bluuebunny/crossref_metadata_2025 huggingface dataset:
CryoPlasty Therapy of the Superficial Femoral and Popliteal Arteries: A Single Center Experience
Authors: Samson Russell H. , Showalter David P. , Lepore Michael R. , Ames Scott
Published: June 2007

Long-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral and popliteal arteries. New technologies designed to address the sources of restenosis have recently been introduced. CryoPlasty therapy (Boston Scientific, Natick, Mass) is a new approach designed to significantly reduce injury, elastic recoil, stent implantation, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty with cold thermal energy applied to the plaque and vessel wall. The cumulative effect of limiting the sources of restenosis with CryoPlasty therapy was shown to demonstrate longer term patency in a prospective, multicenter, Investigational Device Exemption study of the PolarCath Peripheral Dilatation System. The CryoPlasty therapy experience of 1 center is reported, in which 47 lesions in 32 consecutive patients (34 procedures, 33 limbs) were treated. The technical success rate was 96%. There were no type 3 flow-limiting dissections, and only 4 (8.5%) lesions were stented. There were no unanticipated adverse events, specifically no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. With an average follow-up of 12 months, only 5 lesions have recurred, 4 requiring re-intervention. The 12-month freedom from restenosis for lesions and limbs treated was 82.2% and 84.4%, respectively. These results are similar to the findings of the Investigational Device Exemption study and are encouraging. CryoPlasty therapy appears to be a viable endovascular therapeutic option to achieve longer term patency without compromising options for future interventions. The lack of early occlusions may be due to a low rate of spiral dissection that may be a particular benefit of this form of angioplasty.
A Multidisciplinary Approach to Carotid Paragangliomas
Authors: Kasper Gregory C. , Welling Richard E. , Wladis Alan R. , Cajacob Daniel E. , Grisham Andre D. , Tomsick Thomas A. , Gluckman Jack L. , Muck Patrick E.
Published: June 2007

The surgical management of carotid paragangliomas can be problematic. A multidisciplinary approach was used to include vascular surgery, otolaryngology, and neuroradiology to treat these patients over 9 years. From January 1992 to July 2001, a multidisciplinary team evaluated patients with carotid paragangliomas. Analyzed patient data included age, gender, diagnostic evaluation, tumor size, preoperative tumor embolization, operative exposure, need for extracranial arterial sacrifice/reconstruction, postoperative morbidity including cranial nerve dysfunction, and long-term follow-up. Twenty-five carotid paragangliomas in 20 patients underwent multidisciplinary evaluation and management. Average age was 51 years (range, 28-83 years), and 52% were male. Diagnostic evaluation included computed tomography in 76%, magnetic resonance imaging/magnetic resonance angiography in 52%, catheter angiography in 60%, and duplex ultrasonography in 16%. An extended neck exposure was required in 11 cases (44%), mandibulotomy was used once (4%), and mandibular subluxation was never required. The external carotid artery (ECA) was sacrificed in 8 cases (32%). The carotid bifurcation was resected in 1 patient (4%) requiring interposition reconstruction of the internal carotid artery. Preoperative tumor embolization was performed for 13 tumors (52%). Operative blood loss for patients undergoing preoperative embolization (Group I) was comparable to the nonembolized group (group II): group I lost 365 +/-180 mL versus 360 +/- 101 mL for group II (P = .48). This occurred despite larger tumors (group I - 4.2 cm versus group II - 2.1 cm, P = .03) and a higher mean Shamblin class (group I - 2.5 versus group II - 1.45, P = .001) for group I. There were no perioperative mortalities. Transient cranial nerve dysfunction occurred in 13 CBTs (52%), 2 (8%) of which remained present after 4 months. Patients with carotid paragangliomas benefit from a multidisciplinary team approach. Neuroradiology has been used for selective preoperative embolization, which has decreased estimated blood loss during excision of larger complex tumors. A combined surgical team of otolaryngology and vascular surgery provides for exposure of the distal internal carotid artery as high as the skull base, limited permanent cranial nerve dysfunction, and selective early division and excision of the external carotid artery for complete tumor resection.
Left Renal Vein Reconstruction After Right Nephrectomy and Inadvertent Left Renal Vein Ligation: A Case Report and Review of the Literature
Authors: Powell Anathea C. , Plitas George , Muhs Bart E. , Stifelman Michael , Maldonado Thomas S.
Published: June 2007

Left renal vein ligation has been used as a technical aid to gain exposure to the perirenal aorta and to control bleeding in abdominal aortic operations. Left renal vein ligation is considered to be well tolerated in patients with 2 functioning kidneys, but has rarely been described in the setting of concomitant right nephrectomy and presents a management challenge. Some reports suggest recovery of renal function may be possible after left renal vein ligation during right nephrectomy, but other suggest that a delay in revascularizing the left renal venous drainage may result in irreversible nephropathy. This article reports the inadvertent division of the left renal vein during right nephrectomy. Renal failure ensued postoperatively. The left renal vein was reconstructed, and renal function was recovered. The inability to reliably predict which patients will have adverse outcome after left renal vein ligation in the setting of a right nephrectomy may necessitate preemptive intervention.
Posterior Tibial Artery Aneurysm
Authors: Danes Stratton G. , Drezner A. David , Tamim Patrick M.
Published: June 2007

Aneurysms of tibial vessels are extremely rare. The majority are pseudoaneurysms caused by trauma. Those that are true aneurysms have been associated with an inflammatory process or were mycotic in origin. We are reporting on a patient with a true posterior tibial artery aneurysm without any causative history. The aneurysm was repaired by resection and interposition of a reversed saphenous vein segment.
Endovascular Repair of a Symptomatic Subclavian Artery Aneurysm in a Patient With Marfan Syndrome: A Case Report
Authors: Tassiopoulos Apostolos K. , Nadalin Betania A. , Labropoulos Nicos , Egofske Peter , Keen Richard R.
Published: June 2007

Endovascular techniques are being employed with increasing frequency in the management of peripheral arterial aneurysms. A 57-year-old patient with Marfan syndrome presented with a symptomatic 5 cm left subclavian artery aneurysm. He underwent successful endovascular exclusion of the aneurysm with immediate improvement of his symptoms. Duplex ultrasound 3 months after the procedure confirmed a patent graft and complete exclusion of the aneurysm.
Endovascular Exclusion of Popliteal Artery Aneurysms With Expanded Polytetrafluoroethylene Stent-Grafts: Early Results
Authors: Rajasinghe Hiranya A. , Tzilinis Argyrios , Keller Theresa , Schafer Jeff , Urrea Sandra
Published: June 2007

There is increasing interest in using endovascular methods instead of surgical reconstruction to treat popliteal artery aneurysms. Exclusive use of the Viabahn stentgraft, a nitinol stent covered with expanded polytetrafluoroethylene, was assessed in the treatment of patients who presented with popliteal artery aneurysms in the absence of acute limb ischemia. Technical success, endoleaks, graft patency, freedom from amputation, and aneurysm sac flow and size changes were assessed by duplex ultrasound. From June 2004 to March 2006, 16 men (mean age, 76 years; range, 65-83) underwent endovascular exclusion of 23 popliteal artery aneurysms (mean diameter, 2.5 cm; range, 1.3-6.7 cm). Nine lesions had partial thrombus on preprocedural duplex imaging. Nineteen of the 23 limbs treated had at least 2-vessel tibial artery runoff. Procedures were performed under local anesthesia using ipsilateral percutaneous antegrade arterial access. All patients received 75 mg/day of clopidogrel afterward. Follow-up assessments included direct clinical examinations and duplex ultrasonography performed 1, 3, 6, and 12 months after the procedure. Primary patency and amputation-free survival were calculated using Kaplan-Meier analysis. Complete aneurysm exclusion (technical success) was achieved in all cases. During the mean follow-up of 7 months (range, 1-21 months), 22 of 23 treated limbs remained asymptomatic. One stent-graft thrombosis occurred 6 months after the procedure and was successfully treated with percutaneous mechanical thrombectomy, balloon angioplasty of a stent-graft stenosis, and insertion of an uncovered nitinol stent. No popliteal artery aneurysm sac size enlargements or endoleaks were detected. At 12 months, the treated limb mean anklebrachial index was 1.0 (range, 0.82-1.31) and the primary and secondary patency rates were 93% and 100%, respectively. Early results with Viabahn endovascular stent-graft exclusion of asymptomatic popliteal artery aneurysms are promising. Patient selection for endovascular repair depends on suitable popliteal artery anatomy, extent of aneurysmal degeneration, and quality of tibial arterial runoff.
Benefits of a Supervised Exercise Program After Lower Limb Bypass Surgery
Authors: Badger Stephen A. , Soong Chee V. , O’Donnell Mark E. , Boreham Colm A.G. , McGuigan Kathy E.
Published: June 2007

This study evaluated the efficacy of an exercise program after arterial bypass surgery. Patients undergoing bypass surgery were randomized to a control group (group I), with standard preoperative and postoperative care, or the intervention group (group II) with a supervised exercise program of twice-weekly treadmill assessments from 4 to 10 weeks postoperatively. Ankle-brachial pressure indices and hemodynamic measurements were recorded before and after exercise. The mean increase of maximum walking distance was 3.8% in group I and 175.4% in group II ( P = .001). There was a significant difference between group I and II in the mean ankle-brachial pressure indices increase at the second assessment (0.08 versus 0.23; P = .02). A supervised exercise program leads to better improvement after lower limb bypass surgery for ischemia, but the feasibility of a formal exercise program would be undermined by the reluctance of patients to participate, both in the short-term and long-term.
Elevated Lipoprotein (a) in Carotid Artery Atherosclerosis is Unrelated to Restenosis After Endarterectomy
Authors: Stinson John , D'Arcy Glenn , Cooke Thomas , Colgan Mary Paula , Hall Mary , Tyrrell Janette , Gaffney Karl , Grouden Maria , Moore Dermot , Shanik Donald Gregor , Feely John
Published: June 2007

To investigate whether lipoprotein (a) (Lp[a]) is a risk factor for the development of carotid artery atheroma and restenosis after endarterectomy, 100 consecutive patients who had undergone endarterectomy were studied with repeat carotid Doppler ultrasonic scans to assess restenosis. The authors recorded history of vascular disease, medications, and smoking habits. Fasting samples were analyzed for serum total cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein Al and B, urate, glucose, and Lp(a). Carotid artery stenosis was associated with higher levels of Lp(a) (390 ±40 vs 142 ±30 mg/L for controls, mean ±EM, P < 0.05), and concentrations were 45% higher (P < 0.05) in the 39 patients who had concomitant peripheral vascular disease. During follow-up (twenty-four to one hundred sixty-eight months) 23% of patients restenosed and the median time to restenosis was one hundred ten months. Cigarette smoking, hypertension, and previous myocardial infarction were weakly associated (P=0.1) with restenosis, but no association was found between Lp(a) levels and restenosis after endarterectomy.
Microcirculatory Effects of Iloprost in Patients with Suspected Secondary Raynaud Phenomenon
Authors: Arpaia Guido , Cimminiello Claudio , Sardina Marco , Rossi Florica , Aloisio Manuela , Curri Sergio B. , Bonfardeci Giuseppe
Published: June 2007

Background: The clinical efficacy of iloprost, a stable analogue of prostacyclin, in patients with Raynaud's phenomenon (RP) has been widely reported. However, its mechanism of action is still unclear, and also unknown is why the benefit lasts for many weeks after therapy is discontinued.

The aim of the present study was to learn what kind of microcirculatory changes occur in the skin of the affected hand one month after the end of iloprost treatment in patients with RP.

Patients and Methods: Eleven subjects (8 women, 3 men, mean age forty-four years) with RP suspected to be secondary to a collagen disease entered the study and were infused with iloprost up to 2.0 ng/kg/minute for six hours on five consecutive days. At baseline and one month after treatment discontinuation, laser Doppler flowmetry, thermography, and computer-assisted video capillaroscopy of the affected hand were performed.

Results: At the end of follow-up, the mean capillary density as recorded by video capillaroscopy was significantly increased as was the skin temperature in the different areas (fingertip, nailbed, tenar, hypotenar). In contrast, laser Doppler flowmetry revealed no significant changes after therapy.

Comment: The improvement of vascularization of the skin and, therefore, the decrease in avascular areas in patients with RP suspected to be secondary to a connective tissue disease appear to be associated with enhancement of nutritional flow. Rather than rely on an angiogenetic effect of iloprost, these modifications may be related to the drug-induced normalization of the described dysfunctional arteriolar-venular anastomoses in the skin of RP patients through redistribution of flow.
Microcirculatory Characteristics in Patients with Buerger's Disease
Authors: Nishikimi Naomichi , Sakurai Tsunehisa , Shionoya Shigehiko , Oshima Motoo
Published: June 2007

The most characteristic pathophysiologic change in Buerger's disease or thromboangiitis obliterans (TAO) is considered the breakdown of microcirculation in the extremity, but this has not yet been proven. The purpose of this study is to examine the damage of microcirculation in TAO objectively, by means of intra-arterial injection of two kinds of radioisotope. In 7 TAO and 4 infrainguinal arteriosclerosis obliterans (ASO) patients, thallium 201 chloride (201TI) and 99mTc macroaggregated human serum albumin (99mTc-MAA) were administered through bilateral common femoral artery injections. In the planar image of the foot, rectangular regions of interest (ROIs) were placed on the foot muscles and toes. Normalized counts of 99mTc-MAA in each ROI were divided by that of 201TI, and the result was defined as the microcirculation damage index, based on their different kinetics. The damage index of the foot muscle was not different between ASO and TAO, but that of the toe was lower in TAO than ASO patients. Lumbar sympathectomy was performed in 5 TAO patients, but it did not improve the damage index. It is concluded that there is breakdown of the microvascular defense system from the beginning of the disease, and critical ischemia make the regional cell function deteriorate as if a precursor to a trophic lesion. Lumbar sympathectomy did not immediately improve microcirculation.
Treatment of “Trash-Hand” Following Intraarterial Injection of Drugs in Addicts
Authors: Borrero E.
Published: June 2007

As intravenous drug abusers grow older, they develop a paucity of superficial veins for access, which compels them to guess at the location of deeper veins for access. On occasion, the drug is injected into an artery, resulting in limb-threatening ischemia.

Five patients (3 men/2 women) with an average age of 35.6 years (range twenty-eight to forty-three years) who inadvertently injected illicit drugs into an upper extremity artery developed a “trash-hand.” The injected drugs include crushed meperidine (2), crushed codeine (2), and crushed haloperidol (1). The patients initially treated with heparin alone (2) or dextran-40 alone (1) had progressive ischemia resulting in amputation of their hand. Patients initially treated with a combination of heparin and dextran-40 had limb salvage.

This small group of patients demonstrates that the combination of heparin and dextran-40 may be advantageous for treatment of patients with “trash-hand.”
Thermal Laser Angioplasty of the Lower Extremities: Comparison of Early and Late Experience
Authors: Bowles M. H. , Smith J. A. M. , Downing G. C. , Galichia J. P.
Published: June 2007

Thermal laser angioplasty (TLA) experience of 59 hospital cases in 1988 (Group A) was compared with 113 outpatient cases treated from March 1989 to September 1991 (Group B). Angiographic success was higher in Group B (66.4%) as compared with Group A (55.9%). Complications of major dissection, perforation, and local thrombus were similar. Distal emboli (P=0.04), retroperitoneal hematomas (P=0.02), and urokinase administration (P=0.03) were more prevalent in Group A. At follow-up (six to thirty-six months), 57% of Group B patients were symptom free but only 36 of Group A were. Symptomatic improvement, despite recurrence of intermittent claudication (IC), was present in 21% of group A and 6% of Group B subjects. Though unpredictable, the mean ankle/arm indices were found in the following clinical categories: 100% reocclusion by angiography, 0.46; IC same as before TLA, 0.56; IC with mild-marked improvement, 0.70%; asymptomatic, 0.94. Average length of lesion-Group A, 10.5 cm versus Group B, 17 cm.

This review does show improved primary success rates with further operator experiences despite tackling of more difficult lesions. The reduction in complications is related to the decreased use of urokinase and the availability of trained support personnel.
Differences Between Acute Nontraumatic Upper and Lower Extremity Ischemia
Authors: Kuukasjärvi Pekka , Salenius Juha-P , Pentti Jussi ,   Finnvasc study group
Published: June 2007

The aim of this study was to analyze the differences in natural perioperative history and risk factors in patients with acute upper and lower extremity ischemia. According to the national vascular registry (FINNVASC) for the period January 1991-November 1992, 599 patients were treated in Finland for acute extremity ischemia. Ninety (15%) patients were treated for acute upper limb ischemia and 509 (85%) for acute lower limb ischemia. Upper extremity ischemia was more common in women (P < 0.05). Patients with acute upper limb ischemia were older, 77.1 versus 73.2 years (P < 0.001). The embolus/thrombosis ratio in patients with acute upper extremity ischemia was 90/10% as against 62.5/37.5% in patients with acute lower extremity ischemia (P < 0.001). Smoking was more common in patients with acute lower extremity ischemia (P < 0.05). No other difference was noted in risk factors between the upper and lower extremity groups. No amputation of an upper limb was done. Mortality after acute upper extremity ischemia was 5.6% and after acute lower extremity ischemia 12.8% (P=0.07). The authors conclude that acute upper limb ischemia was most often caused by embolism and these patients were more often older and women as compared with patients with acute lower limb ischemia. Upper limb ischemia was also more common in the right upper limb. No upper limb amputation was done; however, mortality among these patients was not significantly lower.
The “Substitute Valve” Operation in China
Authors: Zhang Pei-Hua , Jian Mi-Er , Lu Min , Huang Xin-Tian
Published: June 2007

This is a report on 1216 patients (1353 lower limbs) from 24 hospitals in China who were operated on by formation of a “substitute valve.” Reflux of the deep venous system in lower limbs is the indication for this operation. Most of the diseased limbs had primary valvular incompetence of the deep venous system. After a long follow-up, it was found that good postoperative results were obtained and the operation may become widely popular because of its easy performance. In particular it is the operation of first choice for treating lower limbs with severe reflux of the deep veins. Through experimental and clinical study, progress has been gained in creating substitutes of the muscular loop with autogenous materials.
DeBakey-Type IlIb Aortic Dissection with Multiple Aneurysmal Changes of the Peripheral Arteries
Authors: Kawahito Koji , Adachi Hideo , Ino Takashi , Ide Hirofumi , Mizuhara Akihiro , Yamaguchi Atsushi
Published: June 2007

A forty-four-year-old woman presented with a DeBakey-type IlIb dissecting aneurysm, multiple aneurysmal dilatation of the coronary arteries, and a “string-of-beads” appearance of the peripheral arteries (due to cystic medial necrosis and intimal hyperplasia). Upon assessment of her family history and multiple vascular involvement secondary to cystic medial necrosis, an incomplete Marfan's syndrome was suggested. This rare case of multiple aneurysmal changes to the great and peripheral arteries is presented with special reference to the radiographic and morphologic manifestations.
Superior Mesenteric Artery Syndrome Complicated by Pancreatitis
Authors: Bermanski Paul , Golden Richard L. , Ricca Richard J.
Published: June 2007

The threefold purpose of this study is to review the history of the existence and diagnosis of superior mesenteric artery (SMA) syndrome, to add to the weight of evidence of such a syndrome, and to describe the unusual complication of pancreatitis in SMA syndrome. The authors' methods include the review of historical and current literature and a case presentation.

Their patient, who presented with small bowel obstruction after profound weight loss, was evaluated. She was found to have cutoff of the third portion of the duodenum by the superior mesenteric artery. This was complicated by an elevated amylase level. After conservative treatment to restore her weight with enteral and parenteral nutrition was unsuccessful, the authors opted for surgical repair to correct the obstruction. This was successful.

They conclude that SMA syndrome is a real entity. It may be complicated by pancreatitis. Surgical correction may be needed and can be successful in restoring bowel function.
Left Ventricular Endoaneurysmorrhaphy
Authors: Olearchyk Andrew S. , Shariff Haji M.
Published: June 2007

Left ventricular endoaneurysmorrhaphy (LVEA) by internal (synthetic) patch and external (wrapped aneurysmal wall) repair reduces the size of the left ventricle (LV) with preservation of a natural geometry, stabilizes a normal myocardium during systole, and prevents diastolic overdistention. The wrapped aneurysmal wall may contribute to systolic augmentation if it contains some muscular tissue and if it is revascularized. LVEA is warranted for LV aneurysms caused by infarction of more than one coronary artery and involving more than one segment of the LV.
Cardioprotective Effects of Phosphocreatine in Vascular Surgery
Authors: Mastroroberto Pasquale , Chello Massimo , Zofrea Saverio , Bevacqua Egidio , Marchese Antonietta R.
Published: June 2007

The pharmacologic use of phosphocreatine (Pcr) in cardiology and cardiac surgery, along with other so-called metabolic drugs, to prevent the ultrastructural and clinical effects of ischemia on the myocardium has been the aim of many studies during recent years.

To evaluate the protective action of Pcr in a series of surgical vascular patients with an associated heart disease, the authors have included in this study 62 patients undergoing vascular operations and have randomly divided them into a Pcr-treated group and a control group.

The cardiac index (L x min-1 x m-2), the use of inotropic drugs (number of patients), the EKG alterations (ST ≥ 2 mm, arrhythmias) with a Holter registration, and the measurement of ejection fraction by 2D-Echo Doppler analysis were examined.

A statistically significant improvement in the central hemodynamics during the immediate postoperative course was observed in the Pcr group, preserving a good left ventricular function and preventing severe arrhythmias. The results revealed that the use of Pcr induced a more efficacious protection of the myocardium with an improved functional recovery, a positive inotropic effect, and an antiarrhythmic action. Nevertheless there is need for further studies to demonstrate the real benefit of using Pcr for myocardial protection in vascular surgery.
Transcutaneous Oxygen and Carbon Dioxide Measurement in Peripheral Vascular Disease
Authors: Melillo Elio , Catapano Giosue' , Dell'Omo Giulia , Iabichella Letizia , Berchiolli Raffaella , Ferrari Mauro , Pedrinelli Roberto
Published: June 2007

Combined transcutaneous oxygen tension (tcPO2) and transcutaneous carbon dioxide tension (tcPCo2) measurements were carried out at both the subclavicular and metatarsal level in 29 controls and 100 patients with peripheral arterial obstructive disease (PAOD) (intermittent claudication: n = 40, critical limb ischemia: n = 60). Interindividual variation coefficients of arterial and subclavicular tcPCO2 (n = 94 subjects) were superimposable, while tcPo2 variability was twice the arterial value. Furthermore, arterial tensions were better predicted by tcPCO2 than by tcPO2 measurement. In the 75 limbs with an ABI < 0.9 of patients with intermittent claudication, tcPCO2 did not differ significantly from controls (n = 58 limbs), but it was elevated in those with critical limb ischemia (n = 74 limbs), although control and pathological values overlapped widely even in this latter group. At variance with tcPCO2, tcPQ2 was lower in intermittent claudication than in controls, and undetectable in most of the symptomatic limbs with critical ischemia, irrespective of concomitant diabetes. In the overall sample (n = 255 limbs), tcPCO2 did not show significant changes for tcPo2 values ranging from 80 to 10 mmHg, and it increased markedly in several—but not all—patients whose tcPo2 values were below that limit.

To evaluate further the biological significance of an increase in tissue tcPCO2, another sample of 24 subjects underwent acute forearm ischemia for a period of thirteen minutes, a maneuver that increased tcPCO2 markedly, indicating that this parameter is indeed a correlate of drastic reductions in limb perfusion. Thus, tcPCO2 is methodologically less variable than tcPo2 and more predictive of arterial values. However, the wide overlap with control values restrains its use as an isolated diagnostic tool to substantiate PAOD, even in the most advanced stages of disease. Marked elevations in tCPCO2 can be found in patients with critical limb ischemia, although normal values may coexist with low or negligible tcPO2 levels for reasons to be clarified. Further work is needed to establish the extent to which tcPcO2 determination may complement tcPO2 to differentiate extreme from less severe degrees of critical limb ischemia.
Repair of a Superior Mesenteric Vein Injury in a Patient with a Multisystem Trauma
Authors: Flis Vojko
Published: June 2007

The author presents a case of a complex superior mesenteric vein injury and associated multiple injuries (small bowel, infrarenal vena cava, liver, spleen) to illustrate that in specific situations the repair of a superior mesenteric vein may be a procedure of choice.
Isolated Saphenous Venous Aneurysm: Unique Presentation Associated with Ascending Thrombophlebitis
Authors: Back Martin R. , Holt Glenn E. , Peng Shi-Kaung , Stuntz Michael , Donayre Carlos E. , White Rodney A.
Published: June 2007

This report describes a greater saphenous venous aneurysm associated with ascending thrombophlebitis and presenting as a painful groin mass in a middle-aged male. Isolated venous aneurysms are an uncommon clinical entity and the presentation described herein appears unique. Definitive diagnosis was accomplished with noninvasive, duplex ultrasound imaging. Anticoagulation followed by surgical resection of the aneurysm provided symptomatic relief and satisfactory cosmesis and eliminated the risk of thromboembolism. Proposed etiologies and classification schemes, histologic features of, natural history, and clinical approaches to venous aneurysms are discussed with reference to existing literature.
Superior Vena Cava Reconstruction Using An Iliocaval Allograft
Authors: Rhee Robert Y. , Gloviczki Peter , Steers Jeffrey L. , Krom Ruud A. F. , Kitabayashi Kazuo , Wiesner Russell H.
Published: June 2007

Successful replacements of the superior vena cava (SVC) using autogenous saphenous or superficial femoral vein or prosthetic grafts have been previously performed, but the use of allograft for treatment of SVC syndrome has not been reported. The patient treated by the authors was a forty-one-year-old woman who presented with severe venous congestion of the head and neck caused by fibrosing mediastinitis. In addition, she had sclerosing cholangitis and chronic liver failure. To treat her SVC syndrome and provide access for fluid and blood transfusion and for possible venovenous bypass, SVC reconstruction was performed concomitant to orthotopic liver transplantation. A left innominate vein-right atrial bypass was inserted using an iliocaval allograft. The patient had an uncomplicated recovery, and at six months after surgery her SVC allograft is widely patent and her transplanted liver is functioning well. The venous allograft is an excellent conduit for those patients who are receiving immunosuppression therapy to avoid rejection of a transplanted organ.
Proximal Reflux Adversely Affects Distal Venous Function
Authors: Walsh Jon C. , Bergan John J. , Moulton Steven L. , Beeman Sue
Published: June 2007

In limbs with chronic venous insufficiency (CVI), the presence of popliteal vein reflux has correlated with severity of venous insufficiency. Correction of proximal deep venous reflux has improved clinical manifestations of CVI, but the hemodynamic results of doing so have been disappointing. The present study was done to ascertain the effects of proximal reflux upon distal vein function.

A total of 226 patients (175 women, 51 men) entered this study. Venous insufficiency in each of 450 limbs was classified according to Joint Councils' recommendations, and reflux was assessed by a modification of a method of Nicolaides and of van Bemmelen. Reflux in the femoral vein (FV), greater saphenous vein (GSV), popliteal vein (PV), and lesser saphenous vein (LSV) of the nonweight-bearing limb was quantitated by using the ATL 9 duplex scanner with a 5 MHz probe during rapid distal pneumatic cuff deflation. Data obtained included vein diameter, reflux volume, and reflux peak velocity. Limbs with PV reflux with and without FV reflux were then compared with those without PV reflux with and without FV reflux according to sex.

The men in this study group were older than the women (P < 0.05) and had a more advanced stage of venous insufficiency (P < 0.001). Therefore, analyses were performed separately in men and women. In men, when FV reflux was absent, only 14 of 69 limbs had popliteal reflux (20.3%), but when FV reflux was present, 19 of 33 limbs (57.5%) also had PV reflux. In women, when FV reflux was absent, only 33 of 304 limbs had PV reflux (10.9%). However, when FV reflux was present, 12 of 48 limbs (25%) also had PV reflux. The diameter of the FV was not influenced by the presence or absence of PV reflux alone but if both FV and PV reflux was present, a greater FV diameter was observed in women. In men, the popliteal venous diameter was influenced by presence of FV reflux, and in women, PV diameter was increased in diameter if FV reflux was present and PV reflux absent. A trend toward increased volume and velocity of PV reflux flow was seen in women, but in men, PV volume and velocity of reflux flow were significantly greater if FV reflux was present. Limbs with multiple levels of reflux exhibited a higher clinical class of venous stasis than those with lesser numbers of levels of reflux.

Accurate segmental evaluation of venous reflux by duplex scanning allows dissection of the influence of reflux within one venous segment upon another. Further, proximal reflux exhibits a deleterious effect on distal venous function. Correction of femoral venous reflux should be an objective in treating chronic venous insufficiency.
Perioperative Management of Juxtarenal Aortic Occlusion
Authors: Iwai Takehisa , Sato Shoji , Inoue Yoshinori , Takiguchi Noriaki , Sugano Norihide , Takashima Itaru , Aoi Taihei , Konno Susumu , Endo Mitsuo
Published: June 2007

The authors reviewed the surgical treatment and outcome in patients with juxtarenal aortic occlusion. From 1975 to 1993, 44 patients (37 men) with a mean age of 62.6 years underwent surgery for this condition. The vascular lesions included renal-level segmental aortic occlusion in 2 patients, infrarenal complete aortic occlusion in 30, and high aortic occlusion with a patent inferior mesenteric artery in 12. Four patients had subacute occlusion and 40 had chronic occlusion. In the chronic group, the symptom was intermittent claudication in 31 cases, rest pain in 4, and gangrene or ulceration in 5. Impotence was present in most of the men.

Surgical treatment included transaortic thromboendarterectomy in 2 patients, axillobifemoral bypass in 12, and high aortic thromboendarterectomy plus aortobifemoral bypass in 29. Suprarenal aortic clamping was done in 22 patients, with a mean renal occlusion time of 9.3 minutes. Simultaneous renal artery reconstruction was performed in 3 patients.

There were 4 operative deaths (mortality rate 9%), with 2 in the subacute group. Late death from unrelated causes occurred in 9 patients within five years. Lower limb ischemia was cured in all patients and impotence cured in 4 cases. Graft patency was satisfactory after both extra-anatomic and anatomic bypass. Transanal Doppler ultrasound monitoring during the surgery was easy to set and gave the authors useful information about accurate visceral circulation in reference to aortic reconstruction.
Transcutaneous Oximetry is Useful in Vascular Pathology If a Cutaneous Reference Map and a Maximal Exercise Test are Used
Authors: Pola P. , Tondi P. , Lago A. Dal , Santoliquido A. , Gerardino L. , Massari I.
Published: June 2007

The measurement of partial oxygen pressure in arterial blood by use of transcutaneous pulse oximetry (tcPo2) is a technique relatively new to clinical practice. However, there are notable differences of values both in healthy and arteriopathic subjects, depending on which part of the limb the measurement is carried out. The authors define a cutaneous reference map for oximetric measurements in both healthy and arteriopathic subjects. In a group of 200 healthy subjects and a group of 82 subjects affected by obliterative arteriopathy of the lower limbs at the second Fontaine stage, oximetric measurements were carried out under rest conditions. By comparing the oximetric ranges at all examined levels, it can be seen that there is a wide band of overlap between the minimum values of healthy subjects and those of the arteriopathic subjects.

In a group of 30 healthy subjects and in a group of 30 subjects affected by obliterative arteriopathy of the lower limbs at the second Fontaine stage, oximetric measurements were taken at I, II, III back levels of the leg during maximal treadmill test. In this case, by comparing the oximetric ranges between the two groups, it can be seen that all arteriopathic subjects present significantly lower values as compared with those of the healthy subjects at each examined level. This permits a confident diagnosis of pathology.

The authors conclude that in order to make a correct diagnosis of arteriopathy by using transcutaneous oximetry, it is necessary to consider both the measurements carried out under rest conditions and those carried out during maximal treadmill test.
Dacron Graft Replacement with Bilateral Renal Vein Reimplantation for Inferior Vena Cava Leiomyosarcoma
Authors: Sapienza Paolo , Edwards John D. , Mcgregor Patrick E. , Thorpe Patricia E.
Published: June 2007

The surgical treatment of inferior vena cava (IVC) leiomyosarcomas is not well elucidated. The preferred procedures include either IVC wedge resection or ligation. The authors present a case in which Dacron graft replacement of the midportion of the IVC with bilateral renal vein implantation was performed for an IVC leiomyosarcoma. This is, to their knowledge, the first report in the literature describing a technically successful IVC Dacron graft replacement for a primary tumor. The report is presented to demonstrate the technical feasibility of this procedure and the good long-term graft patency rate. At present complete surgical excision of the tumor seems to offer the only chance for a long-term cure.
Renal Revascularization for Uremia
Authors: Rossi Giuseppe , Grossi Robert , Flum David R.
Published: June 2007

Renal revascularization for uremia has achieved variable success and remains a controversial procedure. The authors retrospectively reviewed their experience with renal revascularization to assess operative morbidity and mortality and to quantify its long-term, beneficial effects on renal function. From 1974 to 1993, 15 patients with renal artery occlusive disease and varying degrees of uremia underwent renal artery revascularization. A retrospective review was conducted of these patients. There were 9 men and 6 women with an average age of 61.5 years (range forty-five to eighty-three years). Preoperative serum creatinine ranged from 1.9 to 10 mg/dL with a mean of 5.07 mg/dL. Three groups were identified: Group A-creatinine 1.9-3.4 mg/dL, Group B-creatinine 3.5-5.2 mg/dL, Group C-patients receiving dialysis. Ten of 15 patients had a solitary kidney. Ten of 15 patients had concomitant aortic reconstruction with renal artery bypass. The mean creatinine went from 5.07 mg/dL preoperatively to 2.22 mg/dL on discharge (P = 0.006).

At late follow up (mean 69.1 months) the mean creatinine was 2.62 mg/dL. Late (mean 69.1 months) functional results indicated that 13 of 15 patients (87%) had improved or stabilized renal function. Five of 7 patients who were receiving dialysis preoperatively required no postoperative dialysis because of improvements in renal function. One patient eventually required dialysis although he had not required it preoperatively. There were no operative deaths, but 2 major complications occurred. Mean survival time was one hundred seven months with 80% survival at five years and 60% survival at ten years. On average 63.6 months of dialysis-free survival were noted for the group. Renal revascularization for uremia can be performed with low morbidity and mortality. Long-term follow up indicates a low mortality and a lasting beneficial effect on renal function in the majority of patients. Additionally, this beneficial effect is recognized in patients already receiving preoperative dialysis.
Pseudoaneurysm of Superficial Femoral Artery After Balloon Angioplasty
Authors: Labropoulos Nicos , Giannoukas Athanasios D. , Kutoubi Aghiad Al , Nicolaides Andrew N.
Published: June 2007

This paper presents 2 cases of pseudoaneurysm in the superficial femoral artery (SFA) at the site of dilatation after percutaneous transluminal angioplasty (PTA) in 2 claudicant patients. Localized and calcified tight stenoses in the lower third of the SFA were seen on angiogram. PTA was successful in the first patient, but in the second it failed to open the stenosed part of the artery, and no improvement of the clinical symptoms occurred. Oversized balloons were used in both cases. A localized false aneurysm was seen on angiography four months later in the first patient, and a pulsatile mass in the thigh, corresponding well to the site of the previous PTA, was clinically present three weeks later in the second patient. The diagnosis of pseudoaneurysm was made by intraarterial digital subtraction angiography in the first patient and by color flow duplex imaging (CFDI) in the second. The first patient has maintained a patent SFA with a stable localized false aneurysm at the site of angioplasty fourteen months after the PTA, experiencing only mild claudication, and the second patient underwent a femoropopliteal above-knee bypass operation resulting in relief of the symptoms.
Development of Ultrasound Techniques for Assessment of Aortoiliac Obstructive Disease
Authors: de Smet André A. E. A. , Moll Frans L. , Kitslaar Peter J. E. H. M.
Published: June 2007

The development of ultrasound techniques for assessment of aortoiliac obstructive disease is described. This period started in 1959 with the detection of blood flow with an ultrasonic device. Continuous-wave Doppler devices were designed, and the pulse waves of readily accessible vessels like the common femoral artery were examined. It was soon recognized that the functional status of the aortoiliac arteries could be assessed by the Doppler characteristics of the common femoral artery pulse wave. Qualitative and quantitative methods were used to analyze the femoral Doppler signal. The introduction of duplex scanning made it possible to evaluate the hemodynamics of aortoiliac arteries directly. At present, duplex scanning offers the best method of evaluating the aortoiliac arteries noninvasively.
Placement of Intraluminal Shunt with Much Less Bleeding in Carotid Surgery
Authors: Furui Tomoo
Published: June 2007

The author describes a simple and reliable procedure to place an intraluminal shunt during carotid surgery. In combination with the use of the double-balloon shunt, this procedure enables one to introduce the caudal portion of the shunt into the common carotid artery without any of the massive bleeding that occasionally interferes with shunt insertion.
Evaluation of Everted External Jugular Vein for Patch Angioplasty
Authors: Mueller D. , Baker W. , Bunte R. , Zawacki J. , Kovarik P.
Published: June 2007

Patch angioplasty of the carotid artery is believed to prevent iatrogenic narrowing, as well as reduce potential thrombosis and minimize the incidence of recurrent stenosis. Vascular surgeons prefer autogenous vein, although polytetrafluorothylene and Dacron have been utilized successfully. Saphenous vein harvested from the groin is probably the safest owing to its thickness. External and internal jugular vein have both been used because of their convenience and proven efficacy. These veins are, however, thin, and patch failure and subsequent rupture have been recorded. Recently advocates of this patch have everted the vein and employed double-layer closure for carotid patch angioplasty for additional strength. The authors constructed and examined everted and singlelayer external jugular vein patches placed for five days in canine carotid and femoral arteries. Each vein patch demonstrated necrosis of the intimal layer with an inflammatory and fibrous rebuilding process identified in the media and adventitia. The single-layer patch was identical in characteristics; however, the double-layer patch possessed a dual thickness of the above-mentioned morphologic changes.
Eversion Carotid Endarterectomy: A Safe, Advantageous Alternative to Conventional Carotid Endarterectomy
Authors: Calaitges John , Kashyap Ajaya , Annest Stephen
Published: June 2007

Objective: To compare the results and time and cost efficacy of eversion carotid endarterectomy (ECEA) with standard carotid endarterectomy (SCEA).

Methods: A retrospective analysis of 88 carotid endarterectomies performed by the residents under the guidance of the senior author between January 1, 1991, and December 31, 1993, was done. Fifty-five patients underwent SCEA (44 vein patch, 11 primary closure) and 33 had ECEA. The two groups were compared for operative time, intraoperative evaluation, cost, immediate and delayed morbidity, and restenosis (≥ 50%).

Results: The two groups were found to be similar for age, sex ratio, and associated diseases. The indications for surgery were transient ischemic attack (TIA) (57% ECEA, 64% SCEA), previous stroke with minimal residual deficit (9% ECEA, 17% SCEA), and asymptomatic high-grade stenosis (34% ECEA, 19% SCEA). The average operative time for ECEA was significantly less (99.2 vs 135.2 minutes, P < 0.02). The mean blood loss was also less for ECEA (86 vs 181 cc). Two SCEA patients had immediate postoperative thrombosis resulting in 1 cerebrovascular accident (CVA) (1.8%), and 3 SCEA patients had cranial nerve injuries. In follow-up, 1 patient with SCEA had restenosis and 1 had a CVA unrelated to carotid disease. Morbidity associated with ECEA included 1 unsuccessful ECEA requiring interposition vein grafting and 1 intraoperative repair of an intimal flap. There was no associated residual morbidity. There was no significant difference in stroke rate between the two groups. The operative cost (excluding surgeon fee) was 28% higher for SCEA patients.

Conclusion: Eversion carotid endarterectomy is a safe procedure and can be an important addition to a surgeon's armamentarium in efforts to cut costs while maintaining quality.
An Unusual Case of Celiac and Splenic Artery Aneurysms Related to Fibromuscular Dysplasia
Authors: Gosin Jeffrey S. , Ciocca Rocco G. , Warner J. Sloan , Graham Alan M.
Published: June 2007

The authors describe a thirty-nine-year-old man whose celiac artery aneurysm and multiple splenic artery aneurysms were found to be secondary to fibromuscular dysplasia. This is only the eight such case in the modern medical literature.
Suture Breakage Following Carotid Endarterectomy Surgery
Authors: Haimov Moshe
Published: June 2007

The author reports a case of suture breakage that occurred forty-eight hours after a right carotid endarterectomy was performed in a sixty-eight-year-old man. The problem was corrected at reoperation, but the patient died a week later with irreversible brain damage.
Arterial Autograft for Carotid Replacement During Head and Neck Cancer Surgery
Authors: Tagett Mark , Dahn Michael S. , Salwen Walter
Published: June 2007

Head and neck malignancies occasionally involve the cervical carotid artery, thereby complicating tumor excision. This report describes the use of a superficial femoral artery autograft to reconstruct the carotid artery following excision of the carotid bifurcation in conjunction with radical neck dissection for squamous cell carcinoma. This approach potentially offers greater graft resistance to local wound infection and excellent size matching to the common and internal carotid arteries.