bluuebunny/crossref_metadata_2025 huggingface dataset:
Dry sliding wear characteristics of hybrid aluminum alloy with nano-fly ash and nano-yttrium oxide
Authors: Kumar Vishal , Singh Satnam
Published: September 2024

Aluminum alloys feature impressive levels of strength, ductility, castability, wear resistance, and corrosion resistance, making them highly advantageous for the aviation and automotive industries. This study investigates the dry wear performance of hybrid nanocomposites (HNCs) produced using Al6061 as the matrix, with nano-fly ash (FA) and nano-yttrium oxide (Y2O3) as reinforcing agents, utilizing the stir-casting method. The weight percentage (wt-%) of FA was fixed at 4 wt-%, while the Y2O3 varied from 1 wt-% to 3 wt-%. The specimens were prepared following ASTM-G99 standards and tested using a pin-on-disc apparatus with an E31 steel disc under four different loads: 10 N, 20 N, 30 N, and 40 N. It has been observed that wear rate has been increased with the increase in the applied load. The maximum wear rate has been recorded for the base Al6061 alloy as 5.63 × 10−4 mm3/N-m at 40 N load due to its lower wear resistance and less hardness value. The addition of reinforcement particles in the base alloy results in the grain refinement and improvement in the load-bearing capacity. It has been found that at 40 N load, the Al-6061 alloy reinforced with (4 wt-% FA + 3 wt-% Y2O3) is 56.83% superior in terms of wear resistance (2.43 × 10−4 mm3/N-m) as compared to Al6061 base alloy. The hybrid nano-composite containing 4 wt-% FA + 3 wt-% Y2O3 showed the highest value of microhardness as 123.2 HV, which is 136% higher than that of base alloy due to the higher load-bearing characteristics of the reinforcement particles. Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) have been employed to analyze both unworn and worn surfaces, revealing uniform dispersion of reinforcement particles, the formation of an oxide layer, micro-pitting, wear debris, and material delamination. Grain refinement has been examined using the line intercept method (ASTM E1382-97), and X-ray diffraction (XRD) confirmed the elemental composition of the nano-reinforcements.
Complications of Operative Treatment of Injuries of Peripheral Arteries
Authors: Velinovic M. Milos , Davidovic B. Lazar , Lotina I. Slobodan , Vranes R. Mile , Djukic L. Petar , Arsov J. Vladislav , Ristic V. Miljko , Kocica J. Mladen , Petrovic Lj. Predrag
Published: September 2024

In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16–63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19–61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tlbioperoneal trunk in 4 (3.77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).

A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25.51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases.

Infection developed in 51 (52.57%) patients, and it was significantly ( P < 0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection.

Amputation was necessary in 21 (21.65%) of our patients, and was significantly ( P < 0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).
Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus: Case Report and Review of Surgical Treatments
Authors: Shah Ashish S. , Milano Carmelo A. , Lucke John P.
Published: September 2024

An anomalous right coronary artery arising from the left sinus of Valsalva is a rare but potentially lethal abnormality. We present a case report and literature review of this anomaly as well as its surgical management in the face of unobstructed distal coronary arteries. Furthermore we report the use of intraoperative transesophageal stress echocardiography to evaluate adequacy of graft flow.
Lack of Compressibility of the Common Femoral Vein: An Unequivocal Sign of Proximal Deep Venous Thrombosis on Duplex Ultrasound?
Authors: De Maeseneer M. G. , Tielliu I. F. , Tjalma W. A. , Van Schil P. E.
Published: September 2024

The authors report a case of false positive diagnosis of iliac vein thrombosis on duplex ultrasound.

The misreading of the duplex scan was based on the presence of an incompressible common femoral vein. External compression on the iliac veins, caused by enormous postoperative lymphoceles, was responsible for the false positive diagnosis.
Growing the Vascular Surgical Practice: Venous Disorders
Authors: Bergan John J. , Sparks Steven R. , Owens Erik L. , Kumins Norman H.
Published: September 2024

For the 48th meeting of the International Society for Cardiovascular Surgery, North American Chapter in June 2000. we were asked to organize a presentation with the title displayed above. We welcomed this opportunity because the phrase ‘growing the practice’ literally means giving greater service to underserved patients with vascular disorders. Underserved individuals with vascular disorders include those with nonatherosclerotic arterial disorders, patients with lymphedema, and individuals with a variety of venous disorders including venous insufficiency. The majority of these conditions are not surgical, but venous insufficiency commands attention because its treatments are interventional. Therefore, this presentation will discuss prevalence of venous insufficiency, a unifying concept of its pathophysiology, how treatment may be selected, what the new technology provides, and then a description of coding issues and whether or not interventions are actually worthwhile from the point of view of the patient.
Vascular Ultrasound Surveillance after Endovascular Intervention for Occlusive Iliac Artery Disease
Authors: Myers K. A. , Wood S.R. , Lee V.
Published: September 2024

This paper describes vascular ultrasound surveillance after endovascular intervention for occlusive iliac artery disease. There were 105 patients who had 198 procedures in 155 limbs, consisting of 110 balloon dilatations and 88 stentings. The patients were referred to the vascular diagnostic service by several surgeons. All procedures had been considered to be initially technically successful. Colour-Doppler duplex ultrasound studies were performed shortly before and at serial intervals after operation to determine patency rates. Univariate life table analysis showed 69% primary and 96% assisted primary patency at four years. Primary patency rates at four years were significantly worse for stentings (60%) compared to balloon dilatations (71%) ( P<0.05). Maximum peak systolic velocities (PSV) were recorded from the treated arteries. Receiver operating characteristics curves showed that PSV >300 cm/s was most accurate for predicting technical failure. Haemodynamic success rates at four years were 72% for PSV >300 cm/s. Results for procedures that were initially successful indicate that long-term primary patency rates for iliac endovascular intervention are acceptable and that assisted primary patency rates are excellent.
Transfemoral Insertion of a Bifurcated Endovascular Graft for Aortic Aneurysm Repair: The First 22 Patients
Authors: Chuter T. A. M. , Wendt G. , Hopkinson B. R. , Scott R. A. P. , Risberg B. , Walker P. J. , White G.
Published: September 2024

The purpose of this study was to evaluate and optimize a system of transfemoral bifurcated graft insertion for endovascular repair of infrarenal aortic aneurysm. Grafts were inserted through bilateral femoral arteriotomies in 22 patients. Placement was guided by fluoroscopy. Results were assessed by completion angiography, with computed tomography scanning or duplex ultrasonography at 1, 3 and 6 months. The first 11 insertions were complicated by failed insertion in two cases, proximal leakage in one, graft limb thrombosis in five and wound infection in one. The second 11 insertions were complicated by retrograde leakage around the distal graft orifice in two patients. One of these was associated with aneurysm rupture, leading to the sole mortality of the series. There were no instances of graft migration or embolism. In conclusion, the lessons learned during the first 11 insertions were responsible for the improved results apparent in the second 11 insertions. When applied in properly selected patients, transfemoral insertion of a bifurcated graft is a reliable method of isolating an aortic aneurysm from the circulation.
Twenty-Year Clinical Experience with the Greenfield Filter
Authors: Greenfield L. J. , Proctor M. C.
Published: September 2024

The purpose of this study was to characterize the long-term safety and efficacy of the stainless-steel Greenfield filter. All patients who underwent Greenfield filter placement at three institutions during tenure of the senior author (L.J.G.) were entered prospectively into a filter registry and followed on an annual basis. Follow-up consisted of clinical examination to evaluate the status of venous disease or recurrence of pulmonary embolism, abdominal radiographs to determine the stability of the filter and an evaluation of the patency of the inferior vena cava and lower extremities. This report summarizes the 20-year experience. The rate of recurrent pulmonary embolism was 4% and the caval patency rate was 96%. Some filter movement of no clinical significance was seen in 8% of cases. There was no procedural mortality and morbidity was minimal. Greenfield filter insertion provides long-term protection from pulmonary embolism while preserving caval patency.
Repair of the Supradiaphragmatic Inferior Vena Cava Lacerated during Redo Open-Heart Surgery
Authors: Demirtaş M. , Aykut S. , Dagsali S.
Published: September 2024

Laceration of the inferior vena cava is among the more lethal of the vascular traumas. True mortality is higher if the lacerated segment is located in the upper part of the inferior vena cava, especially in the supradiaphragmatic portion. Knowledge of injuries of the inferior vena cava is mostly limited to those related to external trauma. The inferior vena cava may be lacerated during reoperation because of inappropriate dissection or uncontrolled traction. The authors used a diaphragmatic pericardial flap to repair the lacerated anterior wall of the supradiaphragmatic inferior vena cava and obtained good results in two cases requiring repeat open-heart surgery.
Adult Respiratory Distress Syndrome following Closure of a Chronic Ventricular Septal Defect: Possible Relationship to the Use of Intracardiac Gelatin-Resorcin-Formaldehyde Glue
Authors: Trivedi U. H. , Black J. J. M. , Aps C. , Young C. P.
Published: September 2024

Gelatin-resorcin-formaldehyde glue is now widely used in cardiac surgery, particularly in Europe. A case is reported where its use may have contributed to the pulmonary dysfunction seen postoperatively after elective closure of a postinfarct ventricular septal defect. It is believed that this is a result of a relatively high exposure of the pulmonary circulation to the glue, in particular to formalin. Although not proven, the authors advise caution when using the glue within the cardiac chambers.
Composite Porosity of Expanded Polytetrafluoroethylene Vascular Prosthesis
Authors: Nagae T. , Tsuchida H. , Peng S.-K. , Furukawa K. , Wilson S. E.
Published: September 2024

Polytetrafluoroethylene (PTFE) prostheses were modified to produce two types of composite porosity PTFE grafts: type I - inner 60 μm/outer 20 μm and type II - inner 20 μm/outer 60 μm. These composite porosity PTFE designs were investigated for bleed through, graft healing and patency and compared with high porosity PTFE (60 μm) and standard PTFE (20 μm) grafts. The grafts were implanted into the carotid and femoral arteries of dogs and retrieved after 4, 12 and 18 weeks. Both composite porosity grafts showed significantly less bleed through than standard and high porosity grafts after reperfusion. In composite grafts, the 60-μm layer allowed fibrovascular tissue and histiocyte ingrowth from perigraft tissue, but the 20-μm layer did not. Neointima formation occurred earlier and endothelialization was more extensive in high porosity grafts, but seroma formation occurred in 25% of cases. In type I composite porosity grafts, smooth muscle cells of neointima migrated into the pores of the graft, providing a firmly anchored intima. Type II composite porosity grafts allowed better ingrowth of fibrovascular tissue at the outer layer from the perigraft tissue; however, endothelialization was not completed. Composite porosity grafts should be considered for evaluation in specific clinical situations.
Primary Aortoesophageal Fistula Caused by an Atherosclerotic Thoracoabdominal Aortic Aneurysm: A Case Report and Review of the Literature
Authors: Hageman J. H. , Nein A. G. , Davis J. T.
Published: September 2024

A 55-year-old woman suffered an episode of massive hematemesis caused by an aortoesophageal fistula from an atherosclerotic thoracoabdominal aortic aneurysm. In situ grafting of the thoracic portion of the aneurysm was followed by sepsis and a sinus tract between the mid-esophagus and the aortic prosthesis. Graft removal, aortic closure, esophageal closure and axillobifemoral bypass allowed clearing of the sepsis and recovery. Severe hypertension followed aortic closure and extra-anatomic bypass and resulted in the eventual death of the patient 16 months later from dissection of the ascending aorta with pericardial tamponade. There are very few treated cases of aortoesophageal fistulas caused by atherosclerotic aneurysms reported in the literature. Furthermore, there are no reported cases where the aorta was closed at the level of the subclavian artery with extra-anatomic bypass to restore blood flow to the lower half of the body.
Tracheoinnominate Artery Fistula following Tracheostomy
Authors: Keçeligil H. T. , Erk M. K. , Kolbakir F. , Yildirim A. , Yilman M. , Ünal R.
Published: September 2024

Tracheoinnominate artery fistula is a relatively rare but highly lethal complication occurring in patients with long-standing tracheostomies. Early evaluation of this problem and prompt aggressive therapy are necessary. When massive haemorrhage begins, immediate arterial compression, control of the airway and subsequent treatment of the injured artery may be lifesaving. Immediate surgical exploration through a median sternotomy is necessary to control the proximal and distal innominate artery. After the damaged artery has been excised, vascular reconstruction can be performed to preserve the connection between the proximal and distal ends of the innominate artery. A pedicled pericardial patch was successfully used for the tracheal reconstruction.
Beneficial Effects of Hypertonic Mannitol in Acute Ischemia — Reperfusion Injuries in Humans
Authors: Shah D. M. , Bock D. E. M. , Darling R. C. , Chang B. B. , Kupinski A. M. , Leather R. P.
Published: September 2024

Acute ischemia-reperfusion of extremities is characterized by edema, compartment syndrome and neuromuscular dysfunction. Intravenous hypertonic mannitol has been shown to be of benefit in several experimental models. The authors' 5-year experience with the use of hypertonic mannitol and the treatment of acute ischemia reperfusion injuries in humans has been reviewed. Some 186 patients with acute arterial occlusion following thromboembolism (149) and trauma (37) were treated. Hypertonic mannitol (25 g intravenous bolus followed by 5–10 g intravenous/h) was given perioperatively. Length of preoperative ischemia varied from 1 to 24 h. Some 57.5% of patients had preoperative neuromuscular dysfunction. Following revascularization, limb salvage was obtained in 97.7% of surviving patients and neuromuscular dysfunction improved in 89%. Overall, 15% required fasciotomy. The mortality rate was 3.2%. These data suggest that hypertonic mannitol may have some protective effect in acute ischemia-reperfusion injuries of human extremities. It may decrease the need for fasciotomy and minimize neuromuscular dysfunction.
Thrombolytic Therapy for Acute Deep Venous Thrombosis: How Much is Enough?
Authors: Comerota A. J. , Katz M. L. , White J. V.
Published: September 2024

Twenty-eight patients treated with thrombolytic therapy for acute deep venous thrombosis were monitored prospectively with non-invasive testing every 12–24 h during treatment to evaluate thrombus response and whether duration of therapy was appropriate. Some 75% (21 of 28) of patients demonstrated improvement with lytic therapy with 36% (10 of 28) demonstrating complete lysis; 95% of responders (20 of 21) initiated lysis within 24 h. Some 33% (7 of 21) of all responders and 64% (7 of 11) of those having partial lysis had treatment terminated during thombus resolution but before maximal lysis. Non-invasive testing indicated that thrombolytic therapy for acute deep venous thrombosis is frequently terminated before maximal lysis of the thrombus. Monitoring thrombus response with venous duplex imaging should be part of the treatment strategy of deep venous thrombosis if thrombolytic therapy is used. This approach should increase efficacy and potentially reduce complications of thrombolytic therapy for acute deep venous thrombosis.
Femoral Artery Aneurysms: Long-Term Follow-Up and Results of Surgical Treatment
Authors: Sapienza P. , Mingoli A. , Feldhaus R. J. , di Marzo L. , Cavallari N. , Cavallaro A.
Published: September 2024

Aneurysmal dilatation of the femoral artery is a rare condition of uncertain aetiology. Between January 1972 and December 1992, 31 atherosclerotic femoral aneurysms in 22 patients were seen. There were 21 men and 1 woman; mean(s.d.) age was 70.1(10.4) years. Thirteen (42%) femoral aneurysms (group 1) were isolated aneurysms, two being bilateral. Eighteen (58%) were associated with a non-contiguous abdominal aortic aneurysm, four being unilateral and seven bilateral femoral aneurysms (group 2). The mean(s.d.) size of these aneurysms was 4.7(1.5) and 3.5(0.7) cm in groups 1 and 2 respectively ( P<0.01). Of the limbs in group 1, 12 were treated by an interposition bypass. A ruptured profunda femoris artery aneurysm was ligated in one limb as an emergency operation. All patients in group 2 underwent an aortobifemoral graft. There was one operative death. Three early thromboses were observed; two autogenous saphenous vein interposition grafts and one limb of an aortobifemoral. One late thrombosis occurred in an expanded polytetrafluoroethylene graft in group 1. The five-year patency rate was 80% for group 1 and 88.9% for group 2 (P= n.s.). The overall 10-year limb salvage rate was 100%. These findings suggest that isolated femoral aneurysms are larger and more frequently symptomatic than femoral aneurysms associated with an abdominal aortic aneurysm. The association between femoral aneurysm and abdominal aortic aneurysm was found to be higher in patients with bilateral femoral aneurysms compared with those with unilateral lesions (P<0.05). In the treatment of isolated femoral aneurysms better early results were obtained with expanded polytetrafluoroethylene interposition grafts.
Renal Artery Aneurysm: A Report of 28 Cases
Authors: Lumsden A. B. , Salam T. A. , Walton K. G.
Published: September 2024

Renal artery aneurysms are being increasingly encountered due to the wider use of angiography. From 1972 to 1992, 28 patients with renal artery aneurysm were identified in the present study, including 18 women and 10 men, with a mean age of 58 years. The aneurysms were discovered incidentally in 39% of patients during evaluation for hypertension in 39%, and during investigation of abdominal pain in 22%. Only 7% of patients had symptoms directly attributable to the aneurysm. Aneurysm size varied from 0.5 cm to 8 cm in diameter, with a mean of 2.1 cm. The main renal artery was involved in 52% of cases, and primary branches in 44%; the remainder were intraparenchymal. There was a slight right-sided predominance in this series. The etiology of the aneurysms included atherosclerosis (75%), fibromuscular disease (21%), and Ehlers-Danlos syndrome (4%). Surgical therapy was undertaken in 10 patients (36%). Procedures performed included aortorenal bypass in four patients, aneurysm excision and renal artery repair in three, partial nephrectomy in one, and total nephrectomy in two. Although the natural history of renal artery macroaneurysms is not known with certainty, potential complications include embolization and rupture. The authors' indications for surgery include: (a) symptomatic or enlarging aneurysms; (b) renal embolization; (c) aneurysms in pregnant females or those considering pregnancy; (d) renovascular hypertension; (e) aneurysms > 2.5 cm. Most symptom-free aneurysms <2.5 cm in diameter can be safely treated expectantly.
Femoropopliteal Bypass Revisited: An Analysis of 138 Cases
Authors: Plecha E. J. , Freischlag J. A. , Seabrook G. R. , Towne J. B.
Published: September 2024

Femoropopliteal bypass is utilized for infrainguinal arterial reconstruction in patients with claudication, rest pain, non-healing ulcers and gangrene. Reported patency and limb salvage rates have varied considerably and controversy exists concerning conduit choice. The purpose of this study was to reveiw the authors' results with femoropoplital bypass to determine factors which may influence outcome in a contemporary series of patients. Between 1986 and 1991, 138 femoropopliteal bypasses were performed in 120 patients. Mean follow-up was 28 (range 1–66) months. Autogenous vein was used in 59% and polytetrafluoroethylene (PTFE) in the remainder. Above-knee anastomoses were performed in 34% and below-knee in 66%. The secondary patency for autogenous vein grafts (95% at 4 years) was significantly better than for PTFE grafts (69% at 4 years; P<0.01). Secondary patency for below-knee autogenous vein grafts also was better than that for below-knee PTFE grafts (95% versus 50% at 4 years; P< 0.02). Limb salavage rates were worse for below-knee PTFE grafts than all other groups ( P<0.01). Eight of 15 failed above-knee PTFE grafts were salvaged with below-knee autogenous vein grafts and did well. In the present series, autogenous vein femoropopliteal grafts demonstrated better overall patency and limb salvage. Below-knee PTFE bypasses should be reserved for limb salvage cases in patients without adequate autogenous conduits. Failed PTFE grafts can be salvaged by autogenous bypasses, yet an advantage to this approach was not seen.
Changes in the Proportion of Types I and III Collagen in the Left Ventricular Wall of Patients with Post-Irradiative Pericarditis
Authors: Chello M. , Mastroroberto P. , Romano R. , Zofrea S. , Bevacqua I. , Marchese A. R.
Published: September 2024

Pericardectomy for post-irradiative constrictive pericarditis achieves poor results because of the extensive damage to the heart and pericardium caused by ionizing radiation. The extracellular structural protein, collagen, is responsible for the functional integrity of the myocardium and allows reversible interdigitation and the transmission of force between contracting myocytes. Collagen concentration and composition were examined in the cardiac tissue of three patients undergoing pericardiectomy and post-irradiative pericarditis. Normal heart tissue was taken at autopsy from patients without cardiac disease and acted as controls. Total collagen concentration (mean(s.e.m.)) was significantly increased in the ventricular tissue of patients with post-irradiative pericarditis compared with that of the controls (119.8(16.6) versus 50.4(5.2) mg/g dry weight, P<0.01). Although there was an increase in concentration of both type I and III collagen, a disproportional increase in type I was observed. The proportion of type III collagen was lower in patients with post-irradiative pericarditis than in the control group (33(2.6)% versus 38.2(3.7)%, P<0.05). The results of the present study suggest that this marked alteration in collagen concentration and proportion may contribute to the impaired diastolic distensibllity of the ventricles seen in this group of patients.
Coronary Artery Surgery with Induced Temporary Asystole and Intermittent Ventricular Pacing: An Experimental Study
Authors: Khanna R. , Cullen H. C.
Published: September 2024

Coronary artery bypass grafting performed without cardiopulmonary bypass presents a difficulty in performing coronary anastomoses on a beating heart. A non-cardiopulmonary bypass technique in sheep by which individual sutures can be placed on a still heart is described. Epicardial pacing wires were placed and a curved needle passed between the aorta and pulmonary artery into the muscular interventricular septum and directed caudally and to the riqht The tip of the needle now lay in the vicinity of the outflow of the bundle of His. No cardiac chamber or vital structures were traversed. Injection of lignocaine here resulted in immediate ventricular asystole. Ventricular pacing restored cardiac output. After establishing local control of the vessel coronary anastomosis was performed stopping ventricular pacing for the few seconds required to place a single suture and reinstating it between the passage of sutures. Reversion to sinus rhythm occurred spontaneously.
In Situ Arterial Allografting for Aortoiliac Graft Infection: A 6-year Experience
Authors: Koskas F. , Plissonnier D. , Bahnini A. , Ruotolo C. , Kieffer E.
Published: September 2024

Between October 1988 and May 1994, all aortoiliac graft infections seen in the authors' service were treated by in situ arterial allografting after resection of any infected graft or tissue. Some 83 consecutive cases were treated; there were 68 isolated primary prosthetic infections (82%) and 15 aortoenteric fistulae (18%). Emergency arterial allografting was performed in five cases (6%), elective allografting in 64 cases (77%) and elective allografting after emergency palliative revascularization using a temporary prosthetic graft in 14 cases (17%). Arterial allografts were harvested from cadavers as part of a programme to retrieve multiorgan transplant tissue. Fifteen patients (18%) died either intra- or postoperatively. Three died during the operation, one from septic shock and two from uncontrollable coagulopathy. Twelve patients died in the early postoperative period, from from septic shock, two from myocardial infarction, two from pneumonia, one from a pulmonary embolism, one from an intestinal infarction, one from recurrence of a duodenal fistula and one from disruption of the native aorta at the suture line. Three patients presented with an early complication directly related to the use of the allograft. Eleven early survivors of the series died during follow-up. Among these late deaths, only one could likely be allograft-related. In four patients, the aortic segment of the allograft was mildly dilated on late computed tomography scan; three were reoperated on for disruption of the extra-abdominal segment of their allograft. All four cases were managed with simple suture of the allograft or with the use of a new allograft. Fifteen patients exhibited 19 late occlusive lesions of their allograft; 17 of these lesions had to be treated either with transluminal angioplasty or with surgery using autogenous or allograft material. In all but one case, secondary patency could be achieved through these additional procedures. Late occlusive disease was more prevalent in the femoral segment of the allograft than in the iliac or. moreover, the aortic segment. There were no late amputations in this series.
Radical Open Endvenectomy with Autologous Pericardial Patch Graft for Correction of Budd-Chiari Syndrome
Authors: Koja K. , Kusaba A. , Kuniyoshi Y. , Iha K. , Akasaki M. , Miyagi K.
Published: September 2024

A surgical technique for the treatment of Budd-Chiari syndrome associated with vena caval obstruction has been devised. The occluded hepatic vena cava and hepatic veins were reconstructed by open endvenectomy, using an autologous pericardial patch graft and a femorofemoral bypass technique. The hepatic artery and portal vein were not controlled with vascular clamps during the surgery. Between 1979 and 1994, 29 patients were treated using this technique and achieved good results. All the patients did well with good function of the reconstructed vena cava and of the hepatic veins, and showed acceptable reduction of symptoms caused by portal hypertension and caval stagnation.
Myocardial Revascularization in a Hemophiliac
Authors: Nahas C. , Jones J. W. , Beall A. C. , Lafuente J. , Irani M.
Published: September 2024

The case of a mild hemophiliac who underwent a successful and uncomplicated myocardial revascularization is presented. The procedures was safely performed while the patient was receiving factor VIIIC.
Changing Patterns of Atheroembolism
Authors: Sharma P. V. Pathanjali , Babu S. C. , Shah P. M. , Nassoura Z. E.
Published: September 2024

Among 1011 patients undergoing infrarenal aortic and infrainguinal vascular surgery in a 90-month period (1986–1993), 29 patients (2.9%) with clinical, angiographic and pathologic evidence of atheroembolism were identified. Over one-third (44.8%) of atheroemboli were iatrogenic and the rest spontaneous. All iatrogenic atheroemboli were precipitated by angiographic ( n = 11; 84.6%) or operative manipulation ( n = 2; 15.4%). The sources of emboli were in the abdominal arota (16), iliac (seven) and femoropopliteal (six) arteries. ‘Trash foot’ occurred in 19 patients (seven bilateral) and occlusions of tibioperoneal/digital arteries were seen in seven, renal and dermal microcirculation in two each, and calf muscles in one. Larger conduits were affected in three instances (common femoral, popliteal and in situ saphenous vein graft). The management consisted of 54 (43 surgical and 11 endovascular) procedures concurrently with thrombolytic, anticoagulant and antiplatelet therapy. Three early (10.3%) and two late (6.9%) deaths (overall mortality rate 17.2%), eight major (27.6%) and five minor (17.2%) amputations, and four (13.8%) instances of renal failure occurred in 17 patients resulting in a 58.6% complication rate. Besides initial angiography, 53 invasive procedures were required in 25 patients. Among these, 12 patients could be managed with a single definitive procedure in contrast to a group of 13 patients that required 41 (average 3.2 per patient) procedures. The incidence of foot ischemia, reoperation and amputation was higher in the spontaneous group, whereas, the iatrogenic group incurred a higher incidence of endovascular interventions, greater mortality and new onset renal failure. The high morbidity and mortality of atheroemboli demand prompt recognition and treatment, as well as attempts at prevention to achieve good results.
A Rare Case of Multiple Atherosclerotic Aneurysms Involving the Femoral Artery
Authors: Okada K. , Okada M. , Ota T. , Yoshida M. , Toyoda Y.
Published: September 2024

Atherosclerotic aneurysm of the deep femoral artery is a rare peripheral aneurysm that is likely to have associated aortoiliac aneurysms. The case of a patient who had five atherosclerotic aneurysms located in the abdominal aorta, bilateral common iliac arteries, and the left common femoral and deep femoral arteries is reported. He underwent a semi-emergency operation for the aneurysm of the deep femoral artery, followed by a two-stage operation for the aortoiliac aneurysms. The aneurysm of the deep femoral artery was repaired, and reconstruction of the distal deep femoral artery successfully performed with direct anastomosis to the superficial artery. In this report, the clinical presentation of multiple atherosclerotic aneurysms and the details of surgical reconstruction are described.
Heparin — Controversies and Misconceptions
Authors: Blaisdell F.W.
Published: September 2024

The previous dogmas regarding heparin therapy are currently being challenged. It is apparent that the experimental work on which guidelines for heparin therapy are based do not necessarily have any relevance clinically. Once clotting has been initiated, there are multiple factors that result in a relative refractory response to heparin anticoagulation. In addition, it is now apparent that heparin's effect cannot be accurately monitored with current tests of anticoagulation. Most importantly, the risk of bleeding does not correlate with heparin levels but with clinical risk factors and to the presence or absence of functioning platelets. For this reason, sufficient heparin should be given initially to ensure that clotting is under control. If this is not done, all of the risk of heparin anticoagulation is assumed with none of the benefit. Life-threatening clotting conditions require high doses of heparin, equivalent to those required for cardiopulmonary bypass. Even though there is no good laboratory test available to ascertain the adequacy of anticoagulation, assessment of the clinical response is sufficient. When heparin levels are adequate, clinical improvement is evident as manifest by decreased pain and improvement in well-being, cardiac function, and/or collateral flow.
Comparison of Clinical Follow-up and Duplex Surveillance of Infrainguinal Vein Bypasses
Authors: Golledge J. , Wright I. , Lane I. F.
Published: September 2024

The evidence in support of surveillance has been principally based on the favourable primary-assisted patency of stenosed grafts following revision (60–80% at S years) compared with the poor secondary patency of revised occluded grafts (20–40% at 5 years). Both the capital cost and workload generated by surveillance are considerable. More information is needed on the benefits of surveillance compared with clinical follow-up. A retrospective comparison of 50 vein grafts (44 reversed, six in situ) undergoing colour-coded duplex surveillance and 50 vein grafts (46 reversed, four in situ) under clinical follow-up, with duplex scans obtained only when clinically indicated, has been performed. Four (8%) stenoses of ≥50% were identified in the surveillance group. One 50% proximal anastomotic stenosis failed to progress on sequential scans. Three stenoses were treated (one mid graft, two popliteal) by vein patch angioplasty (two cases) and transluminal angioplasty (one case). Both groups were followed-up for 12 months. Secondary patency at 12 months (88% surveillance; 80% clinical follow-up) was not significantly different ( P = 0.3). Similarly, limb salvage at 12 months (94% surveillance: 88% controls) was not significantly different ( P = 0.4). A large randomized prospective study comparing duplex surveillance and clinical follow-up is warranted.
Venous Thrombotic Complications of Pregnancy
Authors: James K. V. , Lohr J. M. , Deshmukh R. M. , Cranley J. J.
Published: September 2024

A total of 30 040 pregnancies were reviewed at one institution over 5 years to determine the incidence of venous thrombotic complications. Thirty-one patients experienced such complications related to pregnancy (incidence 0.1%); 13 had deep venous thrombosis and 14 had superficial venous thrombophlebitis diagnosed by duplex ultrasound. Four had pelvic vein thrombophlebitis diagnosed by computed tomography scan; three patients (one from each group) sustained a non-fatal pulmonary embolus. Of those with deep venous thrombosis, 10 (77%) were left-sided, and three (23%) were right-sided. Three had a prior history of deep venous thrombosis and one of pulmonary embolism. Of those with superficial venous thrombophlebitis, seven (50%) were left-sided, six (43%) were right-sided, and one (7%) was bilateral. Most with deep venous thrombosis presented later in pregnancy; three in the first trimester, two in the second, three in the third, and five early postpartum. Most (10/14) with superficial venous thrombophlebitis presented within 48 hours of delivery. Distribution of thrombi in those with deep venous thrombosis was compared with 643 non-pregnant women with a similar condition. A pattern of proximal involvement on the left was found, with left common femoral vein (54% versus 28%, P = 0.03) and superficial femoral vein (62% versus 26%, P = 0.006) more often involved in pregnant patients. The average number of vein segments involved was greater on the left than the right (5.3 versus 3.7). Symptoms of chronic venous insufficiency developed in three with deep venous thrombosis (25%) and in three with superficial venous thrombophlebitis (27%). None had recurrence of deep venous thrombosis. It is concluded that venous thrombotic complications associated with pregnancy are not necessarily benign, with the risk of pulmonary embolism and chronic venous insufficiency not limited to patients with deep venous thrombosis only.
Expeditious Management of Ischemic Invasive Foot Infections
Authors: Chang B. B. , Darling R. C. , Paty P. S. K. , Lloyd W. E. , Shah D. M. , Leather R. P.
Published: September 2024

Management of infected ischemic diabetic limbs requires antibiotic therapy, abscess drainage, and revascularization. However, revascularization is often delayed for several days or weeks as the infection is controlled. In an effort to decrease hospital stay and costs and to increase limb salvage, a series of 974 extremities with distal occlusive disease were managed with autogenous distal bypass. Some 136 of these limbs (125 diabetic) had severe invasive infections. These patients received intravenous antibiotics in all cases and abscess drainage if necessary. Vascular reconstruction was carried out as soon as possible, within 48 h of admission. An in situ bypass was used preferentially (107 cases). Patients were maintained on intravenous antibiotics in the perioperative period. Partial foot amputations, when necessary, were performed in 111 cases, usually 3–5 days after vascular reconstruction. There were no graft infections or major wound infections. There were two cases of skin edge necrosis requiring reoperation due to flap mobilization and consequent ischemia. Urgent revascularization with an autogenous conduit may be carried out in patients with invasive foot infections expeditiously, with high rates of limb salvage. Graft and wound infections are not common in this setting. Costly prolonged pre-bypass hospitalization in these cases is unnecessary.
False Aneurysm of the Inferior Gluteal Artery following Penetrating Buttock Trauma: Case Report and Review of the Literature
Authors: Holland A. J. A. , Ibach E. G.
Published: September 2024

The case of a 28-year-old man who presented with a false aneurysm of the inferior gluteal artery 3 months after a penetrating wound to the buttock is reported. Percutaneous transcatheter embolization was unsuccessful. At operation, abdominal access was used for control, with a gluteal approach to provide exposure of the aneurysm. The presentation and management of patients with this pattern of injury are discussed, and the relevant literature reviewed.
An Acute Phase Reaction in Diabetic Patients with Foot Ulcers
Authors: Upchurch G. R. , Keagy B. A. , Johnson G.
Published: September 2024

The acute phase reaction is a molecular response to noxious stimuli. Over 50 glycoproteins have been identified as reactants. While this is likely a protective response, some of the changes could be detrimental to body homeostasis. The objective of this study was to examine whether an acute phase reaction occurs in diabetic patients with foot ulcers. In age- and sex-matched populations, measurements of C-reactive protein, fibrinogen, albumin, hematocrit, whole blood viscosity and protein C were performed on: (i) 24 diabetic patients with a foot ulcer (group A); (ii) eight diabetic patients without foot ulcer (group B); and (iii) seven patients without diabetes (group C). Analysis of variance was used to compare means of each respective group (mean (s.d.)). Group A demonstrated an increase in C-reactive protein (5.6 (5.4) mg/dl) compared with group B (0.78(0.46) mg/dl; P = 0.013) and group C (0.71 (0.26) mg/dl; P = 0.026). Fibrinogen was also increased in group A (619 (205) mg/dl) compared with group B (310 (58) mg/dl; P = 0.005) and group C (370 (88) mg/dl; P = 0.04). Hematocrit (37(6)%) and albumin (3.5 (0.5) g/dl) were decreased in group A compared with group B (hematocrit 46 (4)%; P < 0.0001: albumin 4.3 (0.3) g/dl; P = 0.0005) and group C (hematocrit 45 (3)%; P = 0.005; albumin 4.6 (0.3) g/dl; P < 0.0001). No difference was found in whole blood viscosity and levels of protein C. There also was no significant difference demonstrated between any of the parameters studied when comparing groups B and C. In conclusion, these results indicate that diabetic patients with a foot ulcer undergo an acute phase reaction as evidenced by a rise in C-reactive protein and fibrinogen compared with diabetic patients without a foot ulcer and normal control patients. As more is learned about the acute phase reaction, this information may prove valuable in the management of the diabetic patient.
Operative Risks of the Maze Procedure Associated with Mitral Valve Surgery
Authors: Melo J. Q. , Neves J. P. , Abecasis L. M. , Adragão P. , Ribeiras R. , Seabra-Gomes R.
Published: September 2024

Twelve patients were operated on for mitral valve disease with concomitant chronic atrial fibrillation. Valve repair was performed in five patients and replacement in seven. Maze I and maze III procedures were applied in eight and four patients, respectively, and are compared. There was a regular rhythm in all maze I patients with a constant junctional rhythm in three and an alternating sinus and junctional rhythm in the remainder. In one case, part of the left atrium was in atrial fibrillation with the remaining atria in sinus rhythm. In the maze III group, one patient was always on a regular rhythm, two had episodes of atrial fibrillation and one was in atrial fibrillation with controlled ventricular rate. Echocardiography showed atrial contraction in two maze I patients, but systolic atrial flow across both atrioventricular valves could only be demonstrated in two patients in the maze III group.
Artificial Chordae in the Treatment of Anterior Mitral Leaflet Pathology
Authors: Zussa C. , Polesel E. , Rocco F. , Valfrè C.
Published: September 2024

This report describes the authors' clinical experience with expanded polytetrafluorethylene (ePTFE) sutures to replace the anterior mitral leaflet chordae for valve repair. Between November 1986 and July 1995, 203 patients underwent operations with e-PTFE chordae insertion. Among these, 122 had artificial chordae utilized for anterior mitral leaflet repair. Four patients had the valve replaced during the same operation because of an unsatisfactory result. One patient died from respiratory insufficiency 16 days after operation. Transoesophageal echocardiography at discharge from hospital showed no evidence of regurgitation in 81 cases, and trivial regurgitation in 36. During a mean follow-up of 36.6 (range 1–106) months two other patients died from causes unrelated to the valve repair, while one patient had a transient ischaemic attack returning to sinus rhythm. Two patients were reoperated on 12 and 18 months respectively after their initial operation for progression of valvular degeneration causing natural chordae rupture. Among the remaining 113 patients, 111 are in New York Heart Association functional class I and yearly transoesophageal echocardiography has shown absent or trivial regurgitation. The utilization of e-PTFE as artificial chordae for anterior mitral leaflet pathology is a safe and reliable procedure, yielding excellent results and increasing the number of candidates for valve repair.
Kidney Salvage in a Case of Ruptured Renal Artery Aneurysm: Case Report and Literature Review
Authors: Schorn B. , Falk V. , Dalichau H. , Mohr F. W.
Published: September 2024

A 79-year-old woman presented with hypovolaemic shock caused by rupture of a left renal artery aneurysm. She was successfully treated by arterial reconstruction with functional salvage of the kidney. The frequency of renal artery aneurysms, their risk of rupture and the results of urgent surgery are discussed.
Pathogenesis of Abdominal Aortic Aneurysm: An Update and Look toward the Future
Authors: Grange J. J. , Davis V. , Baxter B. T.
Published: September 2024

To date, aneurysm research has been primarily descriptive, reiterating the complex nature of the disease process. Enhanced by the convergence of matrix biochemistry, cell biology and immunology, this work is providing important new insight into how matrix metabolism is regulated in the diseased aorta. The focus is now on the inflammatory process and its regulation of the matrix remodeling which occurs with abdominal aortic aneurysm. A family of matrix-degrading enzymes appear to have a central role in this process. As we have learned from the evolution of the treatment of other pathologic processes such as peptic ulcer disease, the most effective pharmacologic therapies are designed from a thorough understanding of the pathophysiology of the disease. We are quickly moving forward in formulating a comprehensive understanding of the various complex interactions that result in the formation of aortic aneurysm. Given the progress of the past decade, we can expect the identification of aneurysm-associated genes and clinical trials of anti-inflammatory medications and protease inhibitors as we enter the 21st century.
Outcome of Abdominal Aortic Aneurysm Repair in Patients with Previous Spinal Cord Injury in the Department of Veterans' Affairs Hospitals
Authors: Jacobs D. L. , Longo W. E. , Peterson G. J. , McKirgan L. W. , Virgo K. S. , Johnson F. E.
Published: September 2024

A retrospective review was carried out to determine the morbidity and mortality of abdominal aortic aneurysm repair in patients with previous spinal cord injury. A population-based study utilizing computer records on all patients in Department of Veterans' Affairs medical centers from 1987–1991 identified 31 patients with spinal cord injury who underwent subsequent infrarenal abdominal aortic aneurysm repair. Additional information was obtained from individual medical records. Some twenty patients (65%) were paraplegics and 11 (35%) were quadriplegics. Aneurysms were most commonly discovered incidentally during work-up of other conditions. All patients had no symptoms referable to their abdominal aortic aneurysm. In total, 29 patients (94%) underwent elective operations. The complication rate (57%) involved mostly pulmonary, cutaneous or urinary tract morbidity. The 30-day mortality rate was 3% for elective abdominal aortic aneurysm repair. Two patients were operated upon as emergencies for rupture, with one operative death. Long-term follow-up revealed a median survival duration of 5.4 years after aneurysm repair. In conclusion, abdominal aortic aneurysm repair in patients with previous spinal cord injury has a low mortality rate. Postoperative complications are often related to spinal cord injury and are potentially preventable; thus, such injury should not preclude surgical intervention for abdominal aortic aneurysm.