bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative Morbidity Following Red Cell Deformability Changes During Cardiopulmonary Bypass Using Bubble and Membrane Oxygenators
Authors: Belboul Ali , Khaja Najib Al , Bergman Per , Roberts Donald , William-Olsson Göran
Published: November 2007

The preoperative blood cell trauma and postoperative morbidity were com pared in a prospective randomized study in two groups of patients undergoing cardiac surgery with extracorporeal circulation (ECC). One group was oxygen ated during ECC with a membrane oxygenator (MO) and the other with a bub ble oxygenator (BO). Red cell trauma was ascertained by a standard microfiltration technique that expressed the rheologic properties of standard ized red cell suspensions.

The filtrability of the cell suspension was significantly reduced during ECC for both membrane (MO) and bubble (BO) oxygenators. However, the bubble type proved to be more traumatic, and the difference was statistically signifi cant after thirty minutes of ECC. The filtrability was reduced by 20% in the MO group and by 35% in the BO group at the end of ECC (p < 0.01).

A significantly higher frequency of postoperative bleeding (p < 0.05), blood transfusion (p < 0.05), and arrhythmias was found in the BO group (p < 0.01).

This study demonstrates that the microrheology of red blood cells is better preserved with the membrane oxygenator, which is associated with a smoother postoperative course, owing probably to a better preserved microcirculation. The membrane oxygenator can be recommended even for short perfusions and routine procedures requiring cardiopulmonary bypass (CPB) and should be used whenever possible.
Is Aortoprofunda Bypass a Successful Operation for Multilevel Occlusive Disease?
Authors: Kalman Peter G. , Johnston K. Wayne , Walker Paul M.
Published: November 2007

During a ten-year period (1976-1986) at the Toronto General Hospital, 121 patients underwent aortoiliac reconstruction with one or both of the distal anas tomoses to the level of the profunda femoris artery. The cumulative five-year graft patency rate in 117 patients surviving the operation was 97±1.3%, the cumulative five-year clinical success rate (patent graft and clinical improve ment) was 76±5.2%, and the cumulative five-year hemodynamic success rate (patent graft and improved ankle/brachial pressure ratio) was 67±5.9%. There was no significant difference in cumulative clinical success when stratified for sex, preoperative grade (claudication vs limb salvage), proximal anastomosis (end-to-end vs end-to-side), or length of profundoplasty. The authors' experi ence indicates that aortoprofunda bypass is a successful operation for the man agement of multilevel vascular occlusive disease with very few patients requiring subsequent distal revascularization. It is not unusual to observe clini cal improvement despite a relatively small increase in "resting" ankle/brachial index. A gradual decrease in clinical and hemodynamic success can be expected secondary to either anastomotic hyperplasia or progression of distal athero sclerotic disease.
Microangiographic Study of Healing Wounds in Canine Intestinal Anastomoses
Authors: Julian Thomas B. , Kolachalam Ramachandra B.
Published: November 2007

The microcirculatory evolution of healing wounds has not been well documented. The authors tested the generally accepted hypothesis that an end-to-end, stapled anastomosis (EEA) causes less microcirculatory compromises to the wound edge than an end-on, single-layer, hand-sewn anastomosis (HSA) does. The quanti tative measurement of the microcir culation associated with hand-sewn and stapled colonic anastomoses was carried out in two groups of dogs, each containing 28 animals. The mi crocirculatory evolution with use of either technique was similar, and the data in this study failed to support the common belief that the "B" shape of the staples results in mini mal trauma to the microcirculation and thus allows capillary growth through the tissue enclosed by the staple. In contrast to other studies, however, the authors noticed cross- circulation as early as the third post operative day in either technique. Moreover, by this angiographic method, they noted a gradual in crease in the extent of cross-circula tion from days 3 to 13 in both types of anastomoses. To their knowledge this study represents the first report of a comparison of trauma caused to the microcirculation by mechanical su tures and single-layer, hand-sewn technique.
Experimental Study of Effects of the Ultrasonic Surgical Aspirator on the Vascular System
Authors: Akiyama Kazuya , Watanabe Sunao , Amano Shigeo , Sawatani Osamu , Nishida Hiroshi , Endo Masahiro , Koyanagi Hitoshi
Published: November 2007

The effects of an ultrasonic surgical aspirator on the vascular system was evaluated in 12 mongrel dogs. The pathologic effects of the device were investi gated in femoral vessels by light and electron scanning microscopies and the physiologic effects by measuring the internal mammary arterial and femoral venous blood flow.

Changes in the intimal surface of arteries (platelet aggregation and fibrin network formation) were more frequent at higher vibration amplitudes, while such changes were less common in the vein. Disintegration and loss of the vascu lar wall did not extend beyond the adventitia. There was no obvious change in the blood flow pattern or flow rate after administration of ultrasonic vibrations.

The results showed that by keeping the output below 110 microns and using the aspirator together with other conventional surgical devices for dissection, damages to the vascular wall may be held to a minimum. This device can be a very useful supplementary tool in cardiovascular surgery.
Recanalization of Occluded Peripheral Arteries by "Hot Tip" Laser System
Authors: Perbellini Antonio , Barbieri Enrico , Taddei Giuseppe , Scuro Alberto , Mazzilli Giulio , Imperio Stefano , Lino Marcello , Destro Gianni , Lucchese Luciano
Published: November 2007

Recanalization of long-segment arterial occlusion is not feasible with the standard angioplasty technique, because of the inability to cross the occlusion. To restore the patency of the vessel the "hot tip laser system" was used. The hot tip laser recanali zation was performed on 41 patients (aged forty to seventy-eight, mean sixty). Thirty-nine patients had a complete femoral-popliteal occlusion — measuring 3 to 45 cm long, mean 17.4 cm, and 2 had an iliac occlusion 1-2 cm long. Eleven patients showed severe and 22 mild to moderate calci fications. After unsuccessful attempts to cross the occlusion by the wire, a 2-2.5 mm hot tip coupled to a 12 Watts argon laser was used. The laser procedure was always followed by balloon angioplasty. A successful re canalization was obtained in 28 of 41 occluded arteries (68%). In 7 patients the occlusion, heavily calcified, could not be crossed. In 1 patient there was intimal dissection with acute throm bosis on the first day. In 5 patients (12%) with long calcified occlusion the procedure was complicated by perforation. The hot tip system is ef fective in the recanalization of long occlusions. Inability to cross the oc clusion and perforation are more common in heavily calcified vessels.
Peripheral Vascular Reconstruction in Werner's Syndrome—A Case Report
Authors: Kimura Tadahiro , Yoshizaki Satoshi , Sano Makoto , Hanai Gento , Banno Tetsuya , Matsumoto Sumio , Horibe Yoshimune
Published: November 2007

A fifty-one-year-old Japanese man with Werner's syndrome underwent suc cessful reconstruction of peripheral arteries. His chief complaints were rest pain and intermittent claudication in the left lower extremity. Clinical manifestations included short stature, low body weight, stocky trunk with thin limbs, graying hair, peripheral muscular atrophy, a high-pitched voice, bilateral cataracts, typical facies, atrophic skin, and diabetes mellitus. Angiograms showed multi ple and severe calcified stenoses of the left femoropopliteal artery. The operative method used was semiclosed thromboendarterectomy.

To the authors' knowledge, this case is the first surgical correction of a pe ripheral vascular lesion in a patient with Werner's syndrome.
Bilateral Carotid Endarterectomy: Impact of Staging on Early Results
Authors: Karlson Karl J. , Najafi Hassan , Javid Hushang , Monson David O. , Fannanapazir Khazeh
Published: November 2007

Successive bilateral carotid endarterectomies were performed in 323 pa tients ; 193 (60%) had both sides operated on within fourteen days during the same hospitalization (Group I), and 130 (40%) were discharged after the first operation and readmitted for contralateral carotid endarterectomy more than two weeks later (Group II). High-risk patients who were older and sicker com prised the majority in Group II. Otherwise no attempt had been made to be selective based on preconceived criteria. There were 4 deaths (2.1 %) in Group I, and 1 death (0.7%) in Group II. Permanent neurologic complications occurred in 10 (5.2%) Group I patients and 8 (6.1%) Group II patients. Transient neuro logic complications were found in 8 (4.1%) of patients in Group I and 14 (10.8%) in Group II. No patients in Group II suffered any neurologic compro mise because of the waiting period between operations. A history of hyperten sion or previous cerebral infarction was found to place patients at increased risk for the development of permanent neurologic complications. Postoperative hy pertension after the second endarterectomy was greater in Group I than in Group II patients.

Observations from this retrospective review support the concept that staging of bilateral carotid endarterectomies in two hospitalizations allows elderly, sicker patients to be operated on as safely as younger, otherwise healthy individ uals. The indications for staging bilateral carotid endarterectomies in separate hospitalizations should be liberalized in order to minimize complications.
Experimental Use of Fluorescein for Visualization of Coronary Arteries
Authors: Laub Glenn W. , Banaszak Damien , Sakert Tam , Gonzalez-Lavin Lorenzo , Magovern George J.
Published: November 2007

Intraoperative delineation of the coronary anatomy during coronary bypass operations is critical for suc cessful revascularization. Two tech niques utilizing fluorescein to en hance the visualization of the coro nary arteries were evaluated in a ca nine model. A previously described method using fluorescent cardiople gia to arrest the heart produced sub- optimal contrast. Excellent visualiza tion of the coronary circulation was obtained when the heart was arrested with crystalline cardioplegia and then reinjected with fluorescein cardiople gia.
Automatic Implantable Cardioverter Defibrillators: Surgical Approaches for Optimal Function
Authors: Yee Edward S.
Published: November 2007

The automatic implantable car dioverter defibrillator (AICD) has significantly enhanced the treatment of malignant tachyarrhythmia but has complex requirements for contin uous function. Forty-nine patients (pts, ages nine to seventy-nine) from 377 pts studied for life-threatening tachyarrhythmias (13%) underwent AICD hardware placement during the first forty-eight months of clinical investigation. Access was dictated by (1) prior operative procedures (17 pts), (2) adequate sensing thresholds (12 pts), and (3) low thresholds (ie, s 15 watts) for successful defibrilla tion configuration (21 pts). Late com plications and morbidity (26 pts, 53%) have been the rule, the most common due to: (A) generator fail ures (15 pts), (B) patches or lead mal positions (4 pts), (C) inappropriate sensing from lead failures (3 pts), and (D) required explanations (leads only for 2 pts and units for 2 pts). There has been only 1 operative death among the 49 pts and none for the 21 revisions and generator changes (overall 1/70 procedures, 1.4%). However, survivals at one, two, and three years were 82%, 56%, and 40% respectively with the majority of late deaths attributed to congestive heart failure (CHF).

In summary, (1) AICD morbidity remains frequent but can be mini mized. Incidental placement should be avoided owing to associated mor bidity (explantation). (2) Optimal configurations usually require (a) ep icardial access, (b) patches directed at the ventricular focus for lower de fibrillation thresholds, (c) generator implantation adjusted for habitus, growth in children, and frequent generator failure. (3) Long-term sur vival has been poor in patients with associated CHF.
Combined Therapy for Arterial Stenosis with Angioscopy and Transluminal Balloon Angioplasty After PTFE Grafting— A Case Report
Authors: Sueda Taijiro , Matsuura Yuichiro , Hayashi Saiho , Ishihara Hiroshi , Hamanaka Yoshiharu , Kanehiro Keiichi , Yamaguchi Toshio , Fukuoka Haruto
Published: November 2007

Stenosis of the distal right popliteal artery after femoropopliteal bypass grafting was visualized by angioscopy and successfully treated by transluminal balloon angioplasty (TBA) through polytetrafluoroethylene (PTFE) graft. This approach is an attractive alternative to surgical angioplasty and/or graft revi sion, especially in patients with peripheral anastomotic stenosis of distal arterial stenosis after bypass grafting.
Inhibition of Endothelium-Dependent Relaxation by Free Hemoglobin in the Human Internal Thoracic Artery
Authors: Spyt Thomas J. , Blake Karen L. , Watt Pamela A. C. , Thurston Herbert
Published: November 2007

Hemolysis and postoperative hypertension are well recognized complications of cardiopulmonary bypass (CPB). The rise in the concentration of total and free hemo globin is directly related to the duration of CPB.

It is well established that free hemoglobin binds and inactivates endothelium-derived relaxing factor, and the authors have studied the effects of low concentrations of free hemoglobin on the endothelium-dependent and endothelium-independent relaxation of the human internal thoracic artery (ITA).

In the presence of free hemoglobin the endothelium-dependent relaxation induced by acetylcholine was reduced by 80% with 0.5 μM free hemoglobin (P< 0.01) and by 52% with 0.1 μM free hemoglobin (P<0.05). Sodium nitroprusside, endothelium indepen dent, produced relaxation of almost 100%. These results indicate that relatively low concentrations of free hemoglobin significantly inhibit endothelium-dependent but not endothelium-independent relaxation. This may influence blood flow in the ITA and may be a contributory factor in postoperative hypertension.
Extracranial Carotid Artery Aneurysms;
Authors: Kjellberg Sten , Deshmukh Narayan
Published: November 2007

Carotid artery aneurysms are rare. Three cases of carotid artery aneurysms, one false, one ruptured, and one nonruptured are presented. All were treated successfully without complications. Relevant literature regarding pathophysiology, differential diagnosis, and options in surgical treatment is reviewed.
Coronary-Subclavian Steal with Concomitant Carotid Disease: Indication for Axilloaxillary Bypass
Authors: Jones David R. , Hill Ronald C. , Heiskell C. Andrew , Hollingsed Michael J. , O'Keefe Michael , Nelson Mark G.
Published: November 2007

Coronary-subclavian steal syndrome is a potential complication of coronary artery bypass grafting when the internal mammary artery is used as a conduit. Concomitant carotid artery disease complicates the syndrome by introducing a possible simultaneous cerebral steal phenomenon. The authors present the first reported case of a patient who had symptomatic coronary-subclavian steal with significant carotid occlusive disease. An axilloaxillary bypass was performed instead of the standard carotid-subclavian bypass. Recommendations concerning the diagnosis and management of this syndrome are presented and the indication for axilloaxillary bypass is outlined.
Hepatic Salvage with Renosplenic Arterial Bypass
Authors: Shutze W.P. , Vanderpool B.D. , Hempel G.K.
Published: November 2007

Extraanatomic vascular bypasses are useful in treating renal and visceral occlusive disease. The splenic artery can be a good conduit in such cases and splenorenal bypass is a well-appreciated technique for treating renovascular obstructions. If there is severe ostial celiac stenosis or occlusion, then this particular anastomosis (splenic to renal) actually revascularizes the foregut via retrograde flow in the splenic artery Although this method of celiac axis reperfusion has not been previously described, it was successfully employed recently in a situation where severe hepatic ischemia persisted following superior mesenteric artery embolectomy The reasons for residual ischemia following visceral embolectomy are discussed as well as the alternative methods for extraanatomic intraabdominal vascular reconstruction.
Surgical Correction of Elongated Internal Carotid Artery
Authors: Papachristou Euripides , Dragojevic Dusan
Published: November 2007

The authors present the results of surgical correction of kinking and coiling of internal carotid in 63 patients who underwent 68 procedures; 51 patients (53 procedures) had kinking of the artery and 12 (15 procedures) had coiling. There were 2 intraoperative or postoperative deaths (2.9%) and 1 permanent cerebral ischemic event (1.5%). In 3 cases (4.4%) there was paresis of the ipsilateral recurrent laryngeal nerve with complete remission within six weeks. These results indicate that surgical correction is the treatment of choice for these anatomic lesions.
Long-Term Survival after Reconstructive Operation in Patients with Arteriosclerosis Obliterans
Authors: Ota Toshiaki , Okada Masayoshi , Yoshida Masato , Tsukube Takuro , Matsuda Hitoshi
Published: November 2007

Postoperative long-term survival for arteriosclerosis obliterans (ASO) of lower extremities was examined in 218 patients who underwent reconstructive surgery from 1973 to 1992. The causes of late deaths and their relation to the arteriosclerosis of various organs were also examined. Patients were divided into three groups according to the type of operation: aortoiliac/femoral (AIF), axillo/femorofemoral (AxF), and femoropopliteal bypass (FP) and were then divided into two subgroups according to the times of operation: "former decade" (subgroup F, 1973-1982, AIF 43, AxF 31, FP 10) and "latter decade" (subgroup L, 1983-1992, AIF 58, AxF 40, FP 36). The mean ages at operation for AIF-F/L were sixty/sixty-three years, and these were significantly younger than sixty-nine/seventy for AxF-F/L and sixty-five/sixty-seven for FP-F/L. There were 74 late-death patients, and of them, 57 (77%) died of arteriosclerosis-related diseases of various organs such as ischemic heart disease. Among these 57 patients, 39 (68%) experienced organ failure as a preop erative complication, whereas in the remaining 18, such failure was not clinically evident prior to operation. The survival rates at five/ten years after operation were 84%/61% in AIF-F, 88%/76% in AIF-L, 49%/20% in AXF-F, 75%/52% in AXF-L, and 73%/73% in FRL. The survival rate at ten years for subgroup L was 66% and was higher as compared with 42% for subgroup F owing in large part to the significant improvement in AXE

In conclusion, for patients with ASO, postoperative life expectancy improved recently, but arteriosclerosis of various organs was still the main cause of late deaths. Lifelong critical care for systemic organs was necessary even in patients in whom such lesions were not yet clinically evident at the time of operation.
Hemodialysis Vascular Access and Complications
Authors: Al-Wakeel Jamal , Huraib Sameer , Mitwalli Ahmed , Abu-Aisha Hassan , Al Mofti Adnan , Faqih Saad , Al Salman Mosaad , Ali Memon Nawas
Published: November 2007

From January, 1985, to July, 1991, 105 uremic patients had 148 vascular accesses for chronic hemodialysis. Thirty-three (31.4%) patients received more than one access. Of 148 accesses, 131 (88.5%) were arteriovenous (AV) fistulae and 17 (11.5%) were AV grafts. The mean hospital stay for patients with AV fistula was twenty-four days and for those with polytetraflouroethylene (PTFE) graft was thirty-five days. The maturation period for fistulae and grafts was six to eighty-one days and two to forty-five days respectively

Early postoperative complications included death in 1 patient, major bleeding in 6 (4.6%) fistulae and primary failure in 28 (21.4%) fistulae and 2 (11.8%) grafts. Deep vein thrombosis occurred in the upper limb of 1 patient with AV graft, and ischemic manomelic neuropathy developed in 1 patient with AV graft.

Late complications included bleeding in 6 (4.6%) fistulae and 4 (23.5%) grafts, ischemia in 2 (0.15%) fistulae and late failure due to thrombosis in 19 (14.5%) fistulae and 7 (41.2%) grafts. Infection of the access occurred in 18 (13.7%) fistulae and 14 (82.3%) grafts and led to death in 1 patient. AV fistulae patency rate was 80% after one year and 67% after five years. The patency rate for AV grafts was 67% after one year and 48% after five years.
Effect of Chronic Smoking on Digital Blood Flow: A Preliminary Report
Authors: Santosh V. , Bhatnagar B.N.S. , Gautam A. , Reddy L.P. , Rai U.C.
Published: November 2007

A study of digital blood flow was carried out using a "mercury-in-silastic" strain gauge in 50 individuals. Forty heavy smokers (25 asymptomatic chronic heavy smokers and 15 smokers with overt thromboangiitis obliterans—TAO) were studied. Ten individuals who had never smoked served as controls. Chronic heavy, long-term smoking causes signifi cant reduction in digital blood flow. A further reduction occurs in those with overt symptoms of TAO. Monitoring of digital blood flow could provide a good screening test for determining the status of peripheral blood flow in chronic smokers.
Effect of Intensive Walking Exercise on Skeletal Muscle Blood Flow in Intermittent Claudication
Authors: Weiss Th. , Fujita Y. , Kreimeier U. , Messmer K.
Published: November 2007

Walking exercise is generally accepted as a valid therapeutic regimen in the treatment of peripheral arterial occlusive disease (PAOD) of Fontaine stage II. In order to quantify the effect of walking exercise and/or drug therapy on regional muscular blood flow, PAOD Fontaine stage II was induced by multiple ligations of the femoral artery and of all side branches in one hindlimb of mongrel dogs; the contralateral extremity served as control.

The animals underwent walking exercise with increasing intensities on a tread mill five days per week over one year; one group received 600 mg buflomedil (BF) per day orally in addition. At the end of the training period, the regional blood flow in all skeletal muscles of both hindlimbs was quantified by means of 15 μm radioactively labeled microspheres at resting conditions, after treadmill exercise (ten minutes) with or without preinjection of BF (3 mg/kg body weight) into the abdominal aorta.

At resting condition and at the end of treadmill exercise the regional muscular blood flow did not differ significantly between the diseased and control extremity Supplementary oral treatment with BF over one year had no significant effect; the increase in muscular blood flow during treadmill exercise was not enhanced after intra- aortic injection of BE

Consequently walking exercise has the potential to increase the functional capacity of collaterals in intermittent claudication and to restore blood supply to skeletal muscle.
Efficiency of a Centrifugal Pump for Distal Circulatory Support During Cross-clamping of the Descending Thoracic Aorta
Authors: Gang Liu  , Fukunaga Shintaro , Sueda Taijiro , Matsuura Yuichiro
Published: November 2007

To demonstrate efficiency and to determine the ideal circulatory support using the centrifugal pump, the authors designed an experimental study in 6 mongrel dogs 13.3 to 18.5 kg in weight. The descending thoracic aorta was cross-clamped for two hours without the use of vasoactive drugs or blood products. They developed methods of optimizing use of the centrifugal pump to achieve satisfactory hemodynamic and metabolic efficiency Aortic pressure proximal to the clamp was essentially maintained unchanged by regulating flow with the pump during cross-clamping. Bypass flow tended to decrease (from 83 ±13 to 53 ±22 mL/kg/min) during prolonged clamping; distal nonpulsatile pressure was still maintained between 114 ±34 to 127 ±30 mmHg (mean ±SD). Animals were observed for more than twenty-four hours postexperiment; 3 of six dogs were able to stand and walk normally, while the other 3 dogs were only able to move their hind legs but unable to walk normally or stand for more than twenty-four hours. The cause of the paraparesis was unclear. It may be related to spinal cord ischemia secondary to hepatic steal. It also suggests that this method of circulatory support is not able to prevent paraplegia following two-hour cross-clamping of the descending thoracic aorta.
Familial Incidence of Abdominal Aortic Aneurysms
Authors: Speziale Francesco , De Santis Francesco , Giannoni Maria Fabrizia , Massimi Gregory J. , Brait Cristina M. Chaves , Fiorani Brenno , Flaishman Isac , Fadda Gian Franco , Fiorani Paolo
Published: November 2007

The rupture of an abdominal aortic aneurysms (AAAs) is associated with a mortality rate exceeding 50%. To reduce this figure it is necessary to increase the frequency of early diagnosis and elective surgery. Screening the general population for occult AAAs has proven cost ineffective. Only by identifying high-risk subgroups will screening programs be improved. The aim of this report was to investigate by ultrasonography the prevalence of previously unknown aortic dilatations among first-degree relatives (parents, siblings, and children) of patients operated on for AAAs.

Ninety-one (52.6%) of the 173 living first degree-relatives of 51 patients who underwent AAA resection were submitted to an aortoiliac ultrasonographic examina tion to establish aortic diameter and morphology. There was at least 1 first-degree relative with an AAA (multiplex family) in 10 families (19.6%) before ultrasound screening. With ultrasound a previously unknown infrarenal aortic dilatation was detected in 14 subjects (9 men/5 women; 10 siblings and 4 children) of 12 different families. Specifically, these aortic dilatations consisted of 10 AAAs (diameters ranged from 2.6 to 4.3 cm) and 4 aortic blebs. These occult aortic dilatations were located in 50% of cases in the lower third of the infrarenal abdominal aorta. The cumulative incidence of multiplex families was 35.3%. This study suggests a familial tendency to have an important etiologic role in the formation of AAAs. Family screening of, above all, male siblings older than forty-five years will help identify occult AAAs and reduce the mortality rates associated with their rupture.
Leiomyosarcoma of the Inferior Vena Cava
Authors: Ohdan Hideki , Fukuda Yasuhiko , Tanaka Issei , Kikkawa Masafumi , Haruta Naoki , Inagaki Kazuo , Yamamoto Yasuji , Fukuhara Toshiyuki , Oshiro Hisashi , Dohi Kiyohiko
Published: November 2007

A case of a thirty-nine-year-old woman with leiomyosarcoma of the inferior vena cava (IVC) is described. The tumor arose from the middle segment of the IVC, and liver metastasis of the tumor was found. The tissue of the tumor obtained at laparotomy was positive for estrogen receptor and progesterone receptor. The patient has been treated with combined multimodal therapy including resection of the main tumor, intrahepato-arterial chemotherapy, and hormonal manipulation. To the authors' knowledge, this is the first case of leiomyosarcoma of the IVC in which the presence of steroid receptors was determined.
Patterns of Vascular Disease in Blacks and Whites
Authors: Maxwell J. Gary , Covington Deborah L. , Paige Churchill M. , Misick Lofton N. , Clancy Thomas V.
Published: November 2007

Differences between blacks and whites with regard to their affliction with vascular diseases are widely accepted. The purpose of the present study was to examine the demo graphic characteristics of hospitalized patients who had one of several vascular surgical procedures or who were discharged with a vascular related diagnosis in order to compare the relative frequency and relationship of these diagnoses and procedures between the two racial groups. Data regarding race, gender, and age were taken from two sources: the 520-bed regional medical center hospital in North Carolina and the National Inpatient Profile (NIP), which is representative of patients admitted to short-term, nonfederal hospitals. In both the regional hospital data and the national data blacks are underrep resented among patients having carotid endarterectomy, abdominal aortic aneurysm surgery, and coronary artery bypass grafting. Conversely, blacks are overrepresented among patients admitted for cerebrovascular accident, hypertensive heart and hyper tensive renal disease, and lower extremity amputation. While one explanation for the differing patterns of vascular disease in whites and in blacks is that there is a genetically based difference in the two groups, there are important weaknesses in this interpretation. The differences may be explained by differing access to medical care, as well as by other complex socioeconomic factors. Prospective, population-based studies of the populations at risk may be required for definitive answer to whether a true difference exists.
External Valvuloplasty of the Saphenofemoral Junction
Authors: Zamboni Paolo , Gasbarro Vincenzo , Marcellino Maria Grazia , Murgia Anna Paola , Feo Carlo , Liboni Alberto , Donini Ippolito
Published: November 2007

Thirty-five patients (32 women, 3 men, mean age thirty-four years old) underwent external valvuloplasty of the saphenofemoral junction (EV-SFJ). The surgical rationale of this operation is the evidence, in the first stage of primary varicose disease, of a normal valvular apparatus in a dilatated phlebosclerotic vein wall. EV-SFJ restores valve function by correcting vein wall dilatation.

EV-SFJ was performed under local anesthesia and, in the last 10 cases, with intraop erative angioscopy This examination confirms the presence of a complete apparatus of the terminal and of the subterminal long saphenous valves and allows the intraoperative control of the correction of vein wall dilatation. Follow-up was from five to fifty-seven months (average forty-two months).
Cardiac Rupture in a Patient with Old Myocardial Infarction: Rupture of Established Transmural Fibrosis
Authors: Okabe Masanori , Odo Takafumi , Nakashima Yoshiyuki , Arakawa Kikuo
Published: November 2007

The authors describe a patient who died of cardiac tamponade due to rupture of the free wall of the left ventricle sixteen years after a myocardial infarction. Examination at autopsy showed total discontinuation of the transmural fibrosis with calcification and fresh bleeding.
Successful Management of An Aortoduodenal Fistula Associated With An Inflammatory Thoracoabdominal Aneurysm
Authors: Dyke Garry W. , Vowden Peter
Published: November 2007

A case of aortoduodenal fistula secondary to an inflammatory thoracoabdominal aneurysm is reported. A brief review of the literature relating to this condition is presented, and surgical options for the treatment of this condition are discussed.
Angiographically Occult Vascular Malformation of the Occipital Lobe
Authors: Naik R.T.S. , Dinakar I. , Purohit A.K. , Ratnakar K.S.
Published: November 2007

Angiographically occult intracranial vascular malformations (AOIVM) are rare. Cerebral infarction due to AOIVM in the occipital lobe in an old person is also rare. The case of a fifty-year-old woman with a hemorrhagic infarction in the occipital lobe due to throm bosis of an AOIVM is reported.
Improvement of Spinal Cord Electrical Activity with Lazaroid (U74006F) During Operations on the Thoracic Aorta: Evaluation of a Novel Lipid Peroxidation Inhibitor
Authors: Olah Andreas , Cernaianu Aurel C. , Gaprindashvili Teimuraz , Cilley Jonathan H. , Neuwirth Michael M. , Ansari Nasarin , DelRossi Anthony J.
Published: November 2007

Reperfusion injury may contribute to spinal cord damage after cross-clamping of the thoracic aorta (AXC). Tirilazad (U74006F), a potent free radical scavenger and lipid peroxidation inhibitor, has proven to be beneficial in ischemia/reperfusion models. The authors investigated the efficacy of U74006F in preventing paraplegia following forty-five minutes of normothermic AXC distal to the origin of the left subclavian artery. Thirty-two mongrel dogs were assigned to receiving either vehicle as pretreatment (control, n = 7) or 1.5 mg/kg U74006F (group II, n=7) or 3 mg/kg U74006F (group III, n = 10) infused into the descending aorta distal to the clamp for twenty minutes during reperfusion, or 3 mg/kg U74006F IV as pretreatment twenty-five minutes before the onset of ischemia (group IV, n = 8).

Mean proximal (BPpr) and distal (BPdx) aortic pressures and somatosensory evoked potentials (SEP) were measured at baseline and at minutes 2, 5, 7, 10, 15, 30, and 45 after AXC. SEP and neurologic outcome (Tarlov criteria) were assessed twenty-four hours postprocedure. There was no difference between BPpx or BP dx and their counterparts in the U74006F-treated animals and the control. SEP returned faster in all treatment groups when compared with controls. However, the neurologic outcome did not differ among groups. The authors conclude that although U74006F did not improve the neurologic outcome, it had a positive effect on the recovery of electrical activity of the spinal cord following transient ischemia. This suggests that the injury to the spinal cord induced by AXC is caused, in part, during reperfusion.
Limb Salvage With H.E.L.P (Heparin-induced Extracorporeal LDL Precipitation) In Peripheral Arterial Disease (PAD)
Authors: Lechner P. , Walzl M. , Walzl B. , Lechner H. , Cesnik H.
Published: November 2007

Heparin-induced extracorporeal LDL precipitation (H.E.L.R) is based on the fact that lipoproteins and fibrinogen are precipitated at a pH value of 5.12 in the presence of heparin. The elimination of excess fibrinogen from the patient's blood leads to a marked improvement in microcirculation, followed by an increased oxygen supply to the tissue. This permits performance of limb-saving surgical procedures instead of mutilating amputations.

Ten patients suffering from far-advanced peripheral arterial disease (PAD) were submitted to 10 H.E.L.P. treatments each instead of undergoing amputations. Surgery could be limited to the removal of necrotic tissue only Wound-healing was uncompro mised in all the patients, and the H.E.L.P. treatment was free of side effects.
Traumatic Popliteal and Trifurcation Arterial Injuries: How Can We Predict the Ultimate Outcome?
Authors: Özçelik Cemal , Inci Ilhan , Kir Altan , Toprak Mustafa , Kandemir Nail , Eren Nesimi , Özgen Gökalp
Published: November 2007

During a sixteen-year period ending in March 1993, 63 patients with 88 popliteal or trifurcation arterial injuries underwent surgical management, and the ultimate outcome was recorded according to both mangled extremity severity score (MESS) and risk clas sification at Dicle University. There were 14 major (22.2%) and 3 minor (4.8%) ampu tations and 4 (6.3%) deaths. Of 40 patients with an ischemic period of more than eight hours, 13 required amputation. According to MESS, there were 28 patients with scores of 7 or more (44.4%). In this group 13 patients required amputation (46.4%), and 8 had a good outcome (28.6%). As regards patients' classification by risk factors of nerve injury, soft-tissue injury, and open fracture, 15 of 17 patients having one or less risk factor had a good outcome (88.2%), whereas 20 of 46 patients having two or more risk factors had good outcome (43.5%). A comparison of patients having one or less risk factor with those having three risk factors found statistical significance according to amputation rates (P < 0.05). The difference in amputation rates between 23 patients who were operated on within less than eight hours and 40 patients who were operated on within more than eight hours was statistically nonsignificant (P > 0.05).
Caliber-Persistent Artery (Dieulafoy's Ulcer) of the Stomach: An Unrecognized Cause of Recurrent Upper Gastrointestinal Bleeding
Authors: Markel Arie , Kopelman Doron , Ophir Orna , Suissa Alain , Schein Moshe
Published: November 2007

Dieulafoy's ulcer is a submucous vascular malformation usually located in the gastric fundus. This lesion can be the cause of recurrent, massive gastrointestinal bleeding that can cause a high fatality rate if the condition remains unrecognized. Because the lesion is very small it can be easily overlooked at endoscopy. The authors describe a case of Dieulafoy's ulcer, presenting as repetitive episodes of upper gastrointestinal hemorrhage, that was treated successfully by suture ligation of the bleeding lesion. Increased awareness of this condition is necessary for an earlier diagnosis and prevention of fatal massive bleeding.
Endoluminal Placement of PTFE Graft-Stent Devices in a Canine Model
Authors: Back Martin R. , Kopchok George E. , White Rodney A. , White Geoffrey , Yu Weiyun , Wilson Samuel E.
Published: November 2007

Endovascular placement of stents lined with prosthetic vascular graft materials offers promise in the treatment of dissections, aneurysms, and atherosclerotic occlusive disease. This study reports the development of and initial experience with polytetraflu oroethylene (PTFE) graft-stent devices endoluminally deployed in canines. Each iliac artery in 6 heparinized dogs received a 6-mm-diameter tubular PTFE graft mounted on either an 8 mm Palmaz stent (PS) or a metallic-ringed graft attachment device (GAD). The graft-stent devices were introduced from the femoral artery through a 14 Fr delivery catheter. Positioning and balloon expansion of the graft-stent devices were aided by fluoroscopic and intravascular ultrasound (IVUS) assessment. Animals were studied acutely (n = 2) or at weeks 1, 2, 4, or 8 after placement. No interval anticoagulation was used. All 6 PTFE-PS devices remained patent. Two of 6 PTFE-GAD devices occluded (at two and four weeks, respectively) owing to initial inadequate deployment. Nonoccluding thrombus was present in an additional 2 PTFE-GAD devices (acute and at one week, respectively) and in 2 PTFE-PS devices (at one week and two weeks, respectively). Complications included groin hematomas in 2 animals (at one week and two weeks, respectively) caused by the large traumatic delivery catheter.

Endoluminal placement of PTFE graft-stent devices is feasible. Accurate assessment of deployment by IVUS, reduction of delivery catheter size, and improved graft-stent design are required.
Foot Venous Pressure Measurement in Patients with Varicose Veins
Authors: Matsuda Hitoshi , Ota Toshiaki , Okada Masayoshi
Published: November 2007

For the evaluation of the severity of varicose veins, foot venous pressure (FVP) measurements utilizing manual calf compression were applied to 52 limbs with varicose veins (group V) and 12 limbs of healthy volunteers (group C). Group V was divided into three groups: group V1 comprising 37 limbs without stasis syndrome, group V2 comprising 9 limbs with pigmentation, and group V3 comprising 6 limbs with preulcerative or ulcerative skin change.

First, comparison of manual calf compression with the toe-stand test was performed, wherein a higher reproducibility was revealed for subjects undergoing manual calf compression. Also, a lower ambulatory venous pressure (AVP) and a higher percentage of FVP drop (%drop = [pressure at rest-AVP]/pressure at rest) was obtained with manual calf compression, confirming that this method apparently emptied the calf venous pool. Based on these findings, FVP at four seconds after compression (4SP) and its ratio of increase (4SR% = [4SP - AVP] / [pressure at rest - AVP]) were instituted by use of this method, in addition to AVP, % drop, and 50%/90% of calf-refilling times (RT50/RT90).

When the values of the four groups were compared, differences were insignificant between groups C and V1, while significant differences were found between groups V2 (continued on next page) (Abstract continued) or V3 and groups C or V1 in all parameters examined. The number of abnormal limbs that had values beyond the ranges for group C increased from group V1 to group V3. Such abnormalities were best revealed by 4SR% and RT50.

In the postoperative FVP measurements of 17 limbs, all parameters of all limbs were restored to the normal range, except for % drop of 4 limbs, and 4SR%, RT50, and RT90 of 1 limb.

Based on these findings, all parameters examined in this study were considered to be sufficient for the evaluation of the severity of varicose veins. In particular, 4SR% and RT50, which reflect venous reflux in the early venous refilling phase, were the best diagnostic parameters.

The usefulness of FVP measurement utilizing manual calf compression and the significance of the early phase of venous refilling in the varicose veins limbs were confirmed.
Ruptured Abdominal Aortic Aneurysms
Authors: Masclans Joan R. , Planas Mercè , Bermejo Begoña , Serra Joaquim , Porta Isabel , Sobregrau Rafael , de Latorre Francisco J.
Published: November 2007

A study of 80 patients with ruptured aortic aneurysms admitted over an eight-year period to the Intensive Care Unit of the authors' hospital was undertaken.

All the information was introduced to a data base and processed for statistical treatment by use of a software program.

Most patients admitted to the emergency room presented diffuse or localized abdominal pain. An abdominal mass was present in 40% of the cases. Hypotension was usually present with shock in 20% of the patients. The diagnosis was confirmed essen tially by computerized axial tomography. In 27% of the patients, operation was under taken based on clinical grounds only. Sixty-seven percent of the patients showed one or more complications. Acute renal failure (51%), sepsis (31%), acute respiratory insuffi ciency (20%), mesenteric ischemia (13%), coagulopathy (11%), and neurologic compli cations (11%) were the most often encountered. The mortality rate was 42.5%; shock was the most common cause of death, and mesenteric ischemia was the second.
The Vasa Vasorum in the Abdominal Aorta of the Dog
Authors: Pisco João Martins , Correia Miguel , Esperança Pina José Antònio , de Sousa Luis Aires
Published: November 2007

The authors studied the distribution of the vasa vasorum in the abdominal aorta of the normal dog and following surgically created aortic stenosis. Twelve dogs with normal aorta and 6 dogs with surgically created stenosis in the abdominal aorta were used. The dogs with aortic stenosis were sacrificed at two, four, and six weeks after creation of the stenoses. The vasa vasorum network was evaluated by the Spalteholz technique, microan giography, histology and scanning electronic microscopy (SEM).

In the normal aorta there is in the adventitia a network of vessels from which arise arterioles that extend up to the outer third of the media. At the stenotic zone there is interruption of the vasa vasorum and proliferation on each side of the stenosis up to 5 mm.

The authors conclude that the effect of revascularization techniques on vasa vasorum of surgically created stenosis should be analyzed at least 5 mm away from the stenosis.
Surgical Procedures of the Carotid System in the Elderly
Authors: Papachristou Euripides A. , Dragojevic Dusan
Published: November 2007

In this study the operative and postoperative results in 84 patients older than seventy-five years who underwent 106 surgical interventions of the carotid system are compared with those of 320 patients aged less than seventy-five who underwent 413 similar procedures. The authors encountered 2 (2.4%) permanent and 1 (1.2%) transient central nervous system ischemic events in patients older than seventy-five, whereas in younger patients there were 4 (1.3%) permanent and 5 (1.6%) transient events. In addition there were 2 deaths (2.4%) in the older group and 5 (1.6%) in the younger group. These differences are not statistically significant and suggest that age alone should not be a contraindica tion to surgical interventions of the carotid system.
Blunt Trauma Injury of the Caval Junction
Authors: Cangiotti L. , Muiesan P. , Maffeis R. , Nodari F. , Giulini S.M. , Tiberio G.
Published: November 2007

A case report of caval bifurcation injury associated with right common iliac artery throm bosis sustained after a blunt trauma to the abdomen is presented. Different problems are encountered in the management of this type of lesions. These are related to trans portation, resuscitation techniques, and diagnosis and, in the operating room, to an adequate exposure, control of hemorrhage, and vascular reconstruction. A repair of the caval junction has been performed successfully using a polytetrafluoroethylene patch, avoiding stenosis of the lumen, and restoring blood flow in the vena cava. No compli cations such as thromboembolism have been reported and patency has been verified at a four month follow-up.
Long-Term Results of Simultaneous Carotid Endarterectomy and Coronary Artery Revascularization in Patients with Unstable Angina and Cerebrovascular Insufficiency
Authors: Vassilidze Teimouraz , Cernaianu Aurel C. , Gaprindashvili Teimuraz , Gallucci John G. , Cilley Jonathan H. , Grosso Michael A. , DelRossi Anthony J.
Published: November 2007

This study assessed the outcome of 11 consecutive high-risk patients (8 men, 3 women) with symptomatic, high-grade (greater than 70%) bilateral carotid stenosis and left main or triple-vessel disease with unstable angina undergoing emergency simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) revascularization. Seven patients presented with crescendo unstable angina and 4 had type III postinfarc tion unstable angina. All were symptomatic for cerebrovascular insufficiency. Six patients had left main and 5 patients had triple-vessel disease aside from bilateral carotid lesions. There were 8 men and 3 women, (mean age 69.1 ± 3.9 years). The mean preoperative end-diastolic pressure and ejection fraction were 17.2 ±2.4 mm Hg and 35.3 ±6.9%, respectively.

Sequential reconstruction of the carotid artery was followed by CABG with an average number of 3.1 ± 0.3 grafts per patient. One patient had additional aortic valve replace ment and 1 had an automatic implantable cardioverter defibrillator implanted. There was no operative mortality. The overall neurologic complication rate was 27.3% (3 of 11). One patient developed perioperative myocardial infarction and 1 other had respira tory failure. Mean postoperative hospital stay was 24.4 ±4.8 days.

Within one year postoperation, 1 patient died. Two patients had contralateral CEA owing to recurrent transient ischemic attack. The five-year probability of survival was 89%. Our data show that simultaneous CEA/CABG in patients with high-risk coronary and cerebrovascular insufficiency may result in low mortality; however, a relatively increased incidence of short- and long-term morbidity is expected.
Cerebral Ischemia Due to Congenital Malformations of Brachiocephalic Arteries
Authors: Savastano Sergio , Feltrin Gian Piero , Chiesura-Corona Matteo , Miotta Diego
Published: November 2007

Seven cases of congenital anomalies of brachiocephalic arteries are presented; malfor mations include unilateral absence of the internal carotid artery (ICA) (n = 3), unilat eral hypoplasia of the ICA (n = 2), agenesis of the innominate artery (n = 1), and atresia of the subclavian artery (n = 1). All patients but 1 exhibited symptoms of cerebrovas cular insufficiency at the time of radiologic investigation; they were not affected by other cardiovascular malformations, except right aortic arch in 2 cases and left cervical arch in another case. Two patients suffering from congenital subclavian steal syndrome underwent surgery to correct the vascular malformations. Embryogenesis and natural history of such malformations are briefly discussed.