-up (mean 12 yr) all patients were in NYHA class 1 or 11.

Conclusions:

Patients with division of the atrium present early in infancy and with more severe symptoms when associated with other cardiac malformations.
Emergency Surgery of Acute Traumatic Arteriovenous Fistulas
Authors: Ilijevski Nenad , Radak Djordje , Radević Bozina , Bojić Milovan , Kronja Goran , Mišović Sidor , Simić Aleksandar , Jevtić Miodrag
Published: September 2024

The purpose of this report was to analyze the clinical presentation, diagnosis, surgical and non-surgical treatment and the outcome of patients with acute AVFs seen during the last 8 years. During 1991–98 we treated 47 patients with traumatic AVFs. Among these patients 11 were classified as ‘acute’ AVF. All the patients were male and they ranged in age from 17 to 64 yr (mean 25 yr). The time from injury to admission to our two institutions varied from 4 h to 17 days. Emergency surgery was performed in unstable patients and in those with an expanding haematoma based on clinical assessment alone. The acute surgery group consisted of stable patients that were operated after angiography examination. A machinery murmur and thrill were present in seven patients, and peripheral pulses were absent in four patients. The main blood vessels were reconstructed using various techniques in eight patients and minor blood vessel were ligated in three patients. Two lower limb amputations had to be performed, both after reconstruction of popliteal AVFs. In the remaining nine patients reconstruction of the axial vessels was successful and no signs of ischemia developed in patients after ligation of minor vessels. No neurological deficit developed in two patients whose AVFs were vaporised in the neck. The average hospital stay was 8.6 days. Emergency surgery is safe in unstable patients with traumatic AVFs. A thrill and murmur are characteristic signs even in the acute setting, but the examiner must be persistent in looking for them whenever there is a suspicion of a blood vessel injury. Angiography is a reliable diagnostic tool in stable patients, but whether it is essential when there is an expanding pulsating hematoma remains debatable.
Early Assessment of Skeletal Muscle Damage after Ischaemia-Reperfusion Injury Using Tc-99m-Glucarate
Authors: Wiersema A.M. , Oyen W.J.G. , Dirksen R. , Verhofstad A.A.J. , Corstens F.H.M. , van der Vliet J. A.
Published: September 2024

Purpose:

After acute arterial obstruction of the lower extremity, muscle damage is the critical determinant for clinical outcome. The extent of muscle damage and limb viability are currently assessed by clinical examination, which is inaccurate. Tc-99m-pyrophosphate (PYP) has been applied for imaging ischaemia-reperfusion damage. More recently, a new imaging agent, Tc-99m-glucarate (GLUC), was introduced for delineating early myocardial infarction after ischaemia-reperfusion. The aim of this study was to determine if GLUC could delineate early skeletal muscle damage after ischaemia-reperfusion. Both tracers were used in a novel murine model of hindlimb ischaemia-reperfusion.

Methods:

In anaesthetised mice, ischaemia of one hindlimb was maintained for 2, 3 and 4 h using a tourniquet, followed by a reperfusion period of 1 h. Additionally, reperfusion periods of 3, 24 and 96 h were studied after 3 h of ischaemia. PYP or GLUC was injected 45 min before end of reperfusion. Concentrations of both agents were determined in blood, reperfused and contralateral muscle. Reperfused-to-contralateral muscle ratios were calculated. In separate experiments, muscle biopsies were obtained for histologic examination.

Results:

Ischaemia and reperfusion damage was demonstrated histologically. Using scintigraphy GLUC depicted reperfusion significantly better than PYP. After 2, 3 and 4 h of ischaemia, the reperfused-to-contralateral ratios for GLUC were 10.7 ± 0.9, 8.9 ± 0.9 and 8.6 ± 1.1, as compared to 4.5 ± 0.7, 4.9 ± 0.4 and 4.5 ± 0.4 for PYP ( P < 0.05 at all points). For longer periods of reperfusion, the ratios for GLUC decreased to similar levels as observed for PYP.

Conclusion:

The present study indicates that GLUC is a specific early marker of myocyte necrosis after ischaemia-reperfusion. GLUC may become an useful agent for clinical, early, non-invasive monitoring of skeletal muscle damage after ischaemia-reperfusion.
The Effect of Captopril on Membrane Bound Enzymes in Ischemia—Reperfusion Injury
Authors: Isbir C. Selim , Dogan Riza , Farsak Bora , Aydin Makbule
Published: September 2024

There is substantial evidence that Na+ K+/Mg2+ ATPase and Ca2+/Mg2+ ATPase enzymes would effect the membrane integrity. Forty guinea pig ( n = 10 in each group) hearts were studied in an isolated Krebs—Henseleit solution perfused Langendorff cardiac model. The first group was utilized as the control group. Group 2 hearts were arrested with captopril (200 μmol/l) added St Thomas Hospital Cardioplegic Solution (STHCS). Group 3 animals were pretreated with oral captopril (0.3 mg/kg/twice a day) for 10 days and then arrested with STHCS. Group 4 hearts were again pretreated with oral captopril (0.3 mg/kg/twice a day for 10 days) arrested with STHCS and reperfused with captopril added Krebs—Henseleit solution (200 μmoi/l). Hearts were subjected to normothermic global ischemia for 90 min and than were reperfused at 37°C. When the treated groups were compared with control, best results were achived by group 4. The Na+ K+ and Ca2+/Mg2+ ATPase levels increased from 466.38 ± 5.99 to 564.13 ± 7.77 and 884.69 ± 9.13 to 1254.29 ± 5.75 nmol Pi/mg/prot/h respectively ( P < 0.05). These results suggest that captopril protects the membrane integrity and thus played a role at the recovery of depressed membrane bound Na+ K+ /Mg2+ ATPase and Ca2+/Mg2+ ATPase activity and also in ischemia—reperfusion injury.
A Review of Myocardial Normothermia: Its Theoretical Basis and the Potential Clinical Benefits in Cardiac Surgery
Authors: Gaillard Didier , Bical Olivier , Paumier Danièle , Trivin François
Published: September 2024

Myocardial protection during cardiac surgery aims to preserve myocardial function while providing a bloodless and motionless operating field to make surgery easier. Myocardial protection is achieved by decreasing the oxygen needs using hypothermia and producing electromechanical cardiac arrest using potassium infusion which allows surgery to be performed on a non-beating heart. The deleterious effects of hypothermia include dysfunction of enzymatic systems, development of acidosis, a decrease in tissue oxygen delivery, an increase in blood viscosity and a decrease in erythrocyte deformability. Ninety percent of the decrease in oxygen consumption is obtained by inducing electromechanical arrest and inducing hypothermia has little additional benefit. Maintenance of systemic and myocardial normothermia reduces problems and provides a more physiological approach for cardiopulmonary bypass (CPB). The current results obtained using normothermic protection are very encouraging, and it is an easier inexpensive option. This review summarizes the current knowledge on the benefits of normothermia, based upon experimental and clinical studies.
Haemodynamic Changes during Minimally Invasive Coronary Artery Bypass Surgery Using High-Dose Esmolol
Authors: Aleksic Ivan , Buhre Wolfgang , Baryalei Mersa M. , Reitmeier Frank , Tirilomis Theodor , Weyland Andreas , Dalichau Harald
Published: September 2024

We aimed to investigate the effects of high-dose esmolol on haemodynamics and oxygen extraction in minimally invasive direct coronary artery bypass (MIDCAB) surgery patients.

Methods:

In 18 patients, heart rate (HR), mean arterial (MAP), central venous (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and mixed venous oxygen saturation (SvO2) were prospectively measured after induction of anaesthesia (T1), start of surgery (T2), during bypass grafting with β-blockade (T3), and at the end of surgery (T4).

Results:

Mean esmolol dose at T3 was 0.44 ± 0.2 mg kg−1 min−1. HR was unchanged, whereas significant decreases in mean CO (3.1 ± 0.8 vs 4.8 ± 1.0 l min−1 m−2 pre-esmolol), MAP (53 ± 10 vs 89 ± 14 mmHg), and SvO2 (65 ± 10 vs 81 ± 4%) were observed during esmolol administration. All haemodynamic parameters normalized immediately after termination of esmolol (T4).

Conclusions:

Despite unchanged HR esmolol reduced CO and MAP suggesting a favorable reduction of myocardial oxygen consumption. Mean SvO2 during esmolol administration reflects an acceptable ratio of whole-body oxygen delivery and consumption. Haemodynamic changes with high-dose esmolol during MIDCAB surgery remain within safety margins.
Active Infective Endocarditis: Low Mortality Associated with Early Surgical Treatment
Authors: Perić M. , Vuk F. , Huskić R. , Laušević-Vuk Lj. , Nešković A.N. , Borzanović M. , Bojić M.
Published: September 2024

Background:

Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocarditis (PVE). The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE.

Methods:

During a 3-yr period (January 1 1996–December 31 1998), 57 out of 60 patients (pts) with active, either NVE (46 pts) or PVE (11 pts) underwent surgical treatment. There were 11 women (23.9%), average age of the group being 43.3 ± 9.1 yr (18–73). They were operated on 12–35 days, mean 17.7 ± 7.5 days (for NVE) and 5–33 days, mean 13.2 ± 10.1 days (for PVE) after the diagnosis of endocarditis was first suspected. All pts had at least one absolute indication for early surgical treatment, the most frequent being (in NVE) worsening heart failure (19 cases) and inability to control the infection (10 cases), while in PVE it was valve dehiscence (8 cases). In 8 cases of NVE and 2 cases of PVE fresh, antibiotic sterilized aortic homograft was used to replace the aortic valve.

Results:

Operative mortality was 1.8% (1/57) and hospital mortality 5.2% (3/57). Three pts with PVE died before they were operated on, giving an overall mortality of 10% (6/60). Postoperative morbidity included valve dehiscence in two pts (probable late onset recurrent endocarditis — 3.5%), three episodes of acute renal failure (5.3%), four cases of respiratory insufficiency (7.0%) and one chronic pleural effusion (1.8%). All pts that were discharged from the hospital (54/60), are still alive and well 1–35 months postoperatively (mean 20.3 ± 9.6 months), including pts with recurrent endocarditis and valve dehiscence, after they were successfully reoperated.

Conclusions:

Along with early diagnosis and appropriate antibiotic treatment, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients. Our data indicate that early surgical treatment in cases of active endocarditis may be associated with low mortality and morbidity.
Trousseau's Syndrome and Acute Arterial Thrombosis
Authors: Rigdon Edward E.
Published: September 2024

This report describes three patients treated for acute arterial thrombosis due to malignancy-related hypercoagulability (Trousseau's syndrome). The average age was 59 yr. There were two women and one man. The cancers were breast, lung, and pancreas. Atherosclerosis or nonneoplastic hypercoagulable states did not appear to be a factor in any patient. One patient who presented with irreversible arm ischemia and Stage IV breast cancer underwent primary amputation. The other two patients underwent immediate surgical thrombectomy and thrombolytic therapy, and malignancy was discovered during postoperative workup for hypercoagulable states. Both ultimately required amputation. All three patients died due to cancer less than one year after presentation. When a hypercoagulable state is suspected as the cause of acute arterial thrombosis, an evaluation for occult malignancy is indicated. Although aggressive revascularization attempts may be appropriate, the prognosis for limb salvage and long-term survival is poor.
Celiac Artery Compression Syndrome
Authors: Kokotsakis J.N. , Lambidis C.D. , Lioulias A.G. , Skouteli E.T. , Bastounis E.A. , Livesay J.J.
Published: September 2024

Celiac artery compression syndrome occurs when the median arcuate ligament of the diaphragm causes extrinsic compression of the celiac trunk. We report a case of a 65-year-old woman who presented with a three-month history of postprandial abdominal pain, nausea and some emesis, without weight loss. There was a bruit in the upper mid-epigastrium and the lateral aortic arteriography revealed a significant stenosis of the celiac artery. At operation, the celiac axis was found to be severely compressed anteriorly by fibers forming the inferior margin of the arcuate ligament of the diaphragm. The ligament was cut and a vein by-pass from the supraceliac aorta to the distal celiac artery was performed. The patient remains well and free of symptoms two and a half years since operation.

In this report we discuss the indications and the therapeutic options of this syndrome as well as a review of the literature is being given.
Development of Atherosclerosis and Plaque Biology
Authors: Kádár A. , Glasz T.
Published: September 2024

Atherosclerosis is a leading issue in mortality and morbidity in the civilized world. A number of hypotheses for atherogenesis indicate the complexity of initiation and development of this multifactorial disease. Morphologic types of lesions have long since been studied in order to understand plaque evolution and determinants of plaque complication, a frequent cause of acute ischemic accidents. Chemical and pathophysiological studies defined the wide spectrum of molecular interactions between cellular elements of atherosclerotic lesions. Recently, molecular biologic investigations provide a deeper insight into genetic predispositions for the disease and have widened our understanding of the pathogenic mechanisms. Until we can diminish the high prevalence of the disease, precise information is needed on the evolution of atherosclerosis in order to slow progression, select optimal therapies and prevent plaque complications and their consequences.
Percutaneous Transluminal Angioplasty in Patients with Ischemic Tissue Necrosis is Worthwhile
Authors: Mellière D. , Berrahal D. , D'Audiffret A. , Desgranges P. , Allaire E. , Becquemin J.P.
Published: September 2024

Purpose:

Ischemic tissue necrosis is usually associated with long or sequential arterial obstructions. As a result, the role of percutaneous transluminal angioplasty (PTA), which addresses only short lesions, in patients presenting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic patients presenting with grade 4 Fontaine's classification.

Method:

Between January 1992 and December 1997, 1352 patients with aorto-iliac and/or infrainguinal occlusive diseases were admitted to our institution. Three hundred and ten patients who presented with distal gangrene (95.5%) or ischemic ulcers (4.5%) were identified. The patients consisted of 117 diabetics and 193 non-diabetics. PTA alone was performed In 26 diabetics (group 1) and in 30 non-diabetics (group 2). Their charts were retrospectively reviewed and the patients were recalled for clinical examination and non-invasive monitoring.

Results:

Follow-up was available for all patients and ranged from 1 to 4 years. The survival rate was significantly higher in diabetic patients than in non-diabetic patients (96% vs 77% at 1 year; p < 0.05 and 91% vs 66% at 3 years; p < 0.05). In group 1, the primary cumulative patency rate at 1 and 3 years was 76%. In group 2, the primary cumulative patency rate at 1 and 3 years were 85% and 80%, respectively. Three patients in group 1 required a redo PTA at 4 months, resulting in an assisted primary patency rate at 1 and 3 years of 88%. In contrast, no patients in group 2 required additional PTA. In group 1, the limb salvage rate at 1 and 3 years was 84%; and in group 2, 80% and 75%, respectively.

Conclusion:

The results of PTA in both groups were encouraging. Dilation of one or two short stenoses, despite multiple distal lesions, may improve distal flow sufficiently to promote wound healing. Thus, this procedure may be recommended in selected patients suffering from ischemic tissue loss. However, during the first 6 months following PTA, diabetic patients should be followed carefully with Duplex as they are prone to early restenosis.
Hemodynamic Results of Femoral Vein Valve Repair
Authors: de Souza G. G. , Pereira A. H. , Costa L. F. M. , Silva J. C. C. B. , Burihan E.
Published: September 2024

Our aim was to assess the hemodynamic and clinical responses associated with valve repair surgery in 37 patients with severe chronic venous insufficiency. Patients classified as C4–6EpASDPPR (primary venous dysfunction with skin changes with reflux of superficial, deep and perforating veins) were submitted to a novel procedure combining the closed technique described by Kistner with the Dacron sleeve technique described by Hallberg (mean follow-up = 24 months). A significant improvement in Valsalva test results ( P < 0.0001), ambulatory pressure ( P = 0.0099), venous refilling time ( P < 0.0001). and reflux index ( P < 0.0001) was observed. Postoperative reactive hyperemia and gradient tests confirmed absence of venous obstruction signs. On their last visit, 85.3% of the patients had no ulceration, and edema was absent or minimal in over 90%. About 70% of the patients referred partial or complete relief of pain in the affected limb. The combined surgical technique was effective to control venous reflux 24 months after the procedure. A longer follow-up would be necessary to assess long-term results.
Endovascular Stenting of Superficial Femoral Artery Stenosis and Occlusions: Results and Risk Factor Analysis
Authors: Cheng Stephen W. K. , Ting Albert C. W. , Wong John
Published: September 2024

Purpose:

To determine the early and midterm results of femoro-popliteal angioplasty with adjunctive stenting and to identify factors affecting early and continuing success.

Methods:

Sixty-nine consecutive balloon angioplasty procedures on the superficial femoral artery (SFA) were performed in 60 limbs and 55 patients in the operating theater. Fifty-two percent of lesions were occlusions, and 87% involved the distal half or the whole segment of the SFA. Immediate endovascular stenting was used in all procedures, involving the placement of 105 stents, with a mean stented length of 13.8 cm. Twenty-nine procedures (43%) were performed for critical ischemia. Three-monthly duplex ultrasound was used for follow up assessment, with stenosis of > 50% defined as the endpoint for failure. The patient demographic and biochemical data, and procedural details were correlated with success criteria according to Society of Vascular Surgery standards.

Results:

Initial technical success by intent to treat was 92%, with four procedure-related complications and no deaths. Initial success by anatomic, hemodynamic and clinical criteria were 98.3, 96.7 and 93.3% respectively (92.2, 90.6 and 87.5% by intent to treat). Cumulative primary patency at 6, 12, and 24 months was 73.1, 62.6 and 53.8%, and secondary patency 84.9, 72.1 and 72.1% correspondingly. Significant factors relating to inferior patency were occlusions, stented segment length > 10 cm, procedure in claudicants, and the use of the Memotherm stent.

Conclusions:

Angioplasty and stenting of the superficial femoral artery has acceptable primary and secondary patency rates even in the presence of long stenosis and occlusions. A duplex surveillance program is recommended for early detection and timely treatment of restenosis.
Surgical Treatment for Popliteal Artery Entrapment Syndrome
Authors: Ohara Nobusuke , Miyata Tetsuro , Oshiro Hidemi , Shigematsu Hiroshi
Published: September 2024

Purpose:

This study was a retrospective review of 11 limbs of 10 patients with popliteal artery entrapment syndrome (PAES) treated surgically in a 20-yr period.

Methods:

The patients were aged 34.7 ± 17.4 SEM yr. Arteriography findings varied, showing medial deviation in two limbs, poststenotic dilatation in four limbs and occlusion of the popliteal artery in five limbs. In addition, computed tomographic (CT) scanning showed positive findings of PAES in all the limbs.

Results:

The surgical procedures consisted of musculotendonous section (MTS) with autogenous saphenous vein (ASV) graft in seven limbs, MTS and ASV patch angioplasty with or without thromboendarterectomy in three limbs, and MTS alone in one limb. All the ASV grafts were found to be patent during the postoperative follow-up period (10.9 ± 4.0 yr).

Conclusion:

CT scanning was demonstrated to be the most sensitive diagnostic modality for PAES, and MTS with or without ASV grafting method was considered to be the best surgical procedure for PAES.
Deep Vein Thrombosis in Airline Passengers — The Incidence of Deep Vein Thrombosis and the Efficacy of Elastic Compression Stockings
Authors: Scurr John H. , Smith P.D. Coleridge , Machin S.
Published: September 2024

A prospective study to determine the incidence of deep vein thrombosis in passengers on long haul flights, and to determine the efficacy of elastic compression stockings in reducing this incidence. Two hundred patients over the age of 50, with no past history of venous throm-boembolic disease. no co-existing medical problems. and no specific risk factors, undergoing flights of eight hours or more, have been accessed. All patients have undergone Duplex ultra-sound imaging two weeks prior to departure. Immediately prior to departure. a repeat Duplex ultrasound scan was carried out, and blood taken for D-dimer and thrombin antithrombin complex (TAT) as markers of a hypercoagulable state and soluble vascular cell adhesions mol-ecule (VCAM-1). All patients completed a pre-travel questionnaire. The patients were randomly allocated to receive or not receive elastic compression stockings. On return, each patient was again scanned, and a further blood sample taken for analysis.

Those patients with high levels of D-dimer, TAT or VCAM-1, underwent a full thrombophilia screen. Those patients with a positive Duplex scan on visit one or two were excluded from the study. Those patients with a positive scan on return were considered to have developed thromboembolic disease, and underwent further investigations.

The results are being analysed on an intention to treat basis. The stUdy will conclude when 100 patients have been recruited to each group.
Colonisation of Prosthetic Grafts by Immunocompetent Cells in a Sheep Model
Authors: Bobryshev Y.V. , Inder S.J. , Cherian S.M. , Lord R.S.A. , Ao P.Y. , Hawthorne W.J. , Fletcher J.P.
Published: September 2024

The present study examined the distribution of immunocompetent cells in synthetic vascular grafts in an experimental sheep model. Sixty-two adult Merino sheep underwent synthetic patch closure of a longitudinal arteriotomy in the left common carotid artery. The synthetic patch materials used were gelatin sealed Dacron (n = 10). fluoropassivated Dacron (n = 10), Fluoropassiv (n = 12), polyurethane (n = 10), expanded polytetrafluoroethylene (n = 10) and carbon-lined expanded polytetrafluoroethylene (n = 10). The sheep were sacrificed after four weeks when the prosthetic patches were harvested and fixed in 10% neutral buffered formalin. Transverse sections were taken along the graft and paraffin embedded. Serial sections were stained with cell type specific antibodies to identify T-lymphocytes (CD3+). dendritic cells (S-100+), endothelial cells (von Willebrand factor+) and smooth muscle cells (smooth muscle alpha-actin+). All six graft types contained CD3+ and S-100+ cells in the neointima, within the synthetic matrix and in the perigraft layer. Three different tissue responses to synthetic materials were observed and the grafts were classified accordingly into three groups: (1) gelatin sealed Dacron, fluoropassivated Dacron and Fluoropassiv; (2) expanded polytetrafluoroethylene and carbon-lined expanded polytetrafluoroethylene; (3) polyurethane. The three synthetic materials in Group 1 showed almost identical reactions with least accumulation of immunocompetent cells within the synthetic material but greater accumulation of immuno-inflammatory infiltrates in the perigraft vascular tissue. In this group, new vessels penetrated into the synthetic material and there was prominent formation of foreign body (giant) cells. Group 2 showed greater accumulation of immunocompetent cells within the synthetic material itself but only sparse immuno-inflammatory infiltrates in the perigraft tissue. Group 3 showed a high degree of inflammatory response within both the synthetic material and the perigraft vascular tissue. These observations demonstrate that immunocompetent cells colonise the synthetic matrix of grafts and accumulate in the perigraft tissue, but inflammatory responses vary in different graft types.
Tension-Free Left ITA Graft — The Pericardial Strip Technique
Authors: Nezic Dusko , Peric Miodrag , Knezevic Aleksandar , Cirkovic Milan , Jovic Miomir , Bojic Milovan
Published: September 2024

Emphysematous lung occupying the whole dome of the left pleural cavity and expanding well over the midline may occasionally present a significant problem for positioning of the left internal thoracic artery, although the graft has been mobilized up to its origin. To avoid an undue tension on it, we combined a well known technique of the pericardial incision with the pericardial strip technique, enabling the lung to expand freely.
Coronary Reoperations in Patients with a Patent Internal Mammary Artery Graft
Authors: Noyez Luc , van Eck Frans M. , Skotnicki Stefan H. , Brouwer René M. H. J.
Published: September 2024

Objective:

Analysis of short and long term results, clinical, functional and subjective status of patients, with a patent arterial graft, after coronary reoperation (RECABG).

Methods:

Perioperative and follow-up data of 71 patients, undergoing coronary reoperations (1987–8) were studied. A cross-sectional follow-up was conducted, functional evaluation by the Duke Activity Status Index (DASI). and patient's evaluation of his life situation were registered.

Results:

Perioperative mortality was 7%. Eleven patients died during follow-up. The 12-month and 60-month survival was 96% and 80%. Event-free survival was 86% and 51%. Family doctors declared that 55/66 (83%) had benefitted from the coronary reoperations. New York Heart Association decreased significantly from 3.4 ± 0.5 preoperative versus 1.5 ± 0.4 postoperative. The mean DASI was 38.06 ± 10.42. At the moment of the cross-sectional follow-up, 45/55 patients (82%) declared to have benefitted from the coronary reoperations.

Conclusion:

Improvement in New York Heart Association-class, good postoperative functional capacity, and patients positive evaluation, justify coronary reoperations in patients with a patent internal mammary artery graft.
Autotransfusion Decreases Blood Usage following Cardiac Surgery — a Prospective Randomized Trial
Authors: Dalrymple-Hay Malcolm J. R. , Dawkins Sam , Pack Louise , Deakin Charles D. , Sheppard Stuart , Ohri Sunil K. , Haw Marcus P. , Livesey Steven A. , Monro James L.
Published: September 2024

Introduction:

10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial.

Patients and methods:

166 patients undergoing coronary artery bypass grafting (CABG). valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10g/1 or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance.

Results:

There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid.

Conclusion:

Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.
Immunohistochemical and Ultrastructural Evidence that Dendritic Cells Infiltrate Stenotic Aortocoronary Saphenous Vein Bypass Grafts
Authors: Cherian S.M. , Bobryshev Y.V. , Liang H. , Inder S.J. , Wang A.Y. , Lord R.S.A. , Tran D. , Pandey P. , Halasz P. , Farnsworth A.E.
Published: September 2024

We earlier speculated that antigen-presenting dendritic cells may be involved in the immune reactions leading to saphenous vein bypass graft failure. The purpose of this study was to confirm whether dendritic cells are present in stenotic human saphenous vein bypass grafts. Segments of stenotic saphenous vein grafts were explanted from 14 patients at re-do bypass operation and ten normal saphenous veins were harvested during femoro-popliteal grafting. Sections of specimens were analysed using cell type specific antibodies to identify dendritic cells (CD1a, S-100), T-lymphocytes (CD3), macrophages (CD68), smooth muscle cells (α-SMA) and endothelial cells (FVI11). Dual immunostaining, confocal immunofluorescent laser scanning microscopy and electron microscopy were used. Stenotic grafts showed structural alterations of intimal hyperplasia and varying degrees of atherosclerotic degeneration. No cells expressing CD1a and S-100 were observed in the intima and media of normal saphenous veins. Cells expressing these antigens were present around areas of medial neovascularization and within intimal atherosclerotic lesions in saphenous vein bypass grafts. Electron microscopy demonstrated the presence of cells containing a well-developed tubulovesicular system which is unique to cells from the dendritic cell family. Double immunohistochemistry and confocal immunofluorescent microscopy revealed the co-localization of T-lymphocytes with dendritic cells. Dendritic cells are present in stenotic saphenous vein bypass grafts. Dendritic cells may be responsible for antigen presentation and modulation of immune reactions in accelerated graft atherosclerosis through their interaction with T-lymphocytes.
A Case of Coronary Artery Fistula Draining into the Pericardium Causing Hematoma
Authors: Mutlu Haşim , Küçükoǧlu M. Serdar , Özhan Hakan , Kansýz Erhan , Öztürk Servet , Üner Sinan
Published: September 2024

A 28-yr old female patient admitted to our clinic because of dyspnea and chest pain. Her transesophageal echocardiography demonstrated a huge mass on the anterolateral wall of the left ventricle causing dysfunction of the myocardium. Coronary angiography demonstrated left anterior descending artery fistula draining into the pericardial cystic mass. Hydatic cyst was suspected and ELISA and hemagglutinin tests were both negative for Echinococcus granulosus. Magnetic resonance image of the heart showed a mass thought to be a hematoma inside the cyst. She underwent surgery. The cystic lesion with a pure hematoma inside, was excised, and the fistula between left anterior descending artery and the mass was ligated without any complications. To our knowledge, this is the first case of a pericardial hematoma due to a coronary artery fistula, in the English literature.
Endovascular Treatment of Abdominal Aortic Aneurysms
Authors: May J. , White G. H. , Waugh R. , Stephen M. S. , Chaufour X. , Yu W. , Harris J. P.
Published: September 2024

Objective:

The purpose of this paper is to briefly review the historical aspects and outcome of endoluminal abdominal aortic aneurysm (AM) repair and summarise two studies presented at the 1997 and 1998 meetings of the Society for Vascular Surgery.

Patients:

Between May 1992 and September 1998 the endoluminal method was used to repair arterial aneurysms in 304 patients at the Royal Prince Alfred Hospital, Sydney, a tertiary referral teaching hospital. The study focuses on 243 patients with true AAA who underwent primary repair. There were 17 females and 226 males with a mean age of 72 years. Co-morbidities leading to rejection for conventional open repair were present in 83 patients. The criteria for inclusion included a segment of thrombus-free aorta between the lowermost renal artery and the commencement of the aneurysm of 1.5 cm or greater and iliac arteries that allowed access to the aorta from the groin. The technique involved the delivery of an endograft into the abdominal aorta by means of a sheath inserted through the femoral or iliac artery. Laparotomy associated with conventional open repair was avoided. Outcome measures included clinical examination and contrast-enhanced computed tomography (CT) within 10 days, at 6. 12, 18 months after operation and then annually thereafter.

Results:

Endografts were successfully deployed in 226 patients. In the remaining 17 patients endoluminal repair was converted to open repair. There were 8 deaths within 30 days of operation giving a perioperative mortality rate of 3.3%. The two studies presented to the Society for Vascular Surgery concern: (i) a concurrent comparison of the endoluminal versus open methods of treating AAA; and (ii) a comparison of adverse events following endoluminal repair of AAA during two consecutive periods of time.
Experience with Heparin-Bonded Collagen-Coated Grafts for Infrainguinal Bypass
Authors: Lambert A. W. , Fox A. D. , Williams D. J. , Horrocks M. , Budd J. S.
Published: September 2024

The perfect conduit for infrainguinal reconstructive surgery does not exist. When autologous vein is not available, then a prosthetic graft must be used. The use of a heparin-bonded graft has the theoretical advantage of reducing smooth muscle cell proliferation and thrombus formation, thereby reducing occlusion rates. The application of a collagen layer to the external surface of the graft serves to reduce transfabric haemorrhage. Forty-six patients underwent 47 infrainguinal reconstructions using heparin-bonded collagen-coated Dacron grafts over a 4-year period. Twenty grafts were for disabling claudication and 27 for critical ischaemia. Twenty-two grafts were to the above knee popliteal artery (47%), 10 to the below knee popliteal (21%) and 15 to one of the crural vessels (32%). There was a cumulative patency at 4 years of 69% for the above knee grafts, and 30-month patency of 58% and 45% for the below knee and crural grafts, respectively. There were three deaths over the study period and eight patients required major amputations.
Elective Surgery for Small Abdominal Aortic Aneurysms
Authors: Ballotta E. , Da Giau G. , Bottio T. , Toniato A.
Published: September 2024

Background and purpose:

Surgical repair for abdominal aortic aneurysm has become more frequent and the mortality associated with elective surgery has been reduced, but the overall mortality for ruptured aneurysm remains unacceptably high. The dilemma for the vascular surgeon is whether to operate early and electively on asymptomatic small aneurysms, less than 5 cm in diameter, or to delay surgery, adopting a wait-and-see attitude. The purpose of this retrospective study was to review a recent 5-year experience of elective aneurysm surgery, with special emphasis on the perioperative outcome of surgical repair of asymptomatic small aneurysms, in order to evaluate whether early mortality and morbidity justify an aggressive approach.

Methods.

The report concerns a series of 141 consecutive patients who underwent aneurysm repair for small ( n = 65, group I) and large aneurysms ( n = 76, group II). For each group, the age, sex, risk factors and associated diseases, operative and aortic cross-clamping times, estimated blood loss, blood transfusion volume, type of operation and graft, perloperative morbidity and mortality, and causes of death were recorded and compared.

Results:

The majority of patients were males. The mean age of the patients was lower in group I than in group II. No statistically significant difference was found from the comparison of the risk factors and associated diseases in groups I and 11. The mean operating time was 82 minutes in group I, 98 minutes in group II, and the aortic cross-clamping time was also shorter in group I (37 min versus 52 min), whereas blood loss was greater, with a statistically significant difference ( P < 0.05). The operative mortality rate was higher in group II than in group I (1.3% versus 0%, P = NS).

Conclusions:

Elective small aneurysm repair is recommended in good-risk patients for the following reasons: (i) the operative mortality and morbidity rates are lower in small than in large aneurysm patients, and (ii) the small aneurysm repair is technically easier and safer to perform. In addition, there are two other considerations that are more difficult to quantify, but may support an aggressive approach: the cost-benefit ratio is better with early diagnosis and elective surgery, before an emergency operation is required, and personal choice and psychological reasons can induce patients to prefer early elective repair to periodic monitoring by ultrasound or computed tomography scans.
Endoluminal Repair of Infrarenal Abdominal Aortic Aneurysms Using a Modular Stent-Graft: One-Year Clinical Results from a European Multicentre Trial
Authors: Nolthenius R. P. Tutein , vd. Berg J. C. , Biasi G. M. , Piglionica M. R. , Meregaglia D. , Ferrari S. A. , Coppi G. , Pacchioni R. , Gennai S. , Cao P. , Barzi F. , Verzini F. , Maselli A. , Caporali S. , Moll F. L.
Published: September 2024

This is a report of a prospective study to evaluate the safety and efficacy of the Medtronic AneuRx™ stent-graft. Patients with an infrarenal aneurysm with a proximal neck length of greater than 10 mm and a neck diameter not greater than 26 mm and iliac artery diameters of at least 6 mm were accepted for endovascular repair using the Medtronic AneuRx™ modular stent-graft. A total of 104 patients were included in the study. Transfemoral placement of the bifurcated stent-graft was successful in 102 of 104 patients. Two conversions were performed. The mean operating time was 148 min (range 75–480) and the mean blood loss was 605 ml (range 100–2900). The mean follow-up was 15 months (range 12–21). Complications were rare and no kinking or migration occurred. At follow-up, four endoleaks persisted after 12 months. The Medtronic AneuRx™ stent-graft is a safe and efficacious alternative to open abdominal aortic aneurysm repair with excellent early results.
Involvement of Dendritic Cells in Long-Term Aortocoronary Saphenous Vein Bypass Graft Failure
Authors: Cherian S. M. , Bobryshev Y. V. , Inder S. J. , Lord R. S. A. , Reddi K. H. , Farnsworth A. E. , Tran D. , Munro V. F. , Ashwell K. W. S.
Published: September 2024

Antigen-presenting dendritic cells are present in atherosclerotic lesions in human arterial intima, but have not been investigated in atherosclerotic and hyperplastic stenotic lesions that affect vein grafts used as arterial conduits. This study was undertaken to examine whether dendritic cells are present in aortocoronary artery saphenous vein bypass grafts affected by high-grade atheromatous stenosis. Stenotic saphenous vein coronary artery bypass grafts (angiographic luminal stenosis > 75%) were harvested from 10 patients (nine male, one female), aged 42–71 years (mean 56.5) at re-do operation. The mean time interval from bypass surgery to the excision of stenotic grafts was 11.5 years (range 2–21). The specimens were fixed in 10% buffered formalin, embedded in paraffin blocks and the sections stained with antibodies to S-100 (to identify dendritic cells). CD3 (T cells). CD68 (macrophages), von Willebrand factor (endothelial cells) and α-smooth muscle actin (smooth muscle cells) using avidin-biotin complex immunoperoxidase technique. Normal veins were obtained during saphenous vein femora-popliteal grafting. The stenotic venous grafts showed histological features typical of extensive arterialization, intimal hyperplasia, atherosclerotic plaque-like lesions, calcification and thrombosis. In areas of intimal hyperplasia, S-100-positive cells were distributed irregularly among smooth muscle cells. S-100-positive dendritic cells were seen most frequently within atherosclerotic plaque-like lesions where they co-localized with CD3+ cells and CD68+ cells. S-100-positive dendritic cells were also seen accumulating within calcific foci. No S-100-positive ceils were found in normal, ungrafted saphenous veins. We conclude that dendritic cells are present in aortocoronary saphenous vein bypass grafts affected by high grade stenosis. Dendritic cells are probably involved in immune mechanisms of atherogenesis through their interactions with T cells and macrophages. The accumulation of dendritic cells within calcific foci suggests their contribution to the calcification of stenotic venous grafts.
Prevalence and Outcome of Activated Protein C Resistance in Patients after Peripheral Arterial Bypass Grafts
Authors: Fisher C. M. , Tew K. , Appleberg M.
Published: September 2024

The association of activated protein C resistance with peripheral arterial bypass graft patency was assessed A retrospective cohort study of consecutive first-time femoro-popliteal or femoro-distal bypasses performed in patients living within the boundaries of the Area Health Service was performed. Of 242 patients eligible for inclusion, 73 had died, nine refused to participate and 40 were lost to follow-up. Activated protein C resistance was present in nine (7.5%) of the 120 patients tested. In the study group, smoking at the time of surgery, female gender and the use of prosthetic grafts were significantly associated with graft failure on univariate Cox regression analysis, but activated protein C resistance was not. After accounting for confounders, there was a trend ( P = 0.098) for activated protein C resistance to be associated with graft failure (OR 2.90. 95% Cl 0.82–10.3). Patients who died or who were lost to follow-up had significantly earlier operation dates than those who remained alive or tested for activated protein C resistance. However, there was also a highly significant ( P = 0.006) trend for activated protein C resistance in patients who had undergone surgery closer to the end of the study period. Six of the nine patients with activated protein C resistance underwent surqery in the last 10 months of the review period and only three activated protein C resistance patients had a graft patent for more than 8 months. The prevalence of activated protein C resistance in patients undergoing peripheral arterial bypass grafting is greater than in the general population There was a trend for activated protein C resistance to be associated with graft failure A significantly higher proportion of patients with activated protein C resistance was found with more recently performed surgery. The observed results could be accounted for by excess mortality in patients with activated protein C resistance. This hypothesis requires testing prospectively.
The Changes Seen in Balloon-Injured Porcine Femoral Arteries following Sympathectomy
Authors: Lamawansa M. D. , Wysocki S. J. , House A. K. , Norman P. E.
Published: September 2024

On the basis that vasoconstriction may contribute to restenosis following angioplasty, the influence of lumbar sympathectomy on the morphometry of femoral arteries after balloon injury was examined in a pig model. Twenty-six juvenile pigs underwent balloon de-endothelialization of the right femoral artery followed by an open bilateral lumbar sympathectomy ( n = 14) or a sham sympathectomy ( n = 12). Four weeks later flow was measured in femoral arteries. Animals were then killed and the femoral arteries were perfusion-fixed and harvested. Sympathectomy resulted in a significant ( P = 0.04) increase in flow in both the injured (right) and uninjured (left) femoral arteries. Sympathectomy did not inhibit intimal thickening following balloon injury: median (interquartile range) intimal area was 0.4 mm2(0.3–0.9) in the sympathectomy group versus 0.5 mm2(0.4–0.9) in the sham group. Sympathectomy did, however, result in a significant ( P = 0.02) increase in the lumen area: 1.1 mm2(0.8–1.8) versus 0.7 mm2(0.6–0.9). Sympathectomy may reduce vasospasm following angioplasty with the potential for clinical benefit.