bluuebunny/crossref_metadata_2025 huggingface dataset:
Behandlung eines bilateralen Aneurysmas der Arteria iliaca communis mittels unilateraler potentiell-reversiblen Ballonembolisation und sekundärer Y-Endoprotheseneinlage
Authors: Nett  , Pfammatter  , Turina  , Lachat
Published: January 2006

Bilateral common iliac artery (CIA) aneurysms are rare, but more frequently symptomatic than abdominal aortic aneurysms (AAA). In elderly patients with coexisting medical problems, transluminal and/or endovascular procedures are preferred to avoid the risk of morbidity and mortality associated with further general anesthesia and surgery. However, bilateral internal iliac artery (IIA) occlusion during endovascular repair might be associated with significant morbidity, including gluteal claudicatio, and ischemia of the sigmoid colon and perineum. In the presented case report we describe the successful repair of bilateral CIA aneurysms by a total transluminal and endovascular approach. The potentially reversible embolisation of the less diseased IIA with detachable latex balloons preceded the implantation of a bilateral endovascular Y-stent. Both CIA aneurysms were successfully excluded from circulation. No complications were noted and the patient could be discharged four days after surgery. Probationary detechable balloon embolisation of the IIA followed by implantation of an endovascular bifurcated stentgraft is a safe technique. It allows clinical monitoring of acute ischemic complications before bilateral IIA occlusion by the stentgraft. In comparison to coil embolisation these balloons may be easier to remove if for instance, an external-internal iliac artery bypass is needed. Percutaneous balloon puncture might be another option to reverse acute ischemia.
Gluteale AV-Fistel als Ursache eines posttraumatischen Oberschenkelhämatoms
Authors: Bail  , Melcher  , Raschke  , Schroeder  , Schaser
Published: January 2006

A case is reported of a 28-year-old patient with gradually developing massive swelling of the right thigh after sustaining a blunt trauma. Three and a half months after the injury, surgery was performed because of a persisting tumor at the thigh. Intraoperatively, massive bleeding occurred, the bleeding vessel was sutured. Postoperative angiography disclosed arteriovenous (av) fistulae from the internal iliacal artery to a gluteal vein as source for the bleeding. The feeding artery was closed by coiling, the patient recovered completely. To the authors’ knowledge, development of an av-fistula following blunt trauma has not been described previously. Similarly, the differential diagnosis of a posttraumatic bleeding of a congenital av-malformation was not yet reported. The authors emphasize, that prior to the surgery of inadequately behaving hematomas, an angiography should be performed.
Arterielle Läsionen beim Morbus Behçet
Authors: Saba  , Saricaoglu  , Bayram  , Erdogan  , Dilek  , Gebitekin  , Özkan  , Özer
Published: January 2006

Background: Arterial involvement is a rare but serious condition in the course of Behçet’s disease. We aimed to assess the results of therapeutic approaches in our patients with arterial lesions caused by Behçet’s disease. Patients and methods: The records of 534 patients with Behçet’s disease between 1987 and 2002 were retrospectively evaluated for the presence of arterial lesions. All patients were followed up regularly at 3 to 6 months intervals. Results: Arterial lesions were diagnosed in 21 (3.9%) patients. Eight of these patients had pulmonary artery aneurysms (PAA), and the other 13 patients had non-pulmonary arterial lesions. Urgent surgical intervention was performed in three patients with PAA leading to death in all three. In addition, three other patients died due to massive haemoptysis at home despite to immunosuppressive therapy. Only two out of eight patients with PAA are still alive who were treated with cyclophophamide and corticosteroids. Thirteen operations were performed in 7 out of 13 patients having non-pulmonary arterial lesions. Although ten of the operations were primary operations, three reoperations had to be performed. A stent-graft was applied for the management of an iliac artery aneurysm in one patient. Only one patient died 8 years after the first non-pulmonary arterial involvement following a type IV thoracoabdominal aortic aneurysm repair. Five patients with arterial occlusive lesions were successfully treated by corticosteroids. Conclusions: Pulmonary artery aneurysms in Behçet’s disease patients have a poor prognosis despite any form of therapy. High dose corticosteroids alone can be successfully used for isolated non-pulmonary arterial occlusive lesions, unless disabling symptoms occur. Surgery or stent-graft insertion is indicated for non-pulmonary arterial aneurysms because these aneurysms entail high risk of complications.
Dreidimensionale Spiral-CT Venographie zur präoperativen Untersuchung der Varikose
Authors: Uhl  , Verdeille  , Martin-Bouyer
Published: January 2006

Background: The purpose of pre-operative spiral CT venography or veno-CT (VCT) is to provide a precise 3D anatomic depiction of the venous network, to be used as a guideline by the surgeon. Methods : A multislice and multidetector spiral CT acquisition of the lower limb with diluted contrast injection produces about 400 slices in 30 s. Dedicated volume-rendering software compute interactive 3D images of the venous system. Dynamic data are easily exported by email and available for phlebologists and surgeons. As VCT provides no hemodynamic data, an associated color-coded duplex is mandatory. Results: VCT is useful in case of post-operative recurrence (especially of the popliteal fossa), high or dystrophic termination of the short saphenous vein, varices feeded by the Giacomini vein, and to investigate pelvic or pudental varicose veins. A full knowledge of the complex venous networks is possible thanks to interactivity of the resulting 3D model, using rotation and modification of transparency of the tissues. Conclusion : Providing a more complete anatomical information, VCT makes possible a better surgical choice of technique, avoiding anatomic pitfalls, with a more precise and limited skin approach. Accordingly, it may hopefully improve the aesthetic result as well as the efficacy, by reducing the varicose veins recurrence rate.
A case of extracranial internal carotid artery aneurysm
Authors: Keçeligil  , Ünal
Published: January 2006

Aneurysmen der extrakraniellen A. carotis interna sind eine Seltenheit, die jedoch zu lebensgefährlichen Komplikationen wie Ruptur, Thrombose oder Embolie führen können. Die Ursachen des Aneurysma sind unter anderem arteriosklerotische Veränderungen der Gefäße, fibromuskuläre Dysplasien, Traumen, chirurgische Eingriffe der Halsschlagader, Infektionen, Dissektionen, Syphilis und angeborene Defekte. Es sind fünf verschiedene Typen von Aneurysmata definiert, die unterschiedliche Symptome aufzeigen können und unterschiedlicher Behandlung bedürfen. Wir berichten über einen Fall eines extrakraniellen Aneurysma der A. carotis interna und dessen erfolgreiche chirurgische Behandlung.
Die vakuumversiegelte Meshgrafttransplantation beim chronischen Ulcus am Unterschenkel
Authors: Halter  , Kapfer  , Liewald  , Bischoff
Published: January 2006

Background: The covering of defects caused by chronic ulcers on limbs affected by peripheral arterial disease or chronic venous insufficiency is often difficult due to extensive secretion and edema, while chronic bacterial contamination of the wound bed further compromises the conditions for successful healing. Patients and methods: Vacuum-sealed dressing (VSD) offers the option of a closed dressing system for moist wound care that assures firm contact with the wound surface and protection against contamination with nosocomial microbes and decontamination of existing bacteria by means of constant drainage of secretion independent of gravity. VSD is particularly useful in difficult wounds featuring extensive secretion and unfavorable localization and offers many advantages over conventional dressing techniques in terms of improved healing of skin transplants. A total of 35 patients with chronic leg ulcers were treated with vacuum-sealed mesh graft transplantation. Results: Complete healing of the mesh graft transplant was observed in 20 patients (57%). Twelve patients (34%) experienced partial healing (75–90%) of the transplant, while three patients exhibited less than 75% healing of the graft and therefore required a second mesh graft transplantation. Conclusions: VSD is a simple, quick and inexpensive technique that promotes excellent healing of skin transplants. It is particularly useful in difficult wounds with extensive secretion and/or contamination or infection.
Zur Auswahl der Prothese für die Hämodialyse
Authors: Senkaya  , Aytac  , Ercan  , Aliosman  , Percin
Published: January 2006

Background: In patients with chronic renal failure, a major concern is to provide safe and reliable long-term vascular access for haemodialysis. The radiocephalic arteriovenous (AV) fistula remains the first choice vascular access procedure, however the grafts are used in order to obtain vascular access in patients with failed native distal and proximal AV fistulas. The aim of this study was to compare the patency rate of different grafts such as standard wall polytetrafluoroethylene (sPTFE), bovine vein graft, Diastat graft, in these patients. Patients and methods: Four hundred and forty-six AV fistulas were surgically created in 361 patients. Eighty-four out of 361 patients undergoing different graft replacements were retrospectively reviewed. We evaluated the primary patency rates, days between the fistula placement and the last dialysis treatment before thrombosis had occurred, and the secondary patency rate, days between the fistula placement and the last dialysis treatment before the graft was considered completely lost. The graft survival was calculated according to the Kaplan-Meier method. Results: There were 58 (69%) women and 26 (31%) men with a mean age of 54,5 years. The sPTFE (Gore- Tex) graft was used in 41 (41.8%), bovine vein graft (ProCol) in 38 (38.7%) and Diastat vascular grafts in 19 (19.5%) patients. Primary and secondary patency rates for sPTFE graft were 37% and 60%, 68% and 85% for bovine graft and 26% and 42% for Diastat vascular grafts, respectively. Conclusions: This study demonstrates that the bovine vein graft provides the longest patency rate compared to the other grafts even in patients with multiple failed accesses.
Aneurysma der V. poplitea als Ursache multipler Lungenembolien
Authors: Sigg  , Koella  , Stöbe  , Jeanneret
Published: January 2006

Generally, most aneurysms of the venous system are probably congenital and rarely have clinical significance. Popliteal aneurysms are an exception of this rule and are known to be a source of recurrent pulmonary emboli. We present a previously healthy 42 year old man with multiple pulmonary emboli, diagnosed with a high probability lung scan. Venous duplex imaging and magnet resonance imaging showed a mass with connection to the popliteal vein of the left knee, suggesting a venous aneurysm. Despite therapeutic anticoagulation he suffered further pulmonary emboli. After insertion of a temporary vena cava inferior filter aneurysm resection and patch reconstruction of the popliteal vein was performed. By duplex imaging we proved the patency of the popliteal vein after surgical repair. Popliteal venous aneurysms should be kept in mind as possible thromboembolic source in young patients with pulmonary embolism. Our review of the current literature about popliteal venous aneurysms revealed a high rate of pulmonary embolism.
DRG-based cost analysis of inpatient conservative treatment of PAD stage III/IV
Authors: Heidrich  , Rogatti  , Altmann  , Amendt  , Bauersachs  , Diehm  , Fahrig  , Lawall  , Ranft  , Schenker  , Schweizer  , Stiegler  , Wilke
Published: January 2006

Hintergrund: In einer von der Deutschen Gesellschaft für Angiologie (DGA) und dem DRG Competence Center, München, durchgeführten prospektiven Studie wurde geprüft, ob die Kosten für eine konservative Behandlung von Patienten mit PAVK Stadium III/IV (DRG F65) im derzeitigen G-DRG-System adäquat abgebildet sind. Methode und Patienten: Im Zeitraum vom 1. September. bis 16. Dezember 2002 wurden an acht angiologischen Zentren in Deutschland insgesamt 704 Patienten mit der DRG F65 (periphere Gefäßerkrankungen) ausgewertet. Neben der Verweildauer im Krankenhaus wurden die Gesamtkosten (Kostenäquivalente) nach einer von der DRG Research Group der Universität Münster entwickelten Methodik berechnet. Darüber hinaus erfolgte ein Vergleich des Studienkollektivs mit einer von InEK veröffentlichten bundesdeutschen Kalkulationsstichprobe für die DRGs F65A/B. Ergebnisse: Es zeigte sich, dass konservativ behandelte Patienten mit einer PAVK Stadium III/IV (DRGs F65A/B) signifikant mehr Kosten verursachen (p < 0,001) und signifikant längere Verweildauern (p < 0,001) aufweisen als Patienten, die wegen anderer Gefäßerkrankungen ebenfalls in die DRG F65 eingruppiert wurden. Gleichzeitig wurde deutlich, dass angiologische Zentren doppelt so viele Patienten mit kritischer Extremitätenischämie behandeln, wie dies im bundesdeutschen Mittel der Fall ist. Die von InEK bislang veranschlagte Vergütung deckt nicht einmal die Hälfte der tatsächlich entstandenen Kosten für die konservative Therapie der PAVK Stadium III/IV. Schlussfolgerung: Um eine leistungsgerechte Vergütung zu gewährleisten, muss – wie von der DGA beantragt – eine neue Basis-DRG für Patienten mit PAVK Stadium III/IV gebildet werden. Andernfalls wird in Zukunft eine adäquate – den Leitlinien entsprechende – konservative Therapie dieser Patienten, die weder operativ noch interventionell behandelt werden können, nicht mehr möglich sein.
Wie altern Gefäße? Mechanismen und klinische Implikationen
Authors: van der Loo  , Koppensteiner  , Lüscher
Published: January 2006

Altern ist ein wichtiger kardialer und vaskulärer Risikofaktor. Für das Gefäßaltern sind genetische, mechanische und hämodynamische Faktoren ausschlaggebend. So sind altersabhängige Veränderungen in Gefäßen, welche weniger Pulsatilität und Blutdruck ausgesetzt sind, wie Kapillaren und Venen, geringer oder abwesend. Vor allem in den großen Widerstandsgefäßen kommt es im Laufe des Alterns morphologisch zu einer Intima- und Mediaverdickung, verknüpft mit einer vermehrten Einlagerung von Matrixsubstanzen, und letztlich resultierend in verminderter Compliance der Gefäße. Es lassen sich Funktionsstörungen des Endothels nachweisen. Hier kommt es zu einer deutlichen Heraufregulierung der endothelialen Nitric Oxide Synthase (eNOS), welche für die Produktion des endogenen Vasodilatators Nitric Oxide (NO) verantwortlich ist. Paradoxerweise sind trotzdem die Vasorelaxationen im Alter vermindert, da es gleichzeitig zu einer erhöhten Produktion freier Radikale, im Besonderen Superoxid (O2-) kommt. O2- und NO bilden in einer schnell ablaufenden chemischen Reaktion Peroxinitrit (ONOO-), welches Proteine nitriert. Durch diese Nitrierung kommt es zur funktionellen Beeinträchtigung dieser Proteine, so dass verschiedene Signalübertragungswege, z.B. Tyrosilierung von Enzymen, blockiert werden. Primärer Ort der Bildung freier Sauerstoffradikale sind die endothelialen Mitochondrien. Bislang ungeklärt ist, ob der oxidative Stress als ein zentrales Ereignis des Gefäßalterns pharmakologisch beeinflussbar ist. Hier standen vor allem antioxidativ wirkende Vitamine im Mittelpunkt des Interesses. Überraschenderweise wird jedoch Vitamin E im Tiermodell vermehrt mit steigendem Alter in der aortalen Wand eingelagert, was im Rahmen eines altersassoziierten gegenregulatorischen Mechanismus zur Abwendung des vermehrten oxidativen Stresses erfolgt. Umgekehrt ist Vitamin C signifikant vermindert. Es bleibt abzuwarten, ob das Gefäßaltern durch Vitamin C oder andere Antioxidantien günstig beeinflusst werden kann. Für Statine und ACE-Hemmer wurden schon Wirkungen beschrieben, die mit Schlüsselmechanismen des Gefäßalterungsprozesses interferieren. Die Entwicklung therapeutischer Interventionen zur Verlangsamung des Gefäßalterns wird für das Auftreten von Herz- und Gefäßerkrankungen im Alter in Zukunft große Bedeutung haben.
Intra-arterial injection of dissolved Flunitrazepam tablets
Authors: Pratikto  , Strubel  , Biro  , Kröger
Published: January 2006

Intra-arterial application of dissolved tablets is associated with a high risk of tissue necrosis. An early active vasodilatating and recanalising treatment is necessary. We present the case of 21-year-old female who applied three dissolved Flunitrazepam tablets into the ulnar artery and was successfully treated with prostaglandin E1 and recombinant tissue plasminogen activator.
Embolisationstherapie einer arteriovenösen Fistel nach perkutaner Nephrolitholapaxie in Kombination mit der Angioplastie einer ipsilateralen Nierenarterienstenose
Authors: Diehm  , Voss  , Do  , Triller  , Dinkel
Published: January 2006

Wir beschreiben die erfolgreiche selektive Embolisation einer arteriovenösen Fistel mit Makrohämaturie nach perkutaner Nephrostomie und Lithotrypsie. In gleicher Sitzung wurde eine bisher nicht bekannte, hämodynamisch relevante Nierenarterienstenose der selben Niere dilatiert. Die Blutung, die zuvor zur massiven Hämaturie mit rezidivierender Blasentamponade geführt hatte, konnte unmittelbar zum Stillstand gebracht werden. Unter Anwendung der koaxialen Kathetertechnik und Platinmikrospiralen als Embolisationsmaterial konnte das umliegende Nierenparenchym weitgehend erhalten werden. Trotz Verbesserung der Nierenperfusion durch PTRA wurde nach erfolgreicher selektiver Embolisation einer arteriovenösen Fistel keine Nachblutung beobachtet.
The incidence of iliac aneurysms in patients with abdominal aortic aneurysms: Comparison of four centers in Europe and the USA
Authors: Eugster  , Bolli  , Pfeiffer  , Sandmann  , Chuter  , Messina  , Mühlthaler  , Lottersberger  , Fraedrich  , Gürke  , Stierli
Published: January 2006

Background: The purpose of this study was to compare the anatomy of the aortoiliac vessels in patients scheduled for infrarenal abdominal aortic aneurysm (AAA) repair in four different countries. Material and methods: Consecutives series of 100 preoperative CT-scans were evaluated at each center. Diameters of the suprarenal aorta, maximal diameter of the aneurysm, right and left common and external iliac artery as well as the hypogastric arteries were recorded and compared between each center. Results: Configuration of the AAA above bifurcation was similar at each center. The dimensions of the aortic bifurcation and the common iliac arteries were different among the centers. Common iliac arteries with diameters over 25mm were significantly more common at center 1 (p < 0.001, p = 0.002 and p < 0.001). Among centers 2,3 and 4 there was no significant difference in common iliac diameters. Conclusions: Configuration of the iliac arteries in AAA was significantly different for Swiss patients compared to American, Austrian and German patients. Reasons for these differences are unclear, epidemiological or genetic factors may be responsible.
Vasospasm of the scrotum – A manifestation of Raynaud's phenomenon?
Authors: Al-Awami  , Schillinger  , Minar
Published: January 2006

Raynaud's phenomenon (RP) is characterized by local artery vasoconstriction in response to cold exposure or emotional stress. RP appears as attacks of blanching or cyanosis of digits, or both, followed by a hyperaemic phase. Usually the digits of the hands or less commonly of the feet are affected. Other sites such as nose, ears could also be affected. We report a patient who has been suffering for long time of cold induced sensitivity associated with well demarcated pallor of the scrotum.
Gluteal compartment syndrome after abdominal aortic aneurysm repair
Authors: Ishibashi  , Ohta  , Hosaka  , Sugimoto  , Kawanishi  , Yamada
Published: January 2006

A 66-year-old man underwent emergency surgery for a ruptured abdominal aortic aneurysm associated with right common and internal iliac aneurysms. Postoperatively, his right buttock was distended and tender to compression. A CT scan revealed an extremely swollen right gluteus maximus with decreased density. Macromyoglobinuria was noted, and creatine kinase and myoglobin were elevated: 87,800 IU/l and 144,300 ng/ml, respectively. Renal function had deteriorated and he was treated with hemodialysis until the 15th postoperative day. The patient recovered without any discomfort to the buttock or intermittent claudication. To our knowledge this is the first documented case of gluteal compartment syndrome after the repair of an abdominal aortic aneurysm.
Media remodeling – the result of stent induced media necrosis and repair
Authors: Dirsch  , Dahmen  , Fan  , Gu  , Shen  , Wieneke  , Erbel
Published: January 2006

Background: Stents have been introduced clinically to help maintaining the patency of the vascular lumen after balloon angioplasty. To ensure a sufficient lumen of the stented vessel, oversized stents are frequently used. However especially deployment of oversized stents may lead to mechanical injury of the intima and media of the vessel wall. The aim of the study was to characterize the vascular lesions and repair processes within the first 4 weeks after implantation of oversized stents in the rabbit carotid artery and thereby contribute to the understanding of vascular remodeling during stent implantation. Methods: Oversized stents were implanted in the carotid artery of Chinchilla rabbits. Rabbits were sacrificed 3, 7, 14, and 28 days after stent implantation and a detailed histologic and immunohistochemical analysis was performed. Results: The carotid artery was expanded by a factor of 1.3–1.5, leading to a constant dilatation of the vessel. The struts were deeply impressed in the vessel wall, resulting in a disruption of the intima, thrombus formation, media compression and segmental media necrosis. The necrotic media was repopulated by smooth muscle cells by day 7. In contrast to the intima lesions, necrotic areas of the media were not invaded by an inflammatory infiltrate. Formation of neointima, characterized by a confluent layer of endothelial cells and deposition collagen fibers started in close vicinity of the struts. Conclusions: Being part of a high-pressure system, the arterial vessel apparently adapts to constant dilatation. Deployment of oversized stents caused intima disruption, media necrosis of varying degree and constant dilatation of the vessel wall. Necrosis and repopulation of smooth muscle cells of the media took place within the first 4 weeks, leading to the speculation whether the repopulating SMC are more resistant to the constant pressure.
Frostbite in a mountaineer
Authors: Kroeger  , Janssen  , Niebel
Published: January 2006

Cold injury is an objective danger in mountain climbing as well as in many outdoor sports. With increasing number of people practising so-called extreme tourisms physicians can be confronted with frostbite. Thus we present a case of frostbite in a 35 year-old female mountaineer. She took part at a demanding high alpine trekking tour in the Himalayan-area requesting well trained mountaineers experienced in ice- and securing-techniques and good physical condition. At day 12, when the group reached the top of the Parchamo (Nepal, 6273 m), she developed frostbite at all toes leading to amputation finally. Risk factors, prognosis and options for initial treatment are discussed.
Mild hyperhomocysteinemia: risk factor or just risk predictor for cardiovascular diseases?
Authors: Weiss  , Hilge  , Hoffmann
Published: January 2006

Elevated plasma levels of homocysteine (hyperhomocysteinemia) are increasingly recognized as a potential risk for atherothrombotic vascular diseases by numerous epidemiological and clinical studies. There are increasing experimental data that indicate mechanisms by which homocysteine may alter the vasculature in a way that predisposes to atherosclerotic vascular disease. A key event in the vascular pathobiology of hyperhomocysteinemia seems to involve the induction of endothelial dysfunction due to a reduction of the endogenous antiatherothrombotic molecular nitric oxide. Elevated homocysteine levels can be efficiently and safely reduced in most of hyperhomocysteinemic patients by supplementation of folic acid and cobalamin. This reduction is associated with an improvement in endothelial function and other surrogate markers of atherothrombosis, like carotid plaque area and the rate of abnormal stress electrocardiograms. Whether or not this translates into clinical benefits, is still under investigation. The first clinical study on homocysteine-lowering vitamin supplementation in patients that had undergone coronary intervention showed a benefitial effect on the rate on restenosis and the need for revascularization which translated into a reduction of major coronary events. In contrast, in three larger scaled secondary intervention trials in patients with stable coronary disease or post non-disabling stroke, vitamin supplementation had no effect on future vascular events although baseline homocysteine levels were significantly associated with a worse prognosis. Until the results of more clinical trials are available, the clinical relevant question whether or not homocysteine is just a risk predictor or a modifiable risk factor can not definitely be answered.
Are there predictors for the outcome of a PGE1 treatment in peripheral arterial disease with critical limb ischaemia?
Authors: Heidrich  , Schmidt  , Fahrig
Published: January 2006

Background: In a multivariate retrospective analysis was conducted to examine whether and to what extent PGE1 is therapeutically effective and whether there are predictors of response. Patients and methods: The examination included 767 patients (448 women, 319 men) of a mean age of 71.2 years and with peripheral arterial disease (PAD) having existed for 44.7 months on the average. They suffered from critical limb ischaemia (Fontaine’s stages III/IV) and showed average tcpO2 values at the instep of 2 mmHg (0 to 15) and average systolic malleolar artery pressures of 18 mmHg (0 to 35 mmHg). Between 1989 and 2001, the patients had received treatments in hospital with i.v. PGE1 doses (2 x 20 mug or 1 x 60 mug/day) for an average of 34.2 days (mean of responder- and non-responder group). Patients were called responders when pain had markedly decreased or disappeared, necroses had been reduced or healed completely, and vascular reconstruction, PTA or amputations were not necessary. Results: The clinical analysis showed 82.4% of the patients to be responders and 17.6% to be non-responders. It was demonstrated that the outcome of the therapy was not dependent on the supine or sitting tcpO2, the malleolar artery pressure, the patient’s age or sex, the duration of PAD, the number or kind of concomitant diseases, the patient’s general condition, the localization and number of vascular occlusions, the kind of prior therapy, or the number of previous amputations, although differences in some of the parameters, while clinically irrelevant, were found to be statistically significant. They are not predictors of the outcome of a PGE1 therapy. Conclusions: Even in extremely bad haemodynamic situations at the beginning of a therapy (malleolar artery pressures from 0 to 35 mmHg, tcpO2 0 to 15 mmHg, multilevel occlusive disease, multiple previous operations and concomitant diseases), PGE1 therapies of more than 20 days – on the average 35.6 days (mean of responder group) – duration allow clinically relevant positive results to be achieved.
Does calculation of ankle brachial pressure index need revision?
Authors: Diehm  , Kareem  , Diehm  , Jansen  , Lawall
Published: January 2006

Peripheral arterial disease (PAD) is a commonly encountered but a commonly under-diagnosed condition in clinical practice. Ankle brachial pressure index (ABI) is a widely used procedure in its detection. It is also a very good prognostic marker not only of PAD but also of mortality. According to the current guidelines ABI of a side i.e. either the left or the right, is the quotient of the higher of the systolic blood pressures (SBP) of the two ankle arteries of that limb (either the anterior tibial artery or the posterior tibial artery) and the higher of the two brachial SBP of upper limbs. With the currently existing method of ABI calculation, considering only the higher of the SBP of the two ankle arteries, a distal stenosis of the ankle arterial system with the lower SBP, may be missed. We suggest a modification to the currently existing of calculating ABI. The method has been termed by us as the low ankle pressure method. In this method the lowest ankle pressure between the two ankle arteries of a particular side is to be the numerator and the denominator could be the same as before. A study or a series of studies comparing our proposed method with the current one are needed to test its clinical utility.
An unusual presentation of giant cell arteritis
Authors: Simon  , Fritz  , Amann-Vesti  , Schenk Romer  , Fischer  , Kägi
Published: January 2006

A 77-year-old-man with giant cell arteritis who developed bitemporal scalp ulcerations is described. Since 1946 when Cooke et al. reported the first case of scalp necrosis there were approximately 55 cases published. Scalp ulceration is a rare complication of giant cell arteritis and occurs mainly in elderly persons, particularly women. About half of all patients were presented to dermatologists. Most of the patients (70%) had other serious complications of giant cell arteritis: blindness, gangrene of the tongue and nasal septum necrosis. Seventy percent of the cases were confirmed by a temporal artery biopsy. The necrosis were of varying extent and uni- or bilateral. Although, in most cases necrosis has been located bilaterally as in the presented case. Scalp healing was complete nearly in all patients by conservative treatment within a year. Scalp ulceration is a potentially reversible complication of giant cell arteritis which indicates extensive vessel involvement and adequate coricosteroid therapy is required and essential.
Hypoplasie der deszendierenden Aorta thoracalis und der Aorta abdominalis bei Williams-Beuren-Syndrom
Authors: Schenk Romer  , Weishaupt  , Koppensteiner
Published: January 2006

Die Hypoplasie der deszendierenden Aorta ist eine seltene Erkrankung, deren Ursache häufig unklar ist. Pathogenethisch bestehen Assoziationen mit kongenitalen Entwicklungsstörungen, entzündlichen und infektiösen Faktoren sowie hereditären Syndromen. Wir stellen in diesem Artikel eine 24-jährige Patientin mit einer Hypoplasie der Aorta thoracalis descendens und der Aorta abdominalis bei Williams-Beuren-Syndrom vor. Diese seltene Erbkrankheit beruht auf einer Gendeletion auf Chromosom 7, unter anderem dem Elastin-Gen, und ist durch kardiovaskuläre Anomalien, dysmorphe Gesichtszüge und eine mentale Retardation charakterisiert. Die Patientin präsentierte sich mit einer schweren Hypertonie und rezidivierenden abdominellen Krämpfen seit Kindheit. Die Diagnose wurde mittels Duplexsonographie und Magnetresonanzangiographie gestellt. Die Behandlung erfolgte durch Anlage eines aortoaortalen Bypass (von der Aorta ascendens auf die infrarenale Aorta) mit Reinsertion des Truncus coeliacus, der A. mesenterica superior und der rechten Nierenarterie. Die häufigste klinische Manifestation der Aortenhypoplasie ist eine schwere arterielle Hypertonie im jungen Erwachsenenalter. Werden die aortalen Veränderungen nicht rechtzeitig erkannt, ist diese Erkrankung durch die Komplikationen der Hypertonie mit einer hohen Morbidität und Mortalität verbunden.
Three cases with May-Thurner syndrome: A possibly under-reported disorder
Authors: Dogan  , Boke
Published: January 2006

The May-Thurner syndrome is an acquired stenosis of the left common iliac vein causing left lower leg edema, thigh discomfort, and deep venous thrombosis. This condition was first described by May and Thurner in 1956 in 22% of autopsy series. They concluded that it was the underlying factor for deep venous thrombosis on the left side. Here, we present three young female patients with May-Thurner syndrome, but without actual thrombosis. One of these patients was successfully treated with a Wall stent, and the other two patients underwent clinical follow-up with anticoagulant therapy.
Portal vein thrombosis: etiology, diagnostic strategy, therapy and management
Authors: Hidajat  , Stobbe  , Griesshaber  , Schroder  , Felix
Published: January 2006

Myeloproliferative disorder, liver cirrhosis with portal hypertension, deficiency of natural anticoagulant proteins, gene mutation and hepatocellular carcinoma are the most frequent causes of portal vein thrombosis (PVT). Higher accuracy of the diagnostic methods is the reason why today the cause of PVT can be found more frequently. With imaging methods, PVT with or without cavernous transformation can be diagnosed. Fresh thrombus can be undetected in sonography due to the low echogenity but can be recognized in color Doppler sonography, especially with contrast-enhancing agent. Contrast-enhanced 3D MR angiography allows a comparable accuracy in the detection of PVT as digital subtraction angiography. Therapeutical options of PVT consist of mechanical recanalization of the portal vein, local fibrinolysis with or without placement of transjugular intrahepatic portosystemic stent shunt (TIPS), combination of mechanical recanalization and local fibrinolysis, systemic thrombolytic therapy, anticoagulation alone and surgical thrombectomy. Once PVT is found in sonography, Doppler sonography may be performed in order to distinguish benign from malignant thrombus. If further information is needed, MR angiography or contrast enhanced CT is the next step. If these tests are unsatisfactory, digital subtraction angiography should be performed. Until the early nineties, shunt surgery was recommended in patients with PVT who bled despite endoscopic treatment. Today, in symptomatic noncavernomatous PVT, recanalization with local methods is recommended. Additional implantation of TIPS should be performed when the patient is cirrhotic. In recent PVT in non-cirrhotic patients anticoagulation alone is recommended. It is expected that in old PVT anticoagulation can prevent further extension of the thrombus.
Superficial brachial artery
Authors: Atahan  , Cetinus  , Yasim
Published: January 2006

Anomalies of the ramification of arteries in the upper extremity are an important consideration due to the large number of invasive procedures, both diagnostic and therapeutic, performed particularly in the cubital region of the upper limb. It is important for health professionals to be aware of arterial variation to prevent complications during diagnostic and therapeutic procedures. Here, we describe a rare unilateral anomaly of the brachial artery which courses subcutaneously through the right arm to the cubital region in a 75 year-old female patient.
Current evidence and prospects for medical treatment of abdominal aortic aneurysms
Authors: Diehm  , Schmidli  , Dai-Do  , Baumgartner
Published: January 2006

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.
Pulsatility index is better than ankle-brachial Doppler index for non-invasive detection of critical limb ischaemia in diabetes
Authors: Janssen
Published: January 2006

Background: Diabetic polyneuropathy of the feet and legs obscures the diagnosis of critical limb ischaemia (CLI) because of lack of pain sensation. Hence, the Fontaine classification does not apply to these patients. Furthermore, many of them will exhibit medial arterial calcification, which invalidates the application of sphygmomanometry. This study was done to evaluate the pulsatility index (PI) assessed at the ankle arteries by colour Doppler ultrasonography as a non-invasive method to diagnose CLI in diabetic polyneuropathy. Patients and methods: 140 legs of 106 diabetic patients were studied who presented with polyneuropathy and painlessness of the feet; of these, 117 feet displayed an ulcer or gangrene. CLI was defined as the need for arterial revascularisation, as indicated by the physicians in charge on the basis of a) a foot lesion Wagner grade 1–5, and b) a positive arteriography. All patients were subjected to 4 vascular assessment techniques: digital subtraction arteriography, ankle-brachial Doppler index, systolic ankle blood pressure, and PI. Results: Of the 140 legs, 61 (44%) were affected by CLI, and 76 (54%) by medial arterial calcification. A PI < 1.2 indicated CLI with a sensitivity of 0.87 and a specificity of 0.62. The sensitivity and specificity of ankle-brachial index < 0.9, and of systolic ankle pressure < 70 mm Hg to predict CLI was 0.71 and 0.42, and 0.30 and 0.89, respectively. Conclusions: The pulsatility index is a better non-invasive technique than the ankle-brachial Doppler index or the systolic ankle pressure to assess critical limb ischaemia in diabetic polyneuropathy. A pulsatility index < 1.2 at the ankle arteries is a reliable criterion for diagnosis of CLI in diabetic patients with polyneuropathy.
Risk factors for survival in patients with end-stage renal disease undergoing infrainguinal bypass surgery
Authors: Engelhardt  , Bruijnen  , Schaal  , Wölfle
Published: January 2006

Background: A poor longevity and high perioperative morbidity make lower extremity revascularization questionable in patients with end-stage renal disease (ESRD). Therefore, careful selection of patients for surgery is essential. Aim of this study was to assess negative predictors of survival in patients with ESRD undergoing infrainguinal bypass grafting for critical limb ischemia (CLI). Patients and methods: We reviewed the records of 49 consecutive patients with ESRD who underwent infrainguinal bypass grafting for limb salvage. Rates were computed with life-table analysis and compared by log-rank test. Effects of demographic and disease variables on the survival rate were evaluated by Cox proportional hazard regression model. Results: Indications for surgery were rest pain in two (4.1%) and tissue loss in 47 patients (95.9%). Median follow up was 7.8 months (IQR, 2.43 to 16.23). Perioperative (30-day) morbidity and mortality for all patients were 6.1% and 12.2%, respectively. Primary and secondary patency at two years both were 81.4%. Cumulative survival rate at two years and four years were 24.9% and 9.3%, respectively. Limb salvage rate and amputation-free survival rate at two and four years were 80.4%, 53.6%, 21.8% and 14.6%, respectively. Myocardial infarction and congestive heart failure in the patients medical history both had an adverse effect on survival rate with a hazard ratio of 5.52 (95% CI, 1.94 to 15.69) and 3.12 (95% CI, 0.99 to 9.81), respectively. Conclusions: In the presence of myocardial infarction or congestive heart failure in the medical history survival rate is especially poor for patients with ESRD undergoing infrainguinal revascularization. Therefore, bypass surgery for CLI is hardly indicated in this group of patients.
Follow-up after deep venous thrombosis in azygos continuation
Authors: Mouton  , Zehnder  , Wagner  , Mouton
Published: January 2006

Background: To determine the sequelae of patients after deep venous thrombosis in patients with azygos continuation defined as agenesis of the inferior vena cava with collateral flow. Patients and methods: Five patients post deep venous thrombosis in the context of azygos continuation were followed up clinically and with colour duplex ultrasonography. Results: All five patients had to our knowledge after the initial deep venous thrombosis no further thromboembolic events. Three patients after isolated iliac thromboses are symptom free or nearly symptom free, two after more extended thromboses still suffer from venous claudication. Four patients are without anticoagulation, one patient is permanently orally anticoagulated. Conclusions: Azygos continuation may not influence the risk of recurrent venous thrombo-embolism nor the outcome of a deep venous thrombosis. Careful deep venous thrombosis prophylaxis in patients with azygos continuation may be sufficient when a risk factor is present but conclusions lack due to the small numbers of patients of enough supportive data.
Takayasu’s arteritis and ulcerative colitis in a young non-Asian woman: A rare association
Authors: Katsinelos  , Tsolkas  , Beltsis  , Chatzimavroudis  , Papaziogas  , Kapelidis  , Katsinelos  , Atmatzidis  , Paroutoglou
Published: January 2006

The association between ulcerative colitis and Takayasu’s arteritis has been well described in patients of Asian ethnicity. We present the third non-Asian case reported in the English literature, of a 37-year-old woman with a 4-year history of Takayasu’s arteritis, who developed idiopathic ulcerative colitis. She was found to carry the human leucocyte antigens HLA-B52 and DR2, which have been previously noted to be associated with these inflammatory conditions, mainly in the Japanese population. Ulcerative colitis was steroid-dependent despite simultaneous administration of mesalazine. Azathioprime achieved remission of both diseases. The possible pathogenic association of the disorders is discussed.
An extraanatomic bypass method alternative to the obturator bypass
Authors: Besirli  , Cortelekoglu  , Sirin  , Tuzun  , Gurel Sayin
Published: January 2006

Obturator bypass is the preferred method when infectious groin problems are challenging. However, this method can not be applied either in some special settings including the dissemination of the infection towards retroperitoneum and some technical difficulties in handling obturator bypass area (like fibrosis and inability to expose the obturator foramen). We present an alternative bypass method in two cases.
Lässt sich ein Gehtraining durch additive medikamentöse Therapie verbessern?
Authors: Cachovan
Published: January 2006

Hintergrund: Feststellung ob sich ein Gehtraining im Stadium II der peripheren arteriellen Verschlusskrankheit (PAVK) durch additive medikamentöse Therapie verbessern lässt. Methode: Literatur-Übersicht. Ergebnisse: Die Verbesserung der Trainingswirkung durch adjuvante medikamentöse Therapie wird von zwei Studien der Evidenzstufe 2 belegt. Der Netto-Gewinn an Zunahme der Gehstrecke gegenüber Kontrollen am Therapieende beträgt 28–272%. Von den angewandten vasoaktiven Substanzen (Oxyfedrin, Naftidrofuryl, Pentoxifyllin, Prostaglandin E-1) zeigte PGE-1 die stärkste Wirkung. Das Wirkungsprofil von PGE-1 war durch einen raschen Wirkungseintritt, eine günstige Dosis / Wirkung Beziehung und eine verlängerte Nachwirkung charakterisiert. Darüber hinaus wurde eine signifikante und prognostisch relevante Verbesserung der aeroben Leistungskapazität lediglich bei Patienten nach Training und additivem PGE-1 gefunden. Schlussfolgerungen: Eine kombinierte Anwendung von Vasoaktiva zum Training stellt einen rationalen Therapieansatz dar im Sinne einer Trainingsverbesserung und Steigerung seiner Effizienz. Die größten Vorteile zeigte die additive i.v. Infusionstherapie mit PGE-1 während Pedalergometrie. Weitere Studien zu diesem Thema und zur Verbesserung des gesamten Outcomes im Stadium II der PAVK sind erforderlich.
Sinnvolle und unsinnige Indikationen zur angiologischen Rehabilitation für Patienten mit peripherer arterieller Verschlusskrankheit
Authors: Klein-Weigel
Published: January 2006

Die gesetzlichen Grundlagen der Rehabilitation sind in der Bundesrepubik Deutschland im Sozialgesetzbuch definiert. Da die Rehabilitation um so aussichtsreicher verläuft, je früher geeignete Maßnahmen ergriffen werden, ist eine strikte Trennung zwischen Akut- und Rehabilitationsmedizin weder möglich noch sinnvoll. Frührehabilitation wurde deshalb auch vom Gesetzgeber als integraler Bestandteil der akutmedizinischen Versorgung definiert. Der Anteil der Patienten, bei denen die periphere arterielle Verschlusskrankheit die primäre Indikation für eine AHB oder Anschlußrehabilitation darstellt, ist gering und kontrastiert scharf mit der Prävalenz und sozialmedizinischen Bedeutung dieser Erkrankung. Die tatsächliche Inanspruchnahme angiologischer Rehabiliationen lässt daher auf eine Mangelversorgung schließen. Hinzu kommt, dass nur ein Bruchteil der Rehaeinrichtungen mit entsprechenden Zulassungen einen Angiologen beschäftigen oder eine fachangiologische Rehabilitation anbieten. In dem Beitrag wird die These vertreten, dass die angiologische Frührehabilitation im Akutkrankenhaus zu einem ökonomischen Mitteleinsatz beitragen kann und es werden explizit sinnvolle und unsinnige Indikationen zur angiologischen Rehabilitation aufgeführt. Analogien aus der kardiologischen Rehabilitation legen jedoch den Schluss nahe, dass dringend gangbare Konzepte erarbeitet werden müssen, um den Erfolg der Rehabilitation zur Sekundärprophylaxe atherosklerotischer Komplikationen längerfristig zu stabilisieren. Eine anhaltende Verbesserung der Gehstrecke lässt sich demgegenüber durch die Teilnahme an einer ambulanten Gefäßsportgruppe erreichen.
Ist eine konservative Therapie der pAVK 2005 noch indiziert? Wann und womit?
Authors: Rieger
Published: January 2006

In Beantwortung der eingangs gestellten Frage, ob und in wieweit eine konservative Therapie der pAVK 2005 noch indiziert ist und – wenn ja – womit, soll zusammenfassend festgestellt werden: Der gefäßkranke Patient ist ein komplex erkrankter internistischer Patient und bedarf grundsätzlich einer umfassenden vaskulär orientierten internistischen stationären sowie ambulanten Therapie und dies sicherlich auch über das Jahr 2005 hinaus. Im Stadium II ist die konservative Therapie als «first line Therapie» anzusehen. Im Stadium III ist die konservative Therapie als wesentliche Alternative dann einzusetzen, wenn sich Lumen eröffnende Verfahren primär nicht als technisch gut durchführbar und als klinisch erfolgreich anbieten. Im Stadium IV gilt die konservative als «second line Behandlung», als begleitend oder/und als Versuch, die Amputationsebene zu distalisieren. Womit wird behandelt? Mit den vier Ks: Kompetenz Kooperation Kreativität Kostenbewusstsein
Abklärung bei möglicher Gerinnungsstörung
Authors: Stöckli
Published: January 2006

Anhand einer Fallvorstellung werden differentialdiagnostische Überlegungen und gezielte Laboruntersuchungen in der Abklärung einer vermehrten Blutungsneigung diskutiert und das von Willebrand-Syndrom vorgestellt.
Psychische und kognitive Probleme bei Morbus Parkinson – therapeutische Möglichkeiten
Authors: Baronti
Published: January 2006

Les stades avancés de la maladie de Parkinson peuvent être accompagnés de dépression, d'hallucinations, de psychoses ainsi que de troubles cognitifs. Ces manifestations provoquent souvent une invalidité importante et peuvent augmenter la mortalité. Il est indispensable de faire un diagnostic correct afin d'établir une thérapie adéquate. L'optimalisation des dosages de la médication antiparkinsonienne peut améliorer les symptômes dépressifs et doit être tentée avant d'établir une traitement antidépresseur. Lorsqu'on observe des hallucinations ou des symptômes démentiels il est recommandé de simplifier la thérapie. Les anticholinergiques, si nécessaire la sélégiline, les agonistes de la dopamine, et l'amantadine devraient être diminués ou arrêtés. Lors de l'indication d'une monothérapie avec lévodopa, il faut éviter les préparations retard. Si un traitement neuroleptique s'avère indispensable, la clozapine et éventuellement la quetiapine sont les médicaments du premier choix. Il existe des indices qu'un traitement avec des inhibiteurs de la cholinestérase peut diminuer les troubles cognitifs en cas de maladie de Parkinson.