bluuebunny/crossref_metadata_2025 huggingface dataset:
Abdominal Aortic Aneurysms with Primary Arteriovenous Fistula—Case Reports
Authors: Ohgi Shigetsugu , Ito Katsuaki , Maruyama Shigeki , Tanaka Kohichi , Tsujimoto Minoru , Hara Hiroshi , Mori Tohru
Published: November 2007

Abdominal aortic aneurysms with primary arteriovenous fistula can be clas sified into three types (ruptured, shunted, and occult) according to clinical man ifestations. Two cases, in the authors' experience, belonged to the shunted type. Abdominal continuous bruits were the most definite sign to suggest the compli cation of the fistula. B-mode imaging system, combined with directional color Doppler flowmeter, was applied to a test for precise evaluation regarding the fistula and clearly showed the location and size of the fistula, the mural thrombi, and the specific blood flow patterns through the fistula. To prevent both massive bleeding and critical pulmonary emboli through the fistula, com plete venous interruption at the bilateral common iliac veins, as well as of the inferior vena cava, was performed by means of transsaphenous insertion of three balloon catheters so that a better operative field was obtained without any complications.

Precise preoperative evaluation of the fistula, as well as prevention of pe rioperative complications, can facilitate postoperative improvement.
Femoral Occlusion in a Young Racing Cyclist and Nonatherosclerotic Aneurysms in the Autogenous Saphenous Vein Graft Used — A Case Report
Authors: Bevers R.F.M. , Rijksen J.F.W.B.
Published: November 2007

The authors report and discuss a case of a young male smoker with major vascular problems. He was admitted with a femoral occlusion probably caused by his being an amateur racing cyclist. After reconstruction with a reversed autogenous saphenous vein graft he suffered several thrombophlebites of his lower extremities. Despite intensive investigations no cause was found for his apparent thrombotic tendency. Two years after reconstruction he was operated on for a true aneurysm occurring in his saphenous vein graft. Another two years later the whole saphenous vein graft was exchanged for a prosthesis be cause of multiple nonatherosclerotic aneurysms.
Splenic Vein Thrombosis Secondary to Polycythemia Vera—A Case Report
Authors: Amaria Yazdi N. , Mittal Vijay , Hans Sachinder S.
Published: November 2007

Splenic vein thrombosis secondary to polycythemia vera is a rare disorder, only 1 case having been reported in the medical literature. The authors report the second case of isolated splenic vein thrombosis due to polycythemia vera presenting as upper gastrointestinal hemorrhage, which was cured by splenec tomy at their institution. The literature and management of this problem are reviewed.
Control of Left Ventricular and Proximal Aortic Dimensional Decompensation During Clamping of Descending Thoracic Aorta
Authors: Katsamouris Asterios N. , Mastrokostopoulos George T. , Hatzinikolaou Nikolaos S. , Lappas Demetrios G. , Buckley Mortimer J.
Published: November 2007

The dimensional changes (mea sured by ultrasonic miniaturized transducers) of the left ventricle (LV), and proximal aorta (PAo) that accompanied hemodynamic changes during a forty-minute period of cross-clamping of the descending tho racic aorta without (Group A, 5 dogs) or with (Group B, 5 dogs) controlled vasodilation with sodium nitroprus side (SNP) infusion were evaluated in 10 open-chest anesthetized dogs. In both groups, measurements were re peated for another thirty-minute pe riod after declamping. In Group A, during clamping, systemic vascular resistance (SVR), PAo pressure (PAoP), LV systolic pressure (LVSP), and PAo midwall stress increased sig nificantly (p < 0.001). LV end-diasto lic pressure (LVEDP), stroke volume (SV), cardiac output (CO), and coro nary blood flow (CBF) did not show major variations, whereas systolic and diastolic LV wall thickness were significantly reduced (p < 0.02). A re duction in systolic shortening and thickening was observed also (p > 0.05). In Group B, during the same period, CO and CBF increased substantially (p < 0.02). SVR, PAoP, LVEDP, PAo midwall stess, and SV remained close to baseline values, while systolic and diastolic (p < 0.05) segmental length and systolic short ening and thickening increased (p > 0.05). Furthermore, the velocity of systolic shortening in Group B was significantly higher (p<0.005) than in Group A. In conclusion, the data indicate that significant changes, as detected continuously by sonomicro metry, in LV wall geometry and PAo midwall stress were observed during aortic cross-clamping. SNP infusion appeared to be an effective pharma cologic intervention to control these changes and to preserve cardiovascu lar performance.
Pretreatment of Dacron Prostheses with Gelatin: Experimental Research and Clinical Evaluation
Authors: Cavallaro A. , Sciacca V. , Gallo P. , Cisternino S. , di Marzo L. , Mingoli A. , Alessi G. , Stipa S.
Published: November 2007

Experimental evaluation of a new type of dacron graft, pretreated with mod ified mammalian gelatin, has been performed on the beagle dog. After grafting of the infrarenal aorta, dogs were monitored from three days to three months. Pretreatment with gelatin effectively avoided the need for preclotting and did not affect the normal healing of the prosthesis as compared with similarly tex tured not pretreated grafts.

This graft, when applied in man as an abdominal aortic substitute, has yielded uniformly gratifying results (within a follow-up range of twenty to twenty-seven months).
Chest Radiograph in the Acute Traumatic Rupture of the Aorta
Authors: Pinterits Fritz , Grabenwoeger Florian , Dock Wolfgang , Metz Viktor , Appel Wolfgang
Published: November 2007

The authors tried to determine the validity of sixteen well-known signs indicating an acute traumatic rup ture of the aorta on plain chest radio graphs of 22 patients. Angiograph ically 11 of the patients had a tear at the aortic isthmus. It turned out that seven of the sixteen signs (widened mediastinum, loss of the aortic knob contour, opacification of the aorto- pulmonary window, bulging of the vascular pedicle predominantly to the left, left apical cap, depression of the left main stem bronchus, and dis placement of the right paraspinous interspace) are of great diagnostic value.
Angiographic Investigation of the Development of Collateral Circulation in the Rabbit
Authors: Endo Shunro , Branson Patricia J. , Alksne John F.
Published: November 2007

The sequential changes seen on cerebral angiograms of rabbits after bilat eral common carotid artery ligation (carotid occlusion) are described. The basi lar artery increases in diameter and becomes tortuous within two weeks in the majority of animals in this study. The animals with the greatest increase in arterial lumen as determined by angiographic change had the fewest neurologic deficits. This model should be useful for studies on collateral flow.
Ruptured Dissecting Hepatic Artery Aneurysm: A Rare Cause of Abdominal Apoplexy—A Case Report
Authors: Carty G. , Meland B. , Tong G. , Wilson W.
Published: November 2007

This is a case report of a sixty-five-year-old white male who was hospitalized for elective surgery of a recurring left inguinal hernia. On the sixth postopera tive day he was struck by sudden abdominal pain, followed by rapidly progress ing hypovolemic shock, secondary to abdominal apoplexy from a ruptured dis secting aneurysm of the common hepatic artery. His resultant death, approxi mately twenty-four hours following emergency laparotomy, was secondary to persistent hypotension, followed by multiple organ system failure.

It represents the eighth case reported of this entity in the English literature. The previous 7 cases are reviewed. The association with cystic medial degenera tion, essential hypertension, and postoperative status is discussed. Also summa rized are the symptomatology, diagnosis, and management of this very rare and almost invariably lethal condition.
Myocardial Rupture Presenting as Hemothorax Secondary to Congenital Pericardial Defect—A Case Report
Authors: Pappas Peter J. , Cilley Jonathan H. , Groh William C. , Volosin Kent J. , Spagnuolo Vincent , Baldino William A. , Delrossi Anthony J.
Published: November 2007

A patient who sustained myocardial rupture following acute myocardial infarction is presented. The presenting sign was a left hemothorax. Surgical exploration confirmed myocardial rupture and a left-sided pericardial defect. The incidence of congenital pericardial defects and the presentation of myocar dial rupture is discussed.
Traumatic Rupture of the Thoracic Aorta: A Report of 27 Operated Cases
Authors: Buche Michel , Schoevaerdts Jean-Claude , Jaumin Pierre , Dion Robert , Ponlot Robert , Chalant Charles-Henri
Published: November 2007

Twenty-seven cases of traumatic rupture of the thoracic aorta have been operated on in the cardiovascular and thoracic surgery unit at the Catholic University of Louvain: 10 acute ruptures and 17 chronic false aneurysms. The disproportion between the two groups indicates that the acute pathology tends to remain unrecognized, probably because of major associated injuries that can mask the aortic rupture at the time of trauma. To increase the number of cases of acute traumatic rupture of the aorta successfully diagnosed, the diagnosis should be suspected and a routine aortography should be done in every patient who has sustained a high-speed deceleration injury.
Dependence of Rabbit External Jugular Vein Vasoreactivity on Segment Size and Location
Authors: Schwartz Lewis B. , Haines Laurel J. , Massey Marga F. , Kerfoot William W. , McCann Richard L. , Hagen Per-Otto
Published: November 2007

In this study, the dependence of vein segment length, weight, and location on vasore activity was examined. Twenty-four segments from 12 external jugular veins from 6 New Zealand White rabbits were harvested from the proximal (near the thoracic inlet) or distal (near the linguofacial vein/external jugular vein bifurcation) external jugular vein with in vivo lengths of either 3 or 8 mm. Segments were studied in vitro at their resting tension in an organ bath system. The results showed that bradykinin (BK)- and histamine (HIST)-induced maximal active tension was dependent on vessel size (BK: 3 mm segments 0.54 ±0.10 g vs 8 mm segments 1.42 ±0.23 g, P = 0.0003 by paired t test; HIST: 3 mm segments 0.49 ±0.15 vs 8 mm segments 1.10 ±0.24, P = 0.018) and weight (BK: P < 0.0001 by linear regression; HIST: P = 0.0031). In contrast, BK sensi tivity was dependent on location (proximal segments, -logED50 7.81 ±0.15 vs distal segments 8.48 ±0.14, P = 0.0006) but was not dependent on size (3 mm segments 8.24 ±0.22 vs 8 mm segments 8.05 ±0.11, P = 0.33) or weight (P = 0.58). HIST sensi tivity, acetylcholine-induced relaxation (endothelium dependent), and sodium nitro prusside-induced relaxation (endothelium independent) were not dependent on segment length, weight, or location. Because significant differences in vasoreactivity exist along the short length of the external jugular vein, vein segment length and location should be rigorously standardized during vasoreactivity experiments. Increased agonist sensitivity from distal to proximal along the length of a vein may provide an additional mechanism for venous return.
Outcome in the Management of Penetrating Venous Injury
Authors: Khaneja Satish C. , Arrillaga Abenamar , Ernst Alfred , Picard Daniel L. , Pizzi Walter F.
Published: November 2007

The authors report on the management of 33 patients with penetrating venous injuries, 25 due to gunshot wounds and 8 due to stab wounds. During the period of this study we treated 35 venous injuries and two patients, both following femoral artery and vein repairs and limb salvage were lost to follow-up and are excluded. Thirty-two had associ ated thoracic, intraabdominal, or arterial injuries. Duplex imaging was performed in 14 patients and venography in 12. They assessed all 27 survivors for postoperative sequelae. Mean follow-up time was twenty months, ranging from three months to three years. Four patients had suprarenal inferior vena cava injuries. All 4 underwent repair and 2 survived. Seven others had infrarenal vena cava injuries. Three of 5 survived following repair and the other 2 survived after caval ligation. Three patients had iliac vein injuries. Two died after repair and 1 survived with ligation. Seventeen patients had injuries of the femoral vein. Thirteen underwent repair, 7 of whom remained patent. Four had ligations performed. There were 2 injuries of the popliteal vein; both were repaired, but neither remained patent. All 19 patients with femoral and popliteal vein injuries survived with limb salvage. Postoperative sequelae (persistent edema, skin discoloration) were observed in 4 failed venous repairs—2 femoral and 2 popliteal.

Ligation of the infrarenal vena cava and iliac veins, as compared with repair, yielded a greater patient salvage rate. There was no increased morbidity with ligation of the femoral veins, which was undertaken only on unstable patients.
Reversal of Acute Ischemic Renal Failure Due to Aortic Stenosis by Axillofemoral Bypass Graft
Authors: Rapoport Micha , Averbukh Zhan , Strauss Simon , Halevy Ariel
Published: November 2007

Acute renal failure was preceded by prolonged bilateral renal ischemia in a fifty-four- year-old woman presenting with suprarenal abdominal aortic stenosis, severe systolic hypertension, and congestive heart failure. An axillofemoral bypass caused retrograde flow in the lower aorta and reestablished the perfusion of the renal arteries and the ischemic kidneys. This resulted in complete and immediate restoration of renal function and blood pressure even though the patient was anuric for four days prior to the procedure.
An Alternative Surgical Approach to the Management of Symptomatic Aberrant Retroesophageal Right Subclavian Artery in Adults (Dysphagia Lusoria)
Authors: Manouguian S.
Published: November 2007

The case of a forty-four-year-old woman with dysphagia lusoria is presented. The aberrant artery was dissected from the esophagus and divided at its aortic origin through a left anterolateral thoracotomy, and the vascular continuity was reestablished with a Dacron graft without translocation of the artery. The mechanisms involved in the produc tion of symptoms and the surgical techniques are reviewed and discussed. The author believes that the procedure advocated here is an alternative surgical approach to the management of dysphagia lusoria.
A Comparison of Dipyridamole Thallium 201 Scintigraphy and Clinical Examination in the Determination of Cardiac Risk Before Arterial Reconstruction
Authors: Madsen Poul Vasehus , Vissing Michael , Munck Ole , Kelbaek Henning
Published: November 2007

Preoperative clinical examination, including a 12-lead resting ECG, and planar dipyridamole thallium imaging (DTI) were compared in a prospective study of 65 vascular surgical patients in regard to their value for predicting postoperative cardiac complications. Fifty-three patients underwent abdominal vascular procedures and 12 were operated on for peripheral artery disease.

Thirty-six patients had ischemic heart disease (IHD) and/or abnormal findings from 12-lead resting ECG. Of these 36 patients, 11 had nonfatal cardiac complications. The remaining 29 patients were free of IHD and had normal results from ECG. No complications occurred among these 29 patients. There was no postoperative death.

Thallium imaging results were abnormal in 45 patients, showing either redistribution and/or scar tissue or low washout. In 18 of these patients major changes with redistribution were present in all projections. Among these patients, 9 had a nonfatal cardiac complication. In the 27 patients with abnormalities in only one or two projections, only 2 had a cardiac event postoperatively. No cardiac complications occurred in patients with normal thallium scintigraphy findings.

The patients were operated on irrespective of the results of the scans, and all recovered from any cardiac complications that occurred.

In vascular surgical patients with previous IHD and/or abnormal findings from resting ECGs further risk stratification is achieved with DTI.
Ultrastructural Analysis of an in Vitro Endothelialized PTFE Graft: Presence of Viable Endothelium Five Months Following Graft Implantation
Authors: Kadletz Margit , Magometschnigg Heinrich , Grabenwöger Martin , Vodrazka Martin , Wolner Ernst
Published: November 2007

A sixty-four-year-old man underwent aortoprofundal reconstruction for occlusive vascular disease. Prior to graft implantation, autologous endothelial cells were harvested and cultivated for twenty-five days and used to seed an 8 mm polytetrafluoroethylene (PTFE) prosthesis in vitro. Following implantation of the seeded prosthesis the patient had an uneventful postoperative course and was discharged from the hospital fourteen days after the procedure.

Five months later, a second surgical procedure was performed for progressive occlusive disease in the femoral artery. At this operation, femoropopliteal reconstruction was performed using autologous saphenous vein. The proximal anastomosis was constructed 5 cm above the distal end of the previously inserted, endothelialized aortoprofundal graft. A piece of the aortoprofundal graft, removed during the second operation, was examined by electron microscopy This revealed complete coating of the inner graft surface with viable endothelial cells.

The authors believe their findings significant, since they could demonstrate adherence of viable endothelial cells on the inner surface of a PTFE prosthesis five months after implantation.
Spontaneous Rupture of the Iliac Vein
Authors: McShannic Joseph R. , Pidala Mark , Fink John
Published: November 2007

Spontaneous rupture of the iliac vein is exceedingly rare. Only 10 cases have previously been reported in the world literature. Review of these cases revealed a female predomi nance (8/10), in their middle ages or elderly Presenting symptoms were acute abdominal pain, abdominal tenderness and fullness, and hypotension. A case report is presented along with a pertinent review of the world literature.
Giant Iliac Venous Aneurysm Caused by Acquired Femoral Arteriovenous Fistula
Authors: Salman Ergun , Ozeren Murat , Mavioglu Ilhan , Yucel Ertan , Yorukoglu Yavuz
Published: November 2007

A case with a saccular iliac venous aneurysm, about 25 cm in diameter, due to a femoral arteriovenous (AV) fistula caused by a stabbing and penetrating injury with forty-one years' duration and an accompanying aneurysmal left iliac artery is reported. The iliac venous aneurysm was pulsatile and diminished by external compression. The diagnosis was made by physical examination and confirmed with angiography, ultrasonography, and computed tomographic scanning. The AV fistula communication was closed, the left iliac aneurysm was repaired, the giant venous aneurysm was resected, and the iliac vein was anastomosed end to end. The follow-up period was nine months. Literature concerning this subject was reviewed.
Spinal Cord Ischemia and Gluteal Skin Necrosis Following Infrarenal Aortic Aneurysm Repair
Authors: Kayabali Murat , Özgür Metin , Dilege Sükrü , Genç Fatih Ata
Published: November 2007

In this report, a case of spinal cord ischemia and gluteal skin necrosis, following infrarenal aortic aneurysm repair is presented. The major etiologic factor precipitating this condition is believed to be the interruption of both internal iliac arteries. To prevent these complications the authors believe that at least one of the internal iliac arteries should be revascularized to prevent microembolism and hypotension.
Age-Related Changes in the Abdominal Aortic Diameter
Authors: Kanaoka Yasushi , Ohgi Shigetsugu , Mori Tohru
Published: November 2007

As yet no clear criteria are available for differentiation of normal from abnormal abdominal aortic diameter in relation to the development of aortic aneurysm. The purpose of this study was to elucidate the age-related changes in the abdominal aortic diameter. A total of 194 individuals (97 men and 97 women) aged twenty years or more with no abnormalities in the abdominal aorta on physical examination were measured by B-mode two-dimensional ultrasonography for the maximum anteroposterior diameter of the abdominal aorta.

Results were as follows:

1. A multiple regression analysis demonstrated that the age, height, and body weight were factors influencing the aortic diameter. The most significant factor among them was the age (the partial correlation coefficient was +0.811, P<0.01), and the next was the height (the partial correlation coefficient was +0.453, P < 0.01) .

2. The relationship between the diameter and the height was evaluated by stratification of the subjects at ten-year intervals. The correlation coefficients showed significant positive correlations observed in all age groups (P< 0.001) .

3. The relationship between the diameter and the age was studied according to the height by dividing the subjects into five height groups. The correlation coefficients showed significant positive correlations observed in all height groups (P < 0.001 ) .
Noninvasive Estimation of the Internal Mammary Artery Bypass Graft Patency
Authors: Ciccone Marco , di Noia Domenico , Corriero Francesco , Federici Antonio , Rizzon Paolo
Published: November 2007

Echo Doppler of the internal mammary artery (IMA) can be considered a good clinical and diagnostic tool in detecting the flow in the IMA bypass graft.

The aim of the present study was to evaluate the reliability of transcutaneous echo- Doppler ultrasonography in the detection of early and long-term pathologies of the IMA bypass graft.

The study was carried out on 161 consecutive patients (127 men and 34 women, mean age fifty-two ±ten years) who had undergone surgical myocardial revascular ization by anastomosis of the left IMA pedicle to the left anterior descending coronary artery. All patients underwent echo-Doppler examination in resting conditions, during forced hyperventilation and Valsalva maneuver four times per year. Supine exercise test was performed annually for five years, and selective angiography of the IMA graft (IMAg) was done when symptoms and/or conventional stress test and/or echo-Doppler examination required it. The results showed that, for anatomic reasons only, in 87% (140 patients), it was possible to study the IMAg. In these patients, 16 stenoses ≥ 40%-99%, 5 occlusions, and 3 intercostal steals were detected. These results, compared with selective angiography, showed high sensitivity, specificity, and accuracy of echo-Doppler of the IMAg.
Reconstruction of the Carotid Artery Following Extracorporeal Membrane Oxygenation (ECMO)
Authors: Armainsson Lars T. , Ilbawi Michel N. , Hernandez-Argudin Gonzalo , Ostrowski Diane , Tubeszewski Katherine , Roberson David A. , Ramilo Jose L. , Sulayman Rabi F.
Published: November 2007

Although ligation of the carotid artery following extracorporeal membrane oxygenation (ECMO) procedures has not been associated with any apparent acute neurologic changes, its long-term sequelae on cerebral function are still unknown. The authors have adopted a policy of repairing all carotid arteries following ECMO. Between April 1990 and June 1993, 34 consecutive patients underwent carotid artery reconstruction. Indications for ECMO were respiratory distress syndrome in 18, meconium aspiration in 8, pneumonia in 6, myocardial failure in 1, and sickle cell anemia in 1. All patients were neonates (ages seventy-two ± sixty-three hours), except 5 (2, three months; 1, two years; and 2, four years old).

Duration of ECMO was (mean ± SD, 156 ± 68 hours). Arterial cannulation was performed after extended mobilization of the carotid artery by using a Biomedicus (8- 10F) cannula. Following decannulation the traumatized segment was resected and the artery repaired by means of multiple interrupted nonabsorbable 7-0 sutures. No heparin was given. There were no complications related to repair.

Follow-up is available on all patients (7.6 ±4.1 months). Detailed neurologic evalu ation and ultrasound and Doppler studies of the carotid artery were performed on all patients at discharge, at two months, at six months, and at one year following ECMO. All carotid arteries were patent with good flow, except one. Transient communicating hydro cephalus developed in 1 patient but responded readily to medical treatment. The rest have normal-for-age neurologic evaluation. The authors' experience suggests that carotid reconstruction following ECMO is feasible, safe, and probably advantageous in the long term. Further follow-up is necessary before this technique can be applied to all infants undergoing ECMO procedure.
Leiomyosarcoma of Right Iliac Artery
Authors: Özkan Hayati , Üstünsoy Haşim
Published: November 2007

A case of arterial leiomyosarcoma, which is encountered rarely, is presented. The case was a sixty-year-old woman. She was admitted with abdominal pain. A tumoral mass of 4 x 4 x 6 cm was determined on the right common iliac artery, by clinical and radiologic examination. The mass was excised along with the bifurcation of the iliac artery. The arterial continuity was provided by interpositioning a vascular graft. At the pathologic investigation, the mass was diagnosed as vascular leiomyosarcoma.
Leiomyosarcoma of the Inferior Vena Cava
Authors: Heijmans J.H. , Smeets H.G.W. , Janevski B.K.
Published: November 2007

A case of primary leiomyosarcoma of the inferior vena cava is presented. In addition, a brief review of clinical signs, radiologic findings, and pathologic subtypes of this rare entity is given.
The Role of Leukotriene B4 in Chronic Venous Insufficiency
Authors: Danese C. , Cifone M.G. , Zavattaro E. , Marcianò F. , Epiceno A.M. , Perego M.A.
Published: November 2007

In this study the authors evaluate polymorphonuclear (PMN) cell activation by measuring the level of leukotriene B4 (LTB4) in patients presenting chronic venous insufficiency. The blood samples were drawn from affected lower limbs and from healthy upper limbs for comparison. One portion of the PMN, obtained from blood samples, was stimulated with calcium ionophore A23187. The results showed an increase of mean LTB4 levels in both districts, particularly in the lower limb, under basal conditions. Following calcium ionophore stimulation, the LTB4 concentrations in the lower limb did not evidence signif icant changes compared with the basal levels, while they increased in the upper district. These results point to the existence of various degrees of leukocyte activation: the highest at the pathologic site, with lower levels at the other sites. Also noted was a variability of the LTB4 levels between the different individuals in the areas examined, owing probably to subjective, genetic expression for LTB4 receptors and other adhesion molecules.
Retrograde Cerebral Perfusion for Aortic Arch Operation
Authors: Yoshimura Naoki , Okada Masayoshi , Ota Toshiaki , Azami Takashi , Nohara Hideaki , Ataka Keiji , Yamashita Chojiro
Published: November 2007

Deep hypothermic retrograde cerebral perfusion (RCP) has recently been the focus of interest as a simple new technique of brain protection during the operation for thoracic aneurysms. During the period from January 1991 to July 1994, 21 consecutive patients underwent operations on the various portions of the thoracic aorta with the use of deep hypothermic RCP. There were 10 men and 11 women, ages ranging from twenty-eight to seventy-eight (mean 61.4) years old. There were 9 cases with true aortic aneurysm, and 12 with dissecting aneurysm. In 8 patients (38.1%) the procedures were done on an emergency basis for ruptured/impending ruptured aneurysms or acute dissecting aneurysms. Four patients died before the adequate assessment of their neurologic function. One patient had a cerebral infarction probably due to dissection of the left common carotid artery. The remaining 16 patients showed clear consciousness and had no serious neuro logic complications postoperatively. Total perfusion time averaged 297 ± 110 minutes (ranging from 162 to 548 minutes). Rectal temperatures were 20.1 ± 1.4°C (ranging from 18.0 to 22.5°C). RCP time averaged 51.3 ± 13.9 minutes (ranging from twenty-seven to eighty minutes). Blood gas analysis of the returned blood sampled from the left common carotid artery or the innominate artery and the ophthalmoscopic findings demonstrated the insufficiency of blood and oxygen supply to the brain during RCP. Therefore, RCP time should be shortened and pharmacologic cerebral protection is recommended to reduce neurologic complications during operations on the thoracic aorta using RCP.
Prevalence of Carotid Kinking and Coiling in a Population at Risk
Authors: Oliviero Ugo , Cocozza Manlio , Picano Tommaso , Policino Salvatore , Russo Nicola , Fazio Serafino , Coto Vincenzo , Saccá Luigi
Published: November 2007

The prevalence of carotid kinking and coiling in patients with hypertension or diabetes was investigated. The authors studied three groups: 130 subjects with hypertension, 105 with diabetes, and 50 normal subjects who were comparable for age, sex distribution, and the presence of other risk factors. Color flow ultrasonography of the extracranial carotid arteries was performed by standard technique. Hard-copy photographs were obtained in three long-axis and three short-axis projections. The prevalence of carotid kinking and coiling was significantly higher in the group of hypertensive patients than in diabetics and normal subjects (14.6% vs 2% and 14.6% vs 4%, respectively; P < 0.01 for both compar isons). The prevalence of carotid kinking was associated with the duration of hyperten sion, whereas it did not show any association with cigarette smoking and serum choles terol levels. A long-term observation of these patients is necessary for determining the natural history of carotid kinking and the potential for modification by adequate antihy pertensive therapy. The results of this study show that a significantly higher prevalence of carotid kinking is present in hypertensive patients in comparison with normal subjects and diabetics and this is correlated with the time of onset of hypertension.
Prospective, Randomized Comparison of Ampicillin/Sulbactam and Cefoxitin for Diabetic Foot Infections
Authors: Erstad Brian L. , McIntyre Kenneth E.
Published: November 2007

The purpose of this prospective, randomized, double-blind investigation was to compare two different parenteral antibiotics (ampicillin/sulbactam and cefoxitin) in conjunction with appropriate surgical procedures for treatment of patients with diabetic foot infec tions on a vascular surgery service. Thirty-six patients with diabetes mellitus who required hospitalization to treat foot infections were randomized into one of two treatment groups. There were 18 patients with similar baseline characteristics random ized to each treatment group. The Chi-square test was used for clinical and bacteriolog ical comparisons, the Wilcoxon rank sum test was used for comparing duration of hospi talization and clinical signs and symptoms, and Fisher's Exact Test (two-tailed) was used to compare treatment outcomes of the two groups. Based on intention-to-treat analysis, there was no significant difference in treatment outcome (cure + improved) between the ampicillin/sulbactam (15/17) and cefoxitin groups (16/17). Similarly, no significant differences in bacteriologic response were noted. Both ampicillin/sulbactam and cefoxitin, when combined with appropriate surgical interventions, are safe and effective therapies for treating foot infections in patients with diabetes mellitus.
Long-Term Prevention of Sequelae of Chronic Venous Disease with Graduated-Compression Stockings
Authors: Hanley Terrance P. , Kiev Jonathan , Rice Janet C. , Kerstein Morris D.
Published: November 2007

Chronic venous insufficiency (CVI) with associated venous hypertension may lead to stasis dermatitis and ulceration. This sixty-month study determined whether compliance with the use of below-the-knee graduated-compression hosiery affected long-term clinical manifestations.

At one year, 105 patients of 284 (37%) were compliant and 179 (63%) were not. At 2 years, of the available compliant patients (89), none had skin changes; 28% of the available (51) noncompliant patients had skin changes; and 13 of this group (51) had ulceration. At sixty months, of 79 compliant patients available, none had ulceration and 11 had stasis changes. Of noncompliant patients (119) available for assessment, 63 (53%) have chronic skin changes.

Compliance with the use of gradient compression below-the-knee stockings reduces the incidence of venous stasis disease and ulceration.
Laparotomy for Presumed Ruptured Abdominal Aortic Aneurysm: Outcome of Deceptive Emergencies
Authors: Melin Matthew M. , Gloviczki Peter , Cherry Kenneth J. , Bower Thomas C. , Hallett John W. , Baerga Yvonne , Zietlow Scott P. , Stanson Anthony W.
Published: November 2007

Medical and surgical emergencies occasionally present as ruptured abdominal aortic aneurysms (RAAA). To assess benefits of laparotomies and adverse effects of unnecessary operations, the authors reviewed their experience.

Thirteen patients, 9 women, 4 men (mean age: 72 years, range: 41-85) underwent emergency laparotomy between 1988 and 1996 for presumed RAAA and were found to have other surgical or medical emergencies.

All the patients presented with hypotension, 12 had abdominal or back pain, four had pulsatile abdominal mass. Rupture was not excluded by computed tomography scan in three or by ultrasonography in two patients. Laparotomy disclosed intact abdominal aorta in all, but seven patients had abdominal aortic aneurysm. Of five surgical emergencies, laparotomy was indicated in four: three for ruptured visceral artery aneurysms, one for perforated duodenal ulcer. The fifth patient required thoracotomy for ruptured thoracic aneurysm. Four of eight medical emergencies were myocardial infarctions. One iatro genic complication required reoperation for bleeding. Mean hospital stay was 18 days; mean hospital charges were $40,771. Seven (54%) early deaths occurred; none were caused directly by the operation.

Laparotomy was indicated in one third of deceptive emergencies that present as RAAA. Although mortality, morbidity, and costs were high, iatrogenic surgical complica tions were rare and deaths were not caused by unnecessary operations.
Redo Bilateral Renal Bypass After 19 Years: Long-Term Management of Fibromuscular Dysplasia
Authors: Lalka Stephen G.
Published: November 2007

Acute bilateral renal artery occlusion with prolonged anuria carries a poor prognosis for renal salvage that may prompt insufficiently aggressive management. This case report describes successful redo bilateral renal bypass 19 years after revascularization for fibromuscular dysplasia. The role of the renal collateral network in kidney salvage is discussed as is a life-long, aggressive, physiologic, and anatomic postoperative surveil lance program.
How Essential Is the Intensive Care Unit After Carotid Endarterectomy?
Authors: Collier Paul E.
Published: November 2007

This study was designed to determine whether a short recovery room stay could safely and accurately predict which patients required the Intensive Care Unit (ICU) after carotid endarterectomy (CEA).

After review of the records of all patients who underwent CEA at the author's insti tution between 1988 and 1990, a set of criteria was developed for selecting which patients required the ICU postoperatively. These indications included postoperative neurologic changes, cardiac irritability or ischemia, prolonged need for vasoactive medication, and wound hematomas that might compromise the patient's airway.

Between January 1, 1991 and June 30, 1996, 342 CEAs were performed at the author's institution. Forty-two (12%) patients required the ICU postoperatively; 23 had unstable blood pressure, seven had cardiac problems, 10 had neurologic problems (7 permanent, 3 transient), and three had neck hematomas. One patient originally in the ICU for hypertension was transferred back after developing an intracerebral hemorrhage on postoperative day 2, and one patient was transferred into the ICU for unstable blood pressure that developed on the vascular floor. Preoperative risk factors, indications for operation, and anesthetic technique did not predict which patients would need the ICU. Two patients died within 30 days. There were no readmissions after discharge.

Selection of patients for ICU admission after CEA can be safely and accurately deter mined during a 3-hour stay in the recovery room postoperatively. This selection results in efficient use of ICU resources and tremendous cost savings. By adherence to the protocol, 88% of patients did not need ICU after CEA.
Office Removal of Silastic Catheters and Ports is Safe and Cost Effective
Authors: Collier Paul E.
Published: November 2007

Dual-lumen Silastic catheters and ports are being increasingly implanted for long-term infusion of medications and hyperalimentation and for dialysis. These have traditionally been removed in the operating room. The purpose of this study was to determine whether these catheters and ports could be removed safely in the surgeon's office.

The records of all 42 patients who had their catheters and ports removed in the operating room in 1991 were reviewed. No episodes of pulmonary or air embolism, bleeding problems, infections, or returns to the Emergency Department after removal were reported. One seroma developed in a port site after removal. No reason could be found for not doing these procedures in the surgeon's office. Between January 1, 1992 and July 31, 1996, 169 catheters were removed in the office. Forty-nine ports were removed in the office and 12 were removed in an outpatient surgery center by one surgeon who did not feel comfortable doing this procedure in the office.

No patients suffered any embolic or bleeding complications, and none returned to the office or Emergency Department for problems. One patient developed a persistent draining sinus after removal of a contaminated catheter. Surgical charges were $273 for removal in the office or operating room. Charges for use of the surgery center were $1,000.

Office removal of Silastic catheters and ports is extremely safe and cost efficient. This method results in convenience for the patient and saves time for the surgeon.
Guidewire Dislodgment of Inferior Vena Cava Filters During Insertion of Central Venous Catheters
Authors: Kang Steven S. , Borge Marc A. , Mansour M. Ashraf , Labropoulos Nicos , Baker William H.
Published: November 2007

The authors report two cases of titanium Greenfield filters dislodged by guidewires during the insertion of central venous catheters. Both were trauma victims who had the venous catheters inserted into femoral veins several days after correct placement of the inferior vena cava filters. A literature review found nine others cases of guidewire dislodg ment of vena cava filters. Eight Vena-Tech filters and one titanium Greenfield filter had been in place for up to 2 months. The guidewires were inserted into femoral, subclavian, internal jugular, or axillary veins. Filters were dislodged cephalad into the atrium, brachiocephalic, and subclavian veins, or caudad into the distal inferior vena cava. Limiting the distance that a guidewire is inserted into a vein during central line insertion is the easiest way to avoid this complication. Inserting the straight end of the guidewire would also be effective.
Investigation of Laboratory Parameters in Primary Raynaud's Phenomenon: Their Changes and Clinical Significance
Authors: Dalamanga Androniki , Dimakakos Panos , Kostoglou-Papalambrou Maria , Papageorgiou Anthony , Davea-Mela Filanthi , Rizos Demetrios
Published: November 2007

Results were as follows: 77 (62%) patients had cryofibrinogen in their blood plasma, 50 (40%) patients had precipitation of cryoglobulins, and 65 (52%) patients had an increase of α2 globulin in the serum electrophoresis. Of the immunoglobulins, IgM was found increased in 42 patients (34%). Of the clotting time inhibitors, antithrombin III (AT III) had a lower activity in 50 (40%) patients as compared with that of normal subjects. Protein C, protein S, and α1 antitrypsin levels were lower in 21 (16.8%), 13 (10.4%), and 10 (8%) of patients, respectively.

Statistical analysis of the results showed that all the protein fractions except for γ-globulin presented a statistically significant difference as compared with those of the controls (P < 0.0001). Immunoglobulins IgG and IgA of the patients were significantly lower than those of the normal controls (P < 0.001). The C3 and C4 factors of the complement presented statistically significant lower values (P < 0.001 and P < 0.0001 respectively). Finally, AT III appeared in lower values than those of the normal controls, being statistically significant (P < 0.0001).

These results suggest that patients with primary Raynaud's phenomenon present changes in the levels of certain hematologic parameters, a fact that is probably connected with etiology. Thus further study and assessment might contribute to the diagnosis, discovery of the subjective systemic etiology, and better therapeutic management of Raynaud's phenomenon.
Failed Vascular Reconstructive Procedures with Profoundly Ischemic Limbs—Treated by Lumbar Sympathectomy
Authors: Polsky Stuart , Heller Lloyd , Gahtan Vivian , Roberts Andrew , Sariego Joaquin , Matsumoto Teruo , Kerstein Morris D.
Published: November 2007

The purpose of this study was to assess the impact of lumbar sympathectomy on limb loss in patients with prior reconstructive vascular surgery. One hundred and one patients underwent 118 lumbar sympathectomies.

The 118 limbs were grouped presympathectomy into: rest pain (41), tissue breakdown (55), and gangrene (22). All vascular procedures were femoral-popliteal or femoral-distal bypass. No change in segmental Doppler pressures occurred after lumbar sympathectomy.

Sixty-nine of 118 (58%) limbs underwent amputation following sympathectomy, a mean of two (range: one to twenty-two) months following the procedure. Of those limbs with an amputation (69/118), 14/69 (20%) had one reconstructive procedure, 41/69 (60%) had two reconstructive procedures, and 14/69 (20%) had three reconstructive procedures. Of those without an amputation (49/118 limbs), 27 had one vascular recon structive procedure, 9 had two reconstructive procedures, and 3 had three reconstructive procedures before sympathectomy. (continued on next page)

Of the patients with diabetes (47), 44/47 (94%) underwent amputation, 35/44 (80%) with below-the-knee and 9/44 (20%) with above-the-knee amputation. Limb loss (69 limbs) by category was: rest pain, 21/41 (51%); nonhealing ulcers, 38/55 (69%); and gangrene, 10/12 (83%).

Lumbar sympathectomy may be a useful procedure in very selected patients; diabetic patients who undergo reconstructive vascular surgery are not good candidates. Segmental Doppler pressures do not help predict successful or improved outcome following lumbar sympathectomy.
Comparison of Saphenous Veins Removed for Primary Venous Insufficiency with Cadaver Saphenous Veins
Authors: Ortega Francisco , Mompeo Blanca , Sarmiento Lourdes , Centol Aurelia , Saavedra Pedro , Bergan John J.
Published: November 2007

The purpose of this study was to determine the location of valves and to assess valve abnormalities in veins removed for treatment of primary venous insufficiency and cadaver saphenous veins. Twenty-nine saphenous veins from lower extremities of adult cadavers and 39 greater saphenous veins obtained from patients undergoing surgery for primary venous insufficiency were examined. Extremities were chosen from cadavers with no signs of chronic venous insufficiency. All greater saphenous veins from patients were demonstrated to have reflux throughout the length of the greater saphenous vein from ankle to groin.

The total number of valves in surgically removed saphenous veins and those in cadavers was similar—cadaver 8.82 ± 1.31, varicose 8.79 ± 1.67. Varicose saphenous veins had more abnormal valves (2.56 ±1.23 vs 1.51 ±1.18) and the cadaver saphenous veins had more well-preserved valves above the knee (4.45 ±1.27 vs 3.00 ±1.41).

Varicose saphenous veins demonstrate fewer valves in total and more damaged veins in the above-knee segment than a comparable group of cadaver saphenous veins. The cadaver saphenous veins and varicose saphenous veins below the knee are similar with regard to total number of valves and total number of damaged valves.
Histologic Evidence Suggesting That the Right Gastroepiploic Artery is Less Suitable and Less Long Lasting Than the Internal Mammary if Used as a Bypass Conduit
Authors: Ferro Maurizio , Forni Marco , Crivello Roberta , Palladin Daniela , Conti Maggiorino , Palestro Giorgio
Published: November 2007

This study compares the thicknesses of the intima and media and their ratio in the right gastroepiploic (GEA), internal mammary (IMA), left coronary (LCA), and renal (RA) arteries as part of a histologic study of the structure of these vessels at necropsy in 11 newborns aged twenty-one ±22.6 days.

No significant differences were found between the LCA and the other arteries, apart from its media thickness and that of the IMA (P = 0.023). The media was thinnest in the IMA, thickest in the LCA. The values for the GEA were much the same as those for the LCA. The particular structure of the IMA compared with the LCA and GEA, evident in the newborn, explains its resistance to atherosclerotic deposition. The fact that the structure of the GEA is similar to that of the LCA indicates that its resistance to atherosclerosis will be less than that of the IMA when used as a bypass conduit.
Generation of Reactive Oxygen Metabolites by the Layers of Vascular Polyester Grafts
Authors: Glowinski Jerzy , Glowinski Stanislaw , Farbiszewski Ryszard , Chwiecko Marek
Published: November 2007

The continuous exposure to blood components, including pro-oxidants, makes the blood vessel wall susceptible to oxidative stress and free-radical-mediated reactions.The aim of this study was to determine the ability of reactive oxygen metabolite generation, expressed by the content of malonaldehyde (MDA) and 4-hydroxyalkenals in principal layers of polyester grafts during 12 months' observation.

The experiments were carried out on 24 mongrel dogs, in which polyester grafts were implanted into abdominal aorta. Seven days and 1, 4, and 12 months after the operation the grafts were excised. The MDA and 4-OH-alkenal concentrations were determined by the LPO-586 method (Bioxytech, France).

It was found that the MDA concentration in the graft neointima was much higher than in the aorta in the early phase after the operation (P<0.01). With the passage of time this concentration decreased and after 4 months was similar to the values of the normal aorta. On the other hand the MDA concentration in the neomedia and neoad ventitia was much higher than in their aorta counterparts and became even higher in later periods (P<0.01). (continued on next page)

The investigations indicate that the generation of large amounts of lipid peroxides in graft neointima occurs only in the early postoperative period. However, intensive lipid peroxidation in neomedia and neoadventitia was observed throughout the whole exper iment. These changes can suggest that the reactive oxygen metabolites in graft principal layers are generated by neutrophils, while endothelial cells are of less importance.